University Hospitals Sussex NHS Foundation Trust

3. Mr Y, represented by his wife, Ms F, complains about University Hospitals Sussex NHS Foundation Trust’s (the Trust) delay in performing his surgery between March 2023 and June 2024.

4. Mr Y says his condition has deteriorated so much the Trust is unable to carry out the operation. Mr Y says if the operation had been done sooner this would not have been the case.

5. Mr Y also says because the blood flow to his legs is deteriorating, he risks losing his limbs and he struggles to walk. He says he cannot leave the house as he has developed an ischemic ulcer on his right foot. He has been advised to rest it to aid healing and it is too painful to walk on.

6. Mr Y is looking for an independent investigation, an apology, service improvements and a financial remedy.

7. Mr Y was in his late 60’s at the time of these events. He has a history of:

• ischaemic heart disease with multiple coronary stents • heart failure • type 2 diabetes • intermittent claudication • extensive peripheral arterial disease • hypertension • mild aortic stenosis.

8. In October 2022, Mr Y suffered from a coronary event (when blood flow to the heart is suddenly reduced or blocked) which left him needing a prescription of ticagrelor, an antiplatelet medication, for 12 months.

9. In February 2023, the Trust conducted an MDT (multi-disciplinary team) meeting which said if Mr Y was fit, then to carry out a hybrid bifit common femoral artery endarterectomy (CFEA, a procedure to remove plaque from the femoral artery to restore blood flow to the leg) and iliac kissing stents (a procedure to preserve blood flow through the iliac arteries). If he was not suitable for this then he would receive conservative management.

10. During a vascular clinic appointment on 31 May 2023, the Trust said due to the coronary stents Mr Y had fitted six months previously it would not be possible to carry out surgery at this time and he would need to wait until he had been on ticagrelor for 12 months.

11. Mr Y was listed for surgery after a 12 month wait following his above procedure.

12. On 29 February 2024, Mr Y was seen in the nurse led claudication clinic which advised he was on the waiting list and would be reviewed again in six months.

13. An MDT carried out on 3 June 2024 decided Mr Y was not suitable for surgery and the Trust decided to take a more conservative approach to management of his condition. The Trust discussed this with Mr Y on 4 June 2024.

18. Mr Y has raised concerns the Trust delayed his surgery between March 2023 and June 2024.

19. We are sorry to hear of this 15 month delay with surgery and we understand why Mr Y would question this delay and the impact it has had on his future care and treatment.

20. The Trust says it was acting in his best interests and due to the risks of his surgery it could not have considered him prior to this.

21. We understand Mr Y attended a pre-operative assessment on 20 March 2023. Following this appointment, the Trust placed Mr Y on the waiting list for surgery. On 31 May 2023, the Trust told Mr Y it would not be able to carry out a bilateral common femoral artery endarterectomy and kissing iliac stents, but it would review him again.

22. The clinic letter from 31 May 2023 says the reason the Trust was unable to carry out surgery at this time was due to Mr Y suffering from an acute coronary event. Due to this Mr Y was placed on the medication ticagrelor for 12 months.

23. The NICE guidance says following an acute coronary event a patient should be placed on an antiplatelet medication for 12 months along with a dose of aspirin.

24. We understand Mr Y’s coronary event happened in October 2022 and so he would need to take ticagrelor until October 2023.

25. The Trust acted appropriately here.

26. The NHS guidance says if ticagrelor is stopped, ‘your blood will start clotting at the rate it did before you started taking it.’ Our adviser says Mr Y would have been at further risk of an acute coronary event or even death if the ticagrelor was stopped. They also added if Mr Y had remained on ticagrelor and the Trust had carried out the surgery, Mr Y would have been at a higher risk of bleeding.

27. The Trust placed Mr Y back on the waiting list for surgery in November 2023 which was after his 12 months of ticagrelor medication had passed. This is in line with the NHS guidance.

28. We consider the Trust was correct to place Mr Y on ticagrelor and delay his surgery at that time.

29. Once Mr Y was placed on the waiting list for surgery in November 2023, he was not seen again by the Trust until 28 February 2024 which was in the nurse led claudication clinic. This was a wait of around four months.

30. The plan following this appointment on 28 February 2024 was to review Mr Y again in six months’ time.

31. The NHS Constitution recommends a maximum wait of 18 weeks for treatment. However, our adviser added says after the COVID-19 pandemic this guidance was suspended as it was impossible to meet target. They also added surgery focused on high risk and cancer patients and, as Mr Y could walk 50 metres and had no rest pain, he would not be classed as an emergency or high risk patient. This wait is normal considering the pressures the NHS was under at this time and the waiting list lengths.

32. Mr Y’s medical records then show his case was discussed a muti disciplinary team meeting (MDT) on 3 June 2024. During the meeting the Trust discussed the complexity of his case and decided to take a more conservative approach to management of his condition. This decision was made following a review of Mr Y’s CT angiogram, which was not different to the one taken in 2023.

33. Our adviser says it is important to note Mr Y was suffering from extensive peripheral vascular disease and was also suffering from cardiac issues. Whilst there is no guidance on what to do in these situations, our adviser says the Trust acted appropriately and decided on conservative management with risk factor management and regular exercise.

34. We consider the Trust appropriately delayed Mr Y’s surgery until after his 12 months of ticagrelor treatment had ended, and following this due to the delays in the NHS as a whole and Mr Y not being a high risk patient he had to wait a further four months for a further review. Overall, we consider there is no failing here.

35. We are saddened to hear about Mr Y’s failing health and how he feels the Trust gave him false hope. We thank him for bringing his complaint.

1. Mr Y has raised concerns about a delay in his surgery between March 2023 and June 2024. We recognise this was a significant period of time. We consider given Mr Y’s acute coronary event in October 2022 resulting in surgery and medication, and the delays with the NHS waiting times for lower risk procedures, the Trust could not have done more. We will not uphold the complaint overall.

2. We understand this will be disappointing to Mr Y and recognise how devastating learning his operation would not go ahead has been. We hope our explanation of how we have reached our view helps him understand our decision.