Clinical treatment in hospital : Betsi Cadwaladr University Health Board

Mr A complained about his care and management following his referral to an NHS Hospital Trust in England (“the Trust”) which was commissioned by Betsi Cadwaladr University Health Board (“the Health Board”) to provide care/treatment. (The Health Board having commissioned the care from the Trust, remained responsible for the monitoring and oversight of the care which the Trust provided). Mr A complained that a Consultant Neurologist (“the First Neurologist”) based at the Trust failed to diagnose his multiple sclerosis (“MS” – a condition which affects the brain and the spinal cord) between 18 May 2018 and 19 September 2019. Mr A also said that the Health Board should have explored a local referral option before sending him to the Trust. Finally, Mr A complained that the complaint responses received from both the Trust and the Health Board were not robust and were inaccurate.

The Ombudsman found that the investigation into and the time taken to diagnose Mr A’s condition fell below the appropriate standard of care. The investigations following the first consultation were inadequate, despite the First Neurologist noting that Mr A’s presentation in May 2018 was strongly indicative of underlying physical disease. Mr A had clear and ongoing physical signs which strongly suggested a neurological disorder from the first time he was seen in May 2018. The First Neurologist did not question or seek an explanation of Mr A’s ongoing abnormal physical symptoms but attributed them firstly to an unrelated back problem and later to a psychiatric or psychological disorder. The First Neurologist also failed to discuss, recognise, and later review the significance of the ongoing abnormal physical signs that Mr A demonstrated on examination.

The Ombudsman was satisfied that an earlier diagnosis would not have materially altered the outcome of Mr A’s disease, but she was concerned the delay in diagnosis and the attribution of his symptoms to psychological or psychiatric factors caused Mr A unnecessary anxiety and uncertainty. This was a significant injustice to him and therefore this aspect of Mr A’s complaint was upheld.

The Ombudsman was satisfied with the Health Board’s explanation that although there are clinics available locally, the waiting list for a clinic appointment is often longer than at the Trust which is why patients are often referred to the Trust. This aspect of Mr A’s complaint was not upheld.

In relation to complaint handling the Ombudsman was troubled that the Trust, on behalf of the Health Board, did not identify the failings in care provided to Mr A by the First Neurologist when considering Mr A’s complaint. The Health Board also failed to seek an independent clinical opinion to address Mr A’s concerns. The Ombudsman was concerned that the Health Board, both at a commissioning level and in its own right, had failed to ensure that the Trust fully acknowledged and recognised the extent of failings evident in this case together with the impact on Mr A. The Ombudsman concluded that the lack of an open and timely response to Mr A’s complaint was not only maladministration but further added to the injustice caused to Mr A. It also meant that an important part of the Health Board’s monitoring role, which requires it to have rigorous oversight and scrutiny of the commissioned body, was lost. Inevitably, this would have added to the stress and anxiety Mr A experienced, and this aspect of his complaint was upheld.

Mr A was awarded PIP (a benefit to help with extra living costs for people with a long-term health condition) following his diagnosis. The Ombudsman concluded, on balance, that he would have been awarded this had his condition been diagnosed earlier. She therefore calculated the payment Mr A would have received, together with interest at the rate of a County Court Judgment (8%)

The Ombudsman recommend that within 1 month from the date of the this report the Health Board should:
a) provide an apology to Mr A for the failings identified in this report which extended to poor complaint handling
b) in recognition of the financial loss caused to Mr A as a result of the failings pay him the sum of £4,835.38

c) in recognition of the distress and inconvenience caused to Mr A as a result of the delayed diagnosis and having to pursue the matter rigorously himself, at a time when he was unwell, make a payment to him of £1,500
d) in recognition of the distress and inconvenience caused by the failures in complaint handling, make a payment to Mr A of £500
e) write to the Trust as part of its commissioning arrangements, to bring to its attention the concerns highlighted by the Adviser about the need to monitor the First Neurologist’s working practices, including reminding him of the need to adhere to the General Medical Council Guidelines as part of his professional obligations
f) as part of its commissioning arrangements, ask the Trust to ensure that its Neurological Team discuss this case at an appropriate forum as part of reflective and wider learning
g) review its response to this complaint to establish what lessons can be learnt, particularly in relation to when it would be appropriate to seek independent clinical advice on a complaint, as set out in the PTR guidance
h) share this report with the Chair of the Health Board and its Patient Safety and Clinical Governance Group.