A medical centre in the London Borough of Ealing

3. Mr I complains about the care and treatment he received from the Practice, LNWUH and Imperial between March to October 2020.

4. In relation to the Practice, he complains that: • In March 2020 after he reported pain and difficulty going to the toilet, he was only given treatment for constipation and no further investigations were made. Mr I says he was later diagnosed with anal cancer when he attended hospital with the same symptoms.

• In October 2020 he requested the Practice arrange a second opinion for the treatment of his anal cancer (due to his concerns about Imperial and LNWUH) but it did not act on this request.

5. In relation to LNWUH he complains that: • LNWUH did not give him any information about his treatment plan after being diagnosed with anal cancer in May 2020 and pressured him into accepting treatment • Did not give him the medication he needed to sleep prior to a stoma operation carried out on 12 June • Did not give him information about the possibility of developing a hernia as a result of the stoma operation and did not respond to his concerns about this following the operation.

6. In relation to Imperial he complains that: • in July 2020 Imperial conducted a psychiatric report on him without gaining his consent • in July and August 2020 Imperial failed to arrange suitable transport for him to and from hospital which met his needs.

7. Mr I says the Practice’s actions delayed him from the initial diagnosis of anal cancer and receiving treatment after he was unhappy with his treatment.

8. Mr I says that LNWUH did not get his informed consent for his cancer treatment which caused him distress and to reach treatment he was not happy with. He says due to the lack of response from LNWUH the hernia was only diagnosed and treated and operated on in October 2020.

9. Mr I says that Imperial’s actions caused him distress and the issue with transportation caused him avoidable pain and discomfort.

10. Mr I wants a financial remedy from all organisations involved and for them to make service improvements.

12. The law we operate under (the Health Service Commissioners Act 1993) says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. We have discussed this with Mr I to understand the reasons why Mr I could not do so. We have also considered the time the organisation has taken to respond to Mr I.

13. Mr I stated his date of awareness for all parts of his complaint was June 2020. For some aspects of his complaint (for example, the Practice not arranging a second opinion) this does not appear to be possible. However, it is our view Mr I would have been aware of his reason to complain for all aspects of his complaint by October 2020.

14. Mr I did not make his complaint to us in writing until 2 March 2022. As such his complaint is at least five months out of time for all parts.

15. We have considered how the time taken for each organisation to respond to Mr I’s complaint affected the time limit: • Imperial record receiving Mr I’s complaint on 11 August 2020 and responded on 16 September 2020 so local resolution took around one month • LNWUH record receiving Mr I’s complaint on 12 September 2020 and issued its final response on 22 April 2021 taking around seven months • The Practice record receiving the complaint (via NHS England) on 16 April 2021 and NHS England responded on 10 May 2021 taking around one month

16. Though the amount of time taken for all organisations to complete local resolution varied we can see Mr I had all of the final responses by 10 May 2021, around 10 months before he made the complaint to us. Therefore, we do not consider the time taken for the organisations to respond to Mr I’s complaint was the cause of his complaint being out of time for us to consider.

17. We asked Mr I about his reasons for why he was unable to complain before 2 March 2022. Mr I said he had submitted the complaint to us as soon as possible after he received the final responses from the organisations but did not provide evidence to support this.

18. We have considered our records of Mr I’s contact with us. Mr I is recorded as first contacting us on 26 April 2021. At that time his complaint was not ready for us to consider as it was not in writing, and we did not have evidence that all three organisations had responded to his complaint. We informed Mr I of the information we needed and sent him a complaint form to complete.

19. Mr I continued to contact the PHSO between May and August 2021. On each occasion we reiterated he needed to submit his complaint in writing and provide evidence that all three organisations had responded. On each occasion a complaint form was sent out for Mr I to complete. We do not consider, on the balance of probabilities, we would have kept informing Mr I of the need to complete a complaint form if he had already done this.

20. Mr I told us he has dyslexia in an email of June 2021, though he did not specify from this that he needed assistance completing the complaint form as a result. We signposted Mr I to an advocacy service if he needed help with the complaints process or filling out the complaints form. There is no indication Mr I followed up this suggestion.

21. Following August 2021 there was a significant gap in Mr I contacting us until 1 November 2021. At this point Mr I said he had difficulty filling in the form due to his dyslexia and could not find the final responses from each organisation. From our records we attempted to get in contact with Mr I several times throughout November 2021 to arrange completing the form over the phone with him. Mr I did not answer our calls or respond to the messages left for him to arrange an alternative time. After this Mr I did not get in contact with us again until the end of December 2021.

22. As Mr I told us he had not received a final response from the Practice, we contacted the Practice in February 2022 to request this. It provided us with the response that NHS England sent to Mr I on 10 May 2021. We do not consider there was a delay in the Practice providing its final response that meant he could not bring his complaint sooner. Neither do we consider the month taken to provide another copy of this was a significant factor in why Mr I’s complaint is out of time.

23. Having considered this our view is there is not a good reason to set aside the time limit in this case. We were clear with Mr I about what information he needed to provide before his complaint was ready for us on multiple occasions, but he did not provide this in a timely manner. We also attempted to provide assistance to help him to complete the complaint form in light of his dyslexia, but he did not engage with this which further delayed bringing his complaint to us.

1. We have carefully considered Mr I’s complaint about a Medical Practice in the Middlesex area (the Practice), Imperial College Healthcare NHS Trust (Imperial) & London North West University Healthcare NHS Trust (LNWUH). We are sorry to hear about Mr I’s experience with the Practice, LNWUH, and Imperial and the impact he says this had on him.

2. We have decided the complaint falls outside of our time limit. We have not seen a clear reason that explains why Mr I could not have complained sooner after he received all three organisations’ responses by May 2021.