North West Anglia NHS Foundation Trust

7. Mr D complains about the care his wife, Mrs D, received from North West Anglia NHS Foundation Trust (Trust A) in 2024 and 2025. He says the Trust:

• saw his wife late at appointments in neurology, rheumatology and orthopaedics in 2024 and 2025 • failed to provide his wife with a diagnosis or prognosis following referrals to these specialities • disagreed with other neurology consultant’s opinions which caused delays to his wife’s care in January 2024 • refused to prescribe relevant medication during her neurology appointments • incorrectly recorded details of neurology appointments • did not advise the results of his wife’s DEXA scan (an X-ray procedure used to measure bone strength and density) following her orthopaedic appointment in October 2024.

8. Mr D says his wife is in significant pain and has waited over two years without a clear diagnosis. He says the Trust’s mistakes have caused significant inconvenience and travel costs, as he and his wife live rurally and must travel long distances to appointments. This has caused financial stress. He says the Trust has not addressed his complaint and given token apologies.

9. Mr D is seeking acknowledgement of failings, an apology, service improvements and financial remedy.

10. Mr D also complains about the care his wife, Mrs D, received from United Lincolnshire Teaching Hospitals NHS Trust (Trust B) in 2025. He says the Trust:

• delayed seeing his wife at the Emergency Department and discharged her prematurely in January 2025 • failed to diagnose his wife with a fractured foot following multiple X-rays in A&E • wrongly advised his wife’s orthopaedic referral had been made via the urgent pathway when it had been done via the routine pathway • did not contact them with results of orthopaedic tests and scans carried out and failed to keep an arranged telephone appointment.

11. Mr D says his wife is in significant pain and has waited over two years without a clear diagnosis. He says the Trust’s mistakes have caused significant inconvenience and travel costs, as he and his wife live rurally and must travel long distances to appointments. This has caused financial stress. He says the Trust has not addressed his complaint and given token apologies.

12. Mr D is seeking acknowledgement of failings, an apology, service improvements and financial remedy.

13. Mrs D has a clinical background of intercranial hypertension (a neurological disorder which causes severe headaches and vision changes), cervical spine surgery and nephropathy (kidney disease). Between 2021 and 2023, she experienced progressive weakness in her limbs and became increasingly dependent. She began to need a frame for walking and began to struggle with everyday activities.

14. In 2023, Mrs D’s GP referred her for an MRI scan. She was referred to the spinal clinic at a private hospital, where she underwent investigations including further MRI scans to her cervical spine and brain. She also underwent nerve conduction tests (a diagnostic test which measures signals between nerves by applying small electrical shocks to the skin) and the clinician concluded there may be signs of inflammatory neuropathy (a disorder where the immune system attacks the nerves, causing progressive motor and sensory problems). Mrs D was therefore referred to neurology at Trust A.

15. In January 2024, Mrs D attended the neurology clinic at Trust A. The clinic did not find any significant evidence of neuropathy on review of Mrs D’s test results and disagreed with the previous consultant’s conclusion. The Trust discharged Mrs D back to her GP and did not provide her with any medication.

16. In March 2024, Mrs D was re-referred to the spinal clinic at the private hospital. She underwent investigations including a further MRI. She was re-referred to neurology at Trust A, who declined the referral in June 2024. Mrs D was subsequently discharged from the spinal clinic and referred to the pain management team in August 2024. In October 2024, she had a DEXA scan at Trust A to consider any potential signs of osteoporosis.

17. In January 2025, Mrs D had a fall and attended an Urgent Treatment Centre (UTC). A fracture was suspected and she was asked to travel to another hospital, which was part of Trust B. She received an X-ray shortly after arrival, which showed no fracture and suspected ligament injury. Mrs D had a subsequent X-ray at the beginning of February 2025, which also showed no fracture. At the end of February, she had a further X-ray at an orthopaedic clinic at Trust A, which showed a fracture to her fifth metatarsal on the outside of her ankle.

18. In April 2025, Mrs D underwent further neurophysiological investigations at Trust B. She also underwent follow up nerve conduction studies at Trust A. These concluded that Mrs D’s symptoms were not neurological. Trust A arranged for a follow up review in July 2025.

19. Mrs D’s symptoms continue to persist.

North West Anglia NHS Foundation Trust

The Trust saw Mrs D late at appointments in neurology, rheumatology and orthopaedics in 2024 and 2025

23. The records show Trust A apologised for the delays Mrs D experienced while waiting for her appointment. It said that on occasion, patients require additional assessment time which can cause clinics to overrun. It said Mrs D also received an extended appointment to allow for a thorough assessment.

24. The records do not show the length of time Mr and Mrs D waited for their appointments. We acknowledge Mr and Mrs D’s experience and accept their view that the delays were unacceptable. We do not think it is likely we could reach a definitive view on this point from the written records. An investigation into this matter would not be practical and would not reach a satisfactory conclusion. We will therefore not be considering this part of the complaint further.

The Trust failed to provide Mrs D with a diagnosis or prognosis following referrals to neurology, rheumatology and orthopaedics

25. 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 found any indications that something has gone wrong.

26. The records show Mrs D was seen in the Trust neurology clinic several times in 2024 and 2025. She was discharged in March 2025 because the Trust did not consider that further neurological input was needed.

27. GMC ‘Good medical practice’ says clinicians should propose, provide or prescribe drugs or treatment only when they are satisfied it will meet the patient’s needs.

28. Our neurology adviser said the Trust ordered nerve conduction studies and neuroimaging (imaging of the brain and nervous system) which was sufficient to exclude a significant underlying physical cause for her symptoms. They said no further investigations or treatment would have been appropriate given the results of Mrs D’s investigations.

29. Mrs D was seen in the Trust rheumatology clinic in 2024 and 2025. A follow up appointment was arranged for December 2025, following which Mrs D may have been discharged back to her GP if her conditions had stabilised. In March 2025, Mr D contacted the department requesting an urgent review. In its response, the rheumatology department advised there was no specific need for Mrs D to be assessed urgently and it would see her in December as planned.

30. GMC ‘Good medical practice’ says clinicians should adequately assess a patient’s condition, perform a physical examination and take a history. It says they should promptly provide suitable advice and investigations and provide treatment where necessary.

31. Our rheumatology adviser said Mrs D was appropriately assessed in her clinic appointments, had a history taken and physical examination where required. They said that despite Mrs D not presenting with a definitive case of gout, her symptoms were in keeping with gout and the relevant medication was appropriately continued. The clinician also arranged an appropriate follow-up appointment. They said the department promptly and correctly updated Mr D that there was no clinical need for an urgent review when he contacted the Trust in March 2025.

32. Mrs D was seen in the orthopaedic clinic in October 2024, February 2025 and May 2025. It decided not to carry out further investigations or surgery and discharged Mrs D in May 2025.

33. NICE guidance on lower back pain and sciatica says clinicians should not consider a patient’s psychological distress when deciding whether to refer them for a surgical opinion.

34. Our orthopaedic adviser said clinicians appropriately decided not to carry out further investigations or consider surgical intervention. They said Mrs D was frail with considerable comorbidities and clinicians did not identify any surgical targets during her appointments and investigations. They said while it is clear Mrs D’s pain was causing her distress, NICE guidance is clear that this is not sufficient to refer a patient for a surgical opinion. They said Mrs D was treated appropriately and holistically by clinicians in line with guidance.

35. In summary, we have seen no indications that anything went wrong when the Trust did not provide Mrs D with a diagnosis or prognosis following referrals to neurology, rheumatology and orthopaedics. We consider that each department assessed, investigated and treated Mrs D’s symptoms in line with relevant guidance. We will therefore not be looking at this part of the complaint further. We recognise it must have been distressing for Mrs D that none of those specialties were able to provide a diagnosis for her problems.

The Trust disagreed with other neurology consultant’s opinions which caused delays to Mrs D’s care in January 2024

36. The records show that Mrs D attended an outpatient neurology clinic appointment at the Trust in January 2024. In the clinic letter from this appointment, the clinician documented that Mrs D’s previous clinician had raised concerns about Mrs D’s nerve conduction tests, which they thought may have indicated an inflammatory neuropathy.

37. The Trust carried out further investigations, reviewed the results and documented they had not identified any significant evidence of neuropathy. They noted that some level of mild neuropathy would not be unusual given Mrs Ds clinical history of chemotherapy treatment.

38. In June 2024, Mr D contacted the neurology department with concerns that the Trust neurologist had not considered the concerns of Mrs D’s previous clinician following her nerve conduction tests. In a June 2024 clinic letter, the Trust neurologist explained that the nerve conduction results suggested a minor difference in one nerve, but that this was not consistent with other tests conducted by Mrs D’s previous clinician. The Trust’s position remained that the results were not typical or strongly indicative of nerve dysfunction.

39. GMC ‘Good medical practice’ guidance says clinicians should propose treatment based on the best available evidence and only when satisfied the treatment will meet their needs.

40. Our neurology adviser said Mrs D’s previous clinician raised the possibility of inflammatory neuropathy based on her initial nerve conduction results, but had never made a formal clinical diagnosis. They said the Trust neurologist correctly interpreted the evidence of their own investigations as not being supportive of this diagnosis and concluded no further treatment was required.

41. We recognise Mr D’s concern that the Trust did not take the opinions of Mrs D’s previous clinician into account when reviewing her. Having reviewed the evidence, we are satisfied the Trust considered these clinical opinions and ordered relevant investigations, before concluding that the results did not support the diagnosis of inflammatory neuropathy. We consider this was in line with relevant guidance. We will therefore not be considering this part of the complaint further.

The Trust refused to prescribe relevant medication during her neurology appointments

42. The records show Mrs D was not prescribed any medication following her appointments, other than pain relief. The Trust’s final response said other medications were prescribed by Mrs D’s GP and that it contacted them with details of her appointment to allow the GP to adjust and review Mrs D’s medication.

43. NHS England policy on prescribing in primary and secondary/tertiary care says secondary care clinicians should only prescribe medication at an outpatient clinic when the patient has an immediate clinical need and only until the clinic letter could reasonably be expected to have reached the patient’s GP. At this point, the GP would take over responsibility for prescribing.

44. Our adviser said it was entirely appropriate that Mrs D was not prescribed medication other than pain relief at the Trust neurology clinic and that this was delivered via her GP. They said hospitals are commissioned to provide medication for urgent treatment, emergency supply medication when there is an unexpected interrupting of prescription from primary care and ‘hospital only’ medication. They said the Trust acted in line with this policy when it did not prescribe Mrs D’s medication.

45. We recognise Mr D’s concern that the Trust had incorrectly handled Mrs D’s medication prescription. Having reviewed the evidence, we are satisfied the Trust followed NHS England policy when prescribing Mrs D’s medication. We will therefore not be looking at this part of the complaint further.

The Trust incorrectly recorded details of neurology appointments

46. The records show Mrs D attended several outpatient neurology appointments in 2024 and 2025. Mr D says the details of the conversations during these appointments were not accurately recorded in the subsequent clinic letters.

47. In particular, Mr D is unhappy the Trust neurologist suggested Mrs D’s body had ‘had enough’ in the clinic letter of March 2025. In its final response, the Trust explained that the Trust neurologist had made this comment in response to a similar remark from Mrs D when discussing functional neurological symptoms (distressing physical symptoms without obvious underlying neurological cause).

48. There are no transcripts or audio recordings of the outpatient neurology clinic appointments Mr and Mrs D attended, and we cannot know for sure what was discussed. We acknowledge Mr D’s opinion and accept his view that this comment was not appropriate. We do not think it is likely we could reach a definitive view on this point from the written records. An investigation into this matter would not be practical and would not reach a satisfactory conclusion. We will therefore not be considering this part of the complaint further.

The Trust did not advise Mr and Mrs D of Mrs D’s DEXA scan results in October 2024

49. The records show Mrs D underwent a DEXA scan in October 2024 following referral from the Trust orthopaedic department in September 2024. In December 2024, Mr and Mrs D did not attend an arranged outpatient orthopaedic clinic appointment. She was subsequently discharged to a patient-initiated follow-up pathway (where patients book appointments when they need them, rather than attending scheduled appointments).

50. In February 2025, Mr and Mrs D contacted the Trust chasing the results of the scan. The Trust orthopaedic team advised the scan results showed some osteopenia (lower than normal bone density) in Mrs D’s spine and referred her to rheumatology for further review.

51. In March 2025, Mr D contacted the rheumatology department seeking an urgent update. In a letter dated the same day, the Trust advised that a rheumatology clinician had drafted a letter to Mrs D’s GP at the end of January, advising them to prescribe Mrs D alendronic acid as first line treatment for osteoporosis. The clinician had been on leave and had not approved the letter to be issued to Mrs D’s GP. The Trust advised the letter had now been approved and issued to Mrs D’s GP. The records show the letter to the GP was issued on the same day in early March 2025.

52. GMC ‘Good medical practice guidance’ says clinicians should propose suitable drugs or treatment only once they have adequate knowledge of a patient’s health and are satisfied the treatment will meet their needs.

53. Our rheumatology adviser said the Trust rheumatology department reviewed Mrs D’s DEXA scan results and arranged treatment for Mrs D in line with relevant guidance.

54. We recognise Mr D’s concern that the Trust did not promptly advise of the results of Mrs D’s DEXA scan. Having reviewed the evidence, we are satisfied the Trust followed GMC guidance when it reviewed the results and arranged relevant treatment.

55. There was a delay in issuing the relevant letter to Mrs D’s GP, which was possibly influenced by Mrs D’s discharge to a patient-initiated follow-up pathway when she did not attend an appointment in December 2024. Following this, the Trust drafted a letter to Mrs D’s GP in January 2025, but did not issue it until early March 2025 when Mr D chased the Trust for an update.

56. We have not seen any evidence that this delay affected Mrs D’s care. As soon as Mr D followed up, the Trust responded promptly. We will therefore not be looking at this part of the complaint further.

United Lincolnshire Teaching Hospitals NHS Trust

The Trust delayed seeing Mrs D at the Emergency Department and discharged her prematurely in January 2025

57. Mrs D had a fall in January 2025. Following advice from her GP, she attended a UTC for an X-ray to exclude a fracture. Mrs D attended the UTC at 5.30pm and was told the X-ray service closed at 5pm. The records document she was happy to attend the emergency department at Trust B for an X-ray.

58. The Trust triaged Mrs D at 7.12pm and gave her an X-ray by 8pm. The X-ray showed no fracture and the Trust discharged her with a suspected ligament injury at 8.15pm.

59. RCEM guidance on patient care in the ED says patients should have their process of care explained clearly to them and receive regular reviews. It says discharge planning should include bespoke advice and ensure any follow-up arrangements are clearly explained.

60. Our adviser said Mrs D was reviewed, treated and discharged in line with RCEM guidance throughout. They said the records show staff introduced themselves and explained the process of care to Mrs D, regularly reviewed her and gave her regular updates before discharging her with safety netting advice and potential follow up arrangements.

61. Our adviser said the delay in receiving an X-ray was because Mr and Mrs D initially attended the UTC outside of the X-ray department opening times. They said staff explained this to them and they were documented as happy to attend the hospital, where they received an X-ray promptly upon arrival. The X-ray was promptly reviewed and Mrs D was appropriately discharged.

62. We recognise Mr D’s concern that the Trust delayed seeing Mrs D and discharged her prematurely. Having reviewed the evidence, we are satisfied the Trust followed RCEM guidance when reviewing Mrs D, arranging an X-ray and discharging her. We will therefore not be looking at this part of the complaint further.

The Trust failed to diagnose Mrs D with a fractured foot following multiple X-rays

63. The records show Mrs D received two X-rays on her injured foot, one at the end of January 2025 and a second X-ray three days later in February 2025. In both cases, the X-ray report documents that no fracture was identified.

64. In early March 2025, Mrs D attended an outpatient orthopaedic clinic appointment at Trust A and received a further X-ray. The clinician identified an undisplaced fracture (a broken bone where the pieces remain in their proper position) on the proximal fifth metatarsal on the outside of the ankle. The clinician advised Mrs D the fracture would heal without intervention and she declined the offer of a boot.

65. RCR guidance says imaging investigations must be carried out by a qualified individual and must be accompanied by a written report.

66. Our adviser said Mrs D’s X-rays had been carried out by qualified staff and reported in line with guidance. They said Mrs D’s fracture had been visible on both X-rays, but this type of fracture is not always diagnosed. They said ankle X-rays are not typically performed to look for this type of fracture and the X-ray request had been for a potential midfoot fracture, whereas Mrs D’s fracture was at the base of the forefoot. They said the fracture was on the edge of the imaged area but was visible if closely examined.

67. Our adviser said it is understandable that Trust staff missed the fracture on both occasions, but it had been diagnosable. They said it was particularly easy to miss or disregard in the second X-ray. They said fractures of this type can be both diagnosed and overlooked depending on the relative experience of the interpreting radiographer.

68. We recognise Mr D’s concern that the Trust failed to diagnose Mrs D’s ankle fracture despite two ankle X-rays. Having reviewed the evidence, we are satisfied the Trust followed relevant guidance when arranging and reviewing her X-rays. We consider that her fracture was a borderline case which could equally have been diagnosed or disregarded by competent clinicians. We do not consider there was a clear missed opportunity to diagnose Mrs D with a fracture earlier. We will therefore not be looking at this part of the complaint further.

The Trust wrongly referred Mrs D to neurophysiology via the routine pathway having told Mr D the referral was urgent

69. The Trust orthopaedic department referred Mrs D to its neurophysiology department for nerve conduction testing via the routine, rather than the urgent pathway, in February 2025. Mr D told us the Trust clinician told him the referral had been made via the urgent pathway.

70. Mrs D underwent the nerve conduction testing in April 2025, which was outside the Trust’s target of completing referrals within six weeks. She had a follow up appointment in May 2025 to discuss the results. The Trust apologised for the delay in its final response.

71. GMC ‘Good medical practice’ says clinicians should refer a patient to another suitably qualified practitioner when this serves their needs.

72. The decision about whether to refer a patient via urgent or routine pathways is made by considering the patient’s clinical need, particularly whether there is a threat to a patient’s life or limb, or a case of urgent suspected cancer.

73. Our adviser said there is no indication from Mrs D’s records that her symptoms merited an urgent referral. They said she was appropriately referred via the routine pathway as per standard clinical practice and Mrs D received the appropriate investigation of nerve conduction tests.

74. We understand Mr D’s concern that Mrs D was referred to neurophysiology via the wrong pathway given his understanding that Mrs D’s referral was urgent. Having reviewed the evidence, we cannot know why Mr D believed the referral had been made via the urgent pathway as there are no records of this conversation between him and the clinician. We are satisfied Mrs D was referred in line with standard clinical practice. We will therefore not be considering this part of the complaint further.

The Trust did not advise the results of orthopaedic tests and scans and failed to keep an arranged telephone appointment

75. Mr D complains he consistently had to chase for the results of orthopaedic tests and scans carried out by Trust B. He also say the Trust’s orthopaedic department failed to keep an arranged telephone appointment.

76. The records do not show whether there were delays in advising Mr and Mrs D of the results of Mrs D’s scans. They do not document whether a telephone call was arranged and missed by the Trust.

77. We acknowledge Mr D’s opinion and accept his experience that the Trust did not attend an arranged telephone consultation. We do not think it is likely we could reach a definitive view on this point from the written records. An investigation into this matter would not be practical and would not reach a satisfactory conclusion. We will therefore not be considering this part of the complaint further.

78. We thank Mr D for bringing his complaint to us. We wish Mr and Mrs D the best for the future.

1. We have carefully considered Mr D’s complaint about the care and treatment his wife, Mrs D, received from Trust A and Trust B in 2024 and 2025.

2. We are very sorry to hear Mrs D’s experience caused her and Mr D distress.

3. We have seen no indication anything went seriously wrong either Trust’s care and treatment of Mrs D.

4. We consider Trust A followed relevant guidance when it reviewed Mrs D in the departments of neurology, rheumatology and orthopaedics, when carrying out investigations, considering further care and prescribing medication. We did not consider some parts of the complaint in detail where we would not have been able to reach a definitive view on what happened. We explain this in more detail in the statement below.

5. We consider Trust B followed relevant guidance when it reviewed Mrs D at the emergency department and arranged X-rays. We consider it reviewed the X-rays in line with guidance and did not miss a clear opportunity to diagnose her with a fracture earlier. It arranged Mrs D’s referral to neurophysiology in line with guidance and standard clinical practice. We did not consider some parts of the complaint in detail where we would not have been able to reach a definitive view on what happened. We explain this in more detail in the statement below.

6. We hope our explanation below reassures Mr D and Mrs D that both Trusts cared for and treated her in line with relevant guidance and standard clinical practice.