A practice in the South Gloucestershire area

3. Miss A complains about the following actions of the organisations when she was trying to arrange a tonsillectomy, because of recurrent sore throats:

• Plymouth Trust wrongly informed her that because of a change of address she had to be removed from its waiting list for a tonsillectomy in January 2023. She says it also recorded this as being due to patient choice, when Plymouth Trust staff had wrongly advised her.

• Bristol Trust refused to list her for a tonsillectomy in November 2022, despite her meeting the criteria.

• The Practice • did not refer her for a tonsillectomy from June 2022 to November 2023 • told her to gather her own evidence to request funding for a tonsillectomy • did not tell her about her right to challenge any declined funding decisions

4. Miss A says as a result of what happened she was left with no alternative other than to pay for private treatment, as her physical and emotional health was impacted. The outcomes she seeks are to receive financial reimbursement for the cost of the private treatment, and an acknowledgement of failings and apology.

5. Miss A had history of tonsilitis going back to June 2019. She described this causing her significant health issues over the years.

6. She sought treatment for this at both trusts and asked to be placed on their waiting lists for a tonsillectomy. She was offered cancellation appointments but was not able to attend for these.

7. Miss A asked the Practice to arrange for her to have a tonsillectomy. The Practice were not able to arrange this and discussed ways to try and get the treatment she needed.

8. In April 2023 Miss A requested her medical records. She told us she became aware at this point that the organisations had not acted as they should have in arranging her care and treatment.

9. Miss A arranged a privately funded tonsillectomy on 30 November 2023.

10. In January 2024 Miss A raised her complaint, that the organisations had not acted in the way they should have done. She asked to be refunded for the cost of the surgery.

13. Miss A told she became aware she had reason to complain when she received her medical records in April 2023. We think it would have been reasonable for her to have made a complaint at this time.

14. The NHS complaints Policy explains that when it receives a complaint it will try to resolve this. It outlines possible outcomes as ‘reconsideration of a previous decision made by us or the provider of the service’ and ‘expediting an action’.

15. Miss A instead took the decision to arrange and pay for private treatment seven months later, without having raised her concerns about what she considered had gone wrong with the organisations.

16. We asked Miss A the reasons why she had not raised a complaint. She explained she was feeling too unwell and did not feel like anyone was going to help her. She also explained she was in the middle of her master’s degree and this took up a lot of her time.

17. We understand the impact of ill health and are sympathetic to this. We think it would have been reasonable for Miss A to have sought some support from an advocacy organisation, to make her complaint and explain why she considered the organisations had not acted as they should.

18. Using an advocate would have alleviated some of the pressure caused by her health issues, and the demands of her degree on her time.

19. Our guidance on fees paid for private healthcare says we need to consider whether the patient escalated their concerns, to allow the NHS the opportunity to provide the treatment, before resorting to private treatment.

20. This did not happen. Miss A had seven months where she could have allowed the organisations the opportunity to revisit their decision, and to try and expedite her treatment. Instead she did not raise her concerns until six weeks after she had paid for the private treatment.

21. For this reason we cannot conclude Miss A had no alternative other than to pay for private treatment.

22. We understand how upsetting this situation was for Miss A and we are truly sorry for the impact on her health. We hope she will understand the reasons why we have decided not to take further action.

1. We have carefully considered Miss A’s complaints and have decided not to take further action. This is because we cannot reach the conclusion that she had no alternative other than to pay for private treatment.

2. We were sorry to hear about how much this experience affected Miss A and are sorry for the disappointment this decision will cause.