Summary

Mrs B complained about her husband, Mr B’s, care and treatment by Betsi Cadwaladr University Health Board (“the Health Board”). Mr B went to the Emergency Department (“the ED”) at Wrexham Maelor Hospital in April 2022 with urinary retention. My investigation considered whether his symptoms should have led to an urgent suspected cancer referral. My investigation also considered whether the Health Board’s management of Mr B’s care, between April 2022 and February 2023, was clinically appropriate and in line with the suspected cancer pathway. I considered if the Health Board’s communication with Mr and Mrs B, including sharing information about investigations and treatment plans, during this time was appropriate. I also considered if the likely waiting time for a biopsy in August 2022 was reasonable. Finally, my investigation considered the Health Board’s complaint handling of this case.

My investigation found that Mr B was treated appropriately when he attended the ED in April 2022 and this complaint was not upheld. I found that, whilst there were elements of Mr B’s care that were clinically appropriate, Mr B was denied potentially curative surgery. The decision not to offer surgery was based on the view his cancer had spread. However, there was uncertainty about whether this was the case and I concluded that he should have been offered surgery.

Mr B’s treatment fell significantly outside the suspected cancer pathway target time of 62 days from suspicion of cancer to treatment. Mr B had a biopsy done privately due to an unacceptable delay in the Health Board being able to undertake this procedure. Mr B should have had the opportunity to discuss his complex investigation results and treatment plan with a senior clinician. These complaints were upheld. Finally, I found failings in the initial complaint handling of this case.

I recommended that the Health Board should:

  1. Apologise to Mr and Mrs B for the failings identified.
  2. Make a financial redress payment of £6,850 to Mr and Mrs B, which includes reimbursement of costs for a private test and consultation, £1,000 for the injustice caused by denying Mr B potentially curative surgery and £250 for the time and trouble caused to Mrs B for the complaint handling failings identified.
  3. Share my report with relevant clinicians to reflect on my findings.
  4. Review its complaint handling of this case to identify any lessons to be learned.
  5. Summarise actions taken and progress made against the remedial actions and recommendations, following internal and external reviews, including those by:
  • the Health Board’s Urology Steering Group
  • the Getting it Right First Time Team (GIRFT)
  • the Royal College of Surgeons
  • task and finish groups set up following review of the prostate cancer pathway.

The Health Board accepted my investigation findings and recommendations.