Wirral University Teaching Hospital NHS Foundation Trust

3. Mrs N complains on 14 April 2024 Dr T at the Trust did not: • properly exam lesions on her vulvar (external female genitalia, encompassing the structures visible outside the body) during a colposcopy (an examination of the neck of the womb using magnifying binoculars called a colposcope) • did not properly document her colposcopy.

4. Mrs N says Dr T’s failure to properly examine the lesions on her vulvar meant there was a delay in her vulva cancer diagnosis, meaning the cancer was found at stage 2. Stage 2 usually means the tumour is larger than in stage 1, but it hasn't started to spread into the surrounding tissues.

5. Mrs N says the tumour had grown from 2.3cm in May 2024 to 5.8cm in July 2024. Mrs N says this meant she had to have more Magnetic Resonance Imaging (MRI) scans, and major surgeries, such as a wide local excision (a surgical procedure used to remove skin cancers), bilateral groin node dissection (a surgical procedure to remove lymph nodes from both groin areas), and vulvar flap surgery (a surgical procedure to remove the cancerous tissue and preserve as much healthy tissue as possible).

6. Mrs N says she also suffers with constant infections and nerve damage. She is now seeking psychological help the mental trauma she suffered as a result of the delay in diagnosing her vulvar cancer.

7. Mrs N said the delayed diagnosis also caused her family and children stress which has impacted her with greater stress. She said the last 12 months have been horrific, and she now finds herself questioning doctors and hospitals as she is scared they might miss something regarding her health.

8. As an outcome to her complaint, Mrs N wants an assurance that what happened to her will not happen again in the form of service improvements and wants significant compensation in line with level 6 of our Severity of Injustice scale.

9. Mrs N told us she discovered lesions on her vulvar in 2019. Between 2023 and 2024, she visited her GP regarding the lesions. She confirmed she had an abnormal smear in 2023 and 2024 where the lesions were noted. After Mrs N’s smear in 2024, she had a lengthy discussion with her GP regarding the lesions and how they were starting to be problematic, they were bleeding and were painful when she went to the toilet.

10. In 2024, Mrs N was referred for a colposcopy with Dr T due to an abnormal smear result. Mrs N says her GP was aware of the lesions on Mrs N’s vulvar and had written to the gynaecologist to have the ‘large warty lesions which bleed’ investigated. Mrs N additionally says her GP had given Mrs N a prescription only numbing cream called Instillagel for the gynaecologist to apply to Mrs N during her colposcopy as the pain from her lesions was so severe.

11. On 14 April 2024, Mrs N had her colposcopy with Dr T. During her colposcopy with Dr T, Mrs N told us she explained the lesions on her vulvar to Dr T and how painful they were, asking Dr T to apply the Instillagel provided by Mrs N’s GP. Dr T used the Instillagel and performed the colposcopy, examining Mrs N’s cervix. Dr T quickly noted pre-cancerous cells and told Mrs N he could remove the cells during the colposcopy by performing a Loop procedure.

12. Mrs N said she declined for Dr T to remove the cells during the colposcopy because of pain from the lesions and opted to have the procedure done under general anaesthetic. Dr T then ended the colposcopy and scheduled a Loop excision procedure for 16 May 2024. Mrs N says that Dr T did not examine her vulvar lesions and did not dab her lesions with a dye during her colposcopy on 14 April 2024, which Mrs N says delayed her vulvar cancer diagnosis.

13. On 16 May 2024, Mrs N came in for her Loop procedure under the care of a different gynaecologist. Mrs N had explained her painful vulvar lesions to the gynaecologist before her Loop procedure. She says she told the gynaecologist she was worried about pain during the surgery. The gynaecologist assured Mrs N they would be very careful when conducting the Loop procedure and would see Mrs N afterwards of they found anything. Mrs N says after being discharged, the gynaecologist told her they were seriously concerned her vulvar lesions were cancerous. The gynaecologist scheduled for tests and biopsies to be taken to check the lesions.

14. After tests, Mrs N was informed the lesions were cancerous. Mrs N had surgery on 1 July 2024, where a tumour of 5.8cm was removed. Mrs N said she was told by Dr T the cancer would be slow growing. Mrs N says this was not the case and her tumour had grown from 2.3cm in May 2024 to 5.8cm in July 2024.

17. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We have discussed this with Mrs N to understand her circumstances and the outcomes she wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

18. Mrs N raised concerns about the clinical care and treatment provided by the Trust. Mrs N says her quality of life has been permanently and profoundly altered.

19. As an outcome to her complaint, Mrs N has told us she is seeking a financial remedy. As Mrs N did not have a particular figure in mind, she was provided with the PHSO’s Severity of Injustice (SOI) scale. When we explored this further, Mrs N told us she is seeking a level 6 financial remedy of compensation of over £12,500 for the pain and worry this matter has and continues to cause her.

20. Given Mrs N’s complaint, it appears she may have a claim for clinical negligence, as she believes the Trust’s failure to diagnosis her cancer in a timely manner has resulted in harm for which she seeks a financial remedy. Negligence, in law, is an act or failure to act (omission) that does not meet the level of appropriate care expected, resulting in injury or loss. If a doctor or health professional is negligent when giving medical treatment, this is called ‘clinical negligence’.

21. We have gone on to consider whether legal action could achieve all the outcomes Mrs N is seeking. In addition to a financial remedy, Mrs N seeks service improvements to prevent these events happening to someone else. Whilst a court cannot normally direct service improvements, Mrs N may achieve these as a biproduct of her legal case if it is successful.

22. Mrs N has sought legal advice on her complaint. As it is therefore reasonable for her to pursue a legal remedy, we will not be taking any further action on her case.

23. Mrs N can return to us if she finds she is unable to pursue legal action. She can also return to us if, following legal action, she has outstanding outcomes which the court was unable to order, or if the court was unable to consider parts of her complaint.

24. We would ask Mrs N to come back to us promptly if she is unable to proceed with legal action or if there are outstanding outcomes. This is because we are unable to investigate complaints brought to us 12 months after someone has become aware of the problem. We can put this time limit to one side if we think there is a good reason to do so.

Conclusion

25. We were sorry to hear of Mrs N’s experience and the ongoing impact that this has had on them and thank her for bringing her concerns to our attention.

1. We have carefully considered Mrs N complaint about Wirral University Teaching Hospital NHS Foundation Trust (the Trust). Mrs N raises concerns about the actions taken following an abnormal smear test, and she feels opportunities were missed for an earlier cancer diagnosis. We do not doubt the significant distress and trauma these events have caused.

2. Mrs N told us she has approached a solicitor to consider her concerns about the Trust’s care. As Mrs N could take legal action on the matter she has brought to us, and we will take no further action on her complaint at this time. We explain this further below and outline the next steps should Mrs N wish to bring her complaint back to us after exploring a potential legal claim.