Bradford Teaching Hospitals NHS Foundation Trust

Ramsay Health Care UK:

5. Mr P complains about the care and treatment he received from Ramsay Health in relation to cataract surgery he underwent in 2018. He specifically complains:

• he suffered a posterior capsular tear during the procedure • he did not provide fully informed consent for the procedure as Ramsay Health did not tell him that it did not have the facilities to deal with this complication were it to occur and • the tear was not treated as an emergency, and he was sent home to await an appointment at the Trust.

6. He names the consultant ophthalmic surgeon (the consultant) in his complaint.

Bradford Teaching Hospitals NHS Foundation Trust:

7. Mr P complains about the care and treatment he received from the Trust following the cataract surgery he underwent at Ramsay Health in 2018. He specifically complains:

• the Trust sent him home with pain relief when he attended in pain • the Trust damaged his eye during surgery to repair the capsular tear • the Trust has left the capsule too badly damaged to hold a lens • the Trust did not tell him it was unable to repair the capsule and • the Trust did not tell him to be cautious with physical activities and wear eye protection.

8. Mr P names the same consultant in this complaint.

Claimed impact:

9. Mr P has told us he had to undergo two procedures at the Trust to repair the tear he suffered in 2018, and it was unable to fully repair the damage. He says this has left him experiencing ongoing issues including eye strain and headaches and he must now take medication to control the pressure in his eye.

10. Mr P says the capsule was left too badly damaged to hold a new lens leaving the new lens at risk of displacement. He explains the lens displaced in 2023 and he had to have further surgery. He also says he has been signed off work indefinitely and suffers from depression and anxiety because of what has happened.

Outcomes being sought:

11. Mr P would like Ramsay Health and the Trust to provide explanations for what happened, apologise and make service improvements to stop the same things from happening again. He would also like them to pay him a financial remedy.

12. Ramsay Health carried out NHS funded cataract surgery on Mr P’s right eye in 2018. We understand there was a complication during surgery and Ramsay Health did not have the facilities to deal with this. The consultant therefore sent Mr P home to await further surgery at the Trust.

13. Mr P contacted the consultant’s secretary the next day as he was in a lot of pain. The consultant saw him at the Trust later that day and reviewed him. They sent him home with pain relief as there were no theatre slot available to carry out the surgery that day.

14. The Trust performed surgery the following day, and the consultant saw Mr P for post-operative reviews later that month. The Trust performed further surgery the next month and the consultant saw him for a post-operative review the month after that. The Trust then discharged Mr P.

15. In 2023, the lens in Mr P’s right eye displaced when a tree branch hit him on the head leaving him with blurred vision. He went to his local A&E, and they transferred him to the Trust. The Trust saw Mr P in its eye clinic and sent him home to await an appointment.

16. Mr P had a clinic appointment at the Trust later in 2023. This was with a different consultant than he saw in 2018. Mr P’s lens had now fully detached, and he needed specialist surgery to place a new lens. He had a pre-operative assessment in 2024, and the Trust performed surgery later that year.

Ramsay Health Care UK;

20. Mr P complains he suffered a capsular tear during the surgery in 2018. He complains he did not provide fully informed consent for this surgery as Ramsay Health did not tell him it did not have the facilities to deal with this. He also complains Ramsay Health did not treat the tear as an emergency and instead sent him home.

21. The NHS complaints regulations say a person needs to make their complaint to us within a year of becoming aware of the problem they are complaining about. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason for the delay in coming to us.

22. In Mr P’s case, events took place in 2018, and he was aware of his concerns on the day they happened. He originally contacted us with his complaint on in 2024 meaning his complaint is nearly five years out of time. We have spoken with Mr P to understand if there is a good reason for the delay in coming to us.

23. Mr P says he was not aware the Trust was unable to repair the damage caused on in 2018 until the clinic appointment he had with the second consultant in 2023. He says, up until that point, he had been under the impression the damage had been fully repaired, and his lens had been placed in the capsule.

24. Mr P contacted the Trust in 2024 with concerns about how long it was taking to receive a date for the new surgery as well as the care he received in 2018. The Trust acknowledged his complaint and then shared it with Ramsay Health.

25. Ramsay Health wrote to Mr P declining to respond as it said his complaint had been made well outside the one-year time limit. It advised him to seek legal advice or contact NHS Resolution about his request for a financial remedy. We understand he did seek legal advice, and they suggested he complain to us.

26. We think Ramsay Health’s decision not to investigate Mr P’s complaint was reasonable. The NHS complaints regulations say complaints should be made to an organisation within one year. In this case, events took place in 2018, and Mr P was aware of his concerns on the day they happened.

27. We have similarly not seen a good reason for Mr P’s complaint to us being out of time. We have therefore decided not to consider his complaint about Ramsay Health further. However, we hope the information outlined below provides him with some answers about what happened in 2018.

Bradford Teaching Hospitals NHS Foundation Trust:

Issue 1) The Trust sent Mr P home in 2018

28. Mr P complains the Trust sent him home with pain relief when he attended in pain the day after his surgery at Ramsay Health. He says it should have admitted him to hospital. As already explained above, the NHS complaints regulations say a person needs to make their complaint to us within a year of becoming aware of the problem.

29. From what we have seen, Mr P was aware of this concern on the day events took place. He initially brought his complaint to us in 2024 meaning his complaint is nearly five years out of time. We have therefore discussed what happened with him to understand if there is a good reason for the delay.

30. Mr P says a nurse recently told him the Trust should have admitted him due to the pressure in his eye. Whilst we appreciate this information may have added to his concerns, we think he was aware of his complaint in 2018. We have therefore decided not to consider this part of his complaint about the Trust any further.

Issue 2) The Trust damaged Mr P’s pupil during surgeries to repair the capsular tear

31. Mr P complains the Trust damaged his pupil during the first surgery in 2018. He says the consultant initially said it was not an issue and they could repair it during the next surgery. However, following the second surgery, the consultant said they had been unable to repair the damage, and it was too risky to do it now.

32. As already explained above, the NHS complaints regulations say a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so.

33. From what we have seen, Mr P was aware of this concern in 2018. He initially brought his complaint to us in 2024 meaning his complaint is nearly five years out of time. We have therefore discussed what happened with him to understand if there is a good reason for his complaint being out of time.

34. We gather the information the new consultant shared in 2023 led Mr P to question what happened in 2018. We do not think this a good reason for the complaint being brought to us so long out of time. As such, we have decided not to consider this part of his complaint about the Trust any further.

Issue 3) The Trust has left the capsule too badly damaged to hold a lens meaning it had to be placed on the eye itself leaving it at risk of displacement

35. Mr P complains that, following the two surgeries in 2018, the Trust left the capsule too badly damaged to hold a lens meaning it had to be placed on the eye itself. He says he was not aware of this until the appointment with the new consultant in 2023 as the first consultant did not explain this in 2018.

36. We consider Mr P was not fully aware of this issue until 2023 meaning this part of his complaint is in time. We have therefore considered it further.

37. Mr P suffered a posterior capsular tear during the original surgery in 2018. This is where the thin membrane at the back of the eye’s natural lens becomes damaged during surgery. It is a well-recognised complication and one of the most common complications of cataract surgery though still relatively uncommon overall.

38. During surgery, the surgeon opens the front of the capsule to remove the cloudy lens material (cataract). They normally leave the posterior (back) of the capsule intact as it acts as a barrier between the front and back of the eye. It also holds the new artificial lens implant in place.

39. The back of the capsule is very fragile. There are several reasons why it can tear during surgery with the most common cause being how delicate it is. It sometimes gives way when the surgeon removes the lens or cleans the capsule to remove residual lens debris. This is more likely to happen with dense or advanced cataracts.

40. If a posterior tear occurs, the surgeon will usually contain it, prevent any lens fragments from falling into the back of the eye and adjust the plan for implanting the new lens. Depending on the size and location of the tear, the surgeon may still be able to place the new lens in the capsule.

41. If they cannot, the surgeon will choose an alternative position for the lens or use a different type of lens. The surgeon can place the new lens in the sulcus (the space just in front of the capsule), use a scleral fixated lens (where the lens is attached to the wall of the eye) or an anterior chamber lens (where the lens rests in front of the iris).

42. Our adviser saw no evidence the Trust damaged Mr P’s capsule during the two surgeries it carried out in 2018. They said, according to the records from Ramsay Health, the damage to the capsule happened during the surgery there, along with part of the natural lens dropping into the vitreous (the clear, gel-like substance inside the eye).

43. Our adviser explained the type of rupture Mr P experienced cannot be repaired. They said the Trust’s two surgeries in 2018 were to deal with the consequences of the complication. They explained the surgeon removed the dropped lens material and then, a few weeks later, implanted a new lens in the sulcus.

44. Our adviser said placing the new lens in the sulcus is a recognised and accepted approach when the capsule is no longer intact. They said Mr P’s new lens functioned for several years until it displaced following trauma in 2023. They said the Trust then used a different technique to place the next lens.

45. Our adviser explained the Trust used scleral fixation in 2024 which is commonly used when a sulcus placed lens has dislocated. They explained it provides greater long-term stability when the capsule is damaged. Overall, we have seen no evidence the Trust damaged Mr P’s capsule or placed his lens directly on the eye.

46. Our adviser also explained the issues Mr P has experienced since 2018 including eye strain, headaches and needing medication to control the pressure in his eye, etc. are consistent with the long-term consequences of the surgeries in 2018, particularly the Trust’s first surgery in 2018.

47. Our adviser explained this surgery can alter the dynamics of the eye’s fluid and pressure regulation. They said it is well-recognised that patients who experience a posterior capsule rupture and then undergo the surgeries Mr P had at the Trust can develop long term issues.

Issue 4) The Trust did not tell Mr P it was unable to repair the capsule and that the lens had to be placed on the eye itself

48. Mr P complains the consultant did not explain what happened during the surgeries in 2018 at the time. He says he was under the impression the consultant had repaired the capsule, but he later found out this was not the case during the appointment with the second consultant in 2023.

49. We consider Mr P was not fully aware of this issue until 2023 meaning this part of his complaint is in time. We have therefore considered it further.

50. The Trust’s clinic letters from 2018 do explain what happened during each surgery. We understand these were shared with Mr P at the time. However, we recognise they are written using very clinical language.

51. Mr P’s clinical records from the Trust contain very little information about what was discussed during his appointments. The GMC professional standards say doctors must record relevant clinical findings, decisions made, information given to patients and investigations or treatment. It appears this did not happen in Mr P’s case.

52. It is clear from Mr P’s complaint that he did not fully understand what happened during the surgeries in 2018. This suggests it was not clearly explained to him at the time. The GMC professional standards say doctors must give patients the information they need to know in a way they can understand. It appears this did not happen in Mr P’s case.

53. We will consider this further below.

Issue 5) The Trust did not tell Mr P to be cautious with physical activities or that he should always wear eye protection

54. Mr P complains the consultant did not tell him to be cautious with physical activities or wear eye protection. He explains his job involves physical activity meaning he unintentionally put himself at risk of injury between 2018 and 2023. He says it was the second consultant who told him about this in 2023.

55. We consider Mr P was not fully aware of this issue until 2023 meaning this part of his complaint is in time. We have therefore considered it further.

56. Our adviser said the Trust should have provided Mr P with clear advice following the surgeries in 2018. They explained this should have included advice about avoiding activities that could put his right eye at risk and protective measures. This is set out in the RCOphth guidelines. It appears this did not happen in Mr P’s case.

57. We will consider this further below.

Overall

58. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. If we see signs something went wrong, we next look at whether there are signs the events complained about had a negative effect which the organisation has not yet put right.

59. Based on what we have seen, it appears the Trust failed to clearly explain to Mr P what happened during the surgeries in 2018, failed to keep clear records and failed to provide him with appropriate post-operative advice. We do not think this had any impact on Mr P’s care or treatment, but it has clearly caused him unnecessary distress and worry.

60. We have raised our concerns with the Trust, and this prompted it to write to him. In this letter, the Trust acknowledged its records do not show he was told about the original complication, its consequences or the associated risks. It also accepted there were missed opportunities to provide him with clear, tailored information and post-operative advice.

61. The Trust apologised for the impact these issues have had on Mr P and offered him £300 in recognition of the distress and uncertainty it caused him. The Trust also outlined improvements it will be making to its service. These include improving its record keeping, looking at the information it gives patients and strengthening its post-operative advice.

62. Our principles say public bodies should put things right by acknowledging mistakes, apologising, providing appropriate remedies and seeking continuous improvement. We think the Trust’s letter is in line with these principles and an appropriate response to what appears to have gone wrong in Mr P’s case.

63. We will therefore be closing Mr P’s case with us at this stage. We hope our consideration goes some way in addressing his concerns and provides him with some reassurance. We would like to take this opportunity to wish him and his family the very best for the future.

1. We have carefully considered Mr P’s complaint about Ramsay Health Care UK (Ramsay Health) and Bradford Teaching Hospitals NHS Foundation Trust (the Trust). We would like to take this opportunity to recognise the difficulties and distress Mr P has experienced since his original surgery in 2018.

2. We have decided not to consider Mr P’s complaint about Ramsay Health and part of his complaint about the Trust. This is because he brought them to us outside our one-year time limit. We have considered his remaining concerns about the Trust. We have seen indications of poor communication and a lack of post-operative advice.

3. We have raised these issues with the Trust, and it wrote to Mr P recently as a result. In its letter, the Trust acknowledged what went wrong, apologised, offered a financial remedy and outlined improvements it will be making to its service because of what happened. We consider it has now taken appropriate action to put things right.

4. We will therefore not be considering Mr P’s complaint further. We would like to thank him for bringing his concerns to us and for his patience while we investigated them. We hope our consideration has helped him better understand what happened in 2018 and provided some peace of mind.