Decision Report 201902458

Summary

C attended the board in relation to concerns about swelling to their neck area. C was eventually diagnosed with differentiated carcinoma (type of cancer) of the left parotid (salivary gland situated just in front of the ear) with extension to regional nodes and infiltration of the skin.

C said that the board, in particular the ear, nose and throat (ENT) department, failed to provide them with reasonable care and treatment in that the board failed to take their concerns seriously and there was a delay in their diagnosis.

The board’s position was that as soon as the ENT department were presented with symptoms which raised concern, these were acted upon immediately and appropriately to ensure that C was diagnosed quickly and that a plan for further treatment could be developed with C.

We took independent advice from an ENT adviser. We found that there had been failures in the care and treatment C received which led to a delay in diagnosis and treatment, including: a delay between having an ultrasound scan and C being seen in clinic; interpretation of that ultrasound scan and a failure to appreciate the relevance of the time delay to the scan appearances; the classification of C’s referral which should have been classed as urgent; and C’s discharge from clinic and lack of follow-up appointment. We found that the board did not provide reasonable care and treatment to C and upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide reasonable care and treatment. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Consideration should be given to providing follow-up appointments for scan results if concerns are raised by the findings. If ENT patients are discharged prior to investigation results being available, there should be an audit trail to show what action has been taken.
• Patients should be diagnosed in a timely manner. In doing so, clinicians should take into consideration relevant guidance, paying particular attention to any symptoms which would be considered ‘red flag’, and triage referrals as urgent where required.
• When considering investigation findings, clinicians should ensure that they take into consideration all relevant factors. This should include the time elapsed from initial presentation/presentation at time of referral and any delays.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.