Clinical treatment outside hospital : A Medical Practice in the area of Hywel Dda University Health Board

Mr X complained about the care provided to his mother, Mrs Y, by her GP Practice. He complained that:
• There was a delay in providing Mrs Y with a clear and accurate diagnosis.
• Mrs Y was not advised that the reason for a scan she received in January 2018 was to investigate whether she had cancer.
Mr X also complained about the care provided to Mrs Y by the Health Boards. Specifically, Mr X complained that:
• There was a delay in providing Mrs Y with a clear diagnosis between January and September 2018.
• Communication between staff and the family was poor from September 2018 until February 2019.
• Information regarding clinical trials was unreasonably not provided to Mrs Y between September and December 2018.
• Mrs Y was treated with radiotherapy inappropriately and without her having a reasonable knowledge of the intended purpose of the treatment between September and December 2018.
• The Oncology Service operated an unreasonable expectation that meant patients were only seen if they were able to physically attend consultant appointments.
• The First Health Board did not handle the family’s complaint properly.

The Ombudsman upheld the complaint against the Practice that there was a delay in providing Mrs Y with a clear and accurate diagnosis. The Practice initially diagnosed Mrs Y with polymyalgia rheumatica. Whilst this was not unreasonable, the Practice should have reviewed the diagnosis sooner once it became apparent that Mrs Y’s inflammatory markers were not responding to steroid treatment. The Ombudsman did not uphold the complaint about Mrs Y not being told the reason for the scan by the Practice – on balance it was likely from the evidence that Mrs Y was aware of the reason for the scan.

The Ombudsman found there was a small delay in providing Mrs Y with a clear diagnosis between January and September 2018, and as this would have added to her anxiety, she upheld the complaint to that extent only. She also found that there were some failings in communication between staff of the Health Boards and Mrs Y and her family. This part of the complaint was also upheld to that extent. The Ombudsman did not uphold the complaints regarding information about clinical trials being unreasonably withheld or about the appropriateness of radiotherapy treatment. While the Ombudsman found that in practice oncologists would visit patients on the wards where appropriate, it was apparent there was some confusion about this amongst staff on the ground; she therefore upheld that part of the complaint. Finally, the complaint about how the First Health Board handled the family’s complaint was upheld to the extent that there was some evidence of unreasonable delay.
The Ombudsman recommended that the bodies should apologise to the family for the failings identified. She also recommended that the GP involved in Mrs Y’s care should receive training on requesting appropriate scans and that the Practice should carry out a Significant Event Analysis meeting. The Ombudsman also recommended that the First Health Board should provide relevant staff with training on NICE guidance for the management of Cancer of Unknown Primary (CUP). It was also recommended that progress should continue to ensure the First Health Board’s patients are discussed at a CUP Multidisciplinary Meeting at the South West Wales Cancer Centre.