Summary
Mrs C complained on behalf of her grandmother (Mrs A) about the time it took to provide Mrs A with treatment. Mrs A had a long history of incontinence problems, and her GP referred her to the board in August 2012. In November 2012, Mrs A had her first appointment at Wishaw General Hospital. In May 2013, tests at a second appointment identified the problem as stress incontinence. At a third appointment in October 2013 a doctor suggested that surgery might address this, and said that Mrs A would be referred to a specialist consultant. This, however, did not happen and when by January 2014 nothing had been heard, Mrs A, her GP and Mrs C all contacted the hospital. Mrs A was eventually referred to a consultant in February 2014, and was placed on a waiting list for surgery.
Meanwhile, in September 2013 new national guidelines had been produced for managing incontinence in women and subsequently the board formed a group to discuss the best way to treat patients like Mrs A. The group discussed Mrs A's case at their first meeting in March 2014. They decided that, per the guidelines, rather than her being on the waiting list, they should instead refer her to a specialist centre at another board (Hospital 2) to consider her treatment. She eventually had surgery in February 2015, some two and a half years after her initial referral.
In February 2014, Mrs C had complained to the board about the delays. They explained why these happened, acknowledged that they were unacceptable and apologised for this and for the distress caused. Mrs C was unhappy with their response as it did not say whether anything had been done to stop this happening again.
I took independent advice from two advisers, a consultant physician and a consultant gynaecologist. The consultant physician said that the delays after the first appointment were unacceptable, and that there was a failure of care when Mrs A was not referred to the specialist consultant in October 2013. Both advisers found the delay in referring Mrs A to the specialist centre unacceptable, although the consultant gynaecologist confirmed that in Mrs A's case it was entirely correct to follow the guidelines and refer her there for consideration.
I found that there was a general lack of urgency in Mrs A's care, that there were unreasonable delays in investigating and assessing her condition, and that the board did not address these effectively when responding to Mrs C's complaint. I was particularly concerned that Mrs A was not referred to a consultant in October 2013, and that when handling the complaint the board did not try to find out why this happened. I upheld Mrs C's complaint and made four recommendations.
Redress and recommendations
I recommended that the Board:
- (i) conduct a detailed review of the failings around the out-patient appointment of 28 October 2013, particularly treatment time targets and the lack of referral/clinic letter;
- (ii) conduct a review of appointment allocation and waiting times for patients within the uro-gynaecology speciality;
- (iii) apologise and provide an explanation for the delay in referring Mrs A to Hospital 2; and
- (iv) apologise to Mrs C for failing to provide a reasonable response to her complaint.