Summary
Mrs C was suffering from abdominal pain, and was seen at a gynaecology out-patient clinic following referral by her GP Practice in November 2012. She was diagnosed with uterine fibroids in January 2013. Mrs C was admitted to a ward at her local hospital (in another NHS board area) due to the pain. In February 2013, Mrs C's GP contacted the consultant gynaecologist (Consultant 1) in charge of the out-patient clinic, requesting that she be placed on the list for surgery due to the impact her condition was having on her life. Consultant 1 replied to say further discussion was required within the multi-disciplinary team; Mrs C was offered another appointment at the clinic on 2 April 2013. Mrs C decided to seek private treatment, and had successful private surgery on 4 April 2013.
Mrs C made a complaint in June 2013 about the care and treatment she received, as well as communicative difficulties she had had when trying to contact Consultant 1. She received a reply in August 2013, apologising for the administrative backlog that caused delay with her care and treatment. The Board also said it was unlikely Mrs C would have been seen earlier than 2 April 2013 due to the gynaecology service's waiting times overall. Mrs C complained again and the Board issued a final response in February 2014. At this time, Mrs C was told that, in February 2013, Consultant 1 had made a decision that she should be referred for surgery. An appointment for 4 April 2013 was to be offered; a telephone call was made by the Board to her GP Practice on 4 March 2013. Consultant 1 told us that this had been left with the GP to discuss with Mrs C.
My investigation found that more prompt action should have been taken by the Board given Mrs C's worsening condition, and that there was a lack of urgency which meant Mrs C's care plan was not re-assessed. I concluded that to expect Mrs C to wait for a further clinic appointment in April 2013 was not reasonable. In addition, it was not reasonable that Consultant 1 had only contacted the GP Practice by telephone to advise of the offer of surgery; contact should have been made in writing to ensure Mrs C was aware of her options. It was not reasonable to expect the GP Practice to pass on a message about the offer of surgery. In my view, it was likely Mrs C would not have sought private treatment had she known the same procedure would have been available via the NHS at the same time. I also found that the Board's responses to Mrs C's complaints were delayed, having been received well outwith the timeframes within the Board's complaints handling procedure.
Redress and recommendations
The Ombudsman recommends that the Board:
- (i) reimburse Mrs C for the cost of her private surgery on production of receipts;
- (ii) apologise to Mrs C for the failures in communication identified in this investigation;
- (iii) confirm that steps have been taken to address the administrative communication failings identified during their investigation of Mrs C's complaints;
- (iv) review the gynaecology department's internal and external communication arrangements to determine what improvements can be made;
- (v) review the management procedure for the care and treatment of patients like Mrs C who live in another NHS board area;
- (vi) apologise to Mrs C for the delays in responding to her complaints;
- (vii) confirm that a process has been put in place to ensure that a complainant's further comments are addressed timeously; and
- (viii) review arrangements with Mrs C's local NHS board for management of similar joint complaints.