13. 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.
Time between appointments to remove wax and carry out hearing tests
14. Mrs H complains the Trust should have seen her son for back-to-back appointments for clearing the wax in his ear and having his hearing test. She says the tests were spaced too far apart.
15. The Trust said in its response it has a target of six weeks between the request for an appointment with the audiologist and the appointment taking place.
16. Department for Health and Social Care guidance says ‘patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral’.
17. Our adviser confirmed there is no guidance for how soon audiologist appointments should occur after wax is removed from the ear. We acknowledge it is preferable to have these appointments back-to-back to support with patients’ attendance and reduce the inconvenience of making two trips to hospital. The Trust has identified it does not currently offer back-to-back appointments due to resource availability.
18. The Trust advised in its response that it acted in line with guidance for diagnostic waiting times, in that the scheduling of the appointments between appointment to remove wax and audiology appointments were not scheduled more than six weeks apart.
19. We can see A waited six weeks and five days for his first hearing test, and 14 weeks for his second hearing test. These longer waiting times are because Mrs H unfortunately had to cancel some appointments due to A being ill and because she was giving birth. A’s third hearing test was arranged within five weeks of it being requested.
20. Our adviser indicated we would not expect a negative impact on a person if appointments between removing wax and hearing tests occur six to seven weeks apart. Although A waited 14 weeks for his second hearing test, this was due to Mrs H cancelling two appointments. We cannot criticise the Trust for this.
21. Taking into account the diagnostic waiting time targets as detailed above and the clinical advice we have received we have not seen indications of failings in how long A waited between was being removed and an audiology appointment. We will not be taking further action here.
Time it took the Trust to refer A for specialist management
22. Mrs H has said A should have been referred to the specialist management sooner as the Trust identified the need for surgery in October 2023.
23. The Trust have said in the response it suspected A had a collection of fluid within the ear space (glue ear). In October 2023 the Trust identified A may require surgery to insert a small tube (grommet) in his ear. The Trust said before making a decision on surgery it needed to complete a hearing test to confirm this was the right course of treatment.
24. NICE guidance says that a child’s hearing needs to be reassessed after three months when hearing loss is identified.
25. Our adviser told us the Trust would need to have completed a reassessment of A’s hearing loss before they were able refer him for surgery for grommets.
26. Our adviser explained the Trust took the correct course of action for the diagnosis of glue ear at the appointment in October 2023. The Trust referred him for a repeat hearing test before making a decision about whether he was a suitable candidate for a grommet.
27. Following two appointments A could not attend, he attended for a hearing test on 24 January 2024. Due to wax build up the Trust could not complete the hearing test. ENT saw A again on 31 January to clear the wax. In this appointment the ENT doctor noticed his ear drum changes had progressed.
28. The Trust referred A for another hearing test and said it would review him in clinic afterwards to discuss grommet insertion. The hearing test took place on 29 February 2024.
29. The Trust reviewed A in the ENT clinic on 17 April 2024 and then referred A for specialist management as it suspected he had a cholesteatoma (an abnormal growth of skin cells inside the ear).
30. The Trust referred A to specialist management when it recognised his condition was not straightforward glue ear and would possibly need more than the simple insertion of grommets. The condition subsequently progressed to the point where an onward referral was appropriate. Our adviser has indicated it would not have been appropriate for the Trust to refer A for specialist management in October 2023 as the diagnosis at that time was glue ear, which could have been treated by the Trust with grommets.
31. Based on the information provided by Mrs H and the Trust, we do not find an indication of failure by the Trust. We acknowledge the times of the appointments the Trust provided were not ideal and required Mrs H to attend multiple times. The appointment times and diagnosis timeframes do not indicate any failure in the service.
32. We recognise how upsetting this matter has been for Mrs H and A. We appreciate the frustration Mrs H has experienced at having to wait for appointments, particularly when she has had to arrange to attend multiple appointments over time. As we have not seen indications anything went wrong with A’s care, we will not be taking further action.