North Bristol NHS Trust

3. Mr O complains he did not get appropriate treatment from the Trust at a follow up appointment with the vascular clinic on 29 October 2019. This was after he went to the emergency department (ED) on 24 October for a mini stroke (TIA).

4. He complains:

• he should have been given treatment at the follow up appointment • the clinical staff on 29 October were rude and dismissive.

5. Mr O had a major stroke in summer 2021 and he believes this could have been avoided if he was given appropriate treatment in October 2019.

6. Mr O wants an apology and a financial payment.

7. When Mr O was assessed at the ED the neurologist thought he had suffered a mini stroke (TIA), affecting his left eye. The Trust did an ultrasound scan of the blood vessels in Mr O’s neck.

8. The scan showed narrowing of the external carotid artery. This does not increase risk of a stroke and does not need surgical treatment. But, the consultant misread this as narrowing of the internal carotid artery, a condition that may have needed surgery depending on the extent of the narrowing. Mr O was referred to the vascular surgeon for consideration and put on medication to reduce the risk of a stroke.

9. Mr O had a review appointment on 29 October. The Trust reviewed the scan and noted less than 50% narrowing of the external carotid artery that did not need intervention. It sent Mr O away with no further treatment. Mr O says the staff at this appointment were rude and dismissive towards him and did not examine him. He believes he should have been given treatment at this appointment.

10. About 19 months later, Mr O had a stroke affecting the use of his right-hand side and his mental health. He believes this could have been avoided if appropriate treatment was given in October 2019.

14. Before we decide if we should do a detailed investigation of 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 have not seen any signs that something has gone wrong.

15. The Trust’s complaint response says its consultant misread the results of the ultrasound scan, thinking it showed more than 50% narrowing of the internal carotid artery.

16. If this had been the case, our adviser said it would have been appropriate for the Trust to refer Mr O to the vascular clinic, as they did. This is in line with NICE guidance.

17. But, at the follow up appointment on 29 October staff realised the report had been misread. The report showed less than 50% narrowing of the internal carotid artery and greater than 50% narrowing of the external carotid artery. Our adviser did not point to a specific guideline for appropriate action for the Trust to take after realising this mistake.

18. But, our adviser did say it would be good practice for the clinician who made the referral to write to Mr O to apologise and explain the mistake. The clinician had done this and our adviser said the letter was of a good quality in explaining and reassuring Mr O.

19. We think the letter was an appropriate step to put this right. This is in line with our Principles that say organisations should acknowledge mistakes when they happen, apologise and explain what went wrong.

20. After Mr O’s first attendance on 24 October 2019 when it believed Mr O had more than 50% narrowing of the internal carotid artery, the Trust put him on a treatment plan. This was to manage future risk of a stroke.

21. The measures involved were explained in a letter to Mr O’s GP. We looked at this treatment plan against the relevant NICE guidance and got advice from our adviser.

22. The letter outlines the treatment plan as:

• reduce and discontinue aspirin • prescribe antiplatelet medication (clopidogrel) • increase atorvastatin dosage to lower cholesterol • referral to vascular surgeons • request for CT scan.

23. Our adviser said the steps in this plan are in line with NICE guidance that says patients with less than 50% narrowing of the internal carotid arteries (as Mr O had) should not have surgery and should instead receive best medical treatment. Best medical treatment includes controlling blood pressure, administering antiplatelet agents and lowering cholesterol through diet and drugs. Our adviser said the Trust’s actions are in line with the NICE guidance.

24. From the documents we have seen, it seems the consultant wrote to Mr O’s GP to explain what was to be done, including for Mr O to be referred and assessed. This was the day after Mr O’s first attendance at the ED. Once the Trust had realised its mistake on 29 October, the consultant added a note to confirm they had misread the report and that Mr O did not need referral and assessment.

25. This is also repeated in the notes from a Trust meeting on 30 October where clinicians agreed Mr O did not need intervention. The team also agreed best medical management was the correct treatment.

26. Overall, we have seen that the consultant made a mistake. This was in misreading the results of the scan and referring Mr O for a follow up appointment that he did not need. We do not consider this mistake to be a failing as it does not relate to the Trust failing to meet clinical standards. The mistake was put right and we have not seen that it had a negative effect on Mr O’s care.

27. We appreciate this will have been confusing for Mr O and he may have felt dismissed when he was turned away from the follow up appointment on 29 October. Once the Trust realised its mistake, we think it took appropriate action to apologise and explain the situation.

28. Having taken advice and considered the relevant standards, we can see the appropriate treatment for Mr O’s symptoms was non-surgical intervention and best medical treatment as described above. The Trust confirmed this with Mr O’s GP and with Mr O himself to make sure the ongoing treatment was correct.

29. We have not seen any evidence that the Trust failed to act in line with relevant standards and we are not investigating further.

1. We have carefully considered Mr O’s complaint about North Bristol NHS Trust (the Trust). We appreciate the events were distressing and worrying for him.

2. We have decided not to take any further action because we have not seen signs that anything went seriously wrong. We will explain the reasons for this decision in this statement.