Declined request for laser treatment
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 found any indications something has gone wrong.
14. Mrs S complains the Trust declined her request for laser treatment for a lesion on her cheek.
15. Mrs S has a skin condition called spider naevi/haemangiomas on her cheek. The dilated blood vessels have a spider-like appearance.
16. Mrs S originally requested topical timolol for the lesions on her face. The Dermatology Department declined as this is used to treat haemangiomas in children. Our adviser confirmed this.
17. When this was declined, Mrs S requested laser treatment.
18. In their complaint response in July 2024, the Trust explained laser treatment has a very strict referral criteria. It said laser treatment can be offered by the NHS for patients with a persistent presence of small, dilated blood vessels following the resolution of severe rosacea (a long-term skin condition) affecting the whole face. It advised Mrs S laser treatment would not be an appropriate option for her.
19. From Mrs S’s medical records, we have seen she was reviewed by the Trust’s Rheumatology department in January 2023 and diagnosed with mild rosacea.
20. Mrs S saw a consultant Dermatologist in February 2023 where she said she had a past medical history of rosacea and mild seborrheic dermatitis. Seborrheic dermatitis is a common skin condition causing red, flaky, greasy patches to the scalp, face, chest, and skin folds, linked to yeast and sebum overproduction. Mrs S also reported a single dilated blood vessel on her left cheek which the Dermatologist diagnosed as a spider nevus. Our adviser tells us these lesions are common and purely cosmetic.
21. In an email to the Trust in January 2025, Mrs S said she was diagnosed with ocular rosacea and rosacea on her right cheek and requested laser treatment.
22. Our adviser tells us given Mrs S’s skin condition was examined by a Dermatologist one month after the Rheumatologist, and the Dermatologist came to a different diagnosis, it is more likely than not Mrs S was misdiagnosed with rosacea by the Rheumatologist as the Dermatologist is the expert in skin conditions.
23. NICE guidelines for rosacea state specialist treatment options may include laser treatment, but there is no obligation for the healthcare providers to fund or offer these treatments anywhere in the UK.
24. Our adviser has told us there is no NHS guidance concerning the treatment for spider naevi/haemangioma.
25. The NHS cosmetic surgery guidance states the NHS does not provide laser treatment for cosmetic conditions. Laser treatment is available for certain skin conditions that cause significant functional problems. Our adviser tells us funding for visually impactful vascular conditions (birth marks, scars, facial thread veins etc) is at the discretion of the local health provider.
26. We can see Mrs S thought she had rosacea. We have seen on the balance of probabilities this diagnosis was incorrect. Even if Mrs S had been diagnosed with this, we can see the NICE guidelines state there is no obligation for the NHS to fund laser treatment for rosacea.
27. We have seen Mrs S had a spider naevi/haemangioma on her cheek. The NHS does not have any guidance on the treatment of these as they are dealt with as cosmetic issues. We have seen the NHS cosmetic guidance states laser treatment is not available for this type of lesion.
28. We therefore see the Trust acted in line with guidance when it refused Mrs S’s request for laser treatment. For this reason, we will be taking no further action on this part of Mrs S’s complaint.
Taking too long to respond to emails
29. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. Having done so we have found the Trust has already done enough to put right the impact of these events.
30. Mrs S contacted the Dermatology department in March 2024 to request a prescription of timolol for haemangioma on her face. She followed up this request twice in April as she had not heard back from the department. Mrs S complains the Trust took too long to respond to her emails about her concerns. On 12 April the Trust apologised to Mrs S for the delay and shared her query with a clinician.
31. In the Trust’s response dated July 2024, the Trust said the administrative team had apologised for the delay at the time. It again acknowledged the delay in responding to Mrs S’s emails and reiterated its apology.
32. We can see Mrs S waited a short time for her response from the Trust causing frustration and inconvenience. We can see this is level 1 on our Severity of Injustice Scale. Our principles of remedy state an apology is sufficient.
33. The ‘NHS complaint standards’ say organisations should take accountability when mistakes are identified and be open and transparent. We consider the Practice acted in line with these standards when it acknowledged the delay in responding to Mrs S’s emails on multiple occasions.
34. Our ‘Principles of good administration’ says when errors occur, public institutions should acknowledge them, issue an apology, clarify what went wrong, and take steps to put things right. We consider the Practice acted in line with these standards by apologising to Mrs S for the delay on 12 April and sharing her query for review with a clinician on 12 April.
35. We consider the Practice has done sufficient to resolve the delay in responding to Mrs S. We will therefore take no further action.