Our new Public Interest report published today finds delays in scans and treatment more than tripled waiting times and likely contributed to a patient’s cancer becoming more advanced.

The Complaint

We launched an investigation after Mr C complained about the care and treatment he received following his prostate cancer diagnosis.

In particular, we 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 considered the delay in Mr C receiving hormonal therapy and its potential impact on the progression of his cancer.

The Findings

We found 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. However, the scan did not take place for almost four months. We found this delay unacceptable and a clear service failure.

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. This was an injustice for Mr C, leaving him waiting more than 180 days from the point of suspicion to definitive treatment.

We were further concerned about the Health Board’s failure to recognise the delays when responding to Mr C’s complaint. In our report Groundhog Day 2, the office highlighted that poor complaint handling can compound the sense of injustice for complainants and make pursuing concerns exhausting.

Mr C’s case is a clear example. Escalating his 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, we recommended that the Health Board reviews its handling of Mr C’s complaint in line with its legal Duty of Candour, particularly given its failure to acknowledge clear service failures.

Commenting on the report, 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.”

Our Recommendations

We made a number of recommendations, all of which Betsi Cadwaladr University Health Board accepted. These included:

  • Apologising to Mr C for the delays and the injustice caused.
  • Sharing the report with the clinicians involved in Mr C’s care so the findings can be considered and discussed, and providing feedback to us on any improvements identified.
  • 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, and taking appropriate action to ensure patient care aligns with national guidance.
  • Reviewing its local prostate cancer pathways and benchmark it against the National Optimal Pathway and those used by other health boards in Wales, including formal audits before and after any changes.
  • Reviewing Mr C’s case under its legal Duty of Candour to determine how his cancer pathway exceeded 180 days, and reporting the findings to its Quality and Patient Safety and Audit Committees and include its findings in its Annual Report on the Duty of Candour.
  • Reminding complaint handling staff of the need for in-depth and robust investigations.
Read the full report here