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 seen any indications that something has gone wrong.
Syncope
14. Mr F told us the Trust was wrong to say he experienced syncope or presyncope in April 2024. He believes the Trust mischaracterised previous incidents as this also when taking his history.
15. The ESC guidelines explain syncope is transient loss of consciousness due to reduced blood flow in the brain. It is characterized by a rapid onset, short duration, and spontaneous complete recovery. Presyncope describes symptoms and signs which occur before unconsciousness in syncope. The term is also sometimes used to describe these symptoms which are then not followed by loss of consciousness.
16. The ESC guidelines suggest syncope should be diagnosed by taking clinical features from a history, followed by a full examination and an electrocardiogram (ECG). They say abnormal findings on an ECG could suggest a cardiac cause for syncope and would require further investigation.
17. The Trust took a history from Mr F during the appointment in April where he described previous incidents which the Trust deemed to be episodes of syncope or presyncope. These included two incidents where Mr F became unwell following exercise and had to lay down for an hour or so to recover. He also described an incident where he had to lay down feeling unwell for a few minutes before feeling better while golfing.
18. Our advisor reviewed the Trust’s records of these incidents, Mr F’s descriptions of the incidents, and his A&E attendance in October 2023. They explained Mr F’s description of events in October and April suggested he had a near fainting episode (presyncope).
19. Mr F’s descriptions of previous incidents are not materially different to the Trust’s. Our adviser said the descriptions are not different in a way that would influence how the Trust treated him in April 2024. Our adviser said it was appropriate to describe these episodes as syncope or presyncope.
20. In line with the ESC guidelines, the Trust also arranged an ECG. Mr F’s ECG was abnormal. It showed he had bradycardia (a slow heart rate) and new abnormal features which suggested conduction defects in his heart. Our adviser said these abnormalities were enough to raise concerns there was a cardiac cause for syncope. This was irrespective of whether there was a trigger, such as the arm injury Mr F had experienced.
21. Overall, we have not seen indications to suggest the Trust was wrong to say Mr F experienced syncope or presyncope, or that it mischaracterised previous incidents.
DVLA
22. Mr F also told us the Trust first told him to stop driving and report it to the DVLA in April 2024.
23. The NICE syncope guidance says clinicians should advise on a person’s fitness to drive. It also says referrals should be made to an appropriate specialist if there is a suspected cardiac cause.
24. DVLA guidance says drivers have a responsibility to inform the DVLA if a medical condition is likely to affect their driving. It states syncope is a condition that should be reported.
25. We have seen the Trust made a cardiology referral after Mr F’s appointment in April. Our advisor explained there was a suspected cardiac cause of syncope due to Mr F’s abnormal ECG. The Trust also advised Mr F not to drive and to notify the DVLA.
26. It was therefore in line with the NICE guidance for him to be treated as high risk and refer him for a cardiac appointment. It also appears to be in line with both the NICE and DVLA guidance for the Trust to tell him to stop driving and inform the DVLA.
27. Overall, we have not seen indications to suggest the Trust was wrong to tell Mr F to stop driving and report it to the DVLA. Ultimately, it was the DVLA who made the decision, based on the information it had available, regarding whether Mr F could drive.
28. We understand Mr F experienced a lot of stress over the period he was without his driving licence. We are glad to hear he has his licence back and wish him well. We thank Mr F for bringing his concerns to us and hope our statement reassures him about the care he received.