University Hospitals of Northamptonshire NHS Group

5. Mr R complains about the Trust and the care, and treatment provided following an appointment in January 2024. Specifically, he complains:

• about the Trust’s decision to discharge him from neurology on in October 2024 • whether the management options provided by neurology were appropriate • past medical information was not reviewed prior to his appointment in January 2024.

6. Mr R says as a result his symptoms are ongoing, and he continues to take multiple painkillers a day.

7. Mr R wants the Trust to acknowledge failings, and a financial remedy.

8. In 2017 Mr R was diagnosed with Chari malformation type 1. This is where the lower part of the brain pushes down into the spinal canal. There are four main types, but type 1, is the most common.

9. In September 2023, Mr R’s GP referred him to neurology due to worsening neurological symptoms of aphasias (ability to communicate effectively), weakness of hands and balance issues.

10. In January 2024, Mr R had a neurology review. A repeat MRI scan of the brain and neck was requested and a follow-up arranged for six months’ time.

11. At the end of January Mr R had his MRI scan.

12. In October, Mr R had a follow-up appointment. He was discharged from neurology and referred for a spinal review.

16. 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 of failings in discharging Mr R from neurology and that the management options provide were appropriate.

17. We also look at whether there are signs the event complained about had a negative effect which the organisation has not put right. Having done so we have found the Trust has already done enough to put right the impact of not reviewing Mr Rs past medical information before his January appointment.

Discharge and management options

18. Mr R complains about the Trust’s decision to discharge him from neurology in October 2024.

19. In responding to the complaint, the Trust said the symptoms Mr R experienced included pain and tingling across both arms, more on the right than left, aching and intermittent subjective imbalance.

20. The Trust said the aim of consultations and investigations is to find/exclude serious conditions. They said no serious neurological problem was discovered and that minor changes found like Chiari malformation and degenerative changes does not explain Mr R’s symptoms and referred him to the spinal team for a review.

21. GMC guidance in providing a good standard of practice and care says ‘if you assess, diagnose or treat patients, you must:

a. adequately assess the patient’s condition, taking account of their history, and values, where necessary, examine the patient b. promptly provide or arrange suitable advice, investigations or treatment where necessary c. refer a patient to another practitioner when this serves the patient’s needs

22. The clinical records show Mr R had various examinations including MRI scans, and nerve studies and he had been seen by three different clinicians (neurologist, neurosurgeon and neurophysiology).

23. The aim of consultations is to find/exclude serious conditions. Our adviser gave their view that there is no evidence to suggest Mr R had a neurological abnormality based on the results of his MRI scan he had at the end of January 2024, that required neurological input.

24. The MRI scan showed a stable (when compared to the March 2017 scan) Chiari 1 malformation, and (age appropriate) degenerative cervical disease. Our adviser said neither of these were severe enough to account for the patient’s ongoing symptoms. While Mr R has had these symptoms for seven or more years our adviser said it had not progressed.

25. Mr R also complains about whether the management options provided by neurology were appropriate.

26. In the Trust’s response it said the pain management programme of Mindfulness, which involves mediation and breathing techniques, helps a person to accept pain, and be aware of the emotions related to pain and this would be helpful in managing pain and other neurological symptoms. It suggested Mr R explores a pain management programme with his GP.

27. As mentioned in point 23, the clinical records show no neurological abnormality. Our adviser has explained the management options of mindfulness app and pain management were appropriate to manage the symptoms Mr R was experiencing. In situations where no neurological abnormality is found following investigations our adviser said it would not be appropriate to continue investigations. It is best to try and manage patient’s symptoms.

28. We understand Mr R is continually experiencing ongoing symptoms and understand he wants to know the reason for this. The evidence suggests, it was appropriate for the Trust to discharge Mr R as there was no neurological abnormality that could explain the symptoms he was experiencing. The evidence also suggests the management options provided to Mr R were also appropriate. We consider the Trust acted in line with GMC guidance.

Past medical information

29. Mr R complains past medical information was not reviewed prior to his January 2024 appointment.

30. The Trust said all past medical information should be reviewed prior to a consultation and apologised to Mr R that this did not happen. The Trust said it has been shared with the neurology team for their reflection.

31. As mentioned in point 21, GMC guidance says you must ‘adequately assess the patient’s condition, taking account of their history, and values, where necessary, examine the patient’.

32. The clinical records support what Mr R said that the clinician did not review his past medical history. Our adviser explained past medical information should be reviewed prior to a consultation but sometimes it may not be available for several reasons. The clinical records suggest the consultant would go back and look at them after the consultation.

33. We understand how important it is for past medical history to be reviewed prior to an appointment. The evidence suggests, this did not happen. In line with GMC guidance, we consider this to be an indication of failing.

34. When we find an indication of failing, we need to look at what impact this would have had on Mr R.

35. Mr R says as a result his symptoms are ongoing, and he continues to take multiple painkillers a day.

36. Our adviser explained that even if the consultant had reviewed Mr R’s past medical history prior to the appointment in January, it would have had no impact on Mr R. The reason for this is he would still have been discharged from neurology because no neurology abnormality was found.

37. We also need to consider whether the Trust has taken steps to put it right.

38. Our principles of remedy say ‘Public bodies should promptly acknowledge maladministration and poor service and apologise for them. An apology means acknowledging the failure and accepting responsibility for it’.

39. We can see the Trust acknowledged the failure and it accepted that past medical information should have been reviewed. It also apologised to Mr R and said the issue has been passed on to the neurology team for their reflection. We consider the Trust has done enough to put right the indication of failing we saw.

40. We would like to assure Mr R we do not think in any way this diminishes the effect the issues in his complaint have had on him. We will take no further action on this complaint.

41. We thank Mr R for bringing his complaint for our consideration.

1. We have carefully considered Mr R’s complaint about University Hospitals of Northamptonshire NHS Group (the Trust). We are sorry to hear about Mr R’s experience and the ongoing symptoms and pain he is still experiencing.

2. We have seen no indication that anything went seriously wrong. We consider it was appropriate for the Trust to discharge Mr R and that the management options provided were appropriate.

3. We consider the Trust should have reviewed Mr Rs past medical history prior to his appointment in January 2024. There is no indication this had a clinical impact on Mr R. We can see the Trust have acknowledged the failing and apologised for this. We consider no further action should be taken on this part of the complaint.

4. We understand our decision may be disappointing to Mr R. We are sorry we cannot help him further. We have explained our decision in more detail below.