Don't get old and ill in this country

[Seminole]

If my father's notes go "missing" there will be hell to pay. I'm really hoping that I can identify individuals who let my father down. I would much prefer to go after them professionally than sue the NHS.

[Seminole]

I mentioned previously that I had approached a soliciitor regarding my father's stay at the Pru. They have now replied that they won't take the case. In their letter they mention a number of factors that could lead to that decision without being speciific about this particular case. I suspect that the main factor is that the likely financial compensation would be disproportionately small compared to the costs of bringing the action.

 

Looking at the criteria for awarding damages, they emphasise prognosis and financial dependency. Given that my father was 92 and in poor health, he would probably only have lived for a few months beyond his stay in the hospital even if they had behaved perfectly.

 

If my interpretation is correct then it partly explains why the elderly are treated badly by the NHS. If they know that they can't be sued, they know that they can get away with substandard and unprofessional behavior. It also leaves families in a difficult situation. They can proceed to bring the action on a fee paying basis but the costs are crippling. Altervatively they can go down the complaint path but without paying for advice, they may struggle to ask the right questions and understand the answers. Perhaps most importantly the NHS knows that it can tie complainants up in knots and deter even the persistent. For those who ask really awkward questions, I have read that they are quite happy to declare them vexatious and refuse to deal with them.

 

Having said all of that, I am planning to press on. I'm don't know whether I should get a second legal opionion. The first solicitor, Irvin Mitchell, has quite a good reputation. Does anyone know of another reputable firm I could approach?

 

Failing that I am going to submit my complaint to the Pru and copy it to a couple of MPs. I'm also going to compile a full dossier of my father's treatment at the hands of the NHS and press release it even though it is incomplete. If I can't get them into a court of law, I'll get them into the court of public opinion.

[Lindamannion]

Hi Seminole, I went down the road of asking a solicitor regarding my Mums death, which was completely their doing, l have the inquest report. I was informed that owing to my Mums age l would be granted the costs of the funeral, despite the fact at 90 she was healthy for her age, out shopping and having lunch with friends a few days before being admitted to hospital. As a family we became so stressed by it all and my brother had a heart attack, so we did not pursue it any further. I wish you luck and hope you continue with your quest for answers. I am grateful l had my Mum longer than most people, and she had a good life, but l will never forgive the hospital for making her last days so dreadful , she was terrified and we could not help her, no matter how we tried.

[Sali]

From an earlier post:

 

For clarity your father became confused after being given the antibiotic. I have doubts that this was the cause. I can only go on your description of events but this sudden onset of confusion is likely to have been caused by a T.I.A (see post 44) rather than infection or ARF. Which is a point you bring up in your complaint. Did he have an any investigations on his first admission (MRI etc). If not the the hospital was was giving care based on a presumption that his confusion was caused by infection not fact.

 

Forgive me, I feel compelled to return to the diagnosis of vascular dementia and the TIA that could have caused a rapid deterioration in the patient's cognition, rather than an infection.

 

Firstly, I think it would be absolutely wrong for any medic to state either one or the other was the cause - the infection has to be cleared up first.

 

There are a battery of tests - including MRIs - available which would help in determining dementia (I know there are different kinds) but I believe these are almost always circumvented due to lack of money and time, as well as ignorance - willful or otherwise. Even then, the diagnosis should not be set in stone. The medical profession - and many others - seem to view self-doubt as a weakness, when it seems to me to be quite the opposite. We need more self-doubt in this world.

 

Any family should strain every sinew in resisting the diagnosis of dementia because (at this time) it spells abandonment. It is too often used as an excuse by the health service not to investigate and/or to withhold treatment.

 

I agree with you about the legal profession. They don't see us as sentient beings in pursuit of justice or as a vehicle to improve the health service, (or any other system), but as cash cows, existing merely to sate their avarice.

 

Once you have your final response from the hospital and if you are unhappy with their response, your only other course is, as you know, the Ombudsman. I'm sure that too will prove a disappointment. I guess in this climate of heightened sensitivity over the NHS I would also make a fuss with the CQC, who may (you never know), actually do the right thing for once.

[Seminole]

I've had another reply from the London Ambulance Service regarding the 1hr 41mins it took them to send an ambulance in September. Some points:

 

1) I said that I was going to take this matter to an MP. The LAS response was "Members of Parliament have no formal role within the NHS complaints procedure and your recourse opportunity remains with an approach to the Health Service Ombudsman". Is this worthwhile in general? In other words could the Ombudsman, if he chose to do so, lambast the LAS for failing to provide an appropriate service or would he only look at whether they dealt with the complaint properly?

 

2) Apparently their failure to deal with the FOI request appropriately was unfortunate but that I have not been "significantly disadvantaged". I'm going to wait for a response to the FOI enquiry before I decide whether to take the matter to the ICS.

 

3) The LAS insist that £50 is payable for the 999 recording. I've checked this over the phone with the ICO and they say that it should be £10. I'm going to back to the LAS on this and making a formal complaint to the ICO if they continue to push the issue.

 

4) The LAS have offered me a meeting to discuss my concerns. I may well choose to have this meeting but I want to do so in the context of having involved MP(s) and taken the matter to the media first.

 

I've a reply from Kings re my father's stay there in September. It's actually quite helpful in some ways but I'm still digesting it. In practice, it's likely to be mood music for the main complaint against the Princess Royal that went in just before Christmas.

[nolegion]

Well held, if I may say so, Seminole. Looks like you need to fight a war on several fronts.

 

I have some experience of the health ombudsperson's office and I am not alone in thinking in most cases they prove to be a highly dilatory and offensive waste of space. For instance, if you refer a matter to them while it is arguable that the health bodies concerned are still 'processing' your complaint(s), they will take 10 months to tell you referred the matter to it too early, and you will have to start again.

 

And, as you have already guessed, the chances of them actually investigating the matter 'de novo' as opposed to considering how your complaint has been handled, are very slim indeed. They have the power but they don't usually don't exercise it, save in a handful of select cases for window-dressing purposes, because that would be too much like hard work.

 

The ICO is hit and miss – depends whether your complaint (DPA and\or FoI) is allocated to someone who actually knows what they are doing. A lot of the 'officers' are junior, ill-supervised and biased in favour of the entities complained about. Those entities are frequently aggressive and deceitful, and, once again, it takes hard work and accurate knowledge to take them on.

 

To complain about a late FoI response you first need to have asked, in writing, for an 'internal review' of the matter by the body concerned. You can do this even while you still awaiting a response. This 'gives' them another 20 working days (to deal with the request for internal review), but the ICO will usually decline to investigate unless and until it has proof that an internal review was asked for over 20 working days ago.

 

Whether ot not you ever get get an adequate explanation and apology for the delay, you can still complain to the ICO about the lateness. They won't do anything at all significant about it as an individual case, but if people don't complain, the ICO doesn't know where to turn its guns. (And, occasionally, it really does so aim. For instance, the DWP was consistently and insultingly late over an extended period and in respect of many requests a year or two, ago at the WDTK website. The ICO exercised its 'naughty chair' special measures and matters changed big time and fast)

 

DPA. I am glad the ICO confirmed what you and I both thought re the charge for the phone call recording. Cash-flow considerations aside, I would be tempted to pay the £50 under written protest, saying that you are referring the matter to the ICO on the strength of whose advice already received, you expect a ruling requiring re-imbursement of £40 in due course. Then go right ahead and submit your complaint to the ICO without delay. It will take about 6 months.

Edited January 7, 2014 by nolegion

[Seminole]

I've had an interesting response to my FOI to the London Ambulance Service.

 

Between 7pm and 9pm on 6 September 2013 they had 177 category C incidents to which they sent an ambulance. Their average response time was 56 minutes compared to their target of 30 minutes. Included within these stats is their response to my father's 999 call. They took 101 minutes to respond to a 92 year old man with a head injury, i.e. 71 minutes more than their target and 45 minutes more than their average response time in the two hour period.

 

I am going to ask them for one more piece of information- where my father's response time sits in the overall list. I would guess it must be in the worst 25% and possibly even in the worst 10%.

 

On a different note, the LAS is arguing that their emergency call recording systems are partly manually based and this is why they are entitled to charge £50. I'm going to let the ICO be the judge of that.

[Seminole]

I've now had a chance to look in detail at the replies to my complaint regarding my father's stays at Kings College Hospital (non-admission to specialist geriatric ward based on post code and loss of hearing aids).

 

Surprisingly I'm happy with their response. They have increased their capacity to deal with elderly patients by opening a new unit and they reimbursed the costs of the hearing aids with an apology. They have provided some explanation of how my father was dealt with on the ward and say that they have changed procedures to avoid some of the problems that my father experienced.

 

I still have an issue regarding his diagnosis but that is being dealt with under the complaint to the Pru.

 

None of this gets away from the fact that my father was placed on an unsuitable ward and was treated poorly and this will be pointed out to my father's MP and the media in due course.

[Seminole]

I've had a not desperately helpful reply from the ICO regarding my Subject Access Request issue with the London Ambulance Service. They say that they're unable to help in respect of the £50 charge because, since my father passed away, the Data Protection Act no longer applies. I need to seek the records under the Access to Health Records Act. Looks like I'll have to start all over again on this issue.

[Seminole]

I've had an interesting response to my FOI to the London Ambulance Service.

 

Between 7pm and 9pm on 6 September 2013 they had 177 category C incidents to which they sent an ambulance. Their average response time was 56 minutes compared to their target of 30 minutes. Included within these stats is their response to my father's 999 call. They took 101 minutes to respond to a 92 year old man with a head injury, i.e. 71 minutes more than their target and 45 minutes more than their average response time in the two hour period.

 

I am going to ask them for one more piece of information- where my father's response time sits in the overall list. I would guess it must be in the worst 25% and possibly even in the worst 10%.

 

On a different note, the LAS is arguing that their emergency call recording systems are partly manually based and this is why they are entitled to charge £50. I'm going to let the ICO be the judge of that.

 

Interestingly the LAS are having problems providing this number. This is what they've said

 

We do not yet have the information to hand. PED have been unable to provide the information requested and we are currently checking it out with our Emergency Operations Centre colleagues.

 

It's not terribly difficult. All they need to do is to extract the 177 records into Excel, sort them by response time and tell me where my Dad was on the list. With the data I think I could do it in about 30 seconds.They have to have had access to the raw data to provide the initial response.

 

I suspect that the result is rather embarassing. In any event this is the last piece of information I'm waiting for before I go nuclear with my complaint. If I don't get an answer in the next week, I'm pushing the big red button anyway.

[Sali]

Yes, it is the Access to Health Records Act 1990 for deceased relatives, although the NHS were not picky when I applied.

 

I hope it's true that elderly patients will be treated better after your complaint. However, I find it a little ominous when they say they have 'changed procedures' because that's what they always say and the reality is very little changes. The next complainant will almost certainly get the same response. Shortage of staff will always be a major factor in how the vulnerable are treated and cared for, but so much that goes wrong seems to be a complete absence of common sense.

 

I agree with nolegion's views on the Ombudsman: I'm not really sure of their reason for being. I also found the ICO toothless, but I would encourage people to try. What else can we do?

[Seminole]

I share your scepticism.

 

At the end of the day, nothing is going to bring my father back. No amount of compensation would make up for what happened and what's the point of depriving the NHS of funds? All I am going to get from following the complaints process is an apology and details of how things have improved. If/ when I take these matters to the Ombudsman, all I am likely to get is a more detailed apology.

 

In an ideal world I would be able to identify individuals who I could pursue to the GMC etc. In practice this is unlikely to be an option unless someone was guilty of gross negligence rather than just run of the mill poor service. Furthermore I can only begin to imagine the obstacles in the way of doing that.

 

I agree that promises of change are pretty meaningless but all I can do is hope that maybe it gets a little better for someone.

 

Like you I don't have much confidence in any of the formal processes and I am not going to completely knacker myself following them and being bitterly disappointed at the end. What I am going to do is go out of my way to embarass those responsible and make as big a noise as possible outside the complaints process. It might not get me anywhere but I think it's the most effective thing that I can do.

[Seminole]

I've had a further exchange of emails with the ICO. They've confirmed that the Access to Health Records Act is regulated by the Ministry of Health and not the ICO. I suspect that makes any complaint about the £50 charge pretty pointless.

[nolegion]

Seminole. Sali is entirely right about the Access to Health Records Act. It now only applies to the health records of the deceased, and the DPA deals with personal data relating to living individuals.

 

In commenting on the DPA here , I regret to say I had entirely failed to take on board the fact that since you started this thread your father had passed away. Commiserations, and apologies for my clumsiness.

 

Having said which, you are being given the usual, but utterly disgraceful, 'run around' in trying to get basic facts out of health bodies concerning abysmal care.

 

Here's a handful points.

 

- the recording of a telephone call may still constitute personal information in relation to a living person identifiable from the contents of the call and\or other information held in connection with it. If that person was you, then it remains arguable you can continue to require a copy of ar ecording under the DPA: for £10, if the information is not properly classed as a health record.

 

- if the information you require does constitute health records in relation to your father,then the Health Records Act will apply. I am sure you will already have looked at the 'NHS Choices' info on this, The familiar £10 to £50 fees structure applies. However, under this Act, charges upto £50 will be possible in respect of 'manually held' information because, by definition, this act only applies to health records. (And likewise the 40 daytime limit for production.)

 

- if your father left a will in which you are named as an executor, or you been appointed an administrator of his estate, then (in addition to being able to get copies), you can require access to inspect the original records, and that is a powerful tool not available under the current DPA.

 

I wish you luck in your continuing battle.

[Seminole]

Nolegion, thank you for your comments.

 

Unfortunately I was in Egypt at the time of the 999 call and it was made by my father's carer. A second call was made by a family friend shortly before the ambulance turned up. I could ask either of them to go down the DPA path but I would prefer to get the information myself. In all honesty though, I'm not too fussed about hearing the recordings as I pretty much know what was said. I was more concerned with the attempt to charge £50 for a computerised recording. It seems that the LAS not only failed to provide a remotely adequate service to my father but it thinks it appropriate to profiteer out of the information it holds about the incident. I will be drawing this to the attention of my father's MP and the media. It is an organisation characterised by monumental incompetence, evasiveness and mendacity.

 

Thank you for pointing out the right to personally inspect original records. This may be a right I exercise when dealing with the complaint against the PRU.

[Seminole]

Interestingly the LAS are having problems providing this number. This is what they've said

 

We do not yet have the information to hand. PED have been unable to provide the information requested and we are currently checking it out with our Emergency Operations Centre colleagues.

 

It's not terribly difficult. All they need to do is to extract the 177 records into Excel, sort them by response time and tell me where my Dad was on the list. With the data I think I could do it in about 30 seconds.They have to have had access to the raw data to provide the initial response.

 

I suspect that the result is rather embarassing. In any event this is the last piece of information I'm waiting for before I go nuclear with my complaint. If I don't get an answer in the next week, I'm pushing the big red button anyway.

 

That big red button I mentioned..... is getting pressed tomorrow. Detailed letter and backing correspondence will be going to my father's MP, my MP, the Daily Telegraph, the Daily Mail and my Dad's local newspaper. I'll upload the pdf here when it's been sent. Don't know if it will do any good but you never know.

[Seminole]

And here it is. I know that it has personally identifiable data in it but as it's been released to the press I don't think it matters.

 

Edit: Darn the scanner missed one of the pages in the main letter in the pdf. I've attached this as well.

[Seminole]

Well, it's been a few weeks. I've had a reasonable letter from my father's MP wanting to see how I decide to deal with the complaints process. The NHS has responded to my letter. There are some reasonable bits in it but they've failed to respond to some key points and are blaming the care home for my father's bruising. I can see this matter going to the Ombudsman. I still haven't decided whether to pursue the London Ambulance complaint to the Ombudsman but I'm not sure that it will achieve much.

[nolegion]

A gruelling task all round, and likely to continue to be so for some while yet, I fear.

 

My own, limited, experience of the Health Ombudsperson's Office, is;-

 

(i) that it will first pass the complaint back to the complainant - because, it will say, the complainant hasn't complained enough - and specifically enough - about all or any outstanding matters. And then,

 

(ii) when it really can't claim that any more, it will, at best, tell the complainant that it has asked the health body concerned to do more to investigate the matters still complained about and to contact the complainant directly when thay have done so. Whereafter,

 

(iii) the health body concerned - who couldn't give a fig about what the Health Ombudsperson's Office says - will do nothing at all, unless and until the complainant contacts them (that health body) again ,who will then say they have already fully dealt with the complaint and have no evidence on which to take the matter any further. And then,

 

(iv) when the complainant contacts the Ombudsperson's Office for the last time, that office will, this time, eventually, say it is satisfied that it has taken all steps to ensure that the matter has been properly addressed by the health body concerned and that it has no doubt that valuable lessons have been drawn and acted upon – and that there is nothing further the Ombudsman is permitted to do in the matter.

 

I fully realise that this is a bitter, indeed insulting, prospect, Seminole and you have my every sympathy. If you expect the worst though – but don't give up - there is always a chance, just a chance, you can improve on this outcome for every patient's subsequent benefit - as well as achieving some respect for the deceased.

 

(And the position I describe was how the Office acted under its previous 'head'. It just might have changed for the better by now, though I have not encountered any reports to that effect, yet.)

[Seminole]

Yes, I'm quite prepared to believe that that will be what happens which is why I think I'll let the London Ambulance Service complaint quietly drop as I don't really want to be fighting on two fronts.

 

As for the Pru I'm going to write to them narrowing the complaint to those areas where they haven't properly responded or haven't responded at all. I'm going to pass their letter to the Bupa care home to see how they feel about the implied accusation. I'm also going to request a meeting with the Trust (and take along Bupa if they're prepared to get involved). I've known my father's MP for a number of years and he has said that he'll help if the matter goes to the Ombudsman. Ideally I'd like to get him round the table with the Pru as well.

 

What's bothering me the most is that the care home took photos of bruising on the day my father transferred to them. This means that the bruising took place either before, during or after the transfer. The hospital say they didn't notice anything before he was discharged. Someone is telling porkies and I suspect it's the hospital. Hopefully I will be able to get some advice on whether the photos can help to determine when the bruising is likely to have taken place.

 

As for the pneumonia diagnosis, the letter simply says that it's something that can come on very quickly. They've ignored the fact that I reported breathing problems to them before my father was discharged. That particular point is going to be thrown back at them.