Report Date


Case Against

Cwm Taf Morgannwg University Health Board


Clinical treatment outside hospital; Other

Case Reference Number



Upheld in whole or in part

Mr A complained about the care he received from Cwm Taf Morgannwg University Health Board (“the Health Board”). The investigation specifically considered whether there was a failure to identify and diagnose Mr A’s colon cancer via the routine bowel surveillance programme, and whether this failure subsequently caused the treatment he later required to be more invasive, which meant he had to undergo an anterior resection of the colon and have a permanent colostomy bag.

The investigation found that the routine bowel surveillance programme which included radiological investigations, biannual clinic appointments and CEA (a protein produced by some types of cancers) monitoring was appropriate. However there were missed opportunities for further investigations which could have led to an earlier diagnosis. The investigation could not say for certain whether Mr A would have had less invasive treatment options available to him if he had been diagnosed earlier, however, the uncertainty alone represented an injustice to Mr A. Mr A’s complaint was upheld.

The Health Board agreed to apologise to Mr A and pay him a redress sum of £750 to reflect the uncertainty around whether his treatment options could have been less invasive. In addition, it agreed to provide evidence that its Bowel Surveillance Programme included the need for a referral to a Colorectal MDT for specialist advice, if abnormal radiological findings were coupled with a raised CEA level and at that MDT consideration should be given to whether a PET scan is clinically indicated.