East Sussex Healthcare NHS Trust

3. Mr A complains about failings in the care and treatment the Trust provided to his wife for her endometrial cancer [a type of cancer that begins in the uterus] from 2017 until her death in May 2019.

4. Mrs A’s endometrial cancer was treated surgically in June 2017. Following the discovery of a secondary tumour in November, a surgeon removed it in February 2018. Mr A says during appointments with an oncology (cancer) surgeon (the surgeon) in early 2018, Mrs A said she was in pain and had lost her appetite. Mr A complains staff did not investigate these symptoms as soon as they should have and Mrs A did not have a CT scan (computerised tomography scan – a form of X-ray examination) until September 2018. This delayed detection of the secondary tumours in Mrs A’s abdomen. Mr A believes, if not for this delay, Mrs A's cancer could have been treated, although probably not cured, and they might have had more time together.

5. Mr A complains the surgeon’s clinic notes do not reflect what was said during consultations and were, at times, inappropriate as they did not reflect the seriousness of Mrs A’s situation. Mr A also complains staff did not tell his wife she had an aggressive form of cancer and was unlikely to be cured, and they were not kept fully informed.

6. Mr A complains the Trust has not provided adequate explanations of why Mrs A received a letter discharging her from the oncology service when she told the Trust she was unable to attend an appointment in January 2019. This meant she was left without clinical care from the oncology team.

7. Mr A would like an apology, for the Trust to take action so this does not happen to someone else and financial compensation.

8. In spring 2017, Trust staff found Mrs A had a high-grade serous cancer of the endometrium (an aggressive cancer of the womb lining). A CT scan indicated this was at stage one (confined to the womb). The multidisciplinary meeting (MDM) considered Mrs A’s case on 9 May 2017. Staff planned laparoscopic (keyhole surgery) removal of the womb, fallopian tubes, ovaries and pelvic lymph nodes.

9. On 17 May 2017, Mrs A met the lead consultant for gynaecological oncology (the surgeon) and they discussed the planned surgery. A different surgeon carried out the operation on 7 June.

10. 20 June 2017, the MDM considered the pathology results from Mrs A’s procedure. This confirmed the high-grade serous cancer and its spread from the womb to the cervix. The plan was to offer radiotherapy, which was carried out on 22 September 2017.

11. 23 November 2017, a small lump was found on Mrs A’s vulva. A biopsy on 18 December confirmed a secondary cancer from the womb. The surgeon removed the secondary tumour on 23 February 2018.

12. The surgeon saw Mrs A on 11 July 2018. He noted she did not have any abdominal pain but had back pain. As the back pain appeared to be improving, the surgeon said they agreed not to do further radiology investigations at that point. Mrs A complained of lethargy, so the surgeon ordered blood tests. No signs of anaemia or infection were found. Mrs A also explained she felt light-headed and the surgeon, in his clinic letter, asked the GP to monitor her blood pressure.

13. Mrs A was admitted to hospital a few weeks later, where a CT scan showed tumours in her abdomen. The oncology team referred Mrs A to the community palliative care team. The MDM reviewed the CT scan results on 2 October 2018 and the surgeon saw Mr and Mrs A in his clinic the next day. They discussed the results and pain control, and the surgeon said he made sure Mrs A’s GP and the Macmillan team from a local hospice were aware of the situation.

14. Mrs A asked to see the surgeon again and an appointment was made for 9 January 2019. Mrs A was unwell in December 2018 and cancelled the appointment. Soon after, she received a letter from the Trust discharging her.

15. Sadly, Mrs A died in May 2019.

17. The law (Health Service Commissioners Act 1993, section 9 (4)) says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year unless we consider there is a good reason to do so. We discussed this with Mr A to understand the reasons he could not bring his complaint to us sooner. We also considered the time the Trust took to respond to Mr A’s complaint.

18. Mr A confirmed he knew of his reason to complain about his wife’s care when the events happened. We call this the ‘date of knowledge’. For his complaint to be in time, he would have needed to contact us within one year of the date of knowledge.

19. Mr A first contacted us on 14 September 2020. We confirmed with him on 17 September that he had not complained to the Trust about his wife’s care. We said he needed to put his complaint to the Trust first. Mr A complained to the Trust on 22 September 2020.

20. Mr A has said he could not complain sooner because of his bereavement and grief.

21. We recognise the time after Mrs A died would have been very difficult and upsetting for Mr A. We do not underestimate the distress he experienced. But there was a considerable delay of 16 months after his wife died before Mr A complained to the Trust.

22. Having received Mr A’s complaint dated 22 September 2020, the Trust sent its response two months later, on 23 November. Mr A replied on 9 March 2021 with his outstanding concerns. The Trust sent its second response on 18 May. Mr A replied on 2 June and the Trust sent its third and final response on 13 August.

23. We accept that some time was needed to complete the local complaints process. Section 14 of The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the Regulations) states: ‘(1) A responsible body to which a complaint is made must (a) investigate the complaint in a manner appropriate to resolve it speedily and efficiently…’ and ‘(2) As soon as reasonably practicable after completing the investigation, the responsible body must send the complainant in writing a response…’. We consider there was no undue delay and the Trust acted in line with the Regulations.

24. As Mr A remained unhappy with the Trust’s responses, we would have expected him to have acted quickly when he received its final response in August 2021. Although Mr A’s complaint form to us is dated 14 October 2021, his advocate did not email it to us until 4 November. This was nearly three months after the Trust’s final response.

25. We have looked at Mr A’s date of knowledge for the specific issues of his complaint to us:

Issue 1 – Trust delay in investigating Mrs A’s further symptoms

26. Mr A says his wife told staff about her pain and loss of appetite during clinic appointments in 2018. Mrs A had a CT scan in September 2018 and staff found secondary tumours in her abdomen. Therefore, Mr A’s date of knowledge of this issue was September 2018. However, he did not put this complaint to us until 4 November 2021, over three years later.

Issue 2 - Mrs A not told she had an aggressive form of cancer and was unlikely to be cured

27. We cannot be sure when Mr A became aware of this issue. We have therefore used the date of Mrs A’s death as Mr A’s date of knowledge. This was two years and six months before Mr A brought this complaint to us on 4 November 2021.

Issue 3 - Inaccurate notes did not reflect clinic discussions

28. Mr A’s date of knowledge of the claimed failure of clinic letters to reflect 2018 consultation discussions was soon after each clinic. Mrs A received copies of the clinic letters and she shared the contents with Mr A. He did not bring this issue to us until 4 November 2021, approximately three years after the event.

Issue 4 - Mrs A receiving a discharge letter

29. Mr A has confirmed he was aware of the discharge letter when his wife received it in December 2018. It was two years and 11 months before Mr A complained about this issue to us on 4 November 2021.

In summary

30. We have carefully considered the reasons for the time that passed before Mr A complained to us about the above four issues. As previously explained, the law says a person needs to make their complaint to us within a year of becoming aware of the problem.

31. Mr A was aware of the issues he has complained about at the time they happened, several months before his wife died. We recognise this would have been a very difficult time for Mr A and his wife as they were coping with her terminal illness. However, we can see most of the delay happened after Mrs A died. Mr A did not complain to the Trust for 16 months.

32. While it took 11 months for the Trust to complete its handling of Mr A’s complaint, there were no unreasonable delays as the Trust responded to Mr A’s three letters of complaint before concluding its investigation. There was then a delay of nearly three months before Mr A came to us.

33. We accept how distressing these events have been, and continue to be, for Mr A. We accept what happened had some impact on Mr A’s ability to pursue his complaint, certainly in the immediate period following his wife’s death.

34. There remains the significant 16-month delay before Mr A contacted the Trust about his complaint. We consider Mr A could have reasonably contacted the Trust before this, although he was fully engaged in the complaints process once it started in September 2020.

35. We appreciate Mr A’s complaint about his wife’s care is very important to him and continues to cause him concern. But Mr A’s complaint has come to us significantly out of time and, for the reasons given above, we have decided not to look at this complaint further.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mr A’s complaint about the care and treatment East Sussex Healthcare NHS Trust (the Trust) provided for his late wife from 2017 to 2019. Sadly, Mrs A died on 20 May 2019. We extend our sincere condolences to Mr A and recognise these events continue to cause him considerable upset and distress.

2. After careful consideration, we have decided not to consider the complaint further. This is because the complaint falls outside our time limit.