Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

6. Ms O complains about aspects of care and treatment Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust provided to her friend, Mr A in March and April 2024. She says the Trust:

• took too long to diagnose Mr A with cancer • Did not provide Mr A with the correct cancer treatment.

7. She says Mr A died in pain, and she and Mr A’s family feel Mr A could have had a better chance of survival if he had been diagnosed with cancer sooner.

8. Ms O wants the Trust to make service improvements.

9. In October 2023, Mr A initially approached his GP with stomach issues. He had been struggling with IBS symptoms.

10. On 19 March 2024, the Trust referred Mr A on the two-week lower GI (Gastrointestinal tract - a system responsible for the digestion and absorption of food) cancer pathway. This was due to the results of a CT scan which had been requested by the GP.

11. On 23 March, the Trust conducted a colonoscopy (a medical procedure used to examine the large intestine (colon) and rectum). A lesion was seen in the colon and some biopsies were taken.

12. On 2 April, Mr A’s case was discussed in an MDT (multidisciplinary team) meeting.

13. On 18 April, Mr A attended a clinic appointment at the Trust. The consultant explained they were concerned Mr A had bowel cancer, and this had potentially spread to the liver and possibly the lining of the abdomen. They explained further biopsies were required, as the biopsies taken during the colonoscopy were inconclusive.

14. Ms O says the Trust told Mr A at this appointment that if he did have cancer, it was the lowest form.

15. On 30 April, Mr A attended an appointment at the Trust for a liver biopsy. His heart rate was too high, so this could not be carried out.

16. On 3 May, the Trust conducted a liver biopsy on Mr A.

17. On 15 May, the Trust informed Mr A his cancer was terminal.

18. On 24 May, Mr A sadly died.

Diagnosis:

22. Ms O complains the Trust took too long to provide Mr A with a diagnosis of cancer.

23. On 21 March, Mr A’s GP submitted a referral for him to the Trust under the two-week cancer pathway. In its complaint response, the Trust explained it had followed the relevant pathways, however Mr A required some further testing to establish a diagnosis which can take longer than 28 days from the GP referral.

24. Guidance from NHS England states the two week wait pathway is designed to provide patients with a diagnosis at 31 days and definitive treatment by 62 days. By day 62, the Trust had not yet provided Mr A with his cancer diagnosis.

25. In line with the above guidance, the Trust should have provided Mr A with a diagnosis by 21 April (31 days after the GP placed him on the pathway). The Trust did not provide Mr A with his diagnosis until 15 May, a delay of 24 days.

26. It took 65 days from the date Mr A was placed on the cancer pathway before he was informed of his diagnosis. This was primarily because the original biopsy performed on 23 March and colonoscopy was unexpectedly negative, and he had to proceed to a liver biopsy on 3 May to confirm the diagnosis.

27. There is nothing in the medical records to suggest the colonoscopy was not conducted properly. Our adviser explained if cancer had shown up on the colonoscopy, the above timescales are likely to have been met.

28. Mr A attended the Trust for a liver biopsy on 30 April. This had to be delayed, as he had tachycardia (fast heart rate exceeding 100 beats per minute) and ascites (abnormal fluid build up in the abdomen). Ascites needed to be drained before the biopsy could be actioned. This was in line with BMJ guidance on the use of liver biopsy in clinical practice, which highlights there are risk factors associated with conducting a liver biopsy in patients with tachycardia and ascites. This is usually due to risk of bleeding.

29. The diagnosis of cancer was not made until after the liver biopsy on 3 May and Mr A was not told this formally until his outpatient appointment on 15 May. At that time, it was clear that he was too unwell to receive any active therapy.

30. Although the timescale in the guidance was not met, our adviser explained Mr A would have had disseminated malignancy (this refers to cancer that has spread extensively from its original site to multiple parts of the body, often indicating an advanced stage of disease) for up to 18 months before the diagnosis, therefore unfortunately the delay of 24 days would not have made a difference to the curability of the cancer.

31. The Trust diagnosed Mr A with cancer 65 days after his GP placed him on the cancer pathway, when the target written in guidance is 31 days. We find the Trust could not have done anything differently that would have meant Mr A received a cancer diagnosis sooner, as the initial colonoscopy was inconclusive, this meant the Trust had no option but to conduct further biopsies and tests.

32. We therefore do not uphold this part of the complaint.

Cancer treatment:

33. Ms O says Mr A died in pain, and she and Mr A’s family feel he could have had a better chance of survival if he had been diagnosed with cancer sooner.

34. In its response, the Trust explained pain and treatment was discussed during consultations. This can be shown in the medical records, which show Mr A was known to the palliative care team from 20 May, and had access to support from this team for pain relief at end of life. The records also highlight that Mr A declined hospice care.

35. Our adviser explained earlier diagnosis is very unlikely to have resulted in any treatment being feasible, as Mr A’s cancer was sadly very advanced.

36. Our adviser stated although Mr A was too unwell to receive cancer treatment, a course of action from the Trust could have been managing Mr A as a cancer patient between the time of the colonoscopy when likely cancer was visualised, and the actual diagnosis.

37. There is no guidance to say what should happen in this scenario. As Mr A’s diagnosis was not confirmed at this point, we cannot say for certain that the Trust should have provided Mr A with support from the cancer team sooner.

38. Our adviser explained although NHS England guidance states treatment should commence within 31 days of diagnosis, Mr A was too unwell to receive any treatment, shown by the fact he sadly died within several days of his discharge from hospital.

39. We do not consider the Trust not providing cancer treatment sooner to be a failing, as we have seen that Mr A was too unwell to receive this. From Mr A’s medical records, he received input from the palliative care team for his pain relief at the time he needed it.

40. We recognise that Ms O would have experienced distress and uncertainty during the time Mr A’s cancer diagnosis was delayed as she did not know what his prognosis was.

41. We do not uphold this part of the complaint.

42. In considering above, on the balance of probabilities, we have not seen evidence to suggest Mr A’s death could have been avoided had the delay in referral not occurred or that he would have lived longer if the Trust had provided him with further treatment.

43. We are very sorry to learn of Mr A’s sad death, and we do not underestimate the difficult time Ms O has been through.

44. This concludes our final report.

1. Ms O brings a complaint to us about the care the Trust provided to her friend, Mr A. Ms O says the Trust took too long to diagnose Mr A with cancer and did not provide Mr A with the correct cancer treatment. We are sorry to hear the distress this caused Ms O.

2. We consider the Trust could not have diagnosed Mr A with cancer any sooner than it did. We also consider Mr A was unfortunately too unwell to receive cancer treatment.

3. We have not seen evidence in our investigation to suggest Mr A’s death could have been avoided had the Trust diagnosed him with cancer sooner, or that he would have lived longer if the Trust had given him further treatment.

4. We do not uphold this complaint.

5. We are saddened to hear of Ms O’s loss and appreciate this continues to be a traumatising time. We hope our consideration of this complaint helps bring some closure.