Mr A complained about the care that his late mother Mrs B, received at Betsi Cadwaladr University Health Board’s (“the Health Board”) Glan Clwyd Hospital (“the Hospital”). In particular, he said that when it came to the management and care of his mother’s severe rectal prolapse (a rectal prolapse occurs when part of the rectum (back passage) protrudes through the anus), there had been surgical delays by the Colorectal Department going back to 2011. Mr A queried the adequacy of the inpatient medical care provided by a Care of the Elderly Consultant during Mrs B’s admission in May 2018 and had concerns about a delayed diagnosis of his mother’s terminal ovarian cancer during this admission. Mr A was also dissatisfied with the robustness of the Health Board’s complaint response.

The investigation found consistently from 2011 onwards, that in terms of Mrs B’s rectal prolapse management, the clinical decision-making and rationale shown by the Colorectal Surgeons was not in keeping with accepted clinical practice. More straightforward surgical rectal prolapse repair options, including less invasive procedures, were discounted in favour of high risk, unconventional and in one case (which would have  involved the complete removal of Mrs B’s rectum and possibly her anus), extreme treatment options, which would have provided Mrs B with little or no clinical benefit.

Mrs B was initially reluctant to have either a colostomy (where the colon is brought up to the surface of the skin and the bowel opened to form a stoma so the bowel contents can be collected in a stoma bag), or a complete removal of her rectum. As these procedures were the only rectal prolapse treatment options offered to her from 2011 onwards, this was a further factor in the delay.

The Ombudsman was critical of the lack of clinical clarity demonstrated in Mrs B’s case. The mixed messages given to Mrs B concerning the benefits of a colostomy meant it was only on the day of the operation, in March 2018, that she was told definitively the procedure would not benefit her prolapse. Mrs B decided not to go ahead with the operation.

As a result of the failings identified, Mrs B had to endure years of indignity on a daily basis as she dealt with her severely symptomatic prolapse and the accompanying bowel and urinary incontinence. Since 2014, Mrs B had been living with dementia. Mr A referred to his mother being effectively housebound for the last 8 years of her life and being unable to take up social opportunities, including those recommended by the Memory Clinic for her dementia, in case she was “caught short” due to her double incontinence. Whilst the Ombudsman does not have the power to make definitive findings about whether there have been human rights breaches, he was clear that Mrs B’s human rights in relation to Article 8 (which includes the right to respect for private and family life) were engaged as a result of the failings found. He noted that opportunities for Mrs B to develop and maintain her personal identity through external social interactions/relationships were considerably hampered. The family’s relationship with Mrs B and the quality of the time that they spent together were also affected by her rectal prolapse condition and its wider effect, including the uncertainties around Mrs B’s treatment and management. The Ombudsman concluded that the indignity of Mrs B’s condition and the longstanding physical and mental impact the failings had on her and her family caused significant injustice to Mrs B. This part of Mr A’s complaint was upheld.

In relation to Mrs B’s last inpatient admission, and whether her ovarian cancer diagnosis could have been made sooner, the Ombudsman was satisfied on the evidence that Mrs B’s general management and care was appropriate and her ovarian cancer could not reasonably have been diagnosed earlier than it was. Therefore, this aspect of Mr A’s complaint was not upheld.

Finally, the Ombudsman’s investigation found that the Health Board’s complaint response should have identified the extent of the failings when it came to clinical decision-making by the Colorectal team and Mrs B’s delayed rectal prolapse repair. He concluded that the Health Board had missed opportunities to fully learn from Mrs B’s case. The Ombudsman considered the distress and added inconvenience of having to make a complaint to the Ombudsman’s office caused Mr A and the family an injustice. This part of Mr A’s complaint was upheld.

The following recommendations were made to be carried out over a 3 month period:

(a) The Health Board’s Chief Executive should apologise to Mr A, on behalf of the family, for the clinical and complaint handling failings identified.

(b) The Health Board should invite Mr A and his sister to engage with an equivalent to the Putting Things Right Redress process via its Legal and Risk Services Team.

(c) The Health Board should review how its Colorectal team carries out rectal prolapse procedures.

(d) The Health Board should share the points of clinical learning from this case at an appropriate colorectal clinical forum.

The Health Board agreed to implement the above recommendations.