Maidstone and Tunbridge Wells NHS Trust

5. Mr H complains about the care and treatment he received at Maidstone and Tunbridge Wells NHS Trust (the Trust).

6. Mr H says that the Trust:

• took ten weeks to offer him surgery rather than the recommended four to six • did not allow him to use his cannabis vape in the designated smoking and vaping area on the hospital site and instead wheeled him out of the hospital site and forced him to self-discharge.

7. Mr H says that he has lost faith in the Trust and he has anxiety about if he has to attend there again. He says that the delay in him being offered surgery meant that he has less mobility in his knee than he should have as he was unable to participate in the physiotherapy that he should have been doing after his initial surgery.

8. Mr H seeks an apology and explanation as to why he received the care he did. He would also like the Trust to review its policies around patients with a medical cannabis prescription and ensure that all staff are aware of these.

9. On 25 May 2024 Mr H fractured his knee cap. On 28 May 2024, he had surgery to insert metal wires into his knee to support the fracture during the healing process.

10. On 23 October 2024 Mr H attended an orthopaedic clinic at the Trust and discussed with the consultant that he was struggling with a limited range of movement in his knee. Mr H was subsequently listed for surgery to remove metal wires from his knee joint and to perform a manual manipulation under anaesthetic after this clinic.

11. On 16 December 2024 Mr H was admitted to hospital as a short stay patient to have surgery on his knee.

12. Following his surgery Mr H was told that he was not able to use his cannabis vape while on the ward. Mr H said that he was previously told that he would be able to use this.

13. When Mr H attempted to go outside to use his vape, he was told that he needed to self-discharge and leave the hospital site to do so.

14. Mr H explained that two members of security staff then packed up his things, put him in a wheelchair, took him off the hospital site and left him by the side of a road. Mr H said that he had to call his wife to come and collect him from there and bring him home.

Wait time for surgery

18. In May 2024 Mr H fractured his kneecap and had surgery to insert wires into his knee to help to fuse his fracture together during the healing process. On 23 October 2024 Mr H attended an orthopaedic clinic at the Trust and explained to it that he was still having ongoing issues with stiffness in his knee. The Trust put Mr H on a waiting list for surgery to have the metal wires removed from his knee.

19. Mr H says that he was told that he should have surgery within four to six weeks to optimise recovery. Mr H told us that he had to wait ten weeks to have his surgery and that it was only offered to him when he chased it with the Trust. Mr H had his surgery on 16 December 2024. Mr H feels that his recovery has been compromised and he has less mobility in his knee than he should have.

20. In its complaint response on 14 February 2025 the Trust explained that demands are high on their service, and it took unexpectedly longer for it to offer him surgery than it initially thought. It explained that this was because there were patients with a more urgent surgical need who it had to perform surgery on before Mr H.

21. The records show that Mr H attended an orthopaedic clinic on 23 October 2024. The records explain that at this point it had been five months since Mr H’s initial injury and surgery to insert metalwork to support the healing of his patella fracture, and he still had a limited range of movement in his knee.

22. The clinician explained to Mr H that they felt that it was important for him to start moving his knee, to reduce any ongoing stiffness, and that he should have the wires in his knee removed to help to facilitate this.

23. We can see from Mr H’s medical records that he had his surgery on 16 December 2024. This is around eight weeks after he was put on the waiting list for surgery after his visit to the orthopaedic clinic.

24. The information that the Trust provided us with shows that on 10 December 2024, six days before Mr H’s surgery, there were nine other patients waiting for similar surgeries to him and at this time, no other patients had received a date for their surgery. The information shows that the average wait time for patients on this list was nineteen weeks. Given that Mr H received his surgery 8 weeks after he was listed for it, he was seen much quicker than many of the patients on the waiting list.

25. The records show that Mr H had the surgery to have the wires inserted into his knee on 28 May 2024. He then was listed for the removal surgery on 23 October 2024, 5 months after his initial surgery. Mr H was then on the waiting list for around eight weeks, meaning that in total he waited around seven months after his initial surgery before the wires were removed from his knee.

26. The GMC guidance says the treatment you provide must be based on an assessment of the patient, and on your clinical judgement about the likely effectiveness of the treatment options.

27. Our adviser explained that the type of surgery that Mr H was having did not require any prioritisation. They explained that this is because it is best to wait for as long as possible before removing any metalwork to allow a fracture to fully heal.

28. The guidance on timing for surgery explains that earlier manual manipulations under anaesthetic can lead to better outcomes in reducing ongoing stiffness and pain. However, our adviser explained that in Mr H’s case, the Trust needed to consider that his kneecap was fractured, and that any early removal of Mr H’s metalwork to facilitate a surgical manipulation may come with the risk of hindering Mr H’s long-term recovery.

29. Our adviser explained that it is usually recommended that following surgery to wait around six months to ensure that the fracture is fully healed before removing the metal wires. In Mr H’s case, he had to wait around seven months before the mental wires were removed and the surgical manipulation was performed. Our adviser said the longer that a person waits to have metal wires removed is better for the patient, as it ensures that the fracture is fully healed.

30. In Mr H’s case, he had to wait two weeks longer than the four to six weeks he was initially advised of to have his surgery. We recognise that this will have been frustrating for Mr H, but as waiting longer to remove the wires may have actually reduced the chance of complications for Mr H, we consider this wait time was in line with the GMC guidance.

31. Our adviser also said that they have seen no evidence that the wait to have his surgery, had a negative impact on Mr H’s recovery.

32. We recognise that it will have been frustrating for Mr H to wait for his surgery, especially as he was concerned about the ongoing stiffness in his knee. We have seen no indications of a failing with Mr H’s wait time for surgery. We will therefore not investigate this complaint point further.

Use of cannabis vape on the hospital site

33. Mr H told us that he had been previously told by a member of staff at the Trust that he would be allowed to use his medicinal cannabis vape while on the recovery ward after his surgery.

34. Following Mr H’s surgery on 16 December 2026 he was told that he was unable to use his vape on the hospital site. Mr H said that the Trust then ‘forced’ him to self-discharge, and he was taken off the hospital site and left at the side of the road by security staff. Mr H said that he had to call his wife to come and collect him and that he nearly fell over attempting to get out of his wheelchair. Mr H said that this was distressing for him as he felt he was left without any post-operative care due to the Trust’s actions.

35. In its complaint response on 14 February 2025 the Trust explained that it does not allow any patient or staff to either smoke or vape on the hospital site. It said that it rightfully advised Mr H that he would need to self-discharge if he wanted to leave the hospital site to vape and provided him with the self-discharge papers to facilitate this.

36. The Trust also explained in its response that Mr H had begun to attempt to leave the ward without signing any discharge papers or discussions about his follow up care. It said that as a result of this, staff were concerned about his safety and therefore asked security staff to escort Mr H as he left the hospital site to vape. It said that security staff asked Mr H if he wanted to return to the ward or stay outside and Mr H said that he wanted to stay outside to vape.

37. Mr H’s records show that while he was on the recovery ward after surgery, he asked staff if he could use his medicinal cannabis vape. The staff advised him that it was the Trust’s policy that he could not vape anywhere on the hospital site. The records also show that Mr H showed staff his prescription certificate for his medicinal cannabis.

38. The misuse of drugs act explains that ‘a person shall not order a cannabis-based product for medicinal use in humans… unless that product is for use in accordance with a prescription or direction of a specialist medical practitioner’. The NHS England guidance then explains that ‘prescribing of cannabis-based products for medicinal use is restricted to clinicians on the General Medical Council’s Specialist Register.’ The medical records show that Mr H has a prescription certificate from a GMC registered doctor, and he showed Trust staff this while on the ward.

39. The Trust policy on vaping says that ‘it would be inappropriate to allow vaping inside Trust buildings or near entrances. People are permitted to vape outside within the Trust grounds, provided they are well away from other people, and at least several metres from buildings and doorways’.

40. As Mr H has a legal prescription for medicinal cannabis, and the Trust policy explains that people are permitted to vape on the hospital site, the Trust were incorrect to advise Mr H that he needed to leave the hospital site, and therefore self-discharge, to use his vape.

41. Mr H says that as a result of this, he had to self-discharge to use his vape. This was stressful for him, as he had been advised to stay in hospital to be monitored after his surgery. Mr H felt that he was made to self-discharge against medical advice. Mr H also says that he worries about what would happen if he attended hospital again and needed to use his vape.

42. Our NHS Complaint Standards say that Organisations should look at what action will be taken to learn from the experience to continuously improve services and help support staff and give meaningful and sincere apologies that reflect the impact on the people concerned.

43. We approached the Trust and asked if it would consider putting measures in place to ensure that all staff are aware of the Trust’s policy on vaping. The Trust agreed to discuss Mr H’s case with its staff, to ensure that they are fully aware of the Trusts policy on vaping, and to write a letter to Mr H apologising for wrongly advising Mr H that he needed to self-discharge to use his vape, and for the impact of this, and confirming that it has ensured that its staff are aware on the Trust policy on vaping.

44. Based on this we are satisfied that the Trust have taken adequate steps in line with Our NHS complaint standards. The Trust has agreed to take learning from Mr H’s case and apologise to Mr H, which are the outcomes that he was hoping to achieve. As such, we consider we have resolved this aspect of Mr H’s complaint.

Mr H’s self-discharge

45. Mr H told us that the Trust made him self-discharge and leave the hospital site to use his cannabis vape. He said that two members of security staff put him in a wheelchair and took him to the side of a road off the hospital site where they left him.

46. Mr H said he was worried, as he was not steady on his feet after surgery, and nearly fell over when attempting to move his wheelchair. Mr H said he then had to call his wife to come and collect him.

47. In its complaint response on 14 February 2025 the Trust explained that Mr H insisted on using his cannabis vape. It said that the staff were worried about Mr H’s safety, as he had just woken up from surgery, and so asked the security staff to accompany him. It said that when the security staff got Mr H off the hospital site it asked him if he wanted to stay there, or to return to the ward. It said that Mr H told them that he wanted to stay where he was so that he could use his vape and so the security staff returned to the hospital.

48. Mr H’s medical records show that the ward staff told Mr H that he would need to leave the hospital site in order to vape and to do so, he needed to self-discharge. In the notes it explains that Mr H refused to sign the self-discharge papers and called his wife and told her that the staff were forcing him to leave. There is also a copy of the self-discharge paperwork that notes that Mr H refused to sign the self-discharge form, however, was leaving the hospital site.

49. A self-discharge is defined as when an individual leaves the hospital site against medical advice. Although we acknowledge that Mr H did not want to sign the self-discharge form, the records show that the staff at the Trust told Mr H that he was leaving against medical advice and as he did so, was effectively self-discharging.

50. We have considered the information provided by Mr H and the information provided by the Trust and feel that we would not be able to reconcile the differing accounts.

51. Although this does not mean that we do not believe Mr H’s account, we do not feel there is sufficient evidence to allow us to make a decision on the balance of probabilities if Mr H wanted to leave the hospital site in order to vape or if the was ‘forced’ to do so by the security staff.

52. As there are two conflicting accounts of what happened here, and there is no further evidence we can gather to help us reach a decision, we consider that we would not be able to reach a satisfactory conclusion so there would be no value in taking this forward for further investigation. Therefore, we will not be looking into this matter further.

53. We would like to thank Mr H for taking the time to bring his complaint to us. We hope the resolution we have achieved reassures him that the Trust have improved its service should he need to attend the Trust in the future.

1. We have carefully considered Mr H’s complaint about Maidstone and Tunbridge Wells NHS Foundation Trust (the Trust).

2. We would like to thank Mr H for taking the time to bring his complaint to us. We recognise that Mr H feels he was treated unfairly while he was at the Trust. We can understand why this was distressing for him.

3. After consideration, we have seen no indications that the Trust took too long to perform Mr H’s knee surgery, or that the length of time that he had to wait for surgery will have negatively impacted his recovery.

4. We have seen indications that the Trust were incorrect to advise Mr H that he was unable to use his cannabis vape while on the hospital site and that he needed to self-discharge to leave the hospital site to do so. The Trust has agreed to write to Mr H to apologise for this and put measures in place to ensure that all staff are aware of the Trust’s policy on vaping. We consider this is in line with Our NHS Complaint Standards and resolves this aspect of the complaint.