Mr C complained about the care and treatment he received between September 2023 and July 2024 following his prostate cancer diagnosis. In particular, we considered the significance of the delays in Mr C receiving a prostate-specific membrane antigen positron emission tomography scan (“PSMA PET scan” – an advanced imaging test that uses a radioactive tracer to identify and visualise prostate cancer cells). We also considered the delay in Mr C receiving hormonal therapy, and the impact this had on the spread of the cancer.
The investigation found that whilst the care and treatment Mr C received, overall, followed the NHS Wales National Optimal Pathway (“NOP”) for Prostate Cancer, there were significant delays in Mr C’s journey on the NOP which led to him waiting more than 3 times as long as he should have done before his treatment was started. A biopsy in January 2024 indicated that a PSMA PET scan was appropriate for Mr C, but it did not happen for almost 4 months. This delay was unacceptable and amounted to service failure. The delays in Mr C’s pathway more likely than not contributed to his cancer being more advanced. This uncertainty will sadly be an enduring injustice for Mr C and his family, so this part of his complaint was upheld.
In relation to Mr C receiving hormonal therapy sooner, the investigation found that it was appropriate for Mr C not to have started this therapy before the outcome of the PSMA PET scan was known as this would have had a potentially significant impact on the interpretation of the PSMA PET scan itself. However, as there had been a significant and unnecessary delay in Mr C undergoing the PSMA PET scan, it followed that there was also a subsequent delay in his hormonal therapy commencing. This was also an injustice to Mr C and this part of his complaint was also upheld.
Of further concern was the Health Board’s failure to recognise the delays highlighted when it responded to Mr C’s complaint. In the thematic report “Groundhog Day 2”, this office emphasised that when public bodies responded to complaints poorly, this compounded the feeling of injustice and can be an exhausting experience for complainants to have to escalate their concerns to this office. Mr C’s case is a prime example of this: it must have been especially hard for Mr C considering his diagnosis and need for ongoing treatment. Although not specifically outlined within the scope of the complaint, there will be a recommendation that the Health Board reviews its handling of Mr C’s complaint in line with its Duty of Candour and a further recommendation in light of the Health Board’s complaint handling and failure to uphold Mr C’s complaint when there was clear evidence there had been service failures.
This office had previously issued 4 reports about delayed prostate cancer management by the Health Board. The Health Board had been urged to fully commit to change and improvement so that men do not have cause to approach this office again with similar concerns. It is bitterly disappointing to have to report once again on the failings of the Health Board in the same area.
The Health Board agreed to the following recommendations:
a) Apologise to Mr C for the failings identified in this report, especially for the delay in receiving a PSMA PET scan and the uncertainty of whether this delay contributed to his cancer being more aggressive and advanced.
b) Share this report with those clinicians involved in Mr C’s care between September 2023 and July 2024 so the findings can be considered and discussed and feedback to this office any improvements or changes presented during those discussions.
c) Share this report with and remind its complaint handling staff of the need for in-depth and robust investigations.
d) Review its local prostate cancer pathways and benchmark it against the NOP, and with those used by other health boards in Wales. A formal audit before and after changes would be required to provide evidence about the impact of any changes.
e) Review this case, in line with its legal requirements under the Duty of Candour, to determine how Mr C’s cancer pathway journey took more than 180 days. The Health Board should then report its findings to its Quality and Patient Safety and Audit Committees and include its findings in its Annual Report on the Duty of Candour.
f) The Health Board should audit those patients that have required a PSMA PET scan in the last 2 years to establish the interval between the Point of Suspicion (“PoS”) and commencement of definitive treatment. It should also establish the length of time patients had to wait to receive the scan and take appropriate remedial action to ensure patient management is in keeping with national guidance.