Lancashire Teaching Hospitals NHS Foundation Trust

3. Mr N claims that the Trust should have added him to the radiofrequency denervation procedure waiting list in June 2024, instead of requiring further diagnostic injections for treatment for back pain.

4. Mr N says that as a result of this delay, he suffered additional pain for a prolonged period, significant stress and depression.

5. Mr N seeks to be added to the radiofrequency denervation waiting list, being prioritised as if he had been added in June 2024.

6. Mr N was referred to the Trust in January 2024 after receiving medial branch block injections elsewhere. The pain management consultant at the provider observed that Mr N had received short-term pain relief from medial branch block injections. He considered that Mr N may be a suitable candidate for radiofrequency denervation and believed that this would provide long-term pain relief.

7. After a telephone appointment with a consultant in anaesthesia and pain management at the Trust in June 2024, Mr N thought that he had been listed for the radiofrequency denervation procedure and that he would also receive further medial branch block injections while on that waiting list.

8. In December 2024, when Mr N sought an update from the Trust, he found that he was not listed for the radiofrequency denervation procedure. Instead, he was listed for diagnostic medial branch block injections and informed that he would have to wait for these. Once the further injections were received, if these gave a reasonable degree of pain relief, the Trust said that it would then list Mr N for the radiofrequency denervation procedure.

11. 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.

12. Mr N understandably would like the treatment he believes is likely to help him as soon as possible.

13. The Trust explained that it is their practice to repeat the diagnostic injection to ensure reliability, as repeating it helps confirm the consistency of the pain relief and makes it more likely that radiofrequency denervation will be successful. They said that following the injections, if successful, Mr N will be listed for denervation. The Trust acknowledged that the current waiting list position for the injections is less than adequate, and stated that the department are taking a number of steps to address the current position.

14. The guidance states that in providing clinical care, a doctor must propose and provide treatment only when they have adequate knowledge of the patient’s health and are satisfied that the treatment will meet their needs.

15. This is what the consultant is trying to achieve by doing further injections before carrying out the procedure – they want to assess Mr N’s response so they have adequate knowledge of his health and confidence that the treatment meets his needs. It would be important for the doctor to know the objective response to injections that were given in specific places in the spine, before deciding that the radiofrequency denervation procedure would meet Mr N’s needs.

16. Therefore, the Trust’s decision to carry out further diagnostic tests before performing an invasive and potentially risky procedure was in line with the guidance. There is no indication that the Trust did anything wrong in listing Mr N for further diagnostic injections before committing to listing him for radiofrequency denervation.

17. We realise that this is not the outcome Mr N was looking for when he approached us. We hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for it.

1. We have carefully considered Mr N’s complaint about the Trust and are satisfied that the requirement of the Trust for Mr N to receive further diagnostic injections before being listed for a procedure was in line with the applicable guidance.

2. As we have seen no indication of a failing, we have decided not to investigate further. We recognise how important this complaint is to Mr N and understand the disappointment and frustration he feels at having to wait for further injections. We do not underestimate how difficult it is to endure back pain which interferes with daily activities whilst having to wait for treatment to achieve longer-term pain relief.