18. The Trust reviewed Mrs C’s referral on 21 February 2022 and classed her as a P3 patient. NHS RTT guidance says people categorised as P3 should have surgery within three months from the time of their review.
19. This guidance came into effect one month after the Trust’s consultant reviewed Mrs C. Before this, the NHS was still recovering from the COVID-19 pandemic and working towards achieving expected RTTs. The NHS RTT guidance confirms what the Trust should have been working towards during Mrs C’s period of waiting.
20. The earlier version of the same guidance had the same target, but said these targets could not be guaranteed, due to the constraints of the pandemic.
21. The Trust arranged Mrs C’s surgery for 31 May 2022 at first. This date was only ten days later than the guidance’s target time. We cannot say this was a failing because of the pressures the Trust was facing at the time.
22. When Mrs C arrived on 31 May, staff booked her onto the ward but telling her she was on the list but not for surgery. Mrs C spoke to the surgeon who explained staff should have told her that her operation had been cancelled and advised her to go home. They explained her surgery would be rescheduled.
23. Mrs C said that after returning home and contacting the Trust, she found out that she had been removed from the list due to an emergency. The Trust accepted staff should have contacted her.
24. The Trust’s Theatre Scheduling Policy says a patient for elective surgery (scheduled in advance and not an emergency) is not considered ‘booked’ until they have been added to the appropriate operating session within the electronic theatre management system. The Trust told us it booked Mrs C onto the theatre management system for 31 May. The Trust also said a more urgent case needed to be prioritised, so it then removed Mrs C from the system.
25. The same policy says that where potential cancellations before the day of surgery are found, the Trust’s escalation process must be followed. This is relevant to Mrs C’s case.
26. And, the Trust’s SOP says that if cancellations are needed, patients should be told. But, if they wish patients can continue to fast (in preparation for surgery) and the situation can be reassessed the next morning. The SOP says if this is the case the admission should stay on the system to avoid any confusion about a potential bed requirement. It explains the Trust will update the patient by 9am after reviewing the situation, to see if the surgery can go ahead or not.
27. It clearly explains the Trust should contact the patient and tell them this information.
28. There is no evidence to show the Trust contacted Mrs C .
29. The Trust kept Mrs C on the bed list in case the situation changed, in line with its SOP. But, it did not tell her this so she went to the Trust thinking her surgery would definitely go ahead. This is not in line with its policy and is a failing. We can reasonably say this caused her distress and inconvenience.
30. The Trust explained its mistake and confirmed she was put back on the waiting list. It apologised for not having told her in advance. We consider this is enough to address the inconvenience and distress caused. We are satisfied this is in line with our Principles.
31. The Trust then contacted Mrs C and suggested a new date for her surgery. Mrs C expressed concerns that this surgery would be with the surgeon she had spoken to on her first surgery date. She was unhappy with them as she felt they had been rude to her on 31 May.
32. The Trust found another surgeon who reviewed her notes and agreed to treat her. Mrs C’s medical notes for this time say the Trust confirmed the change of surgeon with her. The Trust recorded Mrs C’s request that her admission be put back to after 12 August, due to other commitments she had before this date.
33. In line with her wishes, the Trust provided a new admission date for her rescheduled surgery of 16 August.
34. We recognise this is now outside of the timeframe set out in the NHS RTT guidance. Because of how this new date came about, we cannot say the Trust did anything wrong. The Trust also noted at this time that Mrs C confirmed she was happy with the new date for her surgery, the change in consultant and the response to her complaint.
35. Unfortunately, Mrs C cancelled her planned surgery for 16 August. She needed a tooth extraction. As she was having treatment for breast cancer, she needed confirmation from her dentist that more surgery could go ahead. We cannot say the Trust did anything wrong.
36. On 31 October, Mrs C contacted the Trust to say the dentist had confirmed she could have the surgery. The Trust scheduled a meeting on 3 November and completed Mrs C’s pre-operative assessment on 14 November by phone.
37. The Trust scheduled a surgery date for 2 December but changed this to six days later, 12 December, due to theatre availability.
38. The Trust’s Patient Access Policy says that many patients will choose to be seen at the earliest opportunity. It further says that patients must be allowed to plan their treatment around their personal circumstances.
39. Mrs C declined surgery in December, as she felt this was too close to Christmas. This was her preference and in line with its policy the Trust offered Mrs C another date of 9 January 2023.
40. On 5 January, Mrs C cancelled her surgery due to having a UTI. The Trust had already advised Mrs C it could not complete hip replacement surgery if she had a UTI, so she followed its advice. We cannot say this cancellation was due to a failing on the part of the Trust.
41. The Trust planned surgery for 6 February. Unfortunately, this surgery date could not go ahead due to strike action. We realise this was inconvenient for everyone. As strike action was not something either the Trust or Mrs C could control, it would be unfair for us to say this cancellation was either side’s fault.
42. Mrs C had hip replacement surgery on 28 March. We appreciate the length of time she had to wait and the pain and distress this caused her. We have not seen evidence that the delays were due to failings by the Trust. We recognise how difficult it can be to make a complaint and thank Mrs C for taking the time to bring her concerns to us. We hope we have explained our decision clearly.