Buckinghamshire Healthcare NHS Trust

4. Mrs L complains the Trust declined her referral for back surgery in September 2022. She also complains the Trust missed a splenic artery aneurysm on a scan it carried out in November and rejected her request for a second opinion in June 2023.

5. Mrs L says she was forced to pay for private surgery as the NHS refused to provide surgery. She says she feels neglected. She says she had a poor outcome from the private surgery and feels it would have gone better with the NHS. She says it has taken years out of her life and impacted her financially.

6. Mrs L wants an acknowledgement and apology. She also wants service improvements and a financial remedy for the impact caused.

7. Mrs L has a history of acid reflux, high cholesterol, and hypothyroidism. She was diagnosed with spinal stenosis in 2014. In early 2022 Mrs L began experiencing pain in her lower back which radiated to her buttocks. In May the Trust carried out an MRI scan which confirmed moderate to severe canal stenosis. Spinal stenosis happens when the space inside the backbone is too small. This can put pressure on the spinal cord and nerves that travel through the spine.

8. In August a private organisation carried out a lumbar injection and arranged for physiotherapy to start two weeks later. Mrs L attended a physiotherapy appointment in September and complained her symptoms had worsened. She asked to be referred for surgery. On 5 September the physiotherapy team referred her to the Trust’s spinal orthopaedic team.

9. In March 2023 Mrs L paid privately for surgery on her back. Following the surgery Mrs L experienced new symptoms. She attended the Trust’s ED on 15 April with dizziness and feeling like she needed to urinate more frequently. She discussed these symptoms with her GP, and it referred her to the Trust on 28 April for a second opinion. On 14 May Mrs L attended the Trust’s ED with pins and needles in her legs.

10. On 31 July Mrs L’s GP confirmed a referral to the Trust had been sent for a second opinion and the Trust confirmed it would triage the referral. On 14 August the Trust declined the referral and recommended she return to the surgeon who carried out her surgery.

11. Mrs L made a complaint to the Trust in August about the rejection. It responded in September and offered her an appointment as part of its investigatory process. She attended an appointment on 11 December at the Trust’s trauma and orthopaedics spinal unit. It assessed her and recommended she continue with physiotherapy to support her recovery and improve her symptoms.

Referral and splenic artery aneurysm 14. Mrs L complains the Trust declined her referral for back surgery in September 2022. She also complains the Trust missed an opportunity to identify a splenic artery aneurysm on a scan it carried out in November. A splenic artery aneurysm is a bulging, weakened section of the artery that supplies blood to your spleen and parts of your pancreas and stomach.

15. Mrs L told us she called the Trust in September, after it referred her to its spinal orthopaedic team to be considered for back surgery. She told us she spoke to staff who told her she would not have surgery which she understood meant she was not on a waiting list to be seen. She also told us she attended the Trust for a scan on her back in November where it missed a splenic artery aneurysm. We were sorry to hear about Mrs L’s experience. Understandably, she feels the Trust missed opportunities to treat her earlier and she felt forced to pay for private surgery.

16. We obtained Mrs L’s medical records, but we were not able to see any contact Mrs L had with the Trust by telephone in September or that she attended the Trust for a scan in November. The Trust explained in its final response Mrs L’s referral was accepted in September but there was a significant wait for an appointment.

17. Clearly there are very different accounts between Mrs L and the Trust as to what was happening in relation her referral to the spinal team during the period we have looked at. There is unfortunately no objective evidence we can draw upon to say which is the more accurate account, so it would not be possible for us to prove, or disprove, either version of events.

18. We would like to be able to conduct a meaningful investigation of this complaint, but we would not be able to reach a decision as there is no objective evidence. Unfortunately, we cannot investigate this part of complaint further due to a lack of evidence.

19. Understandably from what Mrs L has told us her experience has caused her great distress, and we are sorry to hear about this. We hope this statement clearly explains our decision not to consider her complaint further.

Second opinion 20. Mrs L also complains the Trust rejected her request for a second opinion in June 2023. Mrs L explained she paid for private surgery on her spine in March 2023 and began to experience new symptoms following the surgery. She says the Trust refused to accept a referral from her GP for a second opinion to review her symptoms following her surgery which we are sorry to hear made her feel neglected.

21. Mrs L’s records show she had spinal surgery at a private organisation in March 2023. In April she visited her GP complaining of dizziness and urinary issues. It referred her to the Trust’s spinal orthopaedic department for a review and confirmed the referral had been received on 31 July. The Trust rejected the referral on 14 August and recommended Mrs L return to her private surgeon for a follow up following her surgery.

22. DOH guidance says the NHS should never subsidise private care with public money, which would breach core NHS principles. It goes on to say to avoid these risks, there should be as clear a separation as possible between private and NHS care.

23. Based on the evidence we have seen the Trust followed NHS guidance as it is clear Mrs L’s symptoms started after her private surgery was carried out. Therefore, the private organisation was best placed to advise as it had all relevant information that related to the surgery that the NHS would not have direct access to.

24. We understand Mrs L is concerned that a consultant did not triage her referral which she feels is not correct. There are no national guidelines which state a specific clinician should triage a referral. Therefore, we cannot say the Trust got anything wrong here.

25. We can also see from the records the Trust offered Mrs L an appointment with the Trust’s spinal team in September but unfortunately, she was unable to attend. However, she did attend an appointment with the Trust’s spinal team in December. It recommended she continue with physiotherapy and did not plan to see her again.

26. We do not wish to underestimate how difficult it must have been to relive these events and explain her complaint to us. We are grateful for the time and effort she has taken to do this. Overall, based on the evidence we have seen, we are satisfied the Trust did not get anything wrong when it rejected her referral in August 2023, and it followed DOH to keep Mrs L’s private and NHS care as separate as possible.

27. We understand Mrs L’s experience has caused her great distress and we are sorry to hear about this this. We hope this statement clearly explains our decision not to consider her complaint further and gives her some reassurances about what happened.

1. We have carefully considered Mrs L’s complaint about Buckinghamshire Healthcare NHS Trust (the Trust). We were sorry to hear about the events that led to Mrs L to complain. Understandably, she feels something went wrong as she told us she was forced to pay for private surgery as the Trust refused her referral.

2. We have looked at the evidence Mrs L and the Trust gave us. We were sorry to hear she feels the Trust incorrectly declined a referral for her to have back surgery and missed an opportunity to diagnose her with a splenic artery aneurysm. We are unable to conduct a meaningful investigation into these parts of her complaint, as there is no objective evidence. Therefore, we cannot say anything went seriously wrong and will not be investigating this part of the complaint further.

3. We also considered Mrs L’s complaint about the Trust’s decision to decline her referral for a second opinion. We have not found any evidence something went wrong with the Trust’s decision to decline her referral. Therefore, we will not be taking further action on this complaint. We will explain our decision in more detail below. We hope the information in our statement gives Mrs L some reassurances about what happened and explains why the Trust did not do anything wrong.