South Tyneside and Sunderland NHS Foundation Trust

5. Mr Q complains about the vascular surgery care and treatment the Trust gave his late wife, Mrs Q, between November 2022 and June 2024. Mr Q complains the Trust:

• delayed performing a vascular procedure from November 2022 to February 2023 • told Mrs Q in February 2023 she would have her operation in four to six weeks, then in April 2023 told her she was not considered a priority patient and would face a further wait for surgery • decided not to perform the elective vascular interventions for Mrs Q in November 2023.

6. Mr Q says the Trust’s failings destroyed his wife’s independence and wellbeing. He said she experienced mental anguish and was left to suffer in pain. Mr Q says this added further distress to both him and his wife at what was already a very difficult time.

7. Mr Q seeks a financial remedy, an acknowledgement of failings and service improvements for patients with vascular issues.

8. Mrs Q suffered with vascular issues with her legs. The Trust referred her to a consultant vascular and endovascular surgeon in August 2022. The surgeon reviewed Mrs Q and placed her on the waiting list for surgery in October 2022.

9. Mrs Q had blood tests in November 2022 which found her white blood cell count was high. She was also suffering from colitis (an infection affecting the lower gastro-intestinal tract). The surgeon decided to delay intervention until her condition settled.

10. The Trust’s vascular surgeon placed Mrs Q back on the waiting list in February 2023. On the same day, the surgeon reviewed her, carried out a pre-operative assessment and spoke with a pharmacist to discuss medication. The surgeon told Mrs Q she would have the operation in four to six weeks and that the anaesthetist would contact her, which did not happen.

11. In April 2023, Mrs Q contacted the surgeon’s secretary. The secretary told Mrs Q her surgery was delayed due to the length of the waiting list and other patients being prioritised. Mrs Q’s GP wrote to the surgeon in June 2023 to clarify the situation. The surgeon reviewed Mrs Q again in July 2023 and arranged a CT scan. The Trust told Mrs Q her operation would take place at the end of August 2023, and subsequently revised this date to mid-September.

12. The CT scan found problems with Mrs Q’s lungs and the surgeon advised her surgery would be delayed if any further investigations were required. Mrs Q was subsequently told she had an abnormality in her lung and she was diagnosed with lung cancer.

13. The Trust referred Mrs Q to the cardiology team. In November 2023, the cardiologist asked the vascular surgeon if he could carry out the planned vascular procedure, as this would help Mrs Q tolerate chemotherapy.

14. At the end of November, the surgeon advised they would not want to perform an elective vascular intervention until lung cancer treatment had concluded.

15. Mrs Q sadly died in June 2024 and did not undergo any vascular surgery.

The Trust delayed performing Mrs Q’s vascular procedure from November 2022 to February 2023

20. 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 seen any indications that something has gone wrong.

21. The records show Mrs Q was on the waiting list for an iIio-femoral percutaneous angioplasty of both her common iliac and common femoral arteries, with right common femoral and bilateral common iliac “kissing” stents (a minimally invasive procedure to improve the blood supply to the legs, carried out by making incisions in the groin).

22. She had a blood test at the end of November 2022. The consultant who reviewed the results documented they were consistent with an infective picture. They identified Mrs Q had recently experienced an episode of colitis and passed the results on to Mrs Q’s vascular surgeon.

23. At the start of December, the vascular surgeon wrote to Mrs Q’s GP to advise Mrs Q’s white blood cell count was 18 and her CRP (a protein which measures the level of inflammation in the body) was 63. They advised since Mrs Q was suffering from colitis, they would delay vascular intervention until the infection settled.

24. In January 2023, Mrs Q’s GP wrote to the vascular surgeon to tell them Mrs Q’s blood tests were being repeated. The vascular surgeon saw Mrs Q in February 2023 and placed Mrs Q back on the waiting list.

25. GMC ‘Good Medical Practice’ says clinicians should make adequate assessment of a patient’s condition. They should promptly arrange suitable investigations or treatment where necessary and propose effective treatment based on the best available evidence.

26. ESVS ‘Clinical Practice Guidelines’ explain the risks of vascular procedures, including potential limb loss, heart attack and kidney failure.

27. Our adviser said the Trust decision to delay Mrs Q’s vascular procedure was appropriate, both to optimise her medical condition and reduce the risk of any complications from the procedure. They explained that while the procedure is minimally invasive, it still carries significant risks. They said it would not have been safe to proceed with treatment while Mrs Q was suffering from an infection, as indicated by her high heart rate and abnormal blood test results.

28. The Trust consultant reviewed Mrs Q’s blood test results and concluded they represented an infective picture when combined her recent admission with colitis. They informed Mrs Q’s vascular surgeon who decided not to proceed with the non-urgent procedure until Mrs Q had been appropriately investigated and treated. This was in line with GMC and ESVS guidance.

29. We recognise Mr Q’s concern that Mrs Q’s surgery was incorrectly delayed. Having reviewed the evidence, we are satisfied the Trust followed relevant guidance when it decided to delay Mrs Q’s vascular procedure. We will therefore not be looking at this part of the complaint further.

The Trust told Mrs Q in February 2023 her operation would take place in four to six weeks, then in April 2023 told her she was not considered a priority patient

30. The records show the Trust vascular surgeon placed Mrs Q back on the waiting list in February 2023 following review. On the same day, she had a pre-operative assessment and was told she would have the operation in the next four to six weeks.

31. In April 2023, Mrs Q contacted the surgeon’s office because she had not been contacted. The surgeon’s secretary told Mrs Q her surgery had been delayed due to the length of the waiting list and other patients being prioritised. Mrs Q was on the elective rather than the emergency waiting list. As a result, she would face a further wait for surgery.

32. The NHS Constitution says patients have the right to a maximum 18-week wait for nonurgent consultant led treatment following a referral. This does not apply if treatment is delayed in a patient’s best clinical interests or if a patient requires further clinical monitoring.

33. There are no NHS guidelines concerning how often waiting lists should be reviewed or how frequently patients waiting for surgery should be contacted.

34. Our adviser said any contact concerning delays in surgery would usually come from a consultant’s secretary or designated departmental waiting list coordinator. They said Mrs Q had been listed for elective, non-urgent surgery in November 2022 and the delay was initially caused by the clinical requirement for Mrs Q’s colitis to settle down. They said Mrs Q’s diagnosis was of ‘intermittent claudication’ (pain or weakness in the legs brought on by exercise and relieved by rest), and that she had been appropriately added to the elective waiting list for her procedure.

35. Given the context of long waiting lists for elective surgery in the NHS in 2023, our adviser did not think it was unusual Mrs Q had not received a date for her surgery by April 2023, or that she had not been contacted with an explanation. They said the surgeon had followed Mrs Q’s investigations proactively, promptly reviewed Mrs Q when her clinical condition changed and clearly explained the reasons for the delay in her treatment.

36. We recognise Mr Q’s concern regarding the delay to Mrs Q’s elective surgery. Having reviewed the evidence, we are satisfied the Trust acted in line with the NHS Constitution when arranging a date for Mrs Q’s surgery and communicated appropriately with Mrs Q. We have seen no indication the Trust gave Mrs Q incorrect information about the waiting list, and consider the situation evolved when patients of higher priority required treatment sooner than her. We will therefore not be looking at this part of the complaint further.

The Trust decided not to perform Mrs Q’s vascular surgery in November 2023.

37. The records show Mrs Q was diagnosed with lung cancer in November 2023. The vascular surgeon explained in a letter to Mrs Q that carrying out the vascular procedure might delay her cancer treatment and explained the increased risks of stent thrombosis (a complication where a blot clot forms inside a stent). The surgeon also discussed these concerns with a respiratory consultant.

38. Mrs Q met with the surgeon in December 2023 and reported a reduction in the distance she could walk to 15 yards, which was a change from when she had first been listed for surgery.

39. Vascular Society guidance on Peripheral Arterial Disease says clinicians should carry out risk assessments prior to surgical intervention, which should include consideration of existing medical conditions. They say the possible risks and benefits of surgical interventions should be considered and discussed with the patient. Finally, they say patients at risk of developing acute limb ischaemia (a sudden, severe decrease in arterial blood flow to a limb) may require immediate surgical intervention to avoid amputation.

40. Our adviser said the decision not to proceed with elective vascular surgery following a cancer diagnosis was in line with standard clinical practice. They said alongside the risks outlined by the surgeon in his letter to Mrs Q, there was also a risk that if the surgery had proceeded it may have been necessary to perform an endarterectomy (a surgical procedure to remove plaque from a blocked artery). Our adviser said this would have risked significant complications post-surgery, which could have significantly delayed cancer treatment and possibly resulted in limb loss.

41. We recognise Mr Q’s concern regarding the Trust decision not to operate on Mrs Q following her cancer diagnosis. Having reviewed the evidence, we are satisfied the Trust acted in line with standard clinical practice when it reached this decision. We will therefore not be looking at this part of the complaint further.

42. We thank Mr Q for taking the time and effort to bring his complaint to our attention. We recognise this was a very difficult and distressing period for him, following which Mrs Q sadly died. We hope our explanation provides reassurance that the Trust’s communication, care and treatment was in line with guidance. We offer Mr Q our condolences and wish him the best for the future.

1. We have carefully considered Mr Q’s complaint about the vascular surgery care and treatment, his wife, Mrs Q, received from the Trust between November 2022 and June 2024.

2. We are very sorry to hear Mrs Q’s experience caused her and her husband anguish and distress.

3. We have seen no indication anything went wrong in the Trust’s treatment. We consider the Trust followed relevant guidance when it decided to delay Mrs Q’s vascular procedure, acted in line with the NHS Constitution when arranging a date for her surgery and communicated appropriately. We consider the Trust decision not to operate on Mrs Q following her cancer diagnosis was in line with standard clinical practice.

4. We hope our explanation below reassures Mr Q the Trust assessed, cared for and treated Mrs Q in line with relevant guidance.