Imperial College Healthcare NHS Trust

6. Miss R complains about the Trust’s care and treatment when she had surgery to remove an ovarian tumour on 2 December 2020 and after the surgery until the summer of 2023.

7. She complains:

• she suffered nerve damage during the surgery • the Trust knew something went wrong during the surgery but did not tell her • she began to have symptoms straight after the surgery but when she raised them with the Trust, it dismissed her concerns • the Trust advised her to have physiotherapy but this did not help • the Trust did not refer her to a neurologist for further investigation • the Trust did not answer her complaint clearly or fully.

8. After the surgery, Miss R says she had severe abdominal and genital pain, meaning she could not go out for long periods and had to work from home. She has also spent nearly £6,000 on private care to try to investigate and resolve her symptoms.

9. Miss R would like an explanation of what happened during the surgery, an apology and a financial payment to cover the cost of private care and for the distress and inconvenience she felt.

10. In December 2020, Miss R had surgery to remove an ovarian tumour.

11. When she woke up after surgery, she noticed something was not right. She says she had very strong, burning pain from the right side of her navel down to the genital area, ‘as if she had torn a muscle’. Even strong painkillers did not help.

12. In January 2021, the pain continued and Miss R told us she began to get other symptoms like incomplete bladder emptying (when your bladder does not completely empty when you urinate), painful bowel movements and uncontrolled muscle spasms and twitches.

13. During her follow up appointments at the Trust, she raised these issues with the consultants.

14. Miss R decided to see a urologist (who treat conditions of the urinary tract and reproductive systems) privately where she had a second urine flow ultrasound scan. The urologist suggested her symptoms were a result of a combination of overactive bladder (a sudden, uncontrolled need to urinate) and hypertonic pelvic floor (the muscles in the lower pelvis are in a spasm or state of constant contraction, meaning they cannot relax and coordinate the control of certain bodily functions) and advised her to start pelvic floor physiotherapy as soon as possible.

15. During her appointment in May, she mentioned this to a consultant at the Trust. She says it was only then that they told her she could have physiotherapy for free at the Trust.

16. Miss R also remembers that in May a consultant at the Trust told her there was a specialist team of urogynaecologists (specialists in urology and women’s diseases) but they did not refer her at that time. She says they advised her to carry on with physiotherapy for three months and if there were no improvements, she should contact them again.

17. Around two months later, she requested a referral to the urogynaecologists. She says they arranged pelvic floor physiotherapy, botox injections into the pelvic floor muscles and medication for neuropathic pain (pain caused by damage to the nervous system). She explains all these treatments only work temporarily. She has also consulted a private chiropractor (practitioner who uses their hands to help relieve problems with the bones, muscles and joints) for her back pain linked with pelvic floor problems.

Care and treatment

20. The law 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.

21. Miss R believes she suffered nerve damage during surgery on 2 December 2020.

22. Miss R says her symptoms began straight after surgery. She says she thought it was normal and the symptoms would disappear in two or three weeks. But, her pain continued and she began to experience symptoms in January 2021.

23. It seems likely she knew she had a reason to complain in January 2021 at the latest. For her complaint to be in time, she would have needed to complain to us by January 2022. She came to us in October 2023 so this part of her complaint is out of time by 22 months.

24. The next part of Miss R’s complaint is that the Trust knew something went wrong during the surgery but did not tell her.

25. Because Miss R felt strongly that she had nerve damage, it is reasonable to say she knew she had a reason to complain about this in January 2021. She complained to us about this in October 2023 so this concern is out of time by 22 months.

26. Miss R says she began to have symptoms straight after the surgery but when she raised them with the Trust, it dismissed her concerns. She says she first raised her concerns in an appointment in January 2021 and again at every appointment after this.

27. Miss R knew she had a reason to complain about this in January 2021. Although she explains she discussed her concerns in appointments, there is no evidence that she complained to the Trust. Again this part of the complaint is out of time by 22 months because she did not come to us until October 2023.

28. Miss R told us it was during her appointment in May 2021 when the consultant told her she could have free physiotherapy. She says they advised her to continue with this for three months and if there was no improvement in her symptoms, to contact them again.

29. It is clear there was no improvement at the end of the three months as Miss R says the physiotherapy ‘did nothing to improve’ her condition. By August 2021, Miss R knew she had a reason to complain about the physiotherapy. Miss R waited to complain to us until October 2023, meaning this concern is out of time by 14 months.

30. Miss R then complains the Trust should have recognised her ‘clear symptoms of nerve damage’ and should have sent her to see a neurologist.

31. Miss R says the reason she did not complain to us about this earlier was because she did not have a clear diagnosis until she saw a neurologist and a pain management consultant in the spring/summer of 2023 and had an ultrasound scan privately. She also says the Trust should have recognised her symptoms and linked them to nerve damage.

32. Although it is unlikely Miss R knew she needed the Trust to refer her to a neurologist, she knew her symptoms were not improving. This is because there was no improvement in Miss R’s condition after three months of physiotherapy.

33. By August 2021, Miss R could have complained about her overall unhappiness with the Trust’s actions. As she included this concern in her complaint to us in October 2023, this part of her complaint is out of time by 14 months.

34. We asked Miss R the reasons why she could not bring her complaint to us sooner.

35. Beginning in January 2021, Miss R says she complained verbally about her symptoms at every appointment, but the consultants ‘always blanked me or trivialised my symptoms or acted very defensive’. She also says they never noted any of her concerns and symptoms on any of the clinic letters and many of her appointments were postponed or cancelled.

36. The Trust said if the issues she had raised at the clinic appointments had been seen as complaints, it would have referred them but it has no record of any referrals.

37. Miss R agrees the first complaint she made to the Trust was in October 2022.

38. It is clear Miss R was unhappy from January 2021 but she waited one year and ten months to complain to the Trust. It is reasonable to say she could have raised her concerns in a complaint sooner than she did.

39. She says it was difficult for her to find out what went wrong with the surgery and the cause of her pain, until she got a clear diagnosis. She did not have this until she saw a neurologist and a pain management consultant and had a private ultrasound scan in the spring/summer of 2023. She also says she had been on a very low income and could not afford private consultations until that time. She says she referred the complaint to us as soon as she had gathered all the information she needed.

40. We understand she wanted a diagnosis for her condition and we recognise the cost involved in doing this privately. But, there was no need to do this before complaining. Miss R should have complained as soon as she was unhappy with the Trust’s care and treatment.

41. She added she did not know she could request a ‘formal investigation’ from the Trust until a friend told her in October 2022. She then emailed the Trust on 16 October.

42. Miss R could have requested this at any time between January 2021 and October 2022. She could have done some research on how to complain if she did not know how to.

43. Next, we considered the time the Trust took to respond to her complaint. It sent its written response on 13 January 2023, meaning it took around three months.

44. There is another written response from the Trust dated 27 July 2023, but this is about the accuracy of her gynaecology clinic letter and not related to the complaint.

45. As it only took three months for the Trust to handle her complaint, we cannot say it added to the delay.

46. Miss R referred her complaint to us in October 2023, meaning there was a nine-month gap between her getting the Trust’s final response and complaining to us.

47. We note the Trust’s response did not say she could refer her complaint to us if she was unhappy with it. But, she could have asked the Trust what she could do next or looked into this herself.

48. We accept Miss R’s explanations for the delay but the evidence shows us large parts of the delay were avoidable. We think Miss R should have followed up on her concerns sooner and we are not putting our time limit to one side to allow us to investigate.

Complaint handling

49. Miss R says when she complained to the Trust about her surgery on 2 December 2020, it did not answer her complaint clearly or fully.

50. Her complaint about the Trust’s response is entirely about the care and treatment she had from the Trust, not the actual complaint handling. As explained above, we have decided not to investigate this part of the complaint.

51. We recognise Miss R does not agree with the conclusions the Trust reached in its responses to her complaint and we do not wish to underestimate the impact the experience has had on her.

52. Unfortunately, it is not possible to look at the Trust’s complaint responses without looking at the main part of the complaint, which is out of time.

1. We have carefully considered Miss R’s complaint about Imperial College Healthcare NHS Trust (the Trust).

2. We recognise this was an extremely painful and upsetting time for her. Miss R has explained how she has had to change her life because of what happened.

3. We have decided Miss R’s complaint about her care and treatment falls outside of our time limit. Having considered her reasons for the delay in making her complaint and the time the Trust took to investigate her concerns, we have not seen good reason to put our time limit to one side.

4. With Miss R’s complaint about the Trust’s complaint handling, it is not possible to look at this without looking at the main part of the complaint, which as explained above, is out of time.

5. We will explain our decision in more detail below.