Hampshire Hospitals NHS Foundation Trust

4. Mrs C complaints about the care provided to her husband, Mr C, on 28 October 2022. Specifically, she complains the Trust failed to carry out investigations and discharged Mr C despite the presence of a 1cm lesion on his tongue.

5. Mrs C told us Mr C suffered pain from the lesion. He became frustrated, upset, and depressed over the course of events. She says the Trust’s delay in diagnosis has affected Mr and Mrs C’s quality of life. Mr C had to travel to a hospital in another city every day for around 10 weeks for treatment. This was expensive.

6. Mrs C has requested financial remedy. She has also requested the Trust take action to reduce the risk of it happening again.

7. Mr C’s GP reviewed him and found a lump in the right side of his throat. The GP referred Mr C to the Oral and Maxillofacial department at the Trust.

8. At the Trust, a speciality doctor in Oral and Maxillofacial Surgery reviewed Mr C on 25 October. On review of his oropharynx (middle section of the throat behind the mouth) the doctor found a 1 cm lesion on the right palatoglossal fold (part of the soft palate). This was outside of their area of expertise, so they made a referral to the Trust’s Ear Nose and Throat (ENT) department.

9. At the Trust, an ENT associate specialist reviewed Mr C on 28 October. The specialist did not find any sinister features and discharged Mr C from ENT.

10. On 12 June 2023 Mr C’s GP made an urgent referral to the Trust ENT. This was because the GP suspected pharyngeal cancer (throat cancer). The GP noted a visible pharyngeal/tonsillar mass.

11. A different ENT specialist at the Trust saw Mr C on 14 June 2023. They arranged an urgent biopsy under general anaesthetic and a CT neck. These investigations led to a diagnosis of malignant neoplasm of oropharynx (a cancer that occurs in the middle of the throat).

12. The Trust completed radical radiotherapy in September 2023. Mr C was later given the all-clear but continues to be monitored.

16. 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.

17. Mrs C told us the Trust failed to carry out additional investigations into the mass in her husband’s throat. She said the Trust should not have discharged Mr C from ENT.

18. In its complaint response the Trust said during the 28 October appointment its ENT speciality doctor (the doctor) carried out an examination. They used a flexible nasendoscopy (a thin flexible tube with a camera used to examine the nose, throat, and voice box). The Trust told us the doctor did not find anything sinister and so they discharged Mr C.

19. The Trust said it raised a Datix (a system used for reporting incidents) report after learning it had missed a potential cancer diagnosis on 28 October. It said an incident review panel and ENT consultant body reviewed the case. Both groups found, based on the evidence available, that it was not clinically inappropriate to discharge Mr C on 28 October. The Trust apologised that Mr C’s diagnosis had not been straightforward.

20. UK national guidance says when there are suspicions of ENT cancer, doctors should use a flexible nasendoscopy to examine a patient’s throat. Doctors should also complete systematic examination of the mouth/throat and neck. It says diagnosis is confirmed via biopsy for any lesion suspected to be either dysplastic (abnormal cell tissue) or malignant.

21. UK national guidance also says ENT cancer may be suspected if there are the following symptoms:

• sore throat or tongue, • associated ear pain, • pain and/or difficulty swallowing, • change in voice quality, • neck lump is present.

22. NICE guidance says ENT cancer might be suspected after clinical assessment or the presence of concerning symptoms. If it is suspected, imaging is required in the form of an MRI neck scan and sometimes a CT neck scan.

23. Medical records from 28 October show the doctor asked Mr C whether he was suffering from any pain, difficultly swallowing, change in voice or weight loss. Mr C said was not at that time.

24. The doctor completed an examination of Mr C’s neck and oral cavity. The doctor found both to be normal. The ENT associate specialist was unable to feel any lumps at the tongue base.

25. Records show Mr C highlighted a point in his mouth. The doctor noted this corresponded to circumvallate papillae. This is a dome-shaped structure on the human tongue containing taste buds.

26. The medical records show the doctor then conducted a flexible nasendoscopy. Both nasal passages and nasopharynx (a structure which connects the nose to the mouth) were found to be normal. The doctor also recorded several other structures within the oral cavity and neck all appeared normal.

27. Our adviser said the doctor appeared to have completed the examination in line with UK national guidance. From the evidence we have seen, it seems the doctor found no concerning features during their examination of Mr C. We note Mr C did not relay any symptoms of concern to the doctor.

28. Based on this assessment the doctor did not have suspicions of cancer, so no imaging was indicated in line with NICE guidance. We also note the examination did not find any lesions which might lead to a biopsy being indicated as outlined in UK national guidance.

29. Given the above, it is our view that there was no indication something went wrong in the decision to discharge Mr C. Because we have seen no indication something has gone wrong here, we will not be considering this part of the complaint further. We appreciate this may be disappointing for Mr and Mrs C. We hope Mr C continues to recover his health and wellbeing.

1. We have carefully considered Mrs C’s complaint about the care provided by the Trust to her husband, Mr C. We were sorry to hear of her concerns. We appreciate the Trust’s actions have caused her distress.

2. We have seen no indication the Trust failed to follow guidance around its decision to discharge Mr C. We have seen no indication the Trust should have completed further investigations.

3. We appreciate our decision may be disappointing for Mrs C. We hope our investigation statement provides an explanation for our decision.