A practice in the Birmingham area

3. Miss T complains the Practice: • did not examine her properly between February and August 2019 and incorrectly diagnosed her with irritable bowel syndrome (IBS) instead of an umbilical hernia • only referred her for surgery once it had information from the Hospital • failed to diagnose divarication of the recti (a gap in the abdomen).

4. Miss T complains the Hospital did not properly explain the divarication of the recti condition in September 2019. She says she did not fully understand what was wrong with her, so she could not make an informed choice about her operation.

5. Miss T complains the Trust did not do her hysterectomy and umbilical hernia surgery properly in January 2020. She says it did not do any scans before the operation. She says the surgery changed from keyhole (an operation with less cuts) to open surgery during the operation, even though she had waited for a year to avoid open surgery. She says she developed an incisional hernia after the operation (a hernia where there was surgery before and the wound does not heal properly).

6. Miss T complains the Hospital may not have drained her correctly during her incisional hernia operation in April 2021. She developed a large seroma (build-up of body fluids) after the operation, that needed surgery.

7. Miss T says the mistakes by all three organisations meant she was left in extreme pain and discomfort for longer than she should have been, in total over two years. She says she was also stopped from making decisions about her surgery, which left her feeling powerless. She says she experienced depression, anxiety and weight gain because she could not exercise. She says she could not run her business and this affected her and her family financially.

8. She would like each organisation to explain to her what happened and why, to apologise, make service improvements and pay her financial compensation.

9. In February 2019 Miss T had an appointment with her GP at the Practice about her stomach that had become very bloated. The Practice investigated possible causes and referred her to a consultant and surgeon at the Hospital in August 2019.

10. On 13 August 2019 the Hospital consultant told the Practice Miss T had divarication of the recti and a paraumbilical hernia (a weakness or hole in the stomach). They also recommended a hysterectomy (removal of the womb). Miss T complained the Practice had missed opportunities to diagnose her condition correctly in the last six months and had instead said she likely had IBS.

11. In November 2018 the Practice referred Miss T for a hysterectomy/umbilical hernia surgery at the Trust. The operation was done on 7 January 2020.

12. Miss T complained of pains after surgery. She developed an incisional hernia. She saw a specialist surgeon at the Hospital about this on 25 February 2021. The Hospital did further surgery on 6 April 2021.

13. Miss T developed a seroma four weeks after the incisional hernia operation. The Hospital reviewed this on 10 June and 8 July 2021. The seroma eventually disappeared without Miss T needing more surgery.

14. Miss T complained to us in November 2022.

16. The law says a complaint needs to be made to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to. We have discussed this with Miss T to understand the reasons why she did not complain to us sooner. We have also considered the time the organisations took to handle her complaints.

17. Miss T says what happened was a series of linked events and it was not until May 2021when she developed a seroma, that she knew there was a problem.

18. We looked at the separate events and when Miss T would have known there was a problem.

19. She complains the Practice did not diagnose her. The Trust diagnosed her with umbilical hernia on 13 August 2019. This is when she became aware that the Practice had not diagnosed her.

20. Miss T complained to NHS England about the Practice’s actions one month later, in September 2019. The Practice replied two months later, on 4 November 2019.

21. For this part of her complaint to be in time, Miss T would have had to complain to us by 13 August 2020. She complained to us about all three organisations on 30 November 2022. This was over two years outside of our time limit.

22. Miss T was unhappy with the Trust’s surgery in January 2020. T. She complained to the Trust on 22 February 2021, 13 months later. It replied on 1 March 2021.

23. For this part of her complaint to be in time, she would have had to complain to us by January 2021. Miss T came to us 22 months outside of our time limit.

24. Miss T has two complaints about the Hospital. The first was the information she got at her consultation on 13 September 2019. To be in time, this complaint would have needed to come to us by 13 September 2020. The second was her surgery on 6 April 2021. She became aware of concerns with the surgery on 4 May 2021 when she developed a seroma. To be in time, this complaint would have had to come to us by 4 May 2022.

25. Miss T only complained to the Hospital on 25 July 2022. It sent her a final response in March 2023. Miss T had already complained to us about its actions in November 2022.

26. When Miss T complained to us in November 2022, although she had not got the Hospital’s complaint response, her first complaint was already over two years out of time and the second complaint was six months out of time. We note most of the delay was because Miss T did not complain to the Hospital until July 2022, 34 months after the first consultation and 14 months after the surgery.

27. We looked at the reasons for the delay. For the complaint about the Practice, Miss T waited three years after getting its complaint response before coming to us. Miss T did not complain to the Trust for over a year and when she got her response, she waited 20 months to bring it to us. Miss T did not complain to the Hospital until nearly three years and 14 months after the events.

28. We asked Miss T why she was not able to make her complaints sooner. She told us this was because her physical and mental health deteriorated. She explained she lost her business and had to move house. She also says she has undiagnosed Attention deficit hyperactivity disorder (ADHD) and this makes it difficult for her to read information properly. She says she did not know about us until 2022.

29. We can see the Practice’s November 2019 complaint response referred her to us if she was unhappy with the outcome. This shows us she knew she could come to us from that time. We have seen from a letter dated 8 October 2019 that Miss Thad details of advocates who could help her with making complaints.

30. We got Miss T’s GP records to help understand the reasons why she delayed complaining. These show she had periods of low mood and a diagnosis of anxiety and depressive disorder. We can see her GP referred her for help in July 2019, but Miss T did not respond to that letter. Her GP recommended counselling to help her in December 2020.

31. Her GP records show she has been on medication for her mental health from before the period we are considering. The first mention of a possible ADHD diagnosis was in December 2022, a month after she came to us with her complaint.

32. We can see this was a very distressing time for Miss T. She was physically uncomfortable and this affected her mental health and personal life. It is clear from her account she has been through a difficult and distressing time and we are sorry to hear this.

33. There are very long gaps in the timelines for the complaints about each organisation. To put the time limit to one side, we would need to be persuaded that Miss T could not have progressed her complaints sooner. We have not seen evidence to persuade us. We do not dispute she had mental and physical health problems, and we accept this would have made things harder. But we cannot see these would have prevented her from bringing a complaint to us sooner. We can see she was able to complain to the three organisations in September 2019, February 2021 and July 2022. She knew about our service as early as November 2019 and she had details of how to access support from an advocate.

34. For these reasons we have not put our time limit to one side.

1. The Parliamentary and Health Service Ombudsman has carefully considered Miss T’s complaint about a practice in the Birmingham area (the Practice), the Priory Hospital (the Hospital) and NHS Birmingham Women’s and Children’s NHS Foundation Trust (the Trust). The complaint is outside our time limit and we have not found a reason to put the time limit to one side to consider it further.

2. We are sorry to hear about Miss T’s experiences while she was waiting for a diagnosis in 2019 and after each of her operations between January 2020 and April 2021. This was clearly a very painful and upsetting time for her.