Issue - it took over three years from the point of referral in 2022, for the SCS surgery to be performed
17. Miss A injured her ankle which led to her undergoing several operations that did not resolve the issue. A physiotherapist diagnosed Miss A with CRPS in 2017. Miss A was visiting a pain management doctor from January 2021, who went on to refer her for consideration for SCS on 11 January 2022.
18. The Trust received this referral on 14 July 2022. In assessing Miss A, staff requested her medical records from her GP, got her to complete an SCS questionnaire on 7 October, performed an MRI scan on 6 January 2023 and raised her case at a MDT pain meeting on 17 March 2023. As a result of these enquires, the Trust’s plan was to perform a trial of burst stimulation through temporary percutaneous electrodes with a switch to paddle electrode if the trial was successful.
19. On 12 April the Trust added Miss A to the surgery waitlist for stage one of her SCS. It was considered ‘routine’ in urgency. The Trust then referred Miss A’s surgery to the second Trust for the stage one trail because of the wait time. The second Trust does not form part of Miss A’s complaint.
20. On 28 July Miss A raised concerns with the Trust about whether staff should try burst stimulation or neuromodulation to treat her. She said staff had previously discussed both options with her. The Trust encouraged Miss A to give both options ample thought. She then confirmed she was keen to proceed with trial of stimulation, to gauge its effectiveness.
21. We see from the records Miss A attended an online education session with the Trust’s staff on 26 September. As part of this session, the Trust explained to Miss A the process, risks and recovery expectations. It was during this meeting Miss A raised concerns about the wait time and how this may impact her desire to start a family.
22. On 30 November the second Trust performed the stage one burst trial of Miss A’s SCS. The Trust made a routine follow-up call to Miss A after her surgery, within which Miss A confirmed receiving 80% overall relief from the SCS procedure, with much less disturbance in sleep due to pain.
23. Miss A attended the Trust on 8 December to conclude her SCS temporary trial. She was reviewed by the Trust and reported being pleased with the outcome and the trial’s effectiveness.
24. She reiterated the overall 70% to 80% reduction in pain and improved sleep. She also noted other benefits, such as the disappearance of the burning sensation in her foot, a lighter mood and improved mobility: indicating to the Trust the trial successfully achieved her goals. Following this review, the Trust added Miss A to the waitlist for stage two of her SCS: again, the Trust considered the procedure ‘routine’ in urgency.
25. In March 2024, Miss A attended her GP surgery regarding her mental health. As a result of this meeting, her GP contacted the Trust on 15 March to make enquires about the wait time and to reiterate Miss A’s desire to start a family. Within the letter, her GP believed Miss A’s SCS was supposed to have taken place in November 2023 and had been postponed.
26. As the Trust’s response explained, this was not the case, outlining the two-stage nature of Miss A’s SCS treatment. At this point she had completed the trial and was on the waitlist for stage two. The Trust also added there was an ‘exceptionally long and varied waiting list’, and the wait time was likely to be between six months and a year because stage two would require an inpatient stay.
27. On 14 April Miss A contacted the Trust regarding the communication with her GP. She indicated her NHS app was giving an estimated treatment start date of April 2024. The Trust responded to Miss A explaining how the app was likely reflecting the generic 18-week wait the NHS strives to achieve for routine surgeries. However, because of demand, the SCS wait time is typically longer than 18 weeks. The Trust raised this with its data management team, acknowledging this was misleading.
28. On 21 February 2025, Miss A had her stage two SCS surgery.
29. We appreciate the target wait time for elective surgery, set out by the Department of Health Guidance, is 18 weeks from the point of referral. Our adviser said Miss A’s surgery would be considered elective and acknowledged her surgery fell well outside of the target in this instance.
30. Given Miss A’s condition and symptoms, our adviser suggested there was nothing to indicate any need for prioritising her surgery and the Trust acted appropriately in categorising its urgency as ‘routine’.
31. As such, whilst the 18-week target was clearly exceeded, our adviser said the Trust acted appropriately in categorising Miss A’s surgery. They explained how the 18-week target is often exceeded as a result of significant backlogs, lack of resources and spikes in patient demand. We recognise how frustrating and stressful this time must have been for Miss A.
32. Given the demands on the NHS, our adviser considered the Trust’s actions were in line with national standards.
33. Our adviser acknowledged the pain Miss A was experiencing and the effect the wait and pain was having on her mental health whilst waiting for her surgery. They explained it is down to the discretion of the Trust whether to prioritise on this basis. That said, they added they saw nothing to indicate any significant need to do so.
34. Our adviser explained surgeries are commonly performed based on clinical urgency and the availability of resources.
35. We understand Miss A expressed a desire to start a family at this time and suggests the surgery wait time impacted her ability to do so. Our adviser said this would not be something the Trust should take into account in determining clinical urgency.
36. We can see from the Trust’s response it considered the factors we have described in its wait list process. This was in line with Good Medical Practice. This says doctors must adequately assess the patient’s conditions, taking into account the patient’s symptoms and psychological factors. Good Medical Practice also says clinicians should prioritise patients on the basis of their clinical need.
37. As such, we have not seen any indication the Trust did not act in line with guidance in respect to prioritising Miss A’s surgery, and in how long she then had to wait for it based on the Trust deeming it ‘routine’ rather than urgent.
38. We recognise this was a difficult period for Miss A, and she wanted to have her surgery earlier than she did. We hope our review helps her understand why this was not possible.
Issue - the Trust communicated poorly throughout, never providing reassurances of definitive or accurate estimates for the surgery
39. We can see the Trust initially put Miss A on the waitlist for the first part of her SCS in April 2023. This part of her surgery was later performed in November that year. She was referred for part two in July 2023, prior to stage one.
40. A discussion took place between the Trust and Miss A about the wait time for the final stage of her surgery in September 2023, prior to stage one, during which Miss A highlighted her desire to start a family. The records do not state that Miss A was informed about the expected length of the wait.
41. We can see the Trust informed Miss A in March 2024 the wait time was approximately six months to a year. There is no other discussion about wait times documented in Miss A’s records.
42. We understand Miss A raised concerns with the Trust about the misleading 18 week wait time on the NHS app on 17 April.
43. The Trust explained, in its final response to Miss A’s complaint, it could not advise on exact wait times of the surgery because of its varying nature.
44. Good Medical Practice says, in section 32, patients must receive information they want or need to know in a way they can understand.
45. Our adviser said the Trust’s communication could have been better. There is no evidence to suggest the Trust advised Miss A of the wait times when it initially referred her for surgery in July 2023, nor when she raised concerns about the wait time in September. Our adviser explained staff should have made Miss A aware about the wait times and doing so would have been in line with Good Medical Practice.
46. We recognise the Trust said it was unable to advise on exact wait times throughout because of the varying nature and need to account for emergencies. We also can see the Trust acted in line with Good Medical Practice in March 2024 when it advised Miss A about the estimated current wait times at that point.
47. Given Miss A raised the issue of waiting times in September 2023, and clearly wanted information about this, we would have expected the Trust to give her this information by this point at the latest. We consider this would have helped address the uncertainty she appeared to have on this matter given she raised it at the time.
48. As we established, the Trust only advised Miss A on the wait time in March 2024. As such, we consider there to be a six-month period of uncertainty for Miss A on this matter, which is explained by the lack of communication from the Trust.
49. We can see from the correspondence between Miss A and the Trust, the Trust recognised it did not advise her on expected wait times before March 2024. This is something the Trust apologised for.
50. Similarly, we see from the records the Trust acknowledged the 18-week timeframe provided by the NHS app, apologising for this, recognising it was misleading and raising this issue with its data management team.
51. In bringing this complaint to us, Miss A was seeking financial remedy and service improvements.
52. Our Principles for Remedy say, ‘where maladministration or poor service have led to injustice or hardship, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise. If that is not possible, the remedy should compensate them appropriately’. This can include financial remedy.
53. Our Principles for Remedy also say organisations should learn lessons from poor service. To ensure they do not repeat poor service, they may make changes to policies and procedures, conduct staff training, or do all these things.
54. As we saw the Trust has not yet done these things, and Miss A seeks these outcomes, we approached the Trust about this. In light of the omission it acknowledged on this issue, it agreed to do these things to resolve Miss A’s complaint.
55. We looked at our Guidance on Financial Remedy. We would put the impact of Miss A’s complaint at level two in our Severity of Injustice (SOI) scale. Level two includes where someone has experienced an emotional injustice like uncertainty for around six months, and we cannot see this has impacted on their dayto-day functioning. Within this, payments range from £120 to £550.
56. Having also looked at similar cases where poor communication led to uncertainty and taking into account the impact of Miss A’s situation, we decided a financial payment of £250 is appropriate to address this impact.
57. The Trust has agreed to this and the implementation of service improvements, of which will be provided through an action plan. The Trust will explain what it will do and when to improve in its action plan. As such, we consider this to be enough to remedy Miss A’s complaint.
58. We recognise the remedy we have agreed will not change Miss A’s distressing experience. We hope it helps bring her closure on the events. We hope the Trust’s action plan, when completed, assures her about the learning it is taking from her experience. We know this was an important goal for her when she raised her complaint with us.