Patient with multiple sclerosis suffered “significant injustice” due to North Wales health board failure

The health board in North Wales has paid compensation and apologised after it failed to diagnose a patient’s multiple sclerosis for 16 months.

Betsi Cadwaladr University Health Board was responsible for the care, which it had commissioned from an NHS Hospital Trust in England.

The Public Services Ombudsman for Wales (PSOW) launched an investigation after Mr A complained about his care and management following his referral to an NHS Hospital Trust in England by Betsi Cadwaladr University Health Board.

Having commissioned the care from the Trust, the Health Board remained responsible for the monitoring and oversight of the service which the Trust provided.

Mr A was concerned that a consultant neurologist who examined him failed to diagnose his multiple sclerosis between 18 May 2018 and 19 September 2019.

He was also concerned that the complaint responses received from both the Trust and the Health Board were inaccurate and not robust.

The Ombudsman upheld the complaint. She found that the investigation into and the time taken to diagnose Mr A’s condition fell below the appropriate standard of care.

When Mr A’s concern was escalated to the Health Board, the Ombudsman was troubled that the Trust 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 Trust’s complaints response and the option available to the Health Board of seeking its own independent clinical opinion was not considered.

The Ombudsman recommended that Betsi Cadwaladr University Health Board 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, the Ombudsman recommended that the Health Board should:

• as part of its commissioning arrangements, ask the Trust 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.

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.”

Gill Harris, Deputy CEO and Executive Director of Integrated Clinical Services, 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.”