Ombudsman finds unacceptable delays in cancer care at north Wales health board

Emily Price

A new report has found that delays in scans and treatment at a Welsh health board likely contributed to a patient’s cancer becoming more advanced.

The Public Services Ombudsman for Wales launched an investigation after ‘Mr C’ complained about the care he received following his prostate cancer diagnosis.

In particular, the Ombudsman considered delays in Mr C receiving a PSMA PET scan – an advanced imaging test that uses a radioactive tracer to identify and visualise prostate cancer cells.

The investigation also probed the delay in the complainant receiving hormonal therapy and its potential impact on the progression of his cancer.

In a public interest report issued today (March 18), the Ombudsman concluded that whilst the care and treatment Mr C received overall followed the NHS Wales National Pathway for Prostate Cancer – there were significant delays at key stages.

As a result, Mr C waited more than three times longer than he should have before his treatment began.

A biopsy indicated that a PSMA PET scan was appropriate for Mr C – but the scan did not take place for almost four months.

The investigation also examined whether Mr C should have received hormonal therapy sooner.

It found that it was clinically appropriate not to start hormonal therapy before the PSMA PET scan was known, as this could have affected interpretation of the scan.

However, because the scan itself was significantly delayed, Mr C’s hormonal therapy was also delayed unnecessarily.

Failure

This meant Mr C waited more than 180 days from the point of suspicion to definitive treatment.

Betsi Cadwaladr University Health Board cited staff sickness and capacity issues as reasons for the delays – but the Ombudsman concluded that this was unacceptable and a clear service failure.

The Ombudsman raised further concerns about the health board’s failure to recognise the delays when responding to Mr C’s complaint.

In the Ombudsman’s report Groundhog Day 2, the office highlighted that poor complaint handling can compound the sense of injustice for complainants and make pursuing concerns exhausting.

The Ombudsman said that escalating Mr C’s complaint further must have been especially difficult given his diagnosis and ongoing treatment.

Whilst complaint handling was not formally within the scope of the investigation, the Ombudsman recommended that the health board reviews its handling of Mr C’s complaint, particularly given its failure to acknowledge clear service failures.

‘Change’

Public Services Ombudsman for Wales, Michelle Morris, said: “This is the fourth report issued over 9 years by my office about delayed prostate cancer management at this health board.

“In previous reports, we urged the health board to fully commit to change and improvement so that men would not need to bring similar concerns to my office again.

“It is therefore bitterly disappointing to be reporting once again on failings in the same area.

“Previous recommendations have not been fully complied with, and the health board’s own improvement plan – agreed with the Royal college of Surgeons – has not been completed.

“A majority of the actions remain outstanding, despite my office having sight of this plan following our last public interest report.

“The health board cited staff sickness and capacity issues as reasons for the delays – explanations that have also been given in previous investigations by my office.

“However, these reasons do not fully explain why Mr C waited more than 180 days from the point of suspicion to definitive treatment.

“On the balance of probabilities, these delays more likely than not contributed to Mr C’s cancer being more advanced.

“The uncertainty this creates will sadly be an enduring injustice for Mr C and his family.”

Recommendations

The Ombudsman made a number of recommendations, all of which Betsi Cadwaladr University Health Board accepted.

These included apologising to Mr C for the delays and sharing the report with the clinicians involved in his care – as well as auditing patients who have required a PSMA PET scan in the last two years to assess waiting times between the point of suspicion and the start of treatment.

Betsi Cadwaladr University Health Board was invited to comment.