Clinical treatment in hospital
Public Interest Report
Public interest report issued: complaint upheld
Betsi Cadwaladr University Health Board
During another investigation into concerns raised by Mr Y, the Ombudsman received evidence from the Health Board which indicated that, at the time Mr Y was placed on the urgent list for prostate cancer treatment in August 2019, there were a total of 16 other patients with the same urgent clinical priority awaiting the same procedure(prostatectomy – surgery to remove the prostate). As I had reasonable suspicion there were other possible incidents of service failure and maladministration in relation to the other patients on the waiting list, I commenced an investigation using my own initiative power of investigation to consider whether the Health Board exceeded the Referral to Treatment Time (“RTT” – the waiting time management rules) target for cancer waiting times for treatment of prostate cancer in respect of the 16 patients who were awaiting prostatectomies.
My investigation found that, in August 2019, the Welsh policy position in accordance with Welsh Government guidance was that, only patients treated in Wales were reported against the Welsh cancer waiting time targets. The Health Board therefore only produced “breach reports” and undertook harm reviews for the patients it treated. This did not apply to patients referred by the Health Board for treatment in England. Of the 16 patients on the waiting list in August 2019, 8 were referred to England for treatment. If they had been treated in Wales, the breaches of the target timescales would have been reported for all 8 patients because the amount of time they waited for treatment exceeded the 62 and 31-day target for cancer RTT (the target times relate to whether a patient had been designated as urgent suspected cancer or non-urgent suspected cancer). Four of the patients on the waiting list who were treated by the Health Board had exceeded the cancer waiting time target and these breaches of the target timescales were reported and harm reviews were completed.
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 Health Board patients treated in England, the geographical location of treatment should not have left these 8patients in the 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. These failures amounted to maladministration.
The new Single Cancer Pathway (“SCP”)which has replaced all previous cancer targets, has addressed the anomaly of the previous approach and all patients now referred from secondary care for treatment outside Wales for their cancer treatment must be included in cancer waiting times monitoring arrangements and all patients not treated within the target should have an internal breach report completed. However, to remedy the injustice to the 8patients, in line with my approach to remedy, I recommended that the Health Board should return these patients to the position they would have been in had they been treated in Wales and carry out a harm review for each patient. I also recommended that the Health Board reviewed its harm review process to ensure it was in line with the requirements of the SCP.
I have 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 seems to be longstanding. I therefore recommended that the Health Board refers the report to its Board to consider capacity and succession planning for the urology department. The Health Board accepted my recommendations.