The Royal Marsden NHS Foundation Trust

3. Mr R complains that The Royal Marsden NHS Foundation Trust’s (the Trust) Musculo Skeletal Service (MSK) failed to adequately investigate the pain he was experiencing in his feet and ankles in September 2018, following a GP referral. Mr R says the physiotherapist examining him pressed on his feet and caused him severe pain. They said it was probably arthritis so no further investigation or treatment was arranged.

4. Mr R says the Trust’s inadequate investigation resulted in a delay in identifying that he had osteoarthritis in both ankles, as well as several other conditions which would require major reconstruction of both feet. This resulted in a delay in a referral to an orthopaedic consultant which allowed the situation to worsen, prolonged his pain and suffering unnecessarily, and limited his treatment options.

5. As an outcome, Mr R would like the Trust to make systemic improvements to the MSK service to prevent this from happening to anyone else.

7. The law 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 Mrs R (Mr R’s representative) to understand the reasons why the complaint could not be brought to us any sooner. We have also considered the time the organisation has taken to respond to Mr R.

Mr R’s explanation for the delay

8. Mrs R said both her and Mr R suffered with their own health issues throughout the pandemic, as well as the loss of loved ones to COVID-19, which delayed Mr R approaching the Parliamentary and Health Service Ombudsman. Mrs R tells us that she has been under significant strain this year after having four medical procedures, including two surgeries.

9. Mr R said that after the shock of his diagnosis, given at a private medical consultation in August 2019, he contacted ‘Advocacy for All’ the following day. With the help of his advocate, Mr R initially complained in September 2019 to St Helier Trust (the Trust that has since taken over the MSK service from Royal Marsden).

10. St Helier Trust responded to say that the complaint had been passed on to the Royal Marden, as this was the Trust responsible for the service at time of the events.

11. Royal Marsden Trust responded in November 2019 and directed Mr R to us. Mr R says he disputed most of the responses and replied to the Trust directly.

12. The Trust acknowledged the follow up letter in November 2019 and advised a further response would be sent by mid December 2019, addressing the points raised in the follow up. This did not happen.

13. The advocate approached St Helier again in February 2020 to ask them to help as Royal Marden had not replied.

14. In March 2020, St Helier contact the advocate by telephone to advise they were working with Royal Marsden to provide a response. Mr R tells us he was frustrated at the lack of responses but understood that there was a pandemic going on, and that hospitals were in the forefront of treating patients.

15. At the end of November 2020, still having had no additional response from the Trust, the advocate advised the only option was to send the case to us. They helped Mr and Mrs R to draft the complaint, but advise this took some time due to shielding from COVID-19.

16. Mr R submitted his complaint to us in February 2021. This was 18 months after he became aware of his cause to complain.

Our Consideration

17. We understand Mrs R has had several surgeries and procedures this year which has prevented her from pursuing the complaint on Mr R’s behalf. We are sorry to hear she is in poor health. When considering the time limit, we consider any delays between the date of knowledge until the complainant contacts us. In this case, Mr R contacted us in February 2021. Therefore, we do not consider that Mrs R’s more recent health issues have affected the time taken for the complaint to be brought to us.

18. We consider Mr R’s private consultation in August 2019 to be a reasonable date of knowledge of his complaint. This is when the private consultant diagnosed Mr R with: • bilateral planovalgus deformity of both feet, • medial arches collapsed severe arthritis in the talon-avicular and subtalar joints bilaterally • broken myersons lines.

19. It was at this point Mr R realised that the assessment in 2018 was not thorough enough. Mr R, with the help of his advocate, submitted his initial complaint to the incorrect Trust. This was because St Helier Trust had taken over the MSK service, but we can see that Royal Marsden issued a complaint response directing Mr R to ourselves in November 2019. This was within five weeks of Mr R submitting his complaint. However, Mr R elected to return to the Trust with a follow up response and did not approach us until February 2021.

20. We understand the COVID-19 pandemic, and subsequent lockdowns, were a truly awful time for everyone and the challenges of managing pre-existing health conditions must have been difficult. We note the first lockdown did not occur until March 2020, five months after the Trust referred Mr R to our service. Therefore, we consider the complaint could have been submitted to us several months before the pandemic was declared.

21. We understand the challenging circumstances facing Mr R and acknowledge the pain he was suffering. We can see that Mr R had advocacy support and it is reasonable to expect that the advocate would be aware of our time limit. As such, we can see no exceptional circumstances that prevented Mr R approaching us sooner than he did and therefore we are unable to put the time limit aside.

22. We additionally note that the Trust is no longer responsible for the MSK service. As such, the value of us looking into this now is likely to be very limited as the Trust would be unable to achieve service improvements for something it is no longer responsible for. This is another reason we have decided not to put the time limit to one side in this case.

1. We have carefully considered Mr R’s complaint about The Royal Marsden NHS Foundation Trust (the Trust). We have decided the complaint falls outside of our time limit. We understand Mr R’s complaint means a lot to him and that our decision may be disappointing.

2. We are unable to put the time limit aside because we can see no exceptional circumstances that prevented Mr R approaching us sooner than he did.