Surgery cancellations
16. Before we decide whether we should conduct a detailed investigation of a complaint, we look at whether there are signs that the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any signs that something has gone wrong.
17. Mr R’s surgery was postponed twice despite him being told his spine was deteriorating. Mr R says the delay in his surgery left him in pain and caused his condition to deteriorate further.
18. The ‘Guide to NHS waiting times in England’ says if the hospital cancels a patient’s operation (on or after the day of admission) and for non-clinical reasons, it should offer another binding date within 28 days or fund the treatment at a date and hospital of the patient’s choice.
19. It also says that if a patient’s operation is cancelled before the day of admission, the hospital or service does not have to provide an alternative option within 28 days. Mr R was advised of the cancellation two days before his first scheduled surgery and the day before his second surgery.
20. Mr R says his GP visited him at home on 12 September 2019, after the first surgery cancellation, and then wrote to the hospital consultant to inform them Mr R’s condition was deteriorating and that he had to prescribe additional pain relief.
21. In responding to the complaint, the Trust said that on the first occasion the surgery had been cancelled due to the surgeon being unwell, and that allocating another surgeon who had not had the opportunity to assess and review Mr R before surgery would not have been appropriate.
22. The Trust said the cancellation of the second surgery was due to the allocated theatre being used for an urgent case, which required specialist theatre equipment. No alternative theatres were available and, due to the clinical urgency, it decided to postpone Mr R’s surgery. The Trust said it fully reviewed all Mr R’s clinical notes to determine the risk of postponing surgery before it made a final decision.
23. Our clinical adviser says cancellation of surgeries depends on various factors such as staffing levels and emergency patients. It cannot be determined by any clinical guidelines or standards. Given the circumstances that happened and the explanations the Trust gave, it is clear the cancellations were unfortunately unavoidable.
24. While we acknowledge it was a frustrating and difficult time for Mr R, the Trust’s actions in relation to the cancellation of his surgeries did not go against any legislation or guidelines. There are no indications of maladministration.
25. In addition to this, the short delay would not have caused a deterioration to his condition. We recognise Mr R is especially concerned that the delays in his surgery caused his condition to worsen. We discussed this with our clinical adviser and we hope Mr R is reassured by what we have seen.
26. Our adviser says the delay in having the procedure would not have caused Mr R’s spinal condition to deteriorate further. According to the letter dated 12 September 2019 from Mr R’s GP to the neurosurgeon, ‘Mr R had reported that he was struggling to lift his head and is in severe pain’. Our adviser says headaches would be caused by the wear and tear in Mr R’s cervical spine and that surgery is not aimed at improving this particular symptom.
27. There is a letter dated 28 September 2020 from the spinal clinical fellow to the GP practice. This was nearly one year after his surgery, and it confirms that Mr R had reported a ‘marked improvement’ to his preoperative symptoms. Mr R had also reported that he did not have any neck discomfort or arm pain or any other symptoms after the operation. We are pleased to hear that the surgery was successful.
Communication
28. If we see signs of failings in a complaint brought to us, we then look at whether there are signs the event complained about had a negative effect which the organisation has not put right. We will only investigate if we think the organisation has not yet done enough to put right any impact from failings.
29. Mr R says that he received a call on 9 September to notify him that his surgery for 11 September had been cancelled. He says he did not accept this and asked for a manager to call back. After not receiving a call back from a manager, Mr R assumed his operation was going ahead and went to the hospital for his surgery.
30. While it was not ideal that he did not get a call back from a manager, Mr R had already been informed that his surgery was cancelled. He made the choice to still go to the hospital after being notified of the cancellation. Mr R could have called again to check with the hospital whether his surgery was cancelled before deciding to travel there.
31. The Trust explained in its response that its investigation highlighted a breakdown in communication between Mr R and the staff involved in scheduling and managing his operation. It says when the call was made to Mr R on 9 September 2019 to inform him of the cancellation, it offered a call from the waiting list manager. It explained that the Trust staff interpreted his response as not requiring a manager call back. The Trust has apologised in its response letter that it was not clear about how it would confirm the cancellation.
32. The Trust’s response appears to be accurate, evidence-based and clear. It has explained its reasoning for the cancellations and how it gave notifications of them. It has also explained how the error happened. Our principles for good complaint handling and good administration say organisations should provide accurate, evidence-based and clear decisions, and the Trust’s response is in line with this.
33. Our principles of good complaint handling (‘putting things right’) explain, ‘in many cases, a prompt explanation and apology will be a sufficient and appropriate response and will prevent the complaint escalating’. We can see the Trust has apologised in its complaint response and provided an explanation.
34. Having carefully looked at all the information, we consider there is no unremedied injustice in this aspect of the complaint and, for this reason, we will not be taking any further action in relation to this.
Complaint handling
35. Mr R says the Trust did not give him a proper apology and did not consider his disability in relation to arranging a local resolution meeting. He also says the Trust failed to take responsibility for the cancellations.
36. Having reviewed the Trust’s response, we can see it apologised for the surgery cancellations and gave clear and detailed explanations for them.
37. In its response on 15 January 2020, the Trust offered to discuss any outstanding concerns further, and Mr R responded that he would like to attend a local resolution meeting. Due to the COVID-19 pandemic, this meeting was put on hold, but the Trust continued to communicate with him about this by sending holding letters in March and June 2020 as well as February 2021. The Trust explained the reasons for the delay. It was not possible to hold a face-to-face meeting due to safety concerns around COVID-19.
38. In February 2021, the Trust sent a further letter to say it was reviewing the possibility of resuming face-to-face meetings and to let Mr R know he had the option of a virtual meeting. Mr R says a virtual meeting would not be suitable for him due to his disability. By the time the Trust was able to offer face-to-face meetings, Mr R had already decided to bring the complaint to us to consider.
39. In August 2021, we tried to reach a resolution by asking the Trust to provide a further written response, which it was willing to do. However, Mr R did not want this, so we considered the case further.
40. We appreciate that Mr R says that due to his disability he could not attend virtual meetings. We do not criticise the Trust for following the government COVID-19 guidance in place at the time. This advised against unnecessary face-to-face contact, and we know that all healthcare settings had to risk assess all in-person contact to limit the spread of COVID-19. This means it was correct for the Trust not to hold face-to-face local resolution meetings, as the risk would have outweighed the benefit. The Trust continued to send Mr R holding letters in March and June 2020 explaining it would be in touch to arrange his meeting when this was possible.
41. The Trust’s response appears to be accurate, evidence-based and clear. It has explained its reasons for cancelling the surgery dates and the reasons for delays with local resolution meetings. Our principles for good complaint handling and good administration say organisations should provide accurate, evidence-based and clear decisions, and the Trust’s response is in line with this. Having carefully considered all the information, we consider there are no signs of failings in the Trust’s handling of Mr R’s complaint.
42. We recognise that the two cancellations and pursuing this complaint during the pandemic has caused Mr R significant worry, and we are sorry to hear of his experience. We hope he is reassured by our investigation and understands the reasons why we are taking no further action.