2. Mr R complains that on 14 July 2023 the Trust inappropriately discharged him from hospital. He is concerned the Trust should have instead transferred him as an inpatient to a spinal unit.
3. Mr R thinks because he was inappropriately discharged, he lost the opportunity to receive spinal surgery sooner. He says surgery would have slowed down the deterioration of his spinal condition.
4. Mr R would like a financial remedy and service improvements.
5. In early July 2023 Mr R tripped and felt a tug on the lower left side of his spine. Initially he felt no pain, but he later experienced numbness in his lower back and from his left knee to his foot.
6. By 10 July Mr R explained he could not walk more than 20 yards without a stick. His right knee needs replacing due to arthritis. So, he would fall over as he could not put all his weight on his right knee. His GP arranged a physiotherapy appointment for 13 July.
Emergency department
7. On 13 July the physiotherapist referred Mr R to the Trust’s emergency department suspecting cauda equina syndrome (CES) due to worsening back pain, reduced sensation in his left leg and saddle (inner thigh and buttock area). The physiotherapist wanted to rule out CES before starting physiotherapy. CES is a medical emergency where spinal severe nerve compression causes severe back pain and bowel or bladder issues.
8. MRI stands for magnetic resonance imaging. It is a scan which uses magnets and radio waves to create detailed images of the body.
9. The Trust conducted an MRI scan of Mr R’s lower back. The MRI scan showed a mild narrowing of Mr R’s spinal canal due to bulging discs and thickened ligaments. The bulging disc was touching nerves, especially on the left side. The Trust did not identify any nerve compression.
10. The Trust admitted Mr R to the clinical decision unit. On 14 July the Trust conducted another MRI scan of Mr R’s whole spine to rule out nerve compression anywhere else. The scan revealed some swelling around Mr R’s spine but no serious issues such as fractures or nerve compression. The Trust concluded Mr R did not have CES.
11. The Trust sought advice from another NHS Trust’s spinal surgery team, and they decided the Trust could discharge Mr R home.
12. At 7pm Mr R says the Trust told him there were no problems with his spine. The Trust discharged Mr R home, with plans for his GP to arrange a neurology referral.
After discharge
13. Mr R’s condition worsened. By the end of July, his GP referred him to a spinal specialist, scheduling a telephone consultation for 9 August.
14. In August numbness spread to his entire leg and halfway up his spine. Mr R contacted his GP who redirected him back to the Trust’s emergency department. He chose to visit a different NHS Trust’s emergency department on 15 August. After it conducted an MRI scan, this other Trust discharged him home, planning an appointment for six weeks’ later. However, the appointment did not occur until November.
15. After Mr R's complaint, the Trust sent his GP a letter on 19 October requesting his GP refer Mr R to a neurology team. The Trust acknowledged it did not do this as planned in July.
16. After Mr R's emergency department visit in August, he saw a neurosurgeon at the other NHS Trust in November. During this appointment the neurosurgeon said Mr R’s MRI scans between July and August showed ‘degenerative changes’. A degenerative condition refers to a gradual decline in health, affecting how the body functions over time. The surgeon gave Mr R the option of:
• ‘continuing with conservative management and physiotherapy’ • nerve root injections, or • decompression surgery to ‘free up the nerve’.
17. Mr R decided on surgery and the surgeon placed him on a waiting list for spinal nerve decompression surgery. Mr R told us the other NHS Trust carried out the surgery on 17 January 2024.
18. Mr R said his reduced mobility makes it hard to leave home. He told us he is now unable to drive and has a blue disability badge. He explained the surgery did not immediately reduce his pain, numbness, or sleeping difficulties, and his mobility did not improve. However, he noted that after surgery, his condition was not deteriorating as quickly as before.
Discharge
22. Mr R complains the Trust inappropriately discharged him from hospital. He recalls the Trust initially planned to transfer him from the emergency department to another NHS Trust's spinal unit for assessment. He thinks the Trust should have continued with this plan. He is concerned the Trust ignored how the arthritis in his right knee prevented him weight-bearing, worsening his difficulties with his left leg.
23. He believes the Trust changed this plan and discharged him home to ‘free up a bed’. We appreciate how this left Mr R feeling like he was not getting the care he needed.
24. The Trust says it was appropriate for it to discharge Mr R home with a referral to neurology to be completed by his GP.
25. BASS represents spine surgeons in the UK and promotes high standards of care, education, and research in spinal surgery. It also provides guidelines for spine-related healthcare issues. BASS Standards for suspected CES say doctors should conduct an emergency MRI scan when CES is suspected. If the MRI scan confirms CES, doctors should urgently refer the person to a neurosurgical team for emergency spinal surgery. If the MRI excludes CES doctors should make a plan for further management and refer to an appropriate service.
26. Our adviser told us on 14 July Mr R did not require emergency spinal treatment. In line with the BASS Standards, it was not necessary for the Trust to transfer Mr R to a spinal unit as an emergency. Our adviser explained it was therefore appropriate for it to discharge him to the care of his GP.
27. The role of the emergency department is to provide immediate care for medical emergencies. The Trust conducted an MRI scan to rule out CES, which was in line with BASS Standards. As the Trust did not identify CES, we have seen no indications of failings in the Trust’s decision to discharge Mr R home as he did not need emergency treatment.
28. The GMC regulates doctors in the UK and sets professional standards. Section 15 of the GMC’s guidance on Good Medical Practice says doctors must arrange any necessary follow-up care promptly.
29. The Trust’s discharge plan was to ask Mr R’s GP to refer him to a neurology team in July. The Trust did not do this until October. We consider this amounts to a delay and is not in line with GMC Good Medical Practice. Therefore, this indicates there was a failing by the Trust.
30. It is understandable Mr R felt frustrated about the lack of immediate treatment, especially when he believed the Trust was going to transfer him for further assessment. This frustration was likely worsened by the Trust’s delay in requesting the referral.
31. Mr R accessed the neurosurgery team, without a GP referral, after visiting an emergency department at another NHS Trust. Neurology and neurosurgery have different roles. Neurology offers non-surgical treatments, while neurosurgery performs brain and spine surgeries.
32. If Mr R's GP had referred him to neurology in July as planned, we cannot predict the neurology team’s actions. Especially as in November, despite worsening symptoms, the neurosurgeon offered monitoring instead of immediate surgery as an option for Mr R.
33. Ultimately, a neurosurgeon at a different Trust chose to proceed with the surgery. Therefore, we see no clear link between the Trust’s delay in asking Mr R’s GP to refer him to neurology and a delay in his neurosurgery.
34. The Trust acknowledged its delay in sending the discharge letter to Mr R’s GP and apologised to Mr R. It recorded this as a clinical incident and is improving communication and preventing missed referrals through electronic handovers.
35. Our Principles for Remedy say an organisation should apologise for poor service. They say organisations should acknowledge errors and provide reassurance that it has taken action to prevent the issue happening again.
36. We recognise that a timely update to Mr R’s GP may have helped him feel better cared for. We have not seen indications that the delay impacted Mr R’s condition, and the Trust apologised and is addressing the issue. This is in line with our Principles for Remedy, so we will not take further action on Mr R’s complaint.
37. We realise Mr R has had a very challenging experience and we are sorry he has had to complain. We are grateful to him for taking the time to raise his concerns with the Trust and with us.
1. We are sorry to hear how Mr R felt unsupported by the Trust. We are sad to learn about the stress and suffering he experienced and continues to experience. We have carefully considered Mr R’s complaint, and we have not seen indications of a link between the events he has complained about and the deterioration of his spinal condition.