Prostate cancer patient “denied potentially curative surgery” by Betsi Cadwaladr University Health Board

A cancer patient in the care of Betsi Cadwaladr University Health Board was denied potentially curative surgery due to an “unacceptable delay”, a new report has found.

The findings, released following an investigation by the Public Services Ombudsman for Wales, came after a complaint was made about the north Wales health board’s care and treatment of Mr B.

It was lodged by Mrs B after her husband had a biopsy done privately due to an unacceptable delay in Betsi Cadwaladr being able to carry out this procedure.

In April 2022, Mr B went to the Emergency Department at Wrexham Maelor Hospital with urinary retention.

As part of the investigation the Ombudsman considered whether Mr B’s symptoms should have led to an urgent suspected cancer referral and if
the Health Board’s management of Mr B’s care, between April 2022 and February 2023, was clinically appropriate and in line with the suspected cancer pathway.

The Ombudsman also investigated:

• If the Health Board’s communication with Mr and Mrs B, including sharing information about investigations and treatment plans, during this time was appropriate;
• If the likely waiting time for a biopsy in August 2022 was reasonable;
• The Health Board’s complaint handling of this case.

What the Ombudsman found

Whilst there were elements of Mr B’s care that were clinically appropriate, including the treatment he received when he attended the Emergency Department in April 2022, the Ombudsman found that Mr B had been denied potentially curative surgery.

The decision not to offer surgery was based on the view his prostate cancer had spread, but, there was uncertainty about whether this was the case.

As a result, the Ombudsman concluded that he should have been offered surgery and that Mr B should have had the opportunity to discuss his complex investigation results and treatment plan with a senior clinician.

The Ombudsman also found that Mr B’s treatment fell significantly outside the suspected cancer pathway target time of 62 days from suspicion of cancer to treatment.

As a result Mr B chose to have a biopsy done privately due to the unacceptable delay in the Health Board being able to undertake this procedure.

Finally, the Ombudsman’s investigation revealed failings in the Health Board’s complaint handling of this case.

Commenting on the report, Public Services Ombudsman for Wales, Michelle Morris, said: “It is of real concern to me that this is the third time my office is highlighting concerns about the Health Board’s delivery of treatment for prostate cancer over recent years.

“Whilst my report notes the ongoing actions outlined by the Health Board, it is concerning that the urology service provision, in particular in relation to prostate cancer, continues to be a problem for the Health Board.

“My predecessor received assurance from the Health Board that it was “grasping the nettle”.

“However, the similarity of the concerns in this complaint raises questions about whether the Health Board’s actions have been effective in improving the service.

“I urge the Health Board to fully commit to change and improvement so people do not have cause to approach my office again with similar concerns.”

The Ombudsman’s Recommendations

The Ombudsman recommended that Betsi Cadwaladr University Health Board should apologise to Mr and Mrs B and pay them £6,850 to reimburse costs they incurred, for the injustice caused to Mr B and in recognition of the time and trouble Mrs B had to go to making the complaint.

In addition, the Ombudsman recommended that the Health Board should:

• Share her report with relevant clinicians.
• Review its complaint handling of this case.
• Summarise actions taken and progress made against the remedial actions and recommendations, following internal and external reviews.
• Betsi Cadwaladr University Health Board has accepted the Ombudsman’s findings and conclusions and has agreed to implement these recommendations.

In light of the concerns identified in this investigation, the Ombudsman’s report will be shared with HIW for it to take into consideration when planning its future work in this area.