Case summaries

These short, anonymised stories show the profound impact that failures in public services can have on the lives of individuals and their families.

Please note we have not published any new case summaries on this page since 2015. In April 2021 we began publishing our casework decision statements and investigation reports on our decisions portal.

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Patient transferred from acute hospital without adequate assessment

Summary 855 | February 2015

Mrs S's daughter complained that her mother should not have been transferred from an acute to a community hospital.

Correct fine for patient when his medical exemption certificate expired

Summary 854 | February 2015

Mr B felt that he had been penalised because of NHS Business Services Authority's lack of communication with other NHS organisations over renewing his certificate which entitled him to free prescriptions.

Medical procedure unlikely to be responsible for ongoing ear, throat and eye symptoms

Summary 853 | February 2015

Mr S started experiencing problems with his ears, throat and one of his eyes after a gastroscopy procedure in summer 2013.

Trust failed to check patient's medication, causing her to miss three doses

Summary 852 | February 2015

Mrs K's daughter complained that the Trust's care of her mother was poor, which caused her unnecessary worry.

Getting it right for a patient in prison with long–term pain

Summary 851 | February 2015

Mr F, a prisoner, had been taking strong painkillers for a long–term health condition.

Wheelchair service made right decision in prescribing a class 2 powered wheelchair

Summary 850 | February 2015

Miss L complained that her local wheelchair service prescribed her a class 2 wheelchair when she had used a class 3 wheelchair for several years.

Ambulance crew were wrong not to take man to hospital, but correct in not giving him CPR

Summary 849 | February 2015

Ms G complained that an ambulance crew did not take her brother, Mr S, to hospital after he collapsed at home. Ms G also complained that at a later date another crew did not attempt resuscitation or defibrillation (an electric shock to the heart to help re–establish normal rhythms) when Mr S was found unresponsive on the floor.

NHS England addressed its complaint handling

Summary 848 | February 2015

We did not uphold Mr J's complaint about poor complaint handling because NHS England had taken remedial action before we became involved.

No fault in care and support of a mental health patient

Summary 847 | February 2015

Mrs A complained on her son's behalf about a lack of care and support provided by the community mental health team, and also about the team's lack of communication with the family.

Trust lost clinical records

Summary 846 | February 2015

Mrs T complained about her treatment in A&E but we could not investigate her complaint fully beacause the hospital had lost her clinical records.

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