14. Mrs O complains that when GEH referred Mr O in March 2022 for consideration of an angioplasty procedure, UHCW did not promptly act on the referral. She complains that despite GEH making an urgent referral on 11 March, UHCW left it until 27 May to make a decision about Mr O’s treatment. Mrs O also complains following this, UHCW did not promptly organise treatment for Mr O before he died.
15. While Mrs O believes GEH made an urgent referral to UHCW, this was in fact a routine outpatient referral. Based on what we have seen, including our independent clinical advice, this was an appropriate type of referral because GEH had already done a direct angiography to diagnose the problem and Mr O’s clinical condition was stable (meaning he was not experiencing sudden and severe illness or symptoms requiring immediate medical attention).
16. Once UHCW received the routine referral from GEH on 11 March, Mr O was entitled to receive treatment within 18 weeks or by 15 July 2022. This is according to the NHS Constitution, which says ‘You have the right to start your consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions.’ Based on what we have seen from the evidence available and the clinical advice, we consider UHCW was taking appropriate steps to arrange Mr O’s treatment within this time, in line with applicable guidance and standards, for the following reasons.
17. We have seen that during April UHCW was arranging an MDT meeting to discuss Mr O’s case, which took place on 27 May. We consider this was in line with the ESC guidelines, which set out the process for decision making when considering medical procedures aimed at restoring blood flow to the heart, including angioplasty. The ESC guidelines say, ‘The Heart Team […] should provide a balanced, multidisciplinary decision making process.’ (section 4.2).
18. Our adviser explained the MDT may recommend tablets only, angioplasty or bypass surgery. He explained the recommendation of the MDT and the type of specialist may differ from that set out in the original referral. The MDT decided Mr O should be referred for heart bypass surgery rather than angioplasty.
19. The ESC guidelines (section 9.2.2) explain for patients like Mr O who have diabetes and multivessel disease (a form of coronary artery disease where two or more of the major arteries are narrowed or blocked), the evidence supports heart bypass surgery over other revascularisation procedures (aimed at restoring blood flow to areas of the heart that have reduced or blocked blood supply). We consider it was in line with applicable standards and supported by the clinical evidence available for UHCW to decide Mr O should be referred for bypass surgery instead of angioplasty.
20. On 14 June UHCW wrote to GEH recommending that it refer Mr O for heart bypass surgery. We consider it was in line with applicable guidance and standards for UHCW to ask GEH to refer Mr O to a specialist able to discuss heart bypass surgery with him. Our adviser explained the initial referral from GEH was intended for a doctor specialising in angioplasty. For a patient to be referred for bypass surgery, the receiving surgeon requires a different set of clinical information. We understand from our adviser that, for this reason, it was appropriate for UHCW to ask GEH to complete another referral to ensure the best care and treatment could be planned.
21. We consider the decision to ask GEH to complete another referral was in line with GMC Good Medical Practice which says, ‘[…] If you assess, diagnose or treat patients, you must […] refer a patient to another practitioner when this serves the patient’s needs.’ (section 15 c).
22. Although GEH made the referral to UHCW on the same day, sadly, Mr O died two days later on 16 June before treatment could be arranged.
23. With the above in mind, we have not seen anything to indicate UHCW made mistakes in its handling of Mr O’s care. We also note that Mr O became very unwell the day after the second referral by GEH. Had he been seen by a specialist at UHCW and a decision made to proceed with heart bypass surgery, he may not have received surgery before he died. The NHS guidance says, ‘The length of time you’ll have to wait to have a coronary artery bypass graft will vary from area to area […] Ideally, you should be treated within 3 months of the decision to operate.’ Mr O sadly died before the decision to operate was made.
24. After considering the evidence available and the relevant guidelines quoted, we have not identified that UHCW should have acted more promptly when dealing with Mr O’s initial referral from GEH or arranging his treatment. We appreciate how distressing it must be for Mrs O knowing that Mr O died before his treatment could be organised. Based on all the evidence available, we do not consider this was due to any failings by UHCW. Despite this we offer our deepest sympathies to Mrs O and hope our independent views and explanations of what we have seen are helpful to her.