North West Anglia NHS Foundation Trust

4. Mrs O is complaining about the care and treatment she had from the Trust in February 2022. She complains she was not referred for a hip operation during an appointment, which led to several months more of pain.

5. Mrs O says her mobility deteriorated significantly in the five months after the appointment, before she was added to the waiting list for the operation. As Mrs O’s mobility decreased, she experienced a lot of pain and her confidence reduced as she struggled to walk. Mrs O was on a waiting list for over eight months, and she felt she had no choice but to pay for the operation privately.

6. Mrs O wants a financial payment in the region of £2,000 towards the cost of the operation.

7. Mrs O was in her seventies when she was referred to the musculoskeletal team in September 2021 after having pain in her right hip. After an X-ray she was referred to an osteopath. She had another X-ray on 25 February 2022. This showed quite advanced osteoarthritis (a joint disease) as there was loss of the joint space in Mrs O’s hip. In a consultation she had at the same time, a consultant decided she would be reviewed again in six months’ time.

8. Mrs O’s condition deteriorated and she was in significant pain. Because of this the Trust brought her appointment forward to July 2022. At that time the Trust put her on the waiting list for a hip replacement.

9. Mrs O was on the waiting list for eight months. The Trust told her there was a significant delay in the procedure being done.

10. Mrs O paid for the operation privately and had it in May 2023.

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. Mrs O feels the delay in adding her to the waiting list in February 2022 led to more pain. She feels they had to pay for an operation they would have been able to have on the NHS, if the Trust had added her to the waiting list in February 2022. We recognise Mrs O was in pain and we are sorry to hear about her difficult experience.

16. We discussed with our adviser whether Mrs O should have been put on the waiting list at the appointment in February. Our adviser said the decision to not put Mrs O on the waiting list was not just based on the X-ray, it goes off how the patient presented at the time and the clinical examination.

17. We note from the clinical records it says that Mrs O said she was responding well to naproxen (anti-inflammatory medication) at the time of the appointment. While it mentions some restriction of movement, this would be expected as Mrs O has arthritis.

18. Our adviser also stated that if non-operative measures were working, it is better to continue with this because of the inevitable risks of surgery.

19. We discussed with our adviser the NICE guideline on osteoarthritis and the ‘core treatments’ that need to be considered before surgery. NICE says it starts with education, advice and information about the condition, progressing to pain relief, potentially steroid injections and manual therapy with joint surgery (in this case the hip replacement) being the final treatment to be offered.

20. NICE guidance discusses how referrals should be made for surgery for people with osteoarthritis who ‘experience joint symptoms that are refractory to non-surgical treatment’. As it seems Mrs O was responding to pain relief at the time of the appointment, she was not referred for surgery.

21. The specialist had arranged to see Mrs O for a review of her symptoms in six months’ time, or earlier if the pain worsened. The NICE guideline mentions the importance of regular reviews of people with symptomatic osteoarthritis. Mrs O’s pain worsened, she came back for a review in July 2022 and she was added to the list for surgery.

22. At the appointment in February 2022, we can see Mrs O had some restricted hip movements as expected, but she had been responding well to pain relief. We can see why she was not referred for surgery at this time as our adviser explained that surgery would be the last resort due to the risks involved.

23. We can see the Trust acted correctly and offered an appropriate treatment plan. We think its decision not to offer surgery in February 2022 was in line with the NICE guidance. Based on this we have found no signs of a failing and will not investigate further.

24. We understand how distressing it has been for Mrs O and we recognise this complaint is important to her. We would like to thank Mrs O for bringing this matter to our attention and we hope that she continues to recover well from her operation.

1. We have carefully considered Mrs O’s complaint about North West Anglia NHS Foundation Trust (the Trust). Mrs O and her husband, who is supporting her with her complaint, say she has suffered physically because of not being referred for a hip operation sooner.

2. They also told us about the effect it had on her mentally, because her hip had deteriorated so much before the operation. We are sorry to hear their concerns and understand it has been a difficult time for them.

3. We have decided not to consider Mrs O’s complaint further because we do not think anything went seriously wrong. We explain our decision in this statement.