An independent provider in the Buckinghamshire area

4. Mr B complains the Unit:

• did not inform him a potential side effect of Xylocaine is a headache, prior to his endoscopy procedure on 7 February 2024 • did not provide him with appropriate aftercare for his symptoms following his endoscopy procedure on 7 February 2024 • did not record and escalate Mr B’s symptoms to the clinical quality team, when he attended the unit on two occasions following his endoscopy procedure.

5. Mr B said had the Unit told him he may experience a headache from Xylocaine, he would not have agreed to use it. He said he experienced a severe headache at the back, front and top of his head, and his nose was continuously pouring. He describes crying due to the intensity of the pain and feeling like his head had been blown off his shoulders. His headache lasted eight hours before it subsided with paracetamol and remained on and off for two days.

6. Mr B said after two days his nose stopped pouring, and it was then he realised he had lost his sense of smell and taste. He said he continues to experience a significant reduction in his smell and taste to this day, which affects his ability to enjoy food and smells as he once did. He said he now gets triggering headaches and a blocked nose from certain strong scents such as cleaning products, perfume or aftershave.

7. Mr B believes if the Unit had provided him with appropriate aftercare and recorded and escalated his symptoms he would have received earlier treatment. He believes this would have resulted in him experiencing less pain, avoided the impact to his taste and smell and his on-going headaches.

8. By bringing this complaint to us, Mr B wants service improvements and a financial remedy.

9. Mr B attended the Unit for an endoscopy procedure in February 2024 after his GP referred him due to a low blood count. Before the procedure, the Unit offered him Xylocaine, a nasal spray, to temporarily numb the area. Mr B agreed to use this.

10. At 10.55am, Unit staff administered Xylocaine into both of Mr B’s nostrils before carrying out the endoscopy procedure. At 11.03am, handover records state Mr B reported the discomfort was worse than expected, a headache and throbbing pain to his face and back of his head. Mr B said his nose was also continuously streaming at that time.

11. The Unit gave Mr B a drink, paracetamol and advised him to breathe some fresh air outside. It also informed the nurse in charge and endoscopist of Mr B’s symptoms.

12. At 11.58am, Mr B’s wife collected him. On discharge, the Unit advised him to go home, rest and continue taking pain relief if needed. At 2pm, the Unit phoned Mr B to check on him. The records state he reported he was ok.

13. Over the next two days, Mr B said his nose continued to stream, felt blocked and he experienced intermittent headaches. Once this settled, he noticed a loss of taste and smell, except for a constant acidic taste, which he attributed to the anaesthetic spray.

14. On 9 and 19 February, Mr B attended the Unit and told them he had lost his sense of smell, but his headache was better.

15. On 20 February, Mr B spoke with his GP regarding his symptoms, who prescribed a steroid nasal spray to reduce any nasal inflammation. His GP agreed to refer to ear, nose and throat (ENT) if this did not relieve Mr B’s symptoms. Mr B said he also tried antihistamines and a nasal wash on the advice of his friend and a pharmacist.

16. On 27 February, the records state the Unit attempted to contact Mr B to check on his welfare but there was no answer.

17. On 29 February, Mr B returned to his GP as his symptoms remained. His GP referred him to ENT. Mr B’s saw his GP again on 8 April and reported his symptoms remained.

18. Between April 2024 and March 2026 Mr B saw ENT five times for further investigations and treatments. Mr B said these treatments also did not relieve his symptoms.

19. In June 2024, Mr B submitted a complaint. Following this, he spoke with the lead endoscopist on 11 July 2024, about his symptoms and experience. The Unit provided responses to his complaint dated 1 August and 20 September 2024.

Did not tell Mr B a potential side effect of Xylocaine is a headache

24. 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.

25. Mr B said the Unit did not tell him he may experience a headache from Xylocaine. He said if it had, he would not have agreed to use it as the headache he suffered was unbearable.

26. In the Unit’s first complaint response, it stated a common side effect of Xylocaine is a headache. It also provided an appendix to this response which included a table titled ‘xylometazoline side effects’, which includes a headache as a common side effect.

27. Our adviser explained the patient advice leaflet (PIL) for Xylocaine, does not list a headache as potential side effect. Our adviser noted in the Unit’s first complaint response, it provided side effects for xylometazoline. Our adviser explained xylometazoline is a nasal decongestant used to relieve nasal congestion, which is a different drug to what the Unit recorded it used prior to Mr B’s endoscopy.

28. We are sorry to hear Mr B experienced a severe headache and continuous runny nose after his endoscopy procedure. We must base our decisions on the evidence available. In doing this, we cannot see any indications the Unit got something wrong when it did not tell Mr B he may experience a headache from Xylocaine. This is because a headache is not listed as a potential side effect for Xylocaine. For this reason, we will not be taking any further action on this part of his complaint.

29. We recognise the Unit provided inaccurate information in its complaint response by listing side effects for a different drug (xylometazoline) and by stating a headache is a common side effect for Xylocaine. We have shared these administrative errors with the Unit so it can take learning from them.

Did not provide Mr B with appropriate aftercare for his symptoms

30. Mr B complains the Unit did not provide him with appropriate aftercare when he developed a headache and continuous runny nose after his endoscopy. Mr B believes had the Unit treated his symptoms differently, he would have experienced less pain and may not have developed a loss of taste and smell.

31. The records state while Mr B was at the Unit, it provided him with paracetamol, a drink and advised him to get some fresh air, while he waited for his wife. Mr B said the Unit initially advised him to attend A&E but later said A&E would unlikely be able to help. Instead, the Unit advised Mr B to go home, rest, continue taking pain relief and contact 111 if his symptoms got worse or did not improve. The records state the Unit also called Mr B a couple of hours after his discharge, to check on his welfare, and he said he was ok.

32. GMC’s Good Medical Practice guidance states clinicians must provide a good standard of practice and care. Any proposed treatment clinicians propose, provide or arrange must be based on their assessment and clinical judgement, considering the likely effectiveness of the treatment options.

33. Our adviser explained the Unit’s aftercare was consistent with standard clinical practice and judgement for patients presenting with symptoms like Mr B had at that time. Our adviser explained that on-going symptoms such as those Mr B experienced, should be assessed and managed initially by a patient’s GP. This is because GPs can prescribe appropriate medication, arrange investigations and make referrals to specialist services such as ENT, which is the correct pathway for investigating a loss of taste and smell.

34. We recognise Mr B said the Unit initially advised him to attend A&E but later said A&E would unlikely be able to help. The Unit’s incident report which it created in May 2024, states it offered to take Mr B to A&E, but he preferred to go home and rest. We recognise Mr B and the Unit’s accounts differ, and Mr B is concerned A&E may have been able to help. On balance, despite there being a difference in accounts, we consider Mr B remained able to seek support from A&E if he felt this was necessary. This is because Mr B did not require a referral from the Unit to access A&E.

35. We also note Mr B’s headache improved with continued pain relief and the Unit called him to check on his welfare, and he reported he was ok. We consider this shows the Unit’s aftercare had a positive effect on treating the symptoms Mr B had at that time. We also consider this demonstrates the Unit showed care for his welfare. Additionally, we recognise the Unit provided appropriate safety-netting advice, so Mr B was aware he had the option to call 111 if his symptoms remained or worsened. We consider these actions evidence a good standard of care in line with GMC guidance.

36. We are sorry to hear Mr B experienced a significant headache and continuous runny nose after his endoscopy procedure. Having considered the evidence available, we have not seen the Unit’s aftercare fell below an acceptable standard. For this reason, we will not be considering this part of Mr B’s complaint further.

Did not record and escalate his symptoms to the clinical quality team

37. Mr B complains that when he later contacted the Unit on two occasions to report he had lost his taste and smell, it did not properly record these concerns and escalate them to its clinical quality team.

38. Our principles say organisations should act in accordance with relevant policies and guidance. They also say organisations should deal with people helpfully, promptly and sensitively, bearing in mind their individual circumstances.

39. The Unit explained in its complaint response that it expected its staff to record Mr B’s concerns and escalate them to its clinical quality team for review. The Unit explained it cannot arrange referrals for further investigation but offered to write to Mr B’s GP to inform them of its investigation. The Unit apologised to Mr B and said it would take learning from his complaint to improve its processes.

40. We asked the Unit what would likely have happened has it escalated Mr B’s symptoms at the time. The Unit told us it would have sought earlier advice from the medical director or lead endoscopist and would have been able to speak to Mr B sooner about his concerns.

41. Mr B’s GP records state he first spoke with his GP about his symptoms on 20 February 2024. This is 13 days after his procedure and 11 days after he became aware of these symptoms and first told the Unit about them. Mr B’s GP prescribed him a steroid spray, which he told us did not help. Mr B said he also tried antihistamines and a nasal wash spray, on the advice from his friend and a pharmacist, which also had no effect. Mr B saw his GP again on 29 February as his symptoms remained and they referred him to ear, nose and throat (ENT) for further investigation.

42. As we explained in paragraph 33, our clinical adviser explained the assessment and management of symptoms, such as Mr B’s, would sit with a patient’s GP. The GP can assess the symptoms, begin treatment and refer to specialist services such as ENT if needed.

43. The Unit’s incident report dated 21 May 2024 states Mr B attended the Unit on 9 February and reported he had lost his sense of smell. It states the Unit advised him to seek advice from his GP. It also states on 19 February Mr B returned complaining of a headache and said his GP had provided him some medication which had no effect. It also states it attempted to contacted Mr B on 27 February, but he did not answer.

44. We know from reviewing Mr B’s GP records he first saw his GP about these symptoms on 20 February, and the GP prescribed him medication. The Unit’s account is inconsistent with this timeline, as the Unit’s account states Mr B said the medication from his GP had no benefit on 19 February, the day before his GP prescribed it. We understand from what the Unit told us it created its incident report after the patient advice and liaison service (PALS) informed it Mr B had made a complaint. It explained the incident report was based on staff recollection, as it did not record Mr B’s concerns at the time.

45. GMC’s guidance for good medical practice states record keeping should be contemporaneous (made at the time). This includes any patient concerns that might be relevant to their ongoing care.

46. We recognise the Unit’s delay in recording its incident report did not meet these standards. Given the inconsistencies between the dates and recording delay, the incident report does not seem to be a reliable source of evidence of exactly what happened. With this in mind we cannot say, on balance, the Unit signposted Mr B to his GP on 9 February.

47. We understand Mr B did see his GP, who prescribed treatment and later referred him to ENT when that treatment did not work. We understand from what our adviser explained this is appropriate pathway to investigate and treat symptoms like Mr B’s.

48. We considered what likely would have happened had the Unit recorded and escalated Mr B’s symptoms in line with our principles, its expected process and GMC guidance. Based on the evidence available, we consider on balance, it is likely that earlier escalation would have resulted in earlier clinical review which likely would have led to advice to contact his GP, rather than materially different treatment from the Unit itself. This is because we understand from our advice the correct pathway for treatment and referrals for Mr B’s symptoms is through his GP. We also recognise the Unit said in its complaint response it does not have the ability to refer patients for further investigations and his GP needed to do this. Our adviser explained this explanation is accurate.

49. We also recognise the symptoms Mr B reports are not known side effects for Xylocaine. However, we note it states that if a patient experiences any side effects, they should talk to their doctor, nurse, dentist or pharmacist. This includes any possible side effects not listed in the PIL. It explains patients can report any side effects directly via the Medicine & Healthcare Products Regulatory Agency’s (MHRA) Yellow Card Scheme. This is a UK system for reporting suspected side effects or problems with medicines, vaccines, medical devices, and other healthcare products to help ensure patient safety. We acknowledge Mr B told us he did speak with a pharmacist and later saw his GP.

50. Mr B told us he first reported his loss of taste and smell to the Unit when he attended his follow up appointment on 9 February. Therefore, he was already experiencing these symptoms when he first told the Unit. Additionally, Mr B told us the treatments he tried from the pharmacist, and GP did not improve his symptoms. Therefore, on balance, we have not seen evidence to say earlier recording and escalation would likely have prevented the symptoms Mr B describes or likely led to a significantly different outcome.

51. We consider it is reasonable to say Mr B was likely worried about his symptoms during the 11-day period between him reporting his symptoms to the Unit and him seeing his GP.

52. Our severity of injustice scale helps us determine whether a financial remedy is appropriate in cases. Level one explains that for low impact injustices such as annoyance, frustration, worry or inconvenience arising from a one-off incident with no lasting effects we generally consider an apology to be sufficient. In these cases, we would not usually consider a financial remedy to be appropriate.

53. We are sorry to hear Mr B continues to experience a reduction in his taste and smell and on-going headaches, which affects his ability to enjoy certain foods and smells. We understand Mr B believes had the Unit recorded and escalated his symptoms he would have received earlier treatment and not suffered pain and the effects to his taste and smell.

54. We must base our decisions on the evidence available. Although we recognise the Unit should have recorded and escalated Mr B’s symptoms when he attended the clinic again, we cannot link this to the main impact Mr B is claiming for the reasons we explained in paragraph 35 and 49. We consider the worry Mr B likely experienced during this time aligns with level one in our severity of injustice scale. In these circumstances, we usually consider an apology is enough to put things right.

55. During our investigation, the Unit shared evidence of the learning it has taken from Mr B’s complaint and actions it has implemented, to improve its services. In summary, this includes:

• a review of its escalation procedures • feedback and staff training • framework and patient information pack updates, to include the risks of the symptoms Mr B experienced • monthly meetings to improve communication between teams • dedicated complaint-handling sessions • the creation of a detailed documentation pathway to ensure staff record patient concerns and clinical assessments consistently.

56. Our principles say organisations should be open and accountable when it gets things wrong and should take learning from complaints to contribute to service improvement.

57. We are satisfied the Unit taken full accountability for not recording and escalating Mr B’s symptoms at the time. It has acknowledged this, apologised, taken learning, and implemented actions to improve its services. It has also reported his symptoms to the MHRA Yellow Card Scheme. These actions are in line with the other outcomes Mr B wanted by bringing his complaint to us and our principles.

58. As such, we do not consider this complaint requires further investigation and will not be taking any further action. We would like to thank Mr B for bringing his complaint to us for our consideration.

1. We have carefully considered Mr B’s complaint about the Unit. We are sorry to hear Mr B experienced a significant headache and continuous runny nose after his endoscopy (a procedure used to examine internal organs using a flexible camera tube). We are also sorry to hear he now has a reduced taste and smell and on-going headaches.

2. We want to reassure Mr B that we did not see any indications the Unit got something wrong when it did not tell him he may experience a headache from Xylocaine (a nasal spray used to numb the area prior to his endoscopy). We also did not see any indications of a failing in the care the Unit provided him for his symptoms after the endoscopy. We have explained our reasons for this in more detail in this statement.

3. We recognise the Unit said in its complaint response that it expected Unit staff to escalate patient symptoms to its clinical quality team. We are satisfied the Unit has already done enough to put right this impact by apologising and taking learning from Mr B’s complaint by implementing actions, to improve its services in the future. Therefore, we will not be considering this complaint further. We have explained our reasons for this in more detail below.