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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 failed to adequately monitor patient
Summary 217 |
Miss A complained that her mother, Mrs A, was not monitored for eight hours and was found unresponsive after suffering a cardiac arrest. Miss A also had some specific concerns about aspects of her mother's care and about the way in which a consultant cardiologist approached the discussion of a do not attempt resuscitation order (DNAR).
Failure in care and treatment at end of 84–year–old's life
Summary 215 |
Failure to provide appropriate end–of–life care meant that Mr F's symptoms were not as well controlled as they should have been. Poor communication caused his family distress, as did failures in looking after his belongings.