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. If we see evidence of this, we look at whether there are signs the events complained about, had a negative effect, which the organisation has not put right.
Cancelled surgery 14. Ms L complains the Trust incorrectly declined to carry out a hysterectomy on 2 February 2024. Understandably, she is concerned the Trust made the wrong decision as she went on to wait for surgery at another organisation which she told us meant she continued to experience pain and constant vaginal bleeding, which we are sorry to hear about.
15. The CPOC guidance recommends that every patient requiring surgery and anaesthesia should undergo a formal nurse led preoperative assessment before the day of admission.
16. It goes on to say that patients should complete a screening self-assessment health questionnaire at the earliest possible point in the surgical pathway to help shared decision making, risk prediction and optimisation. A screening questionnaire will form the basis of clinical triage which will determine which patients may be high-risk and require additional physician assessment.
17. Ms L’s records show the Trust sent her a preoperative questionnaire which she completed on 2 January 2024 and took with her to a nurse led preoperative assessment at the Trust on 11 January. We can see the nurse who carried out Ms L’s assessment noted she had a VNS device fitted and contacted an anaesthetist for advice, who agreed it was safe for Ms L to have surgery. This appears to be in line with CPOC guidelines as it carried out a formal nurse led preoperative assessment and considered whether Ms L’s VNS device was a risk and sought further advice from a physician.
18. Ms L attended the Trust on 2 February for surgery. The anaesthetist discussed Ms L’s anaesthetic history with her and noted her VNS device was not switched off. They sought advice from another anaesthetist and consulted guidelines. The Trust made the decision not to go ahead with Ms L’s surgery. It noted this was for safety reasons relating to her VNS device and diathermy which is a technique used during surgery that uses heat from an electric current to cut tissue or seal bleeding vessels.
19. The Trust explained in its final response that the anaesthetist who provided advice during the preoperative assessment was not aware Ms L’s surgery would be carried out using diathermy which it explains is why it did not raise concerns earlier. The Trust also said the anaesthetist on the day of Ms L’s surgery consulted guidance from the AA.
20. The AA says it is generally safer to formally deactivate the VNS before surgery, even if a patient carries their own magnet. This should be planned in conjunction with the patient’s neurology team. Multidisciplinary input and planning in the perioperative period are needed to optimise patient safety and avoid device damage.
21. Our adviser says the Trust made the right decision not to proceed with surgery on the 2 February. They explain this was to maintain patient safety as it does not appear that the Trust had neurological services and the correct technology to care for a VNS device.
22. Based on the evidence we have seen it appears the Trust followed AA guidance when it made the decision not to proceed with her surgery. We can see it did not consider it safe to continue with Ms L’s surgery as it did not have the facilities to manage her VNS device or consult with her neurological team.
23. The Trust explains the anaesthetist who confirmed Ms L was safe to have surgery was not aware it would be carried out using diathermy. Our adviser says it missed an opportunity to consider referring Ms L to an NHS Trust earlier where there would have been access to technicians and technology to care for a VNS device.
24. We can see from the records the preoperative nurse discussed Ms L with the anaesthetist before the day of Ms L’s surgery. However, we cannot see the information they shared or the consideration it carried out in relation to the surgery she was having and the VNS device.
25. Therefore, we cannot say the Trust followed GMC guidelines which says you must work collaboratively with colleagues and share all relevant information with colleagues involved in your patients’ care within and outside the team. This is because it appears the anaesthetist consulted at the preoperative stage was not aware Ms L’s procedure would be carried out with diathermy.
26. Understandably, Ms L is upset the Trust said it would not proceed with the surgery when she had already been admitted to the Trust. It is clear from what she has told us that it caused her additional stress at an already difficult time for her and feels it could have been avoided as it knew she had a VNS device before the day of her surgery.
27. We discussed this with the Trust. It explained it has reflected on Ms L’s case and apologised that it was not made clear to the anaesthetist at the preoperative assessment stage, that the type of surgery Ms L was due to undergo, required diathermy. It also apologised she was not made aware that her surgery could not go ahead until the day of surgery and acknowledged that this caused her a great deal of distress.
28. The Trust says it has also taken action to change the way the preoperative assessments team liaises with consultants for patients with nerve stimulators. It explained it is a level zero Trust for patients whose needs can be met through routine or basic care. It says as the Trust does not have any escalation capacity for patients requiring higher levels of care, or who are at risk of their condition deteriorating, they would be required to be looked after at a level one Trust or higher for their safety.
29. Therefore, it has also taken action to ensure these patients are now discussed at the multi-disciplinary team meeting following their preoperative assessment, and patients are made aware that they would be unsuitable for surgery at the Trust much sooner than Ms L experienced.
30. As an acknowledgement of the distress the Trust caused Ms L, along with the action already taken, it has offered her a financial remedy of £250.
31. Our Principles say that to put things right organisations provide an apology and try to offer a remedy that returns the complainant to the position they would have been in otherwise. We are satisfied that the actions of the Trust in apologising for Ms L’s experience, taking action to prevent the same thing happening again, and offering a financial remedy are in line with our Principles.
32. We recognise Ms L’s experience has caused her great distress. We hope this gives her some reassurance that the Trust has taken her complaint seriously and addressed the failings identified. As such, we will not take further action on this complaint.
Communication 33. Ms L complains about the Trust’s lack of communication on the day of her cancelled surgery and the days following it. She says she was led to believe the Trust may still be able to do her surgery, but it never contacted her, which are sorry to hear about.
34. Our adviser explains there are no specific guidelines on how to communicate with patients on the day of surgery or the days following. However, we can refer to GMC guidelines which says clinicians must give patients the information they want or need to know in a way they can understand.
35. Ms L’s records show on 2 February, the day of her cancelled surgery, the Trust documented the discussion it had with her about its decision not to proceed with the surgery. It explained the guidelines it had consulted and why this meant it would be safer for her for the surgery to be carried out at an NHS Trust. We can see it noted she was upset with the decision and noted she will be contacted.
36. This appears to be in line with GMC guidelines as we can see the anaesthetist explained the decision not proceed with surgery and why, when it had all the relevant information. It also explained it would contact her.
37. In the Trust’s final response, it explains Ms L attended a further appointment on 5 February for hormone injection which she declined. On 7 February the Trust discussed Ms L at an anaesthetic multi-disciplinary team meeting where it was recommended her surgery be carried out at an NHS Trust. It wrote to her GP on 9 February to explain this and asked for it to arrange an urgent referral to an NHS Trust.
38. Based on the information available to us, it does not appear the Trust contacted Ms L to explain the outcome of the multi-disciplinary team meeting on 7 February. Understandably, she is concerned about this as she explains she had been led to believe it may be able to carry out her surgery. Therefore, it appears the Trust did not follow GMC guidelines here to give Ms L the information she needed to know about its decision to not proceed with her surgery.
39. It is clear Ms L is concerned about the Trust’s communication. From what she has told us she feels this caused her stress which caused her epilepsy to worsen and has no quality of life.
40. We can see the Trust clearly explained on the day of her cancelled surgery that it was not equipped to carry out her surgery. However, we do recognise that had the Trust clearly explained it would refer her back to her GP after her appointment on 5 February, she would have been aware earlier that it would not be carrying out her surgery.
41. We understand how the Trust’s lack of communication would have caused her distress at an already difficult time, and we are sorry to hear about the symptoms she continued to experience after her surgery was cancelled.
42. In the Trust’s response we can see it has acknowledged and apologised for the lack of communication in keeping her informed about its decision to refer her back to her GP and the distress it caused her. It has also specifically apologised that it did not contact her directly to explain its decision and the reasons why.
43. Therefore, we are satisfied that the actions of the Trust in apologising for Ms L’s experience, acknowledging the distress it caused her, and the action it has taken highlighted above, are in line with our Principles.
44. We do not wish to underestimate Ms L’s experience, it is clear it has been a difficult time for her, and we are grateful to her for the time and effort she has taken to bring her complaint us. It is understandable she feels the Trust should have contacted her to explain it was referring her back to her GP.
45. Overall, we did see indications of some failings with communication. We saw no evidence of these leading to a more severe or prolonged impact. Therefore, we are satisfied the actions the Trust has taken to address these mistakes are enough to put right those mistakes. We will therefore not take further action on this complaint.
46. We understand Ms L’s experience has caused her great distress and we are sorry for this. We hope this statement clearly explains our decision not to consider her complaint further and gives her some reassurance that the Trust has taken her complaint seriously and addressed the failings identified.