Royal Devon University Healthcare NHS Foundation Trust

3. Mr O complains about the care and treatment he received from Royal Devon University Healthcare NHS Foundation Trust (the Trust) between 2022 and 2023 when he was suffering back pain. He specifically complains:

• the Trust did not do anything to treat his pain during his visit to A&E 3 June 2023 • the Trust unfairly labelled him as aggressive and discharged him from the Trust.

4. Mr O says the impact of these failings has meant: • his condition has got worse • his pain was prolonged • his recovery was delayed and caused other health issues • he has lost the opportunity for a clinical better outcome.

5. Mr O seeks acknowledgement and financial remedy.

6. Mr O has had back pain for a number of years.

7. On 3 June 2023, Mr O attended A&E with back pain. Staff assessed his symptoms and later discharged him with pain killers and safety netting advice.

8. Mr O attended a spinal clinic on 22 August 2023 with an extended scope practitioner who put him on a provisional waiting list for back surgery.

9. Mr O felt this clinician had recorded information incorrectly, so he complained. He also sent messages via a health app function, which the Trust deemed threatening.

10. The Trust discharged Mr O and said he can get spinal care at neighbouring Trusts. This meant he was taken off the provisional waiting list for surgery.

11. Throughout this period of care, Mr O develop other and more serious symptoms such as weight loss, incontinence, bleeding when going to the toilet and loss of feeling in his genitals.

15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

A&E – 3 June 2023

16. Mr O complains the Trust A&E department did not do anything to treat his back pain.

17. Mr O attended A&E on 3 June 2023. We can see from the medical notes at this stage the pain was localised to his lower back, there was no radiation to other areas, no loss of bladder control, no fever and no numbness. Staff later discharged Mr O with pain relief and safety netting advice if his pain worsened or symptoms changed.

18. NICE CKS states clinicians should identify any red flags. These include, cancer, spinal fractures or cauda equina syndrome, which includes symptoms of urinary issues, and leg pain amongst others. If these red flags are present, staff should arrange emergency admission or specialist referral. However, Mr O did not present any of these symptoms at the time. CKS also says X-rays and other imaging for low back pain is not routinely performed.

19. Therefore, we believe the Trust acted in line with relevant guidelines and it was not required to take any further action with the symptoms Mr O presented with to A&E that day.

Discharge from care and taken off surgery list

20. Mr O complains the Trust unfairly discharged him which also meant he was taken off the list for back surgery.

21. Mr O had a consultation with the extended scope practitioner on 22 June 2023, after which he was put on provisional waiting list for surgery.

22. Mr O explained that after the consultation he was very frustrated. He felt information had been recorded incorrectly by the clinician, they had not listened to him and downplayed the severity of his condition.

23. In the period after the consultation, Mr O sent a letter of complaint to the Trust about this consultation. He also sent messages to the Trust via the MyCare app’s messaging function which included:

‘…you should all be ashamed of your lethargic pedantic pathics selves, I’ve never felt such hatred for so many people. Pray that we never meet outside of this setting because I will not be responsible for my actions you collective waste of human resources.’

24. Following these messages, the Trust made the decision to discharge Mr O and informed him that his spinal care should be delt with at a neighbouring Trust, whilst he could still use A&E at Royal Devon University Healthcare NHS Foundation Trust when necessary. This meant the Trust removed Mr O from the provisional surgery list.

25. Appendix C of the violence and aggression policy sets out examples of what it classes as non-physical aggression, including ‘threats or risk of serious injury to a member of staff, fellow patients or visitors’. The Trust felt Mr O’s message demonstrated non-physical aggression.

26. Appendix G sets out the Trust should deal with such threats. 3.1 and 3.2 says ‘the Trust reserves the right to exclude any person or persons, who, in the considered opinion… causes Trust employees, patients or visitors to fear for their safety’.

27. We understand from the Trust complaint file and internal emails that it viewed Mr O’s message as a threat and so he was excluded from the Trust on these grounds. We are of the view this decision was in line with the relevant policies and we have seen no failings in the Trust’s decision to remove Mr O from the waiting list.

Conclusion

28. We have looked at all the available evidence and concluded that the service Mr O received in A&E on 3 June 2023 was appropriate and in line with guidance. We consider the decision to exclude Mr O from the Trust following the messages he sent was in accordance with relevant policy. Therefore, we will not take any further action.

29. We understand this will not the outcome Mr O was hoping for, but we hope it can provide some reassurance. We understand his back pain was affecting his life and causing much frustration. We hope he is able to get the help he needs.

1. We have carefully considered Mr O’s complaint about Royal Devon and University Healthcare NHS Foundation Trust. We were sorry to hear about the pain he was in and the frustration he felt at being removed from the provisional waiting list.

2. We carefully considered all available evidence and after doing this, we have seen no indication that anything went wrong with the service he received from Royal Devon University Healthcare NHS Foundation Trust. Therefore, we have decided not to consider the complaint further. We have explained our reasons in this statement.