An independent provider in the City of Peterborough area

4. Mr A complains about the care and treatment he received from the Hospital relating to his left knee from August 2021 to January 2024.

5. He specifically says:

• the Hospital did not carry out his surgery until 18 May 2022, despite a different hospital telling him he would need the operation in six months for it to be successful

• the Hospital did not offer him any pain management until April 2023 despite him being in excruciating pain from the moment he had the operation

• the physiotherapy appointments he had did not help him, he could not do any of the tasks

• staff pressured him into buying a muscle stimulator device.

6. Mr A says as a result, he has been left in a considerable amount of pain for a prolonged period of time, he cannot get up the stairs and has had to take a lot of time off work. He also says he is out of pocket by £500 for buying the device.

7. Mr A would like a financial remedy and an apology.

8. The GP referred Mr A to the Hospital as an NHS patient on 17 August 2021. Prior to this Mr A had been seen by another hospital who he recalls had verbally informed him he should have his operation within six months. Mr A explained the other hospital offered to do the operation, but could not guarantee it would be done within six months. Mr A told us the other hospital recommended the Hospital and said the operation would be done in time.

9. The Hospital saw him on 26 August 2021 for an examination of his knee and diagnosed him with chronic recurrent patellofemoral joint instability (developed when the knee dislocates or when there is a traumatic dislocation of the kneecap) and the plan was to arrange an MRI scan and review the results.

10. The Hospital initially offered Mr A surgery on 16 February 2022. Mr A declined this as the date was not convenient. It wrote to him on 17 March with an alternative date.

11. The Hospital performed Mr A’s knee replacement surgery on 18 May.

12. Mr A had physiotherapy appointments on 15 and 22 June.

13. The consultant examined Mr A on 22 June, four weeks’ after his operation and the notes show his operative wounds had healed, his knee was swollen but his kneecap remained stable. The medical notes show Mr A had been in considerable pain following the operation, but at this time the consultant recorded the pain was easing off. The consultant advised him to continue with physiotherapy and said he would review him in July.

14. Mr A had a further physiotherapy appointment on 5 July and had another review with the consultant on 13 July.

15. The consultant examined Mr A and noted his ‘quads activity is very poor’ (quadriceps, the group of muscles at the front of thighs). The records show Mr A was undergoing aggressive physiotherapy and the physiotherapists had organised a muscle stimulator (device that sends mild electrical signals for pain relief) to strengthen his muscles.

16. The consultant then saw Mr A during a review appointment on 24 August. The notes show he had ‘hindfoot valgus deformity’ (ankle deformity) which had been present for 15 years. The consultant referred him back to the foot and ankle clinic for a second opinion.

17. Mr A had further reviews in October and November, alongside ongoing physiotherapy.

18. On 9 November, the surgeon who did his operation referred Mr A to an orthopaedic knee consultant (within the Hospital) for a further opinion. The notes show the orthopaedic consultant did not think a further operation would help.

19. Mr A had follow up appointments at the Hospital on 5 June, 7 August, and 23 September 2023.

20. On 8 January 2024, the Hospital gave Mr A some injections for the pain.

Knee surgery

25. We appreciate the time Mr A spent in bringing his complaint to us and discussing his experience. We are sorry to hear about what happened and how this affected him.

26. Mr A complains that his GP referred him to the Hospital in August 2021 for a knee operation. He recalls a different hospital told him the operation must be done within six months or it would not be successful. The Hospital completed his operation on 18 May 2022.

27. Mr A says the length of time he had to wait meant he was in a considerable amount of pain for a long time and that because it was not done within six months it was not a success.

28. We acknowledge it was an incredibly challenging time for Mr A and we understand the physical and psychological impact it had on him, and still does.

29. We understand Mr A was expecting to have his surgery sooner than he did, and that the wait caused him distress. He has also explained the pain he was in.

30. Mr A’s knee problem (patella instability) was long standing from over ten to fifteen years. As a result, our orthopaedic adviser explains treating it urgently or within six months would not give Mr A a better outcome or cure his pain. They clarified it does not need to be treated within six months.

31. Our orthopaedic adviser explained there is no guidance that says how quickly patients should have the type of knee replacement Mr A had, a patella femoral ligament reconstruction. There is also no evidence Mr A was a priority patient.

32. Our adviser explained the timescale for having the operation would depend on NHS waiting lists. The Hospital told us at that time (2021/2022) its waiting time for NHS patients was typically 52 to 65 weeks.

33. The Hospital received the referral on 17 August 2021 and offered Mr A the operation on 16 February 2022. This is just under six months after it received the referral. We recognise Mr A’s declined this date as it was not convenient. The Hospital offered Mr A the surgery within six months and sooner than its average wait times.

34. We note that the decision not to go ahead with the surgery within six months was Mr A’s and therefore we have not seen any indications of failings here on behalf of the Hospital.

Pain management

35. Mr A is concerned the Hospital did not offer any form of pain management until April 2023, despite him being in excruciating pain. He says this has had a massive impact on him physically and mentally and that he had to buy pain killers online.

36. Our orthopaedic adviser directed us to NICE’s Chronic pain guidance which says:

37. “Arrange specialist referral for people with chronic pain (the urgency depending on clinical judgment) if:

• There are red flag signs and symptoms that may indicate serious underlying pathology • Non-specialist management is failing • Chronic pain is poorly controlled • There is significant distress • Where specific specialist intervention or assessment is required.”

38. There is evidence to show the Hospital prescribed Mr A multiple pain killers after his surgery and at his review appointments in 2022. We recognise this was not helping the pain he was experiencing and therefore, in line with NICE’s Chronic pain guidance, the Hospital referred him to the pain clinic and for physiotherapy for further management.

39. Mr A had his first appointment with the pain team to discuss pain management on 5 June. He had another appointment on 2 September. Following this, the consultant approved a left knee nerve block and trigger point injections which he had on 8 January 2024. This is an injection that targets a nerve or group of nerves to provide temporary pain relief.

40. GMC’s Good medical practice says doctors must provide effective treatments based on the best available evidence and take all possible steps to alleviate patient’s pain and distress.

41. Our orthopaedic adviser explained the pain relief the Hospital prescribed was appropriate management. The Hospital prescribed Mr A with pain relief medication and investigated his persistent symptoms in line with Good medical practice. In line with the above NICE guidance, the Hospital then referred him to the pain clinic about pain management.

42. We do not underestimate how much pain Mr A was in, it is clear he suffered a great deal. We have seen evidence he received appropriate pain management. There is no evidence he only received support from April 2023. We therefore, cannot see any indication anything has gone wrong for this part of Mr A’s complaint.

Physiotherapy

43. Mr A is unhappy with the effectiveness of his physiotherapy sessions. He is concerned he could not do any of the exercises and felt the sessions did not help him and left him in even more pain.

44. The CSP’s Quality Assurance Standards provide clear statements on expected features of how physiotherapists should provide their care. Section 8 includes the standards that apply to physiotherapy management and treatment. The relevant standards say:

• there is a system to ensure that physiotherapy care is based on the best available evidence of effectiveness • appropriate treatment options are identified based on the best available evidence, in order to deliver effective care.

45. Mr A’s treatment focused on improving the strength in the muscles, especially his quadriceps post-surgery.

46. Our physiotherapy adviser explains it is common for patients to develop quadriceps weakness and wasting post-surgery (which was unfortunately the case for Mr A), especially from surgery for kneecap problems.

47. The physiotherapists gave him exercises focusing on strengthening within the limits of what he could tolerate in terms of his pain. He completed them in functional positions such as sitting or standing and our physiotherapy adviser explained Mr A used appropriate equipment such as resistance bands.

48. Our physiotherapy adviser explained the physiotherapists provided suitable exercises for Mr A’s presentation after his surgery. We are reassured they did so based on the best available evidence and therefore in line with the CSP Standards.

49. It is clear from the records and Mr A’s own experience that physiotherapy did not help. We do not underestimate how painful his experience has been, and it is clear the sessions caused him pain and distress.

50. We have not seen indications of failings in the physiotherapy sessions he had.

Purchase of muscle stimulation device

51. Mr A also complains the Hospital pressured him into purchasing a muscle stimulator device for £500 but that did not help him. He is unhappy to be out of pocket by £500 and wants a refund.

52. There is evidence in the medical records that shows Mr A was using this machine in clinic prior to doing strengthening exercises. We have seen no evidence staff pressured him to buy one.

53. We understand that Mr A may have felt there was a clinical need to purchase this device. He describes feeling very pressured. The Hospital has not agreed this happened. There are no records relating to any of these kinds of discussions for us to refer to. Therefore, we have two very different versions of what happened.

54. This is not to diminish Mr A’s version of events or how he felt. In the absence of any independent evidence, we cannot be sure what either party said and therefore cannot disprove either version of events.

55. Therefore, we are not able to investigate this part of Mr A’s complaint.

56. We made this decision considering all the challenges Mr A has faced and empathise with these. We hope we have explained our decision clearly.

1. We have carefully considered Mr A’s complaint about an independent provider in the Peterborough area (the Hospital). We are sorry to hear of the pain, frustration and inconvenience he experienced because of the events he complained about. We recognise this was an incredibly difficult time for him, and understand the ongoing pain and distress he is facing.

2. We have not seen indications of failings in respect of the time the Hospital took to arrange his surgery, his pain management, and the care he received during his physiotherapy sessions.

3. In relation to Mr A’s concerns about the Hospital pressuring him into purchasing a muscle stimulator device, we have not been able to reach a firm view on what happened due to the lack of available evidence. We do not disbelieve Mr A’s account and understand he felt under pressure. We explain the reasons for our decision below.