Report Date


Case Against

Cwm Taf Morgannwg University Health Board


Clinical treatment in hospital

Case Reference Number



Upheld in whole or in part

Mr K complained that the Health Board did not provide appropriate diagnosis and treatment for a post-operative infection his wife experienced between November 2019 and July 2020. He also complained that the Health Board did not handle his complaint properly.

The investigation found that the complications experienced by Mrs K following her surgery were almost certainly due to a rare reaction to textile used in her wound, local seroma (a mass caused by a build-up of fluid) and a possible infection. However, investigations and treatment of Mrs K’s symptoms were appropriate and reasonable throughout her care. The investigation further found that the Health Board’s handling of Mr K’s complaint did not take Mr K’s wish for input and involvement into account and he was not updated adequately on progress.

The Ombudsman upheld Mr K’s complaint that the Health Board did not handle his complaint properly. The Health Board agreed to the Ombudsman’s recommendations to write to Mr and Mrs K to apologise for its lapse in its complaint handling; pay Mr and Mrs K £500 in recognition of the emotional impact caused by its maladministration; and amend its initial acknowledgement letters for formal complaints. The Health Board also agreed to carry out a review of how Mr K’s complaint was handled, identify and apply any lessons learned and provide Mr K with a copy of the review and an update on wider changes in the Health Board’s Governance Teams.