Diagnosis and treatment
11. Before we decide if we should conduct 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 found any indications that something has gone wrong.
12. Mrs H says the Trust did not treat her husband quickly enough, considering his symptoms and the progression of his disease. The Trust say there was no delay in Mr H being seen by the appropriate team.
13. The NHS guidance on waiting times explains the expected waiting time for each year following an urgent cancer referral. The cancer waiting time standards for the NHS from October 2022 would have mandated a definitive treatment in 62 days.
14. The records show the Trust made a 2 week wait referral following the finding of widespread lymphadenopathy found on the CT of 1 October 2022.
15. The Trust diagnosed a neuroendocrine tumour on 1 November. Because Imperial Healthcare took over Mr H’s care following a review on 16 November, the 62-day period to make a decision about treatment defaulted to them according to our adviser.
16. Our adviser also pointed out that Mr H was too unwell for active treatment and indeed suffered a cardiac arrest on 18 November. This indicates that he would not have undergone active cancer treatment during this time.
17. The cardiac arrest occurred within the 62-day period. Therefore, we could not say the Trust should have provided any specific cancer treatment to Mr H sooner than this. We completely appreciate how distressing it must have been for Mrs H to witness how fast her husband deteriorated and the lack of options available to him for treatment. We are satisfied there was no other actions the Trust should have taken, which would have resulted in a preferable outcome for Mr H.
Communication on 5 November
18. Mrs H complains the Trust failed to communicate with her properly on 5 November. She says her husband was confused and left the hospital, but she was not made aware of his state quickly enough. She says her son found him walking by the road near the hospital before they brought him back inside.
19. The Trust say on 5 November, Mr H was more confused than normal and wanted to self-discharge. It says nurses tried to reassure Mr H that it was not advisable or safe to do so. It says Mr H escaped out of the fire exit door but fortunately the nursing team located him and were with him outside.
20. Mrs H says the Trust’s failure to communicate with her on this date about her husband’s condition caused her distress.
21. We are an ombudsman provided for, and funded by, the public. We therefore need to ensure that we maintain a balance in our work between supporting those who complain to us to get a remedy for the injustice they have experienced, while ensuring we use our resources to focus on those where we can achieve the most impact and support those who need our help the most.
22. This means that in some circumstances we will take the decision to not consider a case where someone tells us that the injustice they have experienced has not had a significant or lasting impact on them, or the person they are representing.
23. We appreciate the distress this incident must have caused to Mrs H and we are not taking away from that. Our resources are intended to focus on the more serious issues that are brought to us. In line with this, we have decided not to consider this matter further.
Tumour-lysis syndrome
24. Mrs H says she was unable to properly prepare for this change and thus was not able to provide proper support to her husband. The Trust say they did not provide any cancer treatment to Mr H and thus there was no requirement to warn of the possibility of tumour lysis.
25. The BMJ guidance on tumour lysis syndrome explains ‘spontaneous TLS (tumour-lysis syndrome) is uncommon’. Our adviser has explained that in general, tumour lysis is a consequence of chemotherapy treatment.
26. The British Journal of Haematology ‘Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies’ states ‘patients due to receive chemotherapy for any haematological malignancy should have a risk assessment for TLS’. There is no requirement outlined for any risk assessment, pre-empting, or communication of the possibility of tumour lysis syndrome for patients who are not receiving chemotherapy.
27. Mr H did not receive any treatment for his cancer. As a result, despite how disruptive and difficult the disorder can be to manage, there is no responsibility of the Trust to pre-warn of the possibility of tumour lysis.
28. We completely appreciate how difficult it must have been for Mrs H to be unprepared for her husband’s sudden deterioration. There is nothing to suggest the Trust should have made her aware that this uncommon potential change might occur. As a result, we are not proposing to investigate this matter any further. We hope our analysis provides some reassurance to Mrs H that the care her husband received was appropriate.