The Trust did not add Miss R to the wait list for surgery in August 2024
21. 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 anything has gone wrong with part of Miss R’s complaint.
Miss R attended the Trust for her initial consultation in August 2024. The Trust told her she needed total hip and knee surgery. It said because of her complex medical history a multi-disciplinary team (MDT) meeting would discuss her surgery.
22. The Trust said it would contact Miss R for an appointment. It told her she would have medication injected into her hip joint, known as intra-articular joint injection. This is a diagnostic procedure to help the Trust decide how best to treat her hip and knee.
23. Miss R said she was hesitant to have the intra-articular joint injection and felt she should have been added onto the wait list for surgery after her initial appointment in August 2024. Miss R asked the Trust for a second opinion on 19 March 2025 during her follow up appointment.
24. In the Trust’s response to Miss R’s complaint, the Trust said it was difficult to decide which joint was the most painful.
25. The Trust arranged an MDT meeting to discuss the intra-articular joint and the location of the injection. In the MDT meeting the Trust also discussed what type of hip replacement implant would be required. It decided Miss R would need a custom implant.
26. GMC Good medical practice says doctors should provide suitable advice, investigation or treatment and consult colleagues or seek advice where appropriate.
27. We have seen the Trust discussed Miss R’s case in an MDT meeting and decided to do the injection. This demonstrates the Trust discussed the treatment plan and reached a collaborative decision amongst specialist colleagues.
28. Our adviser explained that in their experience the decision to complete a diagnostic injection was appropriate and a suitable investigation for Miss R’s presenting condition.
29. They also explained without the injection the Trust was unable to identify where Miss R’s pain came from, specifically whether it was the hip or knee.
30. The National Library of Medicine article explains hip pain can present as knee pain and further explains how hip arthritis can present as knee pain.
31. Our adviser also told us the Trust was correct when it did not add Miss R to the wait list for surgery in August 2024. This was because the Trust was unable add her to the waiting list until the joint injection was done, so it knew whether it would be operating on the hip or knee first.
32. From what we have seen, we are satisfied the Trust acted in line with GMC guidance and relevant research when it did not add Miss R to the wait list in August 2023. From what we have seen we are satisfied the Trust needed to complete an intra-articular joint injection for diagnostic purposes, before adding her to the correct waiting list We are satisfied The Trust acted with appropriate guidance when it did not add her to the waitlist in August 2024.
The Trust failed to follow up in a timely manner, after her intra-articular joint injection in November
33. In November, the Trust performed an intra-articular joint injection on Miss R’s hip. It said it would arrange a follow up appointment in four to six weeks.
34. Miss R did not receive an appointment in this time period and telephoned the Trust in January 2025. The Trust told her it had not yet scheduled a follow up appointment for her. During the telephone call, it arranged a follow up appointment for her in February.
35. The Trust cancelled Miss R’s February appointment on the day because of consultant sickness. Miss R complained to the Trust about this.
36. In response to Miss R’s complaint, the Trust rearranged her appointment for March. Miss R attended her follow up appointment with a Trust orthopaedic consultant in March. During this appointment she asked for a third opinion. She also asked to change consultants.
37. The Trust arranged an appointment for April to discuss Miss R’s treatment options with another Trust consultant orthopaedic surgeon. Miss R attended the appointment. The Trust said it would complete surgery on Miss R’s hip before providing any further treatment to her knee. It arranged Miss R’s total hip surgery for September.
38. In September, the Trust carried out Miss R’s total hip surgery as planned. It arranged a follow up for her in November.
39. In the Trust’s response it said it planned for Miss R’s follow up appointment to be within four to six weeks after the injection.
40. It said orthopaedic outpatient appointments are booked by the Trust’s central booking team. It says the booking team booked Miss R onto the next available appointment which was in February 2025. The Trust said unfortunately it had to cancel the appointment because of unexpected sickness, meaning it had to cancel the clinic. The Trust said it then booked Miss R into the next available appointment which was in March.
41. Our adviser explained there is no specific guidance regarding follow up times after this type of injection.
42. GMC Good medical practice guidance says doctors should promptly provide or arrange suitable advice, investigation or treatment where necessary.
43. Our adviser told us in their experience usually, patients would usually be reviewed at some point between six weeks to three months after a joint injection.
44. The Trust offered Miss R an appointment in February. This was exactly three months after her injection. This was not in keeping with the four to six week timeframe the Trust told her about, after the hip injection. When assessing if this was a failing in the care the Trust provided, we hold the Trust accountable to relevant standards and guidance.
45. In this case we have seen the Trust’s timescale for follow up is at the shorter end of the scale our adviser says they would normally expect in this situation, which is up to three months. This means we consider the Trust offered Miss R an appointment three months after her injection.
46. Unfortunately, the Trust cancelled the February appointment. This was exceptional circumstances and was unavoidable, due to staff sickness. It is not what we would normally expect to see, but we recognise sickness cannot be predicted. We can see the Trust rearranged the appointment quickly.
47. We recognise the Trust led Miss R to think her appointment would be much sooner. We can it understand this was distressing for her when this did not happen. We do not underestimate the impact this will have had on her.
The Trust failed to respond to Miss R requests for a follow up appointment.
48. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. Having done so, we have decided the Trust has already done enough to put right the impact in this part of Miss R’s complaint.
49. Following her injection, Miss R waited until early to mid January to telephone the Trust to chase up her follow up appointment. She said she could not get through to the Trust when she telephoned and left numerous voice messages. The Trust did not call her back until February. Miss R cannot recall the exact date of when it arranged her follow up appointment.
50. She told us not being able to get through to the Trust to speak to someone was extremely frustrating. She was in constant pain and worried about the progress of her treatment.
51. In the Trust’s response, it said the consultant did not have a secretary for some time and the Trust was waiting for someone to come in post. It explained this was the reason for the delay and lack of communication with Miss R. It said it had now filled this position.
52. The Trust said at the time of Miss R’s calls, it had instructed the orthopaedic secretaries to provide cover. It acknowledged this had not happened. The Trust said it has now put a plan in place should the situation happen again. The plan is to ensure a named person has the responsibility to cover any absence.
53. PHSO Principles of good administration standards explains it is important to be customer focused. It says public bodies should provide services which are easily accessible and should do what they say they are going to do. They should also deal with people quickly and promptly.
54. From the evidence we have seen, the Trust did not follow this guidance. Miss R was unable to access the service, and the Trust did not respond promptly to her messages. This is an indication of a failing.
55. Miss R told us she telephoned the Trust in early to mid-January. When Miss R first telephoned the Trust, the Trust said it had taken no action after her joint injection because the secretary had retired. The Trust arranged Miss R’s follow up appointment in February for February.
56. Miss R said during this period of around four weeks she was frustrated about the lack of response and anxious about her follow up care. We recognise this was distressing for Miss R. We do not underestimate the impact this had.
57. Miss R said she is seeking an apology, an explanation and a financial remedy as an outcome of bringing her complaint to us.
58. Our Principles for remedy say an appropriate range of remedies may include an apology, explanation and acknowledgement of responsibility and remedial action.
59. The NHS complaint standards say organisations should offer fair remedies and put things right and identify errors and learn from them to improve the service.
60. The Trust’s response acknowledged Miss R could not speak to anyone when she called. It has apologised and taken steps to avoid this error happening again. The Trust has not considered a financial remedy as Miss R did not ask for one.
61. Miss R told us she is also seeking a financial remedy. Our Scale of Injustice identifies a level two injustice as annoyance, frustration, worry or inconvenience lasting between two weeks and six months. Miss R’s injustice is in keeping with the lower end of this level (around £120).
62. We considered if we should ask the Trust to do further work and consider a financial remedy. When Miss R complained to the Trust, she initially did not request financial remedy. The Trust have answered all of Miss R’s complaint and questions. It has provided responses in keeping with what she asked. Given the work already completed by the Trust and the low level of linked injustice, it is not proportionate or fair for us to approach the Trust to ask it to do further work at this stage as Miss R’s outcomes have changed.
63. We are satisfied the Trust’s remedies are in keeping with what we usually expect to see with this level of complaint, and with what Miss R had asked for. We consider the Trust has acted in line with our Principles for remedy. We will not consider this further.
64. We recognise how difficult it can be to make a complaint. We would like to thank Miss R for bringing her concerns to us.