An independent provider in the Northamptonshire area

6. Mr A complains about the care and treatment an eye clinic in the Northampton area (the Clinic) provided him between July and September 2023.

7. He says on 12 July staff dismissed symptoms in his right eye as normal after cataract surgery and did not offer to see him quickly enough. He says when a clinician saw him his eye was damaged, he needed treatment and had to take time off work.

8. Mr A also complains that staff did not recognise he needed an urgent appointment when he contacted the Clinic with concerns about his left eye on 18 September. He says this resulted in a surgeon not examining him until 20 September. At which point he received a diagnosis of a detached retina and a referral to hospital for urgent surgery.

9. Mr A had surgery in hospital on 21 September.  He says at this point his retina had detached and it was not possible to fully restore his eyesight. He has been left with permanent blurred vision and generally poor eyesight which affects his ability to read and carry out normal daily activities.

10. Mr A says the Clinic did not offer to provide further care after acknowledging failings in the care it provided in September. He feels it should have investigated options for improving his eyesight or provided remedial treatment.

11. In bringing this complaint to us he would like the Clinic to acknowledge what went wrong, apologise for the effect on his eyesight and pay some compensation.

12. What follows is a summary of events. We have not included all the details as both parties are aware.

13. On 23 May 2023 Mr A had left eye cataract surgery.

14. On 11 July he had right eye cataract surgery.

15. On 12 July Mr A contacted the Clinic’s emergency telephone line as he was experiencing discomfort and blurred vision in his right eye. The Clinic explained blurriness is ordinary and advised him not to compare his progress to previous surgery on his other eye.

16. A member of staff made a welfare call later that day. Mr A said his vision remained the same and staff offered him an appointment the same day. During the appointment an optometrist noted he had a right eye corneal abrasion and recommended Mr A continue the drops they prescribed after surgery. The clinician also prescribed chloramphenicol ointment and hyoscan plus. They recommended a follow up review in five days, or sooner if problems occurred.

17. On 18 July a consultant reviewed Mr A and noted his right corneal abrasion had healed.

18. On 18 September Mr A contacted the Clinic as his left eye was now cloudy and he had floaters (spots in vision). Staff arranged an appointment for 20 September.

19. On 19 September Mr A contacted the Clinic again as his eye had worsened. Staff liaised with an eye surgeon who recommended Mr A go to eye casualty. Staff noted Mr A wanted to keep his appointment with the Clinic on 20 September.

20. Mr A called the Clinic back later that day as his local A&E was unable to see him as it was closed for cleaning. Staff liaised with the eye surgeon again who agreed to see Mr A the following day as agreed.

21. A consultant eye surgeon reviewed Mr A on 20 September and noted he had retinal detachment. The consultant referred Mr A to hospital for retinal detachment surgery.

22. Mr A had retinal detachment surgery on 21 September. That must have been a really difficult experience for him.

Issue with right eye

26. Mr A says that on 12 July staff dismissed difficulties he was experiencing with his right eye as normal following cataract surgery and failed to offer an appointment quickly enough. He says he had to wait around three days for an examination.

27. Our adviser explained there are no specific guideline for clinicians to refer to on developing symptoms after cataract surgery.

28. In lieu of specific guidelines, the GMC guidance says doctors must provide a good standard of practice and care. If they assess, diagnose or treat patients they must:

• adequately assess the patient’s conditions, taking account of their history • promptly provide or arrange suitable advice, investigations, or treatment where necessary • take all possible steps to alleviate pain and distress.

• consult colleagues where appropriate.

29. Mr A had right eye cataract surgery on 11 July. At 7.30am on 12 July he left a message on the Clinic’s emergency phoneline as he was experiencing discomfort and blurred vision. The clinic called back at 8.30am and offered him the opportunity to be seen face to face that day. Mr A said he would call again if he wanted to come in.

30. Mr A spoke to the Clinic again at around 2pm and it made an appointment for the following day.

31. An optometrist reviewed Mr A at 9.46am on 13 July. The optometrist noted Mr A had a right eye corneal abrasion (a scratch or superficial cut on the front of the eye) and recommended continuing drops prescribed after surgery, they also prescribed chloramphenicol ointment (an eye antibiotic) and hycoscan plus (eye drops to support the healing of damaged eyes). The clinician agreed to review Mr A again in five days, or sooner if problems arose.

32. Our adviser reviewed Mr A’s medical records from 12 July and noted his right eye was symptomatic and he had problems with his vision. This occurred around 24 hours after he had right eye cataract surgery. Our adviser said this suggested Mr A’s symptoms were directly related to the surgery.

33. GMC guidance explains doctors must promptly provide or arrange suitable advice, investigations, or treatment where necessary. Our adviser said symptoms after surgery can be serious and doctors should review patients experiencing symptoms or poor vision within 24 hours of surgery as soon as possible.

34. Our adviser explained that in this context ‘prompt’ investigations would have been for staff to review Mr A in person and provide treatment on 12 July. As this did not happen he experienced around a 24-hour delay in assessment and treatment.

35. The evidence suggests that the Clinic did not provide Mr A with prompt investigation or treatment on 12 July. This was not in line with GMC guidance, and we have seen an indication of failing in this aspect of the complaint.

36. When we identify an indication of failing, we go on to consider the impact the complainant says this had on them and whether we would be able to link the two.

37. Mr A says the Clinic’s actions meant he had to wait around three days for an examination. This was not the case as the Clinic offered him an appointment the day he called, and a clinician reviewed him the following day.

38. The evidence suggests Mr A experienced around a 24-hour delay in assessment and treatment. He says this led to his eye deteriorating and he needed treatment and time off work. He tells us he continues to struggle with his right eye and feels this may have been avoided if he receive an appointment sooner.

39. A clinician saw Mr A within 48 hours of having surgery and within 24 hours of developing symptoms. Our adviser noted that on 13 July an optometrist identified the cause of Mr A’s symptoms, prescribed medication and arranged a follow-up appointment. They said the treatment and follow-up Mr A received was in line with clinical best practice and he would not have experienced any difference in care had a clinician reviewed him 24 hours earlier.

40. We have not seen any evidence that Mr A was experiencing any problems with his right eye following the appointment on 13 July. The records suggest he did not contact the Clinic again during this time.

41. On 18 July an optometrist reviewed him during a follow up appointment and noted his right corneal abrasion had healed. Our adviser said that whilst the Clinic did not arrange to see Mr A promptly when he reported symptoms, there is no evidence that the delay had any impact on his care or condition.

42. Whilst we recognise the Clinic should have arranged for a clinician to review Mr A the same day he reported symptoms with his right eye, we have not seen any indication doing so would have led to any difference in care.

43. Mr A says he had to take time off work when receiving treatment for his right eye. We understand this was frustrating for him. We have seen no indication that the need for time off work was because of any wrongdoing on the Clinic’s part. Our adviser makes it clear Mr A would have needed the same treatment had a clinician reviewed him 24 hours earlier. Meaning we cannot see any indication Mr A would not have needed time off work had the Clinic have seen him promptly.

44. For us to continue consideration of this aspect of the complaint, we would need to see evidence that the indication of failing may have led to the impact Mr A claims. We recognise Mr A still has issues with his right eye and how distressing this is. Whilst we accept Mr A’s issues with his right eye continue to affect him, we cannot see any indication to link this with any potential failing on the Clinic’s part. For this reason, we are not continuing our consideration of this aspect of the complaint.

Issue with left eye

45. Mr A complains the Clinic did not recognise his retina was detaching and did not arrange an urgent appointment on 18 September 2023. This led to him not receiving surgery until his retina fully detached. He says he has been left with permanent poor vision in his left eye which affects his ability to read and carry out normal daily activities.

46. Mr A says the Clinic did not offer to provide further care after acknowledging failings in the care it provided in September. He feels it should have investigated options for improving his eyesight or provided remedial treatment.

47. The law says we cannot investigate a complaint where a person has (or had) the option to take legal action, unless we consider this is (or was) unreasonable in the circumstances. We have discussed this with Mr A to understand his circumstances and the outcomes he wants. We do not consider whether legal action would succeed but whether it would be a reasonable option to look in to.

Is there a legal route?

48. From our conversations with Mr A it is clear that Mr A feels negligence has occurred. He specifically feels that failings on the Clinic’s part led to him having permanent poor vision in his left eye.

49. Mr A says his permanent poor vision has affected his ability to read and carry out normal daily activities. He says he constantly has blurred vision, and this affects his ability to work. He is seeking financial compensation for the impact this has had on his health and his finances.

50. When we spoke to Mr A he was unsure of the amount he would like as he did not want to ‘bankrupt’ the Clinic.

51. Our Severity of Injustice scale allows the Ombudsman to make fair and consistent recommendations. The scale has six bandings ranging from low level injustices of minor worry frustration and annoyance (£0) up to more significant and profound injustices (level six) representative of life changing severity, disability and on occasions loss of life (from around £12,000 upwards at the sixth banding in the scale).

52. We explored this with Mr A and he was still unable to provide a specific figure. We discussed the fact that he feels clinical negligence on the Clinic’s part led to him experiencing a life changing impact and he is seeking a financial remedy in recognition of this. Appropriate remedies for this are likely to be on the upper levels of our scale and potentially involve significant amounts of compensation were he to be successful in any claim.

53. We consider Mr A does have a legal route (thought we cannot comment on any potential success of a claim). This is because he could achieve financial compensation through the court if negligence is found and upheld. We also recognise that as a biproduct of court, an apology and acknowledgement of impact can be provided even though there is no legal route to specifically achieve those things.

Is it reasonable to pursue a legal claim?

54. After establishing there is a legal route, we have gone onto explore with Mr A if it is reasonable for him to pursue.

55. We spoke to Mr A to understand the complaint, the injustices he says he has faced resulting from his experiences and whether legal action would be reasonable for him to pursue.

56. Mr A said he was open to pursuing legal action. We discussed no win no fee options and Mr A was willing to pursue this. He did not tell us about any barriers to pursuing legal action.

57. In summary, we consider it is reasonable for Mr A to pursue a legal route as he has shown willingness to do so, and we have not been made aware of reason to doubt this reasonableness.

58. For the reasons we have provided, we shall take no further action on this aspect of the complaint as an alternative legal route exists and is reasonable to pursue. We are grateful to Mr A for telling us about his very distressing experiences with his sight.

1. We have carefully considered Mr A’s complaint about the Clinic. We are sorry to hear of the difficulties he has been experiencing with his eyesight and the significant impact this continues to have for him.

2. We have seen an indication that something went wrong with the care the Clinic provided on 12 July 2023. Specifically, we are not satisfied that it promptly arranged and provided treatment.

3. Mr A experienced around a 24-hour delay in care. Whilst this is an indication of failing, we have been unable to link this delay with any negative impact on him. The evidence suggests he would have received the same care and treatment had the Clinic seen him promptly. For this reason, we are not continuing our consideration of this aspect of the complaint.

4. Regarding the issues Mr A raises about care in September, we consider he could take legal action. In speaking with him we understand it is reasonable for him to do so.

5. The following statement explains our decision.