Portsmouth Hospitals University NHS Trust

5. Ms O says that in July 2024, after Portsmouth Hospitals University NHS Trust found her colon cancer (cancer that develops on the colon or rectum) had returned, it delayed in providing treatment to her.

6. She says the Trust only acted on this when the Integrated Care Board (ICB) intervened.

7. She says that because of the three-month delay in receiving treatment, the tumour had grown and is now inoperable.

8. She says this means the treatment she is having is to keep the cancer at bay as it cannot be cured.

9. She explains she will potentially undergo treatment indefinitely and this causes her illness after she completes each session. This has had a devastating impact on her life.

10. Ms O is looking for financial compensation of more than £12,500.

11. She would also like Portsmouth Hospitals University NHS Trust to apologise.

12. Ms O is in her sixties and, following a colonoscopy (a procedure to examine the colon and rectum), she was admitted to hospital in June 2023 to remove a suspected cancerous tumour (uncontrolled cell growth) from her bowel.

13. The operation to remove the tumour took place at the end of June. The tumour was a T4b grade 2 adenocarcinoma (where cancer has grown through the wall of the rectum but has not spread) with no spread to the 16 lymph nodes (small structures throughout the body which filter fluid and trap bacteria and cancer cells) that had been removed.

14. Ms O was referred to an oncologist (a cancer specialist) who saw her in August. The oncologist explained the impact of the cancer and that adjuvant chemotherapy (systemic treatment to target cancer cells from the blood often given after removal of a cancerous tumour) may not have any significant impact, but this was available for her should she wish to take this route.

15. Ms O did not accept the offer of follow up appointments to check whether the cancer had returned until a CT scan she accepted in June 2024. This sadly showed signs of the cancer having returned.

Delays in treatment

20. Ms O complains the Trust found her cancer had returned in June 2024 following a yearly CT scan. She says it did not act on this instead delaying her treatment until October 2024.

21. She says the Trust did not act until the ICB intervened at her request and that she had needed to ask PALS to arrange for her to have a PET scan (positron emission tomography – a specialist imaging of tissues and organs to help identify cancer and other conditions).

22. In addition, she says she had asked not to see her previous consultant, but when she attended the Trust for the results of the PET scan, this consultant was present despite the appointment being not being with them.

23. She says she was not offered any further treatment after this and needed to contact the ICB for support.

24. In its responses to Ms O’s complaint, the Trust says this was not the case and that it experienced problems in gaining contact with her to arrange necessary appointments to decide next steps.

25. In addition, it explains that appointments were made but were unsuccessful and, when the relationship with Ms O broke down, it arranged another hospital take over her care. As she refused to attend the other hospital, it took back her care and treated her as an emergency.

26. In reaching our decision we have considered NICE guidance and standards.

27. NICE standard, QS20, says:

‘Adults who have had potentially curative surgical treatment for non-metastatic colorectal cancer (cancer that has no spread into other organs) have follow-up for the first 3 years to detect local recurrence and distant metastases.’

28. It goes on to say follow-ups should include a minimum of two CT scans in the threeyear period along with a clearance colonoscopy within a year.

29. NICE guidance NG151 says:

‘Metastatic colorectal cancer commonly affects the liver, lungs or peritoneum (lining of the abdominal cavity).’

30. The NHS Constitution set out what is expected of clinicians and patients. It requires the following from patients:

‘Please treat NHS staff and other patients with respect and recognise that violence, or the causing of nuisance or disturbance on NHS premises, could result in prosecution. You should recognise that abusive and violent behaviour could result in you being refused access to NHS services.’

31. We also spoke with our clinical adviser to gain insight into what should have happened once the Trust found reoccurrence of Ms O’s cancer.

32. From the medical records provided by the Trust, we can see it saw Ms O in August 2023, after the procedure to remove the tumour from her bowel. This was to discuss adjuvant chemotherapy (a treatment often offered after tumour surgery) to reduce the potential of the cancer reoccurring and improve the chance of survival.

33. The consultant explained the benefit of the treatment was small with a two or three percent chance of improvement on top of the surgery she had undergone. They said the treatment was available should she want to follow this route. The medical records say Ms O opted not to have the chemotherapy.

34. The medical records show the Trust attempted to speak with Ms O on several occasions between December 2023 and June 2024. This was to arrange for her to have a follow up colonoscopy and to book in for a CT scan to monitor her progress. In June 2024, Ms O returned one of the letters and wrote on this that she no longer wanted contact.

35. Ms O had the CT scan in June 2024. This showed a soft mass (an abnormal growth) of 7cm in length, indicating the cancer to have returned.

36. Following this, the Trust tried to contact her to arrange a PET scan and to arrange for her to see a consultant to discuss the results of the PET scan.

37. The medical records show that as Ms O did not engage with the Trust across July, it contacted her GP to ask they help by asking Ms O to arrange the PET scan. She agreed to this in early August, with her GP saying they would let the Trust know.

38. In mid-August, Ms O was contacted by PALS to arrange the PET scan and follow up appointment. She asked she see another consultant other than the two she had seen in 2023 as she had raised complaints about them. She was given an appointment with a different consultant.

39. Ms O attended the follow up appointment after the PET scan. When she attended, the medical records show the original consultant was present at the appointment.

40. This caused Ms O upset and anger. The Trust noted in her medical records she became abusive to all staff members. The consultant noted giving Ms O time to calm, but she remained abusive to all staff present and they asked she leave. The consultant said she did not give them the opportunity to share results with her.

41. Following this, the medical records show the case was discussed at an MDT (multi-disciplinary team meeting). As Ms O had complained about two consultants and the Trust felt she had been abusive to several other members of staff, the MDT decided it would be better if her care was transferred to another hospital. A letter to another hospital was sent in early September and the new hospital offered an appointment at the beginning of October.

42. We have seen an email trail between Ms O and the local ICB. This started after the decision to transfer her care to another hospital. In this, Ms O complains the Trust was withholding the results of her PET scan and denying her treatment for her cancer.

43. In its response to the ICB, the Trust explained this was not the case and outlined the issues it had experienced in gaining contact with Ms O and that it had needed to involve her GP to make the PET scan appointment.

44. It went on to say it had asked another hospital (Trust B) to take over Ms O’s care due to her abusing staff at the appointment to discuss her PET scan results.

45. The email trails from the ICB show once Ms O became aware of the appointment at the new hospital, she declined this and refused the transfer of care. The ICB attempted to help her by arranging transport to get her to the new hospital, but she would not agree to this.

46. The ICB then spoke with the Trust and asked it to take back her care. The Trust said it was willing to do so, but as Ms O had complained about two of the three consultants with the correct specialism to help her, they would need to ask whether one of the three would be prepared to see her.

47. A third consultant, who Ms O had not seen previously, agreed to see her the following week as an emergency.

48. We spoke with our adviser and asked what should have happened after the CT scan found the cancer had returned.

49.  They explained the Trust followed the correct process in attempting to speak with Ms O to arrange a PET scan. This scan would confirm whether the cancer had returned and whether this had spread.

50. They went on to say the case was discussed at MDT’s, with the Trust referring Ms O for a PET scan and making a clinical appointment to discuss the findings.

51. This is in line with the requirements of NICE NG151 which recommends PET-CT scanning to assess ‘disease extent before considering surgery or systemic therapy’.

52. Our adviser also says once the cancer was confirmed to have returned and spread to the peritoneum, the Trust discussed the case at another MDT and decided Ms O should be referred to an oncologist.

53. Again, this is supported by NICE NG151 which requires MDT-led management and treatment aligned to the individual patient.

54. The medical records show the Trust to have acted to engage with Ms O as it not only wrote to her, but it also liaised with her GP when she did not respond to requests for her to make contact.

55. In addition, when Ms O emailed the Trust to complain about not having an appointment for the PET scan (sent three days after she told her GP she would have this), it acted immediately asking that PALS liaise with Ms O to arrange this.

56. The NHS constitution sets out expectations in respect of behaviour from patients. It expects patients to treat staff with respect and explains that abusive or threatening behaviour can result in access to NHS services being withdrawn.

57. The medical notes refer to Ms O being abusive to a member of staff who she had previously complained about and being abusive to other staff members during an appointment to discuss the results of her PET scan.

58. The medical records show when Ms O attended the appointment to discuss the results of the PET scan and became abusive to staff, the Trust did not withdraw access to NHS services as it is able to have done. It shows once it was aware the relationship with Ms O had broken down, it made concerted efforts to find her care with another hospital.

59. In addition, when Ms O refused care at another hospital, the remaining consultant who she had not complained about agreed to see her as an emergency.

60. Also, Ms O did not contact PALS direct to arrange the PET scan as they contacted her after she contacted the complaints manager in respect of not having received an appointment three days after telling her GP she would have the scan.

61. In respect of the intervention of the ICB, Ms O first contacted the ICB after the PET scan and the failed appointment to discuss the results.

62. From this we have not found Ms O needed to contact PALS to get a PET scan or that it was only after the ICB intervened that a PET scan was agreed.

63. After the CT scan indicated the cancer to have returned, we have found the Trust made every effort to contact Ms O to arrange to PET scan when she did not respond to requests for contact.

64. Similarly, when the Ms O attended the appointment to discuss the PET scan, the Trust acted to ensure she was provided care elsewhere when she was asked to leave the hospital. When she refused the care from another hospital, the Trust arranged for her to see only consultant with the correct specialism that she had not seen before to avoid her needing to see either of the consultants she had complained about previously.

65. As such, we have not found failings in the management of Ms O’s treatment by the Trust.

66. In respect of one of the consultants Ms O had asked not to see being at her appointment to discuss the PET scan results, we have found it would have been better had the Trust pre-warned her that her previous consultant would be present. We have not found this is a failing against standards as these do not say who should or should not be present at appointments.

67. We consider as the consultant had a good understanding of Ms O’s cancer and previous treatment and the Trust felt their attendance would be an advantage to Ms O.

68. The Trust has also noted this and explained in its response to her complaint that the consultant, having carried out the original procedure to remove the first tumour, wanted to be involved in the appointment. It apologised for not communicating this to her in advance and acknowledged this will have been distressing for her.

69. We appreciate the medical records do not support Ms O’s recollection of events or chronology, and that she feels she received poor treatment because of having complained about two of the consultants.

70. She disputes she was offered adjuvant chemotherapy in July 2023 saying she was discouraged from taking this route. She also says the Trust did not attempt to contact her across July and August 2024 to arrange a PET scan, with her needing to contact PALS herself to arrange this.

71. In addition, Ms L says she was not abusive during her appointment to discuss the results of the PET scan. She says she was assertive, but not abusive.

72. We have seen the medical records and correspondence from the Trust and her GP which support the Trust tried to contact her. Also, the email trails show the complaints manager contacted PALS to work with Ms O when she added concerns about not being referred for the PET scan after adding this to her ongoing complaint. This was despite only having told her GP a few days earlier that she would have the scan.

73. We are not dismissing Ms O’s recollection or her interpretation of events. The evidence we have seen does not support her view. We are mindful of the stress and upset she was experiencing across this time as she had received unexpected and shocking news about her cancer.

74. We realise that Ms O finds the treatment difficult and that this has had a significant impact on her life as she feels ill after treatment. This will be awful for her to go through on a regular basis, and we understand how badly this affects her day-to-day life.

75. As we have not seen failings in the actions of the Trust, we do not uphold this complaint.

1. Following careful consideration of Ms O’s complaint, our decision is Portsmouth Hospitals University NHS Trust managed Ms O’s cancer treatment in line with guidance and did not delay in providing treatment. We do not uphold this complaint.

2. We are sorry to hear of Ms O’s cancer diagnosis and how the operation to remove the first tumour did not result in the cancer being fully removed. We do not underestimate how devastating living with inoperable cancer is for Ms O.

3. Our decision is that ​Portsmouth Hospitals University NHS Trust did not delay or withhold treatment and that it did not impact her prognosis.

4. We have also found that while it was not best practice for a consultant Ms O had asked not to attend an appointment to discuss treatment options in October 2024, it is not a failing and we are pleased to see the Trust has already addressed this and apologised for not warning her this would be the case.