The Scottish Public Services Ombudsman Investigation Report into the Highland NHS Board (23 November 2022)

Summary

A complaint from a patient was made to the Scottish Public Services Ombudsman (SPSO) about the care and treatment provided during the period January 2018 to September 2021. In January 2018 the patient underwent emergency surgery for a perforated sigmoid diverticulum (a complication of diverticulitis, an infection or inflammation of pouches that can form in the intestines).

An emergency Hartmann's procedure (a surgical procedure for the removal of a section of the bowel and the formation of a stoma - an opening in the bowel) was performed. In April 2018, the patient was seen in an outpatient clinic and informed it would be possible to have a stoma reversal.

The patient complained that the Board had continually delayed the stoma reversal surgery which they required, which as of September 2021 had not taken place. The patient also complained that Covid-19 could not account for the delays between the Board informing patient they were ready for surgery around December 2018 and the start of the pandemic in March 2020. The patient noted that as a consequence they had developed significant complications: a large hernia. The patient added that this had severely impacted their personal life and self-esteem, and left them unable to work and reliant on welfare benefits.

Content

What the SPSO found:

• The length of time the patient waited for a flexible sigmoidoscopy to be carried out was unreasonable.
• The use of a 'named person' list led to an unreasonable delay in carrying out a flexible sigmoidoscopy.
• The length of time the patient waited to been seen at an outpatient clinic in January 2020 to discuss surgery following a flexible sigmoidoscopy was unreasonable.
• The length of time patient waited for their planned surgery was unreasonable.
• The Board failed to address and acknowledge the significant and unreasonable delays in the patient's care and treatment, which occurred during the period before the COVID-19 pandemic started. There was a failure in complaint handling by the Board in relation to patient's complaint.

Outcome needed:

• Patients awaiting elective surgery, particularly flexible sigmoidoscopy/endoscopy should have treatment carried out as soon as possible and where clinically necessary the patient's care should be prioritised.
• Patients requiring flexible sigmoidoscopy/endoscopy should be added to the most appropriate waiting list for this type of treatment. 
• Patients should be followed up at outpatient clinic appointments following flexible sigmoidoscopy/endoscopy within a reasonable timeframe.
• A clear treatment path should be in place for patients whose surgery is delayed that is based on current recognised prioritisation criteria.
• The Board's complaint handling monitoring and governance system should ensure that failings (and good practice) are identified; and that learning from complaints is used to drive service development and improvement.
• The Board should comply with their complaint handling guidance when investigating and responding to complaints.