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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. 

 

Type
Type
Health cases only
Trust delayed diagnosis and follow up of endometriosis
Summary 523 |
Mrs D complained the Trust delayed diagnosing her endometriosis, and this left her in severe pain. She said the delays had also severely affected her fertility and she was unable to start a family as the endometriosis had spread. She felt she had no alternative but to pay for IVF at a cost of around £5,000.
Older woman died from treatable condition
Summary 521 |
Mrs D and Mr E complained that omissions in care by a GP practice caused their mother Mrs H's premature death. Their mother's death caused them considerable distress. Mrs D and Mr E wanted the GP Practice to acknowledge and apologise for the omissions in care, and wanted action to prevent similar failings from happening again.
Trust did not keep clear records or appreciate risk
Summary 520 |
Mr S had a history of depression and had had previous psychiatric inpatient stays. During an inpatient stay, the Trust did not keep clear records that showed his clinician's working diagnosis and treatment plans. It also did not properly appreciate how risks to him changed as his mental health deteriorated.
Trust failed to give necessary medication
Summary 519 |
Mr E complained about the care and treatment the Trust gave his father when he was admitted with complex medical needs. Mr E was unhappy about his father's weekend care, specialist input, medication and nutrition, and the attitude of a nurse towards his mother when she raised concerns.
Patient received poor nutritional and pain care
Summary 518 |
Ms C, Mr B's niece, complained to the Trust that her uncle received poor care and treatment for his gangrenous toe, and had poor nutritional care and pain management. She was also unhappy about its communication with her.
Complaint response was confusing
Summary 517 |
Mr P complained to us about care and treatment he received, which he felt caused damage to his eye. He did not understand the Trust's response to his complaint.
A hospital did not think about the needs of woman with learning disabilities and Down's syndrome
Summary 515 |
Ms G, who had learning disabilities and Down's syndrome, developed pneumonia. She could not swallow and Trust staff had difficulty helping her to eat. Trust staff decided that admitting Ms G to intensive care and attempting resuscitation in the event of a cardiac arrest would be futile because of her poor condition. Ms G's family strongly disagreed and thought that the doctors were discriminating against Ms G on the basis of her disabilities.