Understanding what happened

As a family member, partner, friend or carer of someone who has died whilst in the care of Kent Community Health NHS Foundation Trust, you may have comments, questions or concerns about the care and treatment they received. You may also want to understand more about the reasons for their death. The staff who were involved in treating your loved one should be able to answer your initial questions. However, please do not worry if you are not ready to ask these questions straight away, or if you think of questions later - you will still have the opportunity to raise these with us (the trust) when you are ready through your named contact at the trust.

It is also important for us to know if you don’t understand any of the information we provide. Please tell us if we need to explain things more fully.

Practical information, support arrangements and counselling

We can provide you with information about bereavement support services and practical advice about the things you may need to do following a bereavement. This could include:

• collecting any personal items belonging to the person who
  has died;
• making arrangements to see the person who has died;
• the collection of the death certificate; and
• how to register the death.

Please let us know if we can be of any help regarding these or other issues. The Gov.uk website also provides practical information on what to do following a death.

We also know that the death of a loved one can be very traumatic for families. This can be even more so when concerns have been raised, or when a family is involved in an investigation process. Some families have found that counselling or having someone else to talk to can be very beneficial. You may want to discuss this with your GP, who can refer you to local support. Alternatively, there may be other local or voluntary organisations that provide counselling support that you would prefer to access. Some examples of organisations that may be able to help you are included later in this leaflet.

Reviews of deaths in our care

Case note reviews (or case record reviews) are carried out in different circumstances. Firstly, case note reviews are routinely carried out by NHS trusts on a proportion of all their deaths to learn, develop and improve healthcare, as well as when a problem in care may be suspected.

A clinician (usually a doctor), who was not directly involved in the care your loved one received, will look carefully at their case notes. They will look at each aspect of their care and how well it was provided. When a routine review finds any issues with a patient’s care, we contact their family to discuss this further.

Secondly, we also carry out case note reviews when a significant concern is raised with us about the care we provided to a patient. We consider a ‘significant concern’ to mean:

• (a) any concerns raised by the family that cannot be answered at the time; or
• (b) anything that is not answered to the family’s satisfaction or which does not reassure them.

This may happen when a death is sudden, unexpected, untoward or accidental. When a significant concern has been raised, we will undertake a case note review for your loved one and share our findings with you.

Aside from case note reviews, there are specific processes and procedures that trusts need to follow if your loved one had a learning disability; is a child; died in a maternity setting; or as a result of a mental health related homicide. If this is the case, we will provide you with the relevant details on these processes.

Investigations

In a small percentage of cases, there may be concerns that the death could be or is related to a patient safety incident. A patient safety incident is any unintended or unexpected incident, which could have, or did, lead to harm for one or more patients receiving healthcare. Where there is a concern that a patient safety incident may have contributed to a patient’s death, a safety investigation should be undertaken. The purpose of a safety investigation is to find out what happened and why. This is to identify any potential learning and to reduce the risk of something similar happening to any other patients in the future.

If an investigation is to be held, we will inform you and explain the process to you. We will also ask you about how, and when, you would like to be involved. We will explain how we will include you in setting the terms of reference (the topics that will be looked at) for the investigation. Investigations may be carried out internally or by external investigators, depending on the circumstances.

In some cases, an investigation may involve more care providers than just Kent Community Health NHS Foundation Trust. For example, your loved one may have received care from several organisations (that have raised potential concern). In these circumstances, this will be explained to you, and you will be told which organisation is acting as the lead investigator.

You will be kept up to date on the progress of the investigation and be invited to contribute. This includes commenting on drafts of investigation reports before they are signed off. Your comments should be incorporated in the reports. After the final report has been signed off, the trust will make arrangements to meet with you to further discuss the findings of the investigation.

You may find it helpful to get independent advice about taking part in investigations and other options open to you. Some people will also benefit from having an independent advocate to accompany them to meetings etc. Please see details of independent organisations that may be able to help, later in this leaflet. You are welcome to bring a friend, relative or advocate with you to any meetings.

Where the death of a patient is associated with an unexpected or unintended incident during a patient’s care, staff must follow the Duty of Candour regulation/policy, AvMA Action Against Medical Accidents has produced information for families on Duty of Candour which is endorsed by the Care Quality Commission.

Coroners’ inquests

Some deaths are referred to the coroner, for example where the cause of death is unknown, or the death occurred in violent or unnatural circumstances. When a death is referred to the coroner they may request a post mortem examination. The coroner will then decide whether an inquest is required, to establish the cause of the death. An inquest is a ‘fact finding’ exercise which normally aims to determine the circumstances of someone’s death.

We will inform you if we have referred the death to the coroner. If we do not refer a death to the coroner, but you have concerns about the treatment we provided, you can ask the coroner to consider holding an inquest. It is a good idea to do this as soon as possible after your loved one has died, as delays in requesting an inquest may mean that opportunities for the coroner to hold a post mortem are lost.

We can provide you with contact details for the appropriate coroner’s office via our Patient Advice and Liaison Service.

If you are seeking or involved in an inquest, you may wish to find further independent information, advice or support. There are details of organisations that can advise on the process, including how you can obtain legal representation, at the end of this leaflet.

Providing feedback, raising concerns and/or making a complaint

Providing feedback: We want to hear your thoughts about your loved one’s care. Receiving feedback from families helps us to understand (i) the things we are doing right and need to continue;
and (ii) the things we need to improve upon.

Raising concerns: It is also very important to us that you feel able to ask any questions or raise any concerns regarding the care your loved one received. In the first instance, the team that cared for your loved one should be able to respond to these. After this, your named contact at Kent Community Health NHS Foundation Trust is the best person to answer your questions and concerns. However, if you would prefer to speak to someone who was not directly involved in your loved one’s care, our Patient Advice Liaison Service (PALS) team will be able to help.

Making a complaint: We hope that we will be able to respond to any questions or concerns that you have. Additionally you can raise concerns as a complaint, at any point. If you do this we will ensure that we respond, in an accessible format (followed by a response in writing where appropriate to your needs), to the issues you have raised.

The NHS Complaints Regulations state a complaint must be made within 12 months of the incident happening or within 12 months of you realising you have something to complain about. However, if you have a reason for not complaining to us sooner we will review your complaint and decide whether it would still be possible to fairly and reasonably investigate.

If we decide not to investigate in these circumstances you can contact the Parliamentary and Health Service Ombudsman (PHSO).

Please note you do not have to wait until an investigation is complete before you complain - both processes can be carried out at the same time. For example, a complaint can trigger an investigation, if it brings to light problems in the care that were not previously known about. However, if both the complaint and investigation are looking at similar issues, a complaint could be paused until the associated investigation is complete.

If you are not happy with the response to a complaint, you have the right to refer the case to the Parliamentary and Health Service Ombudsman. PHSO has produced ‘My expectations for raising concerns and complaints for users of health services, it sets out what they should expect from the complaints process.

Please see the frequently asked questions section at the end of this leaflet for more information on what to do if you are not happy with the responses you receive from us.

Independent information, advice and advocacy

If you raise any concerns regarding the treatment we gave your loved one, we will provide you with information and support; and do our best to answer the questions you have. However, we understand that it can be very helpful for you to have independent advice. We have included details below of where you can find independent specialist advice to support an investigation into your concerns. These organisations can also help ensure that medical or legal terms are explained to you.

Some of the independent organisations may be able to find you an ‘advocate’ if you need support when attending meetings. They may also direct you to other advocacy organisations that have more experience of working with certain groups of people, such as people with learning disabilities, mental health issues, or other specialist needs.

The list below does not include every organisation but the ones listed should either be able to help you themselves, or refer you to other specialist organisations best suited to addressing your needs.

In addition all local authorities (councils) should provide an independent health complaints advocacy service, which is independent of the trust, that people can access free of charge. If you would like to use this service, please contact them on:

0300 343 5714
Start your message with SEAP to 80800
kent@seap.org.uk

We may also be able to provide you with details of other organisations and services that provide local support, and if relevant, we would be happy to talk these through with you.

Local/regional organisations