Mr W complained about a delay in receiving a total knee replacement surgery from Swansea Bay University Health Board, which he had been waiting for since August 2019. The investigation considered whether Mr W’s waiting time for surgery was appropriately managed in line with the Welsh Government’s Rules for Managing Referral to Treatment Waiting Times, specifically when his waiting time clock was re-set in October 2023.
The investigation found that Mr W’s waiting time clock was inappropriately re-set in October 2023. It found no evidence that a clinician had documented that Mr W was medically unfit to proceed with surgery. Mr W required a repeat scan, due to the amount of time he had been waiting, which confirmed his fitness to proceed. The decision to re-set the waiting time clock was also not communicated to Mr W and he only became aware when he made a complaint. As a result of the delay, Mr W had experienced pain, reduced mobility and ongoing frustration. Further to this, he is now in a position where he is not able to proceed with surgery and this opportunity has been lost.
In January 2024, this office published 3 reports in the public interest in relation to the Health Board’s management of the waiting list for orthopaedic treatment. These reports found that in all 3 cases the complainants had been treated unfairly because of errors in the way the waiting lists for orthopaedic surgery were managed. One of the recommendations contained within those reports was that the Health Board should carry out an audit of its waiting list to establish whether any other errors had been made relating to the resetting of waiting list times or improper removal from the list. It is concerning that further errors have subsequently been found despite this audit having taken place. This raises concern about the reliability of the audit the Health Board undertook previously.
The Health Board agreed to the following recommendations:
a) Arrange for the Chief Executive to make an apology to Mr W for the failings identified in the management of his waiting time for surgery.
b) Share this report with relevant staff and reflect on the failings identified, in particular the need for there to be a well documented clinical decision before a patient is deemed unfit for surgery.
c) Appoint an independent person to re-audit its orthopaedic waiting list to establish if any other patients have been treated incorrectly in the same way as Mr W, including incorrect waiting time re-set date and/or not being informed of their waiting time clock being re-set. If any are identified, the Health Board should apologise to those patients and ensure the correct waiting list date is recorded. The Health Board should propose a scope for the audit that should be agreed by this office before the audit commences.
d) Given that the Health Board remained of the view, during the course of my investigation, that it was appropriate to reset the clock in Mr W’s case, it should ensure its training for staff on the application of the RTT guidance includes this type of scenario, to ensure that its approach to waiting list management is in keeping with the RTT guidance.
e) Share the report with its Board which should nominate a Committee to maintain oversight and monitoring of the Health Board’s compliance with these recommendations.