Removal from the waiting list
16. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event complained about had a negative effect which the organisation has not put right.
17. Having done so we have found the Trust has already done enough to put right the impact of these events.
18. Ms D complained the Trust removed her from the waiting list for septorhinoplasty in January 2024. She told us she was not given an explanation and had to challenge the Trust to be added back to the waiting list. We recognise it was very distressing to be removed from the waiting list after she had waited so long.
19. A letter from the ENT department to Ms D’s GP on 16 January 2024 said Ms D’s case was reviewed at the Rhinology MDT. It said the MDT decided Ms D did not meet the NHS clinical requirements for septorhinoplasty. The letter said Ms D would be removed from the surgical waiting list. It said the Trust would continue to actively monitor her to assess if her condition progresses.
20. In its complaint response to Ms D in October 2024, the Trust explained it found some patients did not meet the NHS England criteria for surgery. Because of this the MDT decided to remove all affected patients from the waiting list for further assessment.
21. The Trust also said it is its ENT department standard for all patients undergoing revision septorhinoplasty to have a psychology assessment. The Trust told us it removed Ms D from the waiting list because she had not had the required psychology assessment.
22. It is documented in Ms D’s ENT clinic letters she had a follow-up ENT appointment in April 2024. The consultant reassessed Ms D and confirmed she did still require surgery.
23. It is documented in Ms D’s ENT clinic letters she had a telephone appointment with a consultant in July 2024. The plan remained for Ms D to have a psychology assessment prior to surgery. The consultant noted that the Trust could not provide the psychology assessment at that time, so Ms D should be referred by her GP.
24. In August 2024, Ms D had a follow-up appointment. The plan remained for Ms D to have a psychology assessment. It is documented in the clinic letter that once Ms D had completed the assessment, the Trust would add her to the surgery waiting list and take account of her wait of four years.
25. The Trust responded to Ms D’s complaint on 15 October 2024. It said staff are genuinely sorry for the disappointment Ms D experienced with the care provided. It said they deeply regret the distress caused to Ms D by the decision to remove her from the surgery waiting list without sufficient explanation.
26. The Trust explained why the decision was made and again said it will take account of the time Ms D has already waited when it puts her back on the waiting list. It said it would expedite Ms D’s surgery once she had completed the psychology assessment. The Trust reiterated this in a further email to Ms D on 16 October, and to us in an email on 29 September 2025.
27. Ms D completed the psychology assessment in November 2025, once the Trust were running the psychology assessment service again. The Trust has confirmed since undergoing the psychology assessment, Ms D is now on the priority waiting list for surgery.
28. Our NHS complaint standards say staff should give meaningful and sincere apologies and identify suitable ways to put things right for people.
29. We consider the Trust has acted in line with our NHS complaints standards. It has apologised to Ms D for the impact she has experienced and said it would take into account the length of time she had already waited when adding her back to the waiting list. The Trust has now confirmed it has added Ms D to the priority waiting list for surgery. We are satisfied we do not need to take any further action regarding this complaint.
30. We are very sorry Ms D has experienced ongoing breathing problems while waiting for surgery and appreciate this has been a difficult time for her. We hope our decision reassures Ms D about why we think the Trust have done enough to resolve this part of her complaint.
Psychological assessment requirement
31. 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 that something has gone wrong.
32. Ms D complained the Trust made her undergo a psychology assessment as a condition to having a septorhinoplasty.
33. The Trust said its requirement for psychology review prior to septorhinoplasty is a locally agreed standard amongst all rhinologists (a doctor specialised in the nose and its diseases) at the Trust. It said this policy applies to all patients undergoing revision septorhinoplasty.
34. The Trust said its approach is consistent with policies at peer institutions. It said the rationale is to ensure patients have appropriate psychological support and realistic expectations, particularly in revision cases which can be more complex and emotionally impactful.
35. Ms D told us she has never been psychologically unfit for surgery. She said she needs the surgery because of her breathing difficulties caused by a broken septum which is a clinically diagnosed physical issue. Ms D told us ENT consultants have repeatedly confirmed her condition is physical and structural. We understand how distressing it was to be told she had to have a psychology assessment before she could have surgery.
36. It is documented in Ms D’s ENT clinic letters she had a phone appointment to discuss the surgery with a consultant in July 2024. In the letter, the consultant advised it is the department’s standard, as part of best practice, that patients undergoing revision septorhinoplasty should have a psychology assessment.
37. The consultant said because this type of surgery can have functional and cosmetic impacts, the purpose of the assessment is to establish a patient’s motivation and expectations. They said if the psychologist identified any mood disorders or mental health concerns (such as body dysmorphic disorder – a condition where a person worries a lot about flaws in their appearance, which may be unnoticeable to others), they could then refer the patient for treatment to help optimise their outcomes.
38. Our adviser said there are no national guidelines for septorhinoplasty. They told us information on the NHS website makes it clear the NHS will not fund cases that are purely cosmetic. They said any patient presenting via the NHS for cosmetic concerns would normally be assessed by a psychologist to see if there is a reason to apply an exemption to this rule.
39. Our adviser said the Trust’s decision to apply this rule to all revision septorhinoplasty cases is a local one. They said Ms D’s clinic records indicate she experiences a functional problem rather than cosmetic. They said it is possible another Trust without this rule in place might have progressed directly to surgery.
40. The Professional Standards for Cosmetic Surgery say surgeons performing cosmetic surgery should be prepared to avoid or defer surgery pending psychological assessment if they are concerned a patient may be vulnerable, or if the patient has a history of repeated cosmetic procedures.
41. The Trust said although Ms D had functional symptoms, revision septorhinoplasty is recognised nationally as a higher risk category in which psychological input may be required.
42. Overall, we have seen the Trust followed its policy when it required Ms D to undertake a psychology assessment as a condition to revision septoplasty. We have not found any indication the Trust got things wrong in this case, and we will not be investigating this complaint further.
43. We hope we have clearly explained why the Trust acted in line with its policy. We understand the distress Ms D experienced at the thought of undergoing the psychology assessment and we are sorry this is not the outcome she was hoping for.