Wirral University Teaching Hospital NHS Foundation Trust

7. Mr M complains about the care Mrs M received from the Trust. He says the Trust did not inform her, or take any action, after it removed a cancerous tumour during an appendectomy in 2014.

8. Mr M says the Trust only told Mrs M about the tumour in 2022 after it reviewed her medical records. Mr M says therefore the Trust did not provide any treatment or follow up care.  He believes there was a missed opportunity to have prolonged his wife’s life, who sadly died on 29 March 2023.

9. As an outcome to his complaint, Mr M wants service improvements and a financial remedy.

10. Mrs M had an emergency open appendectomy (a surgical procedure to remove the appendix through an incision in the abdomen) at the Trust in 2014. The Trust discharged her after five days.

11. The histopathology (the microscopic examination of tissue) report the Trust produced after the procedure identified a 3mm neuroendocrine tumour (NET) on the tissue removed during surgery. NETs are rare, slow-growing cancers arising from neuroendocrine cells (specialised cells that release hormones).

12. Around one month later the Trust’s surgeon wrote to Mrs M’s GP with details about the surgery, without any mention the histopathology finding of a NET.

13. In 2022, Mrs M had a surgical procedure at the Trust for an unrelated medical problem. As part of the preparation for surgery, the Trust reviewed Mrs M’s medical history and identified it had missed the 2014 histopathology report.

14. The Trust referred the case to its colorectal multidisciplinary team (MDT) meeting. The MDT identified that no clinical action would have been required in 2014.

15. The Trust met with Mrs M in September 2022 and informed her of the 2014 histopathology finding and apologised for its mistake. It confirmed no further clinical action was required.

16. In early 2023 Mrs M was admitted to the Trust having felt unwell for several weeks. The Trust’s investigations diagnosed she had terminal cancer. Around two months after being admitted to hospital, Mrs M sadly died.

17. As part of its complaint investigation, the Trust referred the case through to a specialist NET MDT at a different NHS trust. This MDT also confirmed no clinical action should have happened in 2014.

22. Mr M complains his wife should have been told in 2014 about the NET. He believes this might have led to different investigations and treatment in the years after which might have led to an earlier diagnosis of the cancer Mrs M died from in 2023.

23. The Trust confirmed it should have told Mrs M about the histopathology finding a tumour following the surgery in 2014. It says while it should have made her aware, it would not have arranged for any additional monitoring or investigations. It therefore says it does not believe there was any long-term impact on Mrs M.

24. We agree with the Trust that it did not properly consider the histopathology report in 2014, as it discharged Mrs M without telling her or recording any consideration of it. We have considered what should have happened had the Trust done what it should have.

25. BMJ guidance outlines what should happen where NETs are found following emergency surgery. It says, ‘If the lesion is less than 1cm in diameter… provided complete resection by appendicectomy has been undertaken, this procedure is so likely to be curative that a further resection should not normally be considered, nor would extended follow up appear necessary’.

26. This means that if the tumour is less than 10mm and the procedure has completely removed the tumour, this would be considered to have cured the cancer. It says further surgery or extended monitoring would not be necessary.

27. The histopathology report showed that the tumour was around 3mm, significantly smaller that the 10mm upper limit described in the guidance. The report confirms it was also not on or near the border of the incision and had been completely removed during the appendectomy.

28. We reviewed this alongside our adviser, and we think the BMJ guidance is clear Mrs M’s procedure would be considered to have cured the NET and stopped it from re-occurring. We also think the guidance tells us it would not have been necessary for the Trust to provide any subsequent treatment, investigations or monitoring for Mrs M having completely removed the NET.

29. It therefore seems that the Trust would still have discharged Mrs M and the only difference would be the Trust would have told her about the NET sooner. We therefore cannot see there would have been any clinical impact on Mrs M, including on her subsequent cancer diagnosis and death.

30. We do not wish to diminish the distress Mrs M’s death caused to her family.

31. Mr M has asked us to consider a financial remedy to put right the injustice caused. We use our severity of injustice scale to consider financial remedy. Level 1 on our scale includes cases where there is a one-off incidence of service failure where there are no other adverse effects or wider impact to the individual. We consider the injustice on this case falls on Level 1, for which we would usually consider an apology to be a sufficient remedy. We therefore do not consider a financial remedy is appropriate in this case.

32. The Trust held a meeting with Mrs M in 2022 to inform her of its mistake and apologise directly. The Trust also apologised to Mr M within its complaint responses.

33. We have reviewed the Trust’s complaint file, and we can see it identified the error likely lay with the histopathology report being sent to a clinician who had failed to flag or act upon the finding.

34. The Trust said in its final response it already changed its process several years prior to it realising this error in 2022. The Trust explained it flags any significant cancer results to not just the requesting clinician but also a consultant and its cancer data team to act upon. We can see how it would be beneficial to add a second layer to ensure important findings are not missed. The Trust also said where there is an unexpected finding of cancer, this is clearly highlighted by the histopathologist.

35. Our adviser gave their opinion, which we agree with, that the Trust had appropriately put in place changes to prevent this same issue happening again. We therefore do not think we need to ask the Trust to put any further improvements in place.

36. We think the Trust has done enough to put right the injustice caused by its mistake. We will therefore not take further action on this complaint.

37. In closing, while we can see something went wrong, we do not think there was any opportunity lost to prevent Mrs M’s sad death. This does not diminish the significant and lasting impact on Mr M and his family.

1. We have carefully considered Mr M’s complaint about Wirral University Teaching Hospital NHS Foundation Trust (the Trust). He is unhappy with the care it provided to his wife, Mrs M, and he believes her death could have been prevented.

2. We would like to pass on our sincere condolences and acknowledge the significant impact Mrs M’s death has had on Mr M and their family.

3. We have carefully considered the complaint. We note the Trust failed to act as it should have and that it has taken steps since then to try to remedy matters. Having considered what should have happened, we do not think the mistake the Trust made led to a significant, clinical impact. We think the Trust’s actions in trying to put things right afterwards were reasonable.

4. Based on the impact we think the problem caused, we do not think a financial remedy is appropriate. The Trust has apologised for what happened and confirmed its processes have already changed so the same problem would not happen again.

5. We have decided that the Trust has already done enough to put right the problems with Mrs M’s care. We will not ask it to take any further action.

6. We hope our comments and consideration gives Mr M some answers about his wife’s care.