Greater Manchester Integrated Care

3. Mrs A complains the ICB misdiagnosed her son’s skin condition as pityriasis alba. She also complains the dermatologist who made the initial diagnosis gave a second opinion, saying the first one had been incorrect and her son did have vitiligo. She complains her son’s condition was discussed in front of him although she had asked for this not to happen because it upset him.

4. Mrs A states this issue has caused emotional distress for the family. She says cancelled appointments have also caused stress and for family to take time off work.

5. Mrs A wants the ICB to accept its failings, a written apology and an opportunity to meet with relevant staff.

6. Mrs A’s son was referred to a dermatology clinic in July 2021 when loss of pigment in his skin became more prominent and white hairs appeared on his head. This was diagnosed as pityriasis alba (a skin condition that causes light patches on the face, neck, arms, or belly of children and young adults) after he was seen on 4 August 2021.

7. On 9 August 2021 Mrs A requested a second opinion from the family GP. This was arranged for 29 September 2021, when Mrs A and her son were seen by the same dermatologist as on 4 August, who apologised and said the diagnosis was vitiligo (a condition that causes white patches on the skin due to lack of pigment) and not pityriasis alba.

11. Before we decide if we should conduct a detailed investigation into a complaint, we look at whether there are signs the events complained about had a negative effect that the organisation has not put right. We have found the ICB has already done enough to put right the impact of these events. We have considered each of Mrs A’s complaint points below.

Misdiagnosis

12. Mrs A complains her son’s skin condition was misdiagnosed.

13. Our dermatology adviser explained it is not always easy to differentiate between pityriasis alba and vitiligo, especially in the early stages. They said treating vitiligo as pityriasis alba is not dangerous.

14. Although our adviser could not say what condition the child had at that stage, based on the management plan, they would not expect managing pityriasis alba to have a negative impact. They explained vitiligo is a condition that can cause considerable distress. It appears this family did not feel their distress was recognised, but our adviser cannot see any evidence of physical damage due to the condition being potentially misdiagnosed. The problem appears to relate to communication rather than clinical errors.

15. GMC good practice guidance states: ‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must: adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient.’

16. The dermatology clinic letter to the GP dated 25 August 2021 sets out the patient’s history and details of their examination.

17. The letter following the appointment when a second opinion was given, dated 29 September 2021, notes someone in the family had been diagnosed with vitiligo recently. It says additional history was taken and an examination carried out.

18. Having considered what our clinical adviser told us and that the appointments were carried out in line with GMC good practice, we have not seen any signs of failings in relation to this point.

Second opinion

19. Mrs A complains her son saw the same dermatologist for a second opinion.

20. Our adviser explained the information in the records is limited, but from what the ICB has provided it seems the process followed to reach the diagnosis was correct. Our adviser could not find any clinical guidelines that set out what should happen when a second opinion is requested, but generally we would expect a second opinion to be given by a different clinician. The fact the same dermatologist gave the second opinion has caused distress to the family. We consider this indicates a failing.

21. We have reviewed ICB’s final response to understand whether it has taken action to put things right. The response states ‘the service manager is aware of the issue and we will look at our process to make sure that if a second opinion is requested then this is carried out by another clinician’.

22. We consider this is enough to put right this failing. The ICB has accepted the issue and has set out how it will make sure it does not happen again.

23. Mrs A wants the ICB to accept it got things wrong, a written apology and an opportunity to meet with staff. We have reviewed our severity of injustice scale to decide whether this is required. We consider this complaint point has caused a low-impact injustice, which covers annoyance, frustration, worry and inconvenience, and is the result of a one-off incidence of fault. Our severity of injustice scale states this is a level one injustice and says ‘we will usually consider an apology to be an appropriate remedy for these cases’.

24. The final response accepts there was an issue with the second opinion. It has confirmed there will be service improvements to make sure this does not happen again. The response also states ‘Dr [x] sincerely apologises for any distress caused’. We consider the apology and service improvements are enough to put right this issue.

Discussion

25. Mrs A complains her son’s diagnosis was discussed in front of him and this caused him distress.

26. Our adviser explained a doctor should try to accommodate this type of request. They were unable to find any specific guidance on this, but the NICE vitiligo guidelines accept the condition can be distressing.

27. Our adviser told us if a doctor feels it is important for the child to be told the diagnosis, despite the parents’ wishes, the reasons for this should be explained to the parents first. From the limited information available, we do not know if this happened, and no apology or explanation appears to have been given. We consider this suggests a failing.

28. We have considered the ICB final response to understand whether this has been put right. It states the clinician ‘sincerely apologises for any distress caused and has referred your son to a paediatric dermatologist’.

29. We understand this would have been very distressing for Mrs A and her son, but we consider this falls under level one of our severity of injustice scale as this is distress caused by a one-off incident. We consider the ICB’s apology is enough to put this right and we do not think it needs to do anything more.

30. We will be taking no further action on this complaint. We thank Mrs A for bringing the complaint to us to consider.

1. We have carefully considered Mrs A’s complaint about Greater Manchester Integrated Care Board (the ICB, previously called Trafford CCG). We have decided the ICB has already done enough to put right the impact of these events on Mrs A and her son.

2. We were sorry to read about the distress Mrs A and her son have experienced as a result of the ICB’s actions.