An independent provider in the East Riding of Yorkshire area

5. Mr R complains about how the Hospital assessed him for spine decompression surgery, between January 2023 and November 2023. He says the Hospital failed to follow its own procedures and practices, about checking his BMI rating and smoking status when he became an NHS patient.

6. As a result of the failings Mr R says this meant the Hospital cancelled his surgery scheduled for 20 November 2023. It informed him, he would need to attend a non-smoking rehabilitation programme for 12 weeks and his GP would need to refer him again. The Hospital said this could take up to 40 weeks for it to arrange the surgery. Mr R says his condition was getting worse and he was in a lot of pain. He says he could not wait nearly a year to have the surgery on the NHS and therefore had to pay privately for the procedure. Mr R explained this has caused distress, pain, loss of mobility and financial loss.

7. As an outcome Mr R is seeking the costs he paid for the private procedure.

8. This brief background is only intended to place the key events related to this complaint in context, not to provide a full account of everything that happened.

9. Mr R explained he had been experiencing issues with his back since 2013. In January 2021 he went to his doctor due to the pain he was experiencing. Mr R had some treatment, but he confirms this did not resolve the issue. On 14 December 2022, Mr R asked his GP to make a private referral to the Hospital due to the spinal problems he was experiencing and the length of time the NHS referral was taking.

10. Mr R’s initial appointment on 23 January and 6 March 2023 at the Hospital were on a private basis.

11. On 3 April, the Hospital transferred Mr R to an NHS patient. He says this was after it informed him, he could receive the same treatment as an NHS patient.

12. On 11 September 2023, Mr R opted for decompression of the spine surgery. The Hospital placed Mr R on its waiting list for the surgery. The surgery was later arranged for 20 November 2023.

13. On 2 November 2023, Mr R had a telephone call with the pre-assessment team at the Hospital, who cancelled his surgery because it had not assessed his smoking status or body mass index (BMI).

14. Following this Mr R contacted the Hospital to arrange the surgery privately because he did not want to wait again. On 4 December 2023 Mr R had the spinal surgery privately through the Hospital.

The Hospital did not check Mr R’s BMI rating and smoking status when he became an NHS patient

17. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. Having done so we have found the Hospital has already done enough to put right the impact of these events.

18. Mr R complains about how the Hospital assessed him for decompression surgery of the spine when it transferred him to being an NHS patient. Mr R explained the Hospital did not follow its own procedures and practices, failing to check his BMI rating and smoking status when he became an NHS patient.

19. As a result of the failing Mr R says the Hospital cancelled his surgery arranged through the NHS. He explained the Hospital informed him he would need to attend a non-smoking rehabilitation programme for 12 weeks. Then his GP would need to refer him again, which could take up to 40 weeks for it to arrange the surgery.

20. Mr R says his condition was getting worse and he was in a lot of pain. He explained he could not wait nearly a year to have the surgery on the NHS and therefore had to pay privately for the procedure.

21. The Hospital responded to Mr R’s complaint. Within this it stated it recognised there had been an issue whereby its NHS patients were not being pre-screened prior to their first outpatient consultation. The Hospital stated if it had picked up Mr R’s smoking status sooner, it would not have built up the expectation it could list him for the procedure before he completed the smoking cessation clinic.

22. The Hospital explained the Integrated Care Board establish guidelines that it as a hospital must adhere to. It stated this includes patients from East Riding having a BMI under 30 and not smoking.

23. Within its response the Hospital has apologised for this oversight. It also stated it was sorry it had built up the expectation it could list Mr R for the surgery.

24. Our Principles of Good Complaint Handling say that to put things right organisations should provide an apology, explanation, and an acknowledgement of responsibility, as well as remedial action.

25. Our principles for remedy say, ‘Public bodies should promptly identify and acknowledge maladministration and poor service, and apologise for them. An apology means: • acknowledging the failure • accepting responsibility for it • explaining clearly why the failure happened • expressing sincere regret for any resulting injustice or hardship.’

26. From the Hospital’s response it acknowledges it could have and should have identified Mr R’s smoking status earlier.

27. As a result of this, it has meant the Hospital listed Mr R for surgery through the NHS when he would not be eligible at the time. We acknowledge this has meant the surgery arranged for 20 November could not take place until Mr R had completed the nonsmoking course. We appreciate how frustrating and annoying this would have been for Mr R.

28. Mr R has explained he could not wait a further year for the surgery. Therefore, he arranged and paid for the Hospital to complete it privately. We appreciate the pain and discomfort Mr R was experiencing without the surgery. We understand given the potential further wait why he opted to pay for the surgery privately.

29. Mr R is seeking from the Hospital the costs he paid for the private procedure. The cost of the surgery was £10,170.

30. We have considered what action the Hospital has taken already to put right its error. The Hospital has confirmed it is undertaking regular audits within its outpatient department. It stated all NHS patients are sent to a discreet room to have their BMI and smoking status checked. The Hospital explained a sticker is added to the patient's medical record and highlighted to the consultant. It confirmed if a patient is outside of the guidelines, it enables it to capture this earlier on in the patient’s journey. The Hospital explained this is to try and avoid any unnecessary or delayed waiting times for a procedure.

31. The Hospital also offered Mr R a goodwill gesture of £950.

32. We have been in contact with the Hospital, and it has confirmed this offer is still available to Mr R. The Hospital has explained Mr R would need to contact it directly to accept the offer and this would need to be in full and final settlement of his complaint.

33. We considered our severity of injustice scale. Our scale contains six different levels of injustice that a complaint could fall into, which increase in severity. Each level is then linked to a range of the financial amounts we would usually recommend in those circumstances.

34. Level three says ‘cases would have a moderate impact on the person affected (for example, in terms of distress, worry or inconvenience). For a case to be level three, that impact would usually have been experienced over a significant period of time. A case may also be level three if the impact on the person affected was significant but was only sustained for a short period of time’.

35. We would usually consider financial compensation of between £600 and £1,200 for a level three complaint.

36. Taking into consideration the error and the impact this has caused, we consider Mr R’s complaint would fall within level three of our severity of injustice scale. We acknowledge the frustration Mr R would have experienced with the prospect of needing to wait potentially a further year for the surgery, if he was to have it on the NHS. We recognise the inconvenience and stress this would have caused him. He decided to have the surgery privately soon after he knew his NHS surgery was cancelled, so we consider this impact on Mr R to have been of a short duration.

37. We understand Mr R has requested a financial remedy to cover the costs of the surgery. We consider the remedy the Hospital offered, its service improvements and financial remedy, is in line with level three of our severity of injustice scale. We are satisfied the Hospital has done enough to remedy the injustice, but we also recognise this may be disappointing for Mr R.

38. We understand Mr R has been frustrated and feels let down by the Hospital. We do not wish to downplay the impact the complaint has had on him, and we hope we have clearly explained our careful consideration of his complaint.

1. We have carefully considered Mr R’s complaint about am independent provider in the East Riding of Yorkshire area(the Hospital).

2. We are sorry to learn of the reasons for Mr R’s complaint to us and in no way wish to downplay the distress he has experienced. We acknowledge the Hospital cancelling the surgery so close to when it was due to take place would have been distressing and upsetting for him.

3. We have seen an indication of maladministration with the Hospital not checking Mr R’s smoking status earlier. Having thought about the issues carefully, based on all the available evidence, we consider the Hospital has already done enough to put right the impact of its error on Mr R.

4. We have decided not to consider the complaint further and we will explain this below.