NHS Highland apology to patient over surgery delay after complaint to Public Services Ombudsman
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NHS Highland has been criticised for a lengthy delay in removing a bowel stoma from a patient resulting in significant complications requiring more complicated and risky surgery to put things right.
The Scottish Public Services Ombudsman (SPSO) upheld a complaint from patient C about their care and treatment between January 2018 to September 2021.
NHSH was ordered to apologise to C for the "failings" identified, and also ordered to improve the handling of its own complaints procedure.
An NHSH spokesman said: "We fully accept the recommendations of the report and are very sorry for the failures identified in our care for this patient.
"Our chief executive will be writing to the patient to apologise and explain what has been put in place since this happened. The report has also been shared with our teams."
In January 2018, C had emergency surgery for a complication of diverticulitis, an infection or inflammation in the intestines.
A section of the bowel was removed and the formation of a stoma - an opening in the bowel - was performed.
In April 2018 C was told it would be possible to have a stoma reversal.
C complained that the NHSH Board had continually delayed this reversal surgery they required, which as of September 2021 had not taken place.
C pointed out that the Covid pandemic could not account for the delays between the board informing C they were ready for surgery around December 2018 and the start of the pandemic in March 2020.
As a result C developed a large hernia which "severely impacted their personal life and self-esteem, and left them unable to work and reliant on welfare benefits."
The board explained to the Ombudsman that despite a positive reintroduction of surgery in June 2021, they were required to significantly reduce elective surgical activity as Covid patients again increased.
C was said to be at the top of the list for their surgery, however, C would require two consultants. There were limited high dependency beds available for C's post-operative care, causing further delay. The board were therefore unable to offer a definitive timescale for C's surgery.
The Ombudsman took independent advice from a consultant general and colorectal surgeon (the Adviser) leading to a finding that it was unreasonable for C to have waited eight months between being seen in an outpatient clinic in April 2018 and having a flexible sigmoidoscopy (a non-surgical examination) in December 2018.
The Adviser considered that this delay had been due to C having been unnecessarily placed on a "named person list" requiring a specific consultant to carry out what was a routine investigation.
The Ombudsman stated: "The Adviser also noted that it was a further year before C was placed on the waiting list for surgery and that it appeared that there was no monitoring of C's timeline during this period.
"The Adviser told me that there appeared to have been insufficient priority given to C's treatment post-pandemic.
"In conclusion, the Adviser said that the delays were unreasonable and noted that as a consequence C required more complex, demanding, and risky surgery."
The ombudsman added: "I found that the board unreasonably delayed performing a stoma reversal and upheld C's complaint.
"I was also critical of the board's own investigation of C's complaint."
In June 2022, C underwent surgery to reverse the stoma and repair the hernia.
The SPSO report stated that "A clear treatment path should be in place for patients whose surgery is delayed that is based on current recognised prioritisation criteria," therefore the Ombudsman wants to see evidence by January 23 next year that the findings have been shared with relevant staff "in a supportive manner that encourages learning, including reference to what that learning is."
Regarding the "poor quality" of the board's complaint investigation in that it did not address all the issues raised by C, and failed to acknowledge the significant and unreasonable delays in C's care and treatment, which occurred during the period before the pandemic started, the board's complaint handling monitoring and governance system should ensure that failings are identified, and that learning from complaints is used to drive service development and improvement, said the Ombudsman.
