Report Date


Case Against

Hywel Dda University Health Board


Clinical treatment in hospital

Case Reference Number



Upheld in whole or in part

Miss B complained to the Ombudsman about different aspects of the care her late mother, Mrs M, received whilst a patient at Prince Philip Hospital. Her concerns included:

· Delays in Mrs M’s initial assessment and treatment as a result of a misplacedCovid-19 test sample

· Being admitted to a ward which treated patients suspected of having Covid-19 despite being negative herself

· A failure to investigate and treat the cause of Mrs M’s anaemia;

· The management of Mrs M’s discharge; and

· Failures to communicate significant clinical decisions to the family.

The Ombudsman found that care provided to Mrs M was of an appropriate standard taking into account that the events in question occurred whilst hospitals were experiencing extraordinary pressures as a result of the covid-19 pandemic. However, the Ombudsman did find that there were significant failures in the communication with Mrs M’s family in relation to the Health Board’s communication with Mrs M’s family. Despite the pressures of the pandemic, the Ombudsman considered that these failings had been largely avoidable and therefore upheld this element of the complaint.

The Ombudsman recommended that the Health Board apologise for these communication failings and pay Miss B redress of £250within 1 month of the issuing of the report.