A health board caused “injustice” to eight prostate cancer patients after failing to undertake appropriate monitoring of their care and treatment, according to a new wide-ranging report by the Public Services Ombudsman for Wales.

The Ombudsman launched an investigation into Betsi Cadwaladr University Health Board after a report into the case of a prostate cancer patient raised “reasonable suspicion” that there were further incidents of service failure and maladministration linked to other patients on the waiting list during August 2019.

The Ombudsman used his “own initiative” powers of investigation under section 4 of the Public Services Ombudsman (Wales) Act 2019 to consider whether the Health Board exceeded the Referral to Treatment Time target for cancer waiting times in the cases of 16 patients awaiting prostatectomies as of August 2019.

His investigation found that, at that time in question, the Welsh policy position was that only patients treated in Wales were reported against the Welsh cancer waiting time targets. Therefore, the Health Board only produced “breach reports” and undertook harm reviews for the patients it treated. This process did not apply to patients referred for treatment in England.

Of the 16 patients on the waiting list in August 2019, eight were referred to England for treatment. The Ombudsman’s report found that had these patients been treated in Wales, breaches of the target timescales would have been reported in the cases of all eight patients as they waited longer for treatment than the 62 and 31-day targets for urgent and non-urgent suspected cancer cases, respectively.

By contrast, four of the patients on the waiting list treated by the Health Board in Wales exceeded the cancer waiting time target. These breaches of target timescales were reported, and harm reviews were completed for all four patients.

The Ombudsman’s investigation found that the Health Board failed to monitor the provision of care and treatment for all patients as it should have done under its contracting and commissioning arrangements.

Commenting on the report, Public Services Ombudsman for Wales, Nick Bennett, said:

“While the Welsh policy position at the time meant there was no requirement to produce breach reports to the Welsh Government or to carry out harm reviews for patients treated in England, the geographical location of treatment should not have left these eight patients in a position where they were denied the harm review process because they were treated outside Wales.

“Regardless of the Welsh policy position at the time, the Health Board was obliged to undertake appropriate monitoring of the care and treatment of its patients under its commissioning and contracting arrangements. It should also have considered the impact of the delay in treatment in these cases. These failures amounted to maladministration.

“The new Single Cancer Pathway, which has replaced all previous cancer targets, has addressed the anomaly of the previous approach. All patients now referred from secondary care for treatment outside Wales for their cancer treatment must be included in cancer waiting times monitoring arrangements. Also, all patients not treated within the target timescales should have an internal breach report completed.

“To remedy the injustice to the eight patients whose cases I investigated, I recommended that the Health Board should return these patients to the position they would have been in had they been treated in Wales by carrying out a harm review for each patient. I also recommended that the Health Board review its harm review process to ensure it is in line with the requirements of the Single Cancer Pathway.

“I have now reported on the Health Board’s urology service several times, and I am concerned that issues relating to capacity and succession planning within the urology department seem to be longstanding.

“I have therefore recommended that the Health Board refers the report to its Board to consider capacity and succession planning for the urology department.”

Betsi Cadwaladr University Health Board has accepted the findings and conclusions of the Ombudsman’s report and has agreed to implement his recommendations.

To read the report, click here.