17. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and we have not found any indications that something has gone wrong.
18. We appreciate the time Mr Y and his partner spent in discussing their experience with us, and we are sorry about how these events have affected Mr Y.
19. Mr Y says if the Trust had told him surgery had started again, it is likely he would not have had private treatment.
20. On 17 March 2020, NHS England wrote to all Trusts and GP practices advising them to postpone all non-urgent elective operations from 15 April, for a period of at least three months. This was done to ensure hospitals were able to handle any influx of patients that may need care and treatment for COVID-19, and to reduce the risk of hospital acquired infections.
21. According to the NHS England roadmap, which outlines the plans for restarting all planned procedures, including surgery, specialists were advised to prioritise those with the most urgent clinical need. However, since the beginning of June 2020, some hospitals started to offer elective surgery, but this still had to be first considered based on clinical need.
22. The Trust confirmed it recommenced elective surgeries from 8 June 2020. During this time, it was only able to utilise the day stay unit. Therefore, the Trust was able to operate safely in a day surgery setting for those who did not require a multiple night stay and were not at risk of requiring the HDU (high dependency unit) or the ITU.
23. Mr Y was a bariatric patient and ASA grade 3. This made him ineligible for the above scheme meaning his surgery could not have been carried out at the Trust in June 2020.
24. This is in accordance with the NHS England roadmap, and we cannot say the Trust did anything wrong here.
25. We contacted the Trust and asked it to confirm what processes were in place both for surgeries that had been cancelled, and for restarting them.
26. The Trust said on 24 June 2020, its surgical booking team spoke with Mr Y’s partner. It advised them it could not provide a date for surgery as there was a shortage of beds, and it was not able to operate on anyone ASA 3 or above or do any bariatric procedures.
27. The Trust did mention it was considering using a private hospital, but nothing was guaranteed at this time.
28. In July, the Trust was able to secure private sector operating capacity. However, on 8 July, a consultant obesity physician wrote to Mr Y informing him he was clinically inappropriate to be operated on in this setting.
29. The letter explained the Trust was only carrying out ‘low-risk’ procedures within either the Trust or the private facility. It also explained there was a backlog of several hundred people in total, including urgent and non-urgent operations. The letter said it was unlikely Mr Y would receive surgery in 2020 at all and estimated he would be offered a date between April and June 2021.
30. Mr Y made the decision to have private surgery, costing him £10,000, as he did not want to wait until 2021 for the surgery.
31. The Trust confirms it recommenced bariatric surgery on 24 August 2020 when its ITU was available, and it could offer surgery in its main theatre.
32. The Trust also told us that in August 2020 there was a waiting list for this type of surgery and eight patients were ahead of Mr Y.
33. On 1 November, the waiting list had increased, and no longer included Mr Y as he had been removed from it in October.
34. After careful consideration of the final response letter from the Trust, and further information it provided us, even if Mr Y did not make the decision to have private surgery it is very unlikely, he would have received a theatre date from the Trust in 2020 at all.
35. Our primary investigation found that bariatric surgeries had not started in June as Mr Y thought, but on 24 August, which was after his private procedure.
36. On this basis we have not found any indication the Trust has done anything wrong, as the option for surgery at the Trust was not available to him at this point anyway. There is no indication the Trust knew it would be able to offer surgery when it was in contact with Mr Y in July 2020.
37. Our principles say Trusts should communicate effectively, using clear language that people can understand and that is appropriate to them and in their circumstances.
38. We are satisfied the Trust maintained good contact with Mr Y throughout this period and explained how the pandemic affected its service and managed his expectations accordingly. This is in line with our principles above.
39. We consider that even if Mr Y had been advised earlier that surgery was due to restart in August, he would likely have still chosen private treatment. He tells us that he could not wait until 2021, and it is clear from the information we have seen that he would not have been offered a surgery date in 2020.
40. The decision to seek and pay for private treatment is the responsibility of Mr Y and we cannot hold the Trust accountable for this.
41. We understand Mr Y made the decision to get private treatment based on the information the Trust was giving him at the time, but even if he had waited he would not have received the surgery in 2020.
42. To conclude, we are sorry Mr Y felt compelled to pay for surgery privately due to the pandemic putting strain on NHS resources and prolonging the wait for surgery. We do not underestimate how difficult this time was for him, or the financial implications of that decision.
43. We have found that due to the number of people on the waiting list during August, and the backlog of people in total, it is highly unlikely he would have received the surgery sooner than 2021.
44. Based on this we are satisfied the Trust has done nothing wrong and will not be considering this complaint further.