A man who waited 16 months to be diagnosed with multiple sclerosis is set to be given thousands of pounds in compensation due to the "significant injustice" he suffered. The Public Services Ombudsman for Wales published a report on Wednesday regarding the care given to the north Wales patient, known as Mr A.
The report states that Betsi Cadwaladr University Health Board, which was responsible for Mr A's care, had commissioned an NHS hospital trust in England to assess his condition. The patient claimed that a consultant neurologist based at the English trust failed to diagnose his multiple sclerosis (MS) - a serious disease affecting the brain and the spinal cord - between May 18, 2018 and September 19, 2019.
Mr A also said that the health board should have explored a local referral option before sending him to the NHS trust. He added that the complaint responses received from both the trust and the health board were not robust and were inaccurate.
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The ombudsman found that the investigation and the time taken to diagnose Mr A's condition fell below the appropriate standard of care. The report states: "The investigations following the first consultation were inadequate, despite the neurologist noting that Mr A's presentation in May 2018 was strongly indicative of underlying physical disease.
"Mr A had clear and ongoing physical signs which strongly suggested a neurological disorder from the first time he was seen in May 2018. The neurologist did not question or seek an explanation of Mr A's ongoing abnormal physical symptoms but attributed them firstly to an unrelated back problem and later to a psychiatric or psychological disorder. The neurologist also failed to discuss, recognise, and later review the significance of the ongoing abnormal physical signs that Mr A demonstrated on examination."
When Mr A's concern was escalated to Betsi Cadwaladr UHB, the ombudsman said she was "troubled" that it did not properly review the care delivered to Mr A to assure itself that the care it had commissioned was appropriate. Rather, it appeared to "rubber stamp" the NHS trust's complaints response, and the option available to the health board of seeking its own independent clinical opinion was not considered.
Commenting on the report, Public Services Ombudsman for Wales Michelle Morris said: "I am satisfied that an earlier diagnosis would not have materially altered the outcome of Mr A's disease. However, in my view the delay in diagnosis and attribution of his symptoms to psychological or psychiatric factors caused Mr A unnecessary anxiety and uncertainty. This was a significant injustice to him.
“I am concerned that the health board, both at a commissioning level and in its own right, failed to ensure that the trust fully acknowledged and recognised the extent of failings evident in this case together with the impact on Mr A. The lack of an open and timely response to Mr A's complaint was not only maladministration but it also meant that an important part of the health board's monitoring role, which requires it to have rigorous oversight and scrutiny of the commissioned body, was lost."
The ombudsman recommended that Betsi Cadwaladr UHB should provide an apology to Mr A for the failings identified in her report, as well as a total of £6,835.38 in financial redress. In addition, she recommended that the health board should:
- as part of its commissioning arrangements, ask the Trust in England to ensure that its neurological team discuss this case at an appropriate forum as part of reflective and wider learning;
- review its response to this complaint to establish what lessons can be learnt, particularly in relation to when it would be appropriate to seek independent clinical advice on a complaint, as set out in the 'Putting Things Right' guidance;
- share her report with the chair of the health board and its Patient Safety and Clinical Governance Group.
Gill Harris, deputy CEO and executive director of integrated clinical services at Betsi Cadwaladr UHB, said: “We sincerely apologise to Mr A for the findings identified in the ombudsman report and we will be getting in touch directly with the patient.
"We have accepted the ombudsman's recommendations and we are implementing changes in how we monitor patient care for those who have been referred to hospital trusts in England. We will also share the report with the NHS trust in England which provided the care to Mr A to support their improvement."
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