Mr B complained that his son (“C”) waited two and a half years for urgent paediatric surgery. Mr B said this was an unnecessary wait and had a significant impact on C’s quality of life. C was 11 years old and a patient of Hywel Dda University Health Board (“the First Health Board”) but as it did not deliver the service C required he was referred to Cardiff and Vale University Health Board (“the Second Health Board”). The Second Health Board determined C needed urgent surgery. C received surgery 151 weeks (two years ten months and twenty days) after he was referred for treatment. During that time C suffered frequent infections, which required antibiotic treatment, and needed an open wound on his side dressed three times per week.
The Ombudsman found that this delay was unacceptable; C should have been afforded greater clinical priority by the Second Health Board. The Second Health Board did not regularly review C and did not consider the impact C’s condition had on his life. Further to this the Ombudsman found that the First Health Board should have provided Mr B with the details of a person he could contact if C encountered a delay with his treatment and that the Second Health Board did not inform the First Health Board that it could not meet the Welsh Government Target for RTT time in this case, and consequently alternative options for treatment were not considered.
The Ombudsman said that the impact of the delay in treating the debilitating condition, which could not improve without surgery, could not be underestimated and that C’s human rights may have been compromised. Both the Health Boards accepted the findings in the report and acknowledged their role in the failings of this case.
The First Health Board agreed that within one month it would:
(a) Apologise to C for its part in the failings identified in this report and make a redress payment to him of £500 in recognition of the injustice he suffered as a result of its actions.
The First Health Board also agreed that within three months it would:
(b) Ensure that all patients referred for a service outside of the Health Board are provided with a point of contact at the First Health Board with whom they can raise concerns if the provider breaches (or indicates it will breach) the 36-week Welsh Government target.
(c) Ensure that if a patient, for whom it has commissioned care, advises the First Health Board that they have (or have been informed they will) wait beyond the 36-week Welsh Government target, a system is in place to ensure that alternative options are considered, based upon the merits of each case.
The Second Health Board agreed that within one month it would:
(d) Meet Mr B (and C, if he would like) to apologise for the failings identified in this report.
The Second Health Board also agreed that within three months it would:
(e) Undertake a review of the complete pathway of care C received since his initial referral to the Second Health Board, in 2009. Any further failings should be considered, along with those already identified in this investigation, using a process akin to the redress arrangements. This should include consideration of both the physical and psychological impact that the delay had on C.
(f) Create a process for paediatric surgery cases, which have been commissioned by another health board, which will trigger engagement with the commissioning health board, if the case is likely to breach the 36-week Welsh Government target, so that alternative options may be considered. It should also commence a review of the processes in place to alert the referring health boards in its other service areas.
(g) Undertake a retrospective audit of the management of all urgent referrals on the waiting list, made to the consultant referred to in this case, since June 2014, using an Independent Consultant Paediatric Urologist. If it is established that the waiting list has not been appropriately managed, or there are other cases where, due to their circumstances, a patient should have been afforded greater clinical urgency, create an action plan to address the concerns.
(h) Refer this report to the Health Board’s Equality Manager and to
the Quality, Safety and Experience Committee, to identify how
consideration of human rights can be further embedded into waiting