Shrewsbury and Telford Hospital NHS Trust

4. Mrs L complains about aspects of care treatment whilst in the care of the Trust from 2021 to 2025. She complaints the laparoscopic surgery in June 2024 was unnecessary because the Trust ignored Mrs L’s bowel issues, and she complains doctors did not have a diagnosis for her. Mrs L also complains that, following the operation, the Surgeon discussed treatment while she was recovering from anaesthetic and a decision was made to refer her to another hospital during that conversation, Lastly, she complains the likelihood of her having cancer was not discussed with her.

5. Mrs L says she was left feeling anxious about the possibility of having cancer, and she found her care under the Trust to be stressful and regularly stayed awake at night wondering if she had cancer. The lack of communication regarding her treatment pathway, lack of diagnosis and lack of discussion regarding cancer left her extremely anxious and distressed.

6. Mrs L says she waited a very long time to have surgery which was then abandoned. She says she felt she could not take a job in case she was called in for surgery as she felt it could be at anytime. Mrs L has been out of employment for a long time and she is anxious about her future job prospects.

7. Mrs L would like service improvements, particularly around communication. She would also like a financial remedy.

8. The Trust performed an MRI in March 2023, and an ultrasound in September 2023. These scans identified a cyst which the Trust suspected was an endometrioma (a type of cyst that forms when endometriosis affects the ovaries).

9. In early October 2023, The Trust wrote to Mrs L to explain the surgical plan. This letter explained it suspected Mrs L had either an endometrioma or a haemorrhagic cyst. A haemorrhagic cyst is an ovarian cyst that contains blood due to ruptured blood vessels within the cyst. The Trust also explained that it could not definitively diagnose endometriosis until a laparoscopy had been performed, as an ultrasound could not pick up endometriosis present around the pelvis.

10. In November 2023 Mrs L attended an appointment with the Trust as she was concerned about her symptoms and possible bowel involvement. During this appointment, the Trust explained it was more likely she had an endometrioma and the MRI scan did not show any deep infiltrating endometriosis. It noted it had a discussion with Mrs L about the surgery and had explained the chance of cancer was small.

11. The Trust spoke with Mrs L again prior to surgery in early in April 2024. She had not yet had her appointment with the endometriosis centre. The Trust advised against delaying the surgery as it was unlikely endometriosis was affecting the bowel. It explained that the main priority was to determine whether the ovarian cyst was suspicious for malignancy, although it considered the chance of this was small.

12. In May 2024, the Trust repeated an ultrasound scan. The scan confirmed the left sided cyst was still present. The Trust explained it would generally advise postmenopausal patients to have an ovarian cyst removed as soon as possible. It also noted Mrs L was still waiting for an appointment at the endometriosis centre. It explained that it was reassured by the cyst getting smaller, but it still advised her to have the cyst removed so that cancer could be ruled out. It said the MRI had not shown any deep endometriosis and so bowel involvement was unlikely.

13. In mid-June 2024, the Trust carried out laparoscopic surgery to remove a left sided cyst and to investigate suspected endometriosis. During the procedure, the Trust found multiple adhesions to the pelvic wall, the uterus and bowel, and therefore abandoned the operation.

14. After the surgery, the Trust explained that it was likely an endometrioma rather than cancer, but this could not be confirmed until it had been removed. The Trust said it would again refer her to the endometriosis centre for further surgery, and it would arrange a repeat scan while she waited for this appointment.

15. Following the surgery, the Trust sent Mrs L a letter explaining that the doctor had spoken to Mrs L after surgery to offer open surgery to exclude cancer. At the end of June 2024, the Trust added Mrs L to the waiting list for open surgery.

19. 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 seen any indications that something has gone wrong for most of the issues Mrs L has brought to us. We have explained our decision on each point below.

Diagnosing endometriosis

20. Mrs L complains that her laparoscopy surgery was unnecessary because she had told the doctors about her bowel symptoms. She also complains doctors did not have a diagnosis for her.

21. The NICE endometriosis guidelines set out how suspected endometriosis should be assessed and diagnosed. These guidelines say that for women or people with suspected endometriosis that is not fully managed with analgesia or hormonal treatments should be offered an ultrasound. The purpose of this scan is to identify ovarian endometriomas and deep endometriosis. It can also identify or rule out other pathology which could be contributing to symptoms. The scan helps guide management options and enable referral to an appropriate service.

22. The NICE guidelines also say medical professionals should consider an MRI to diagnose deep endometriosis and assess its extent. The guidelines say that medical professionals should consider a diagnostic laparoscopy in people with suspected endometriosis, even if the scans are normal.

23. The GMC guidelines say that medical professionals should recognise and work within the limits of their competence. If necessary, they should refer to another suitably qualified practitioner when this serves the patient’s needs.

24. The clinical records show that the Trust discussed Mrs L's care with her on three occasions before surgery, in November 2023, April and May 2024. We could not see any records which outlined Mrs L’s concerns about her bowel symptoms. This is not to say we doubt Mrs L’s recollection, only that this had not been documented.

25. Our adviser has explained that ultrasound and MRI scans did not show any deep adhesions, including bowel related lesions. They have also explained that bowel symptoms are not unusual with endometriosis and so would not have indicated adhesions were present.

26. Based on the records and the advice we received, the Trust followed the approach recommended in the NICE guidelines when investigating Mrs L's symptoms. We can see it arranged an ultrasound and MRIs and then proceeded with a laparoscopy when Mrs L’s symptoms persisted.

27. We acknowledge the Trust’s decision not to proceed with further surgery was frustrating for Mrs L. The laparoscopy found more adhesions than previously suspected or had been seen on the scans. We think it was in line with the GMC guidelines that the Trust stopped the surgery when it became more complicated than it had expected. In light of this, the Trust referred Mrs L to more specialist care at the endometriosis centre.

28. We understand Mrs L's frustration that the surgery could not be completed. We have seen no indication that the Trust acted incorrectly when it recommended a laparoscopy or when it referred her to the endometriosis centre after finding more extensive adhesions than expected. Because of this, we will not consider this part of the complaint further.

Communication about a possible cancer diagnosis

29. Mrs L also complains that the possibility of cancer was not explained to her. We recognise that the uncertainty around a possible cancer diagnosis was worrying for Mrs L, particularly as she did not yet have clear answers about the cause of her symptoms.

30. The GMC guidelines say doctors must give patients the information they want or need to know in a way they can understand.

31. It appears the Trust explained that cancer was unlikely during the conversations prior to surgery. The Trust noted in November 2023 and April 2024 that the chance of Mrs L having cancer was small, with an endometrioma being the more likely diagnosis.

32. Following the surgery, it seems the Trust explained again that it was more likely she had an endometrioma rather than cancer. It noted it told Mrs L cancer could not be completely ruled out until the ovary was removed and examined.

33. We understand why Mrs L found this situation frightening. Even where clinicians consider the likelihood of cancer to be low, discussing that possibility can understandably cause significant anxiety. It appears the Trust has acted in line with the GMC guidance, as it seems it told Mrs L there was a possibility of cancer.

34. We appreciate that Mrs L may be disappointed by our decision. However, based on the evidence available to us, we have not seen an indication that the Trust acted incorrectly in this aspect of her care.

Discussion after surgery

35. Mrs L also complains that after her surgery the surgeon spoke to her about the findings and treatment plan while she was still under the influence of the anaesthetic.

36. The GMC guidelines say that all patients have the right to be involved in decisions about their treatment and care, and be supported to make informed decisions if they are able to. The guidelines also say that patients should be given information in a way that they can understand. This information should be clear, accurate, up to date and based on the best available evidence.

37. The guidelines go on to say that medical professionals should check patients understanding of the information they have been given and do their best to make sure they have the time and support to make informed decisions.

38. This means that Mrs L should have had clear communication related to the findings of the surgery and onward plans. We do not think Mrs L was in a position to fully understand or remember detailed information about her operation and future treatment while she was still recovering from anaesthetic.

39. The Trust did write a discharge summary which covered the information Mrs L needed to know. However it appears that this was only sent to Mrs L’s GP, and not to Mrs L. The Trust wrote a clinic letter dated a week after the surgery which does explain the findings and the plan to refer to the endometriosis centre which was sent to Mrs L. However, this would not allow the opportunity to check Mrs L’s understanding of the information being given to her.

40. We do not think the communication of Mrs L’s operation findings is in line with the GMC guidelines. We have gone on to consider the Trust’s response to this.

41. The Trust has acknowledged that Mrs L may have been under the influence of anaesthetic when the surgeon spoke to her following her surgery. It has apologised that this made it difficult for her to remember the conversation.

42. The Trust reassured Mrs L that the conversation detailed in the clinic letter accurately reflected the conversation that took place. The Trust also acknowledged the discharge letter was not sent to her. It apologised for this and said that staff had been reminded to ensure this was done in future.

43. Our NHS Complaint Standards set out how organisations providing NHS care should approach complaint handling. These standards say that organisations should see complaints as an opportunity to develop and improve its services and people. It says responses should be fair and accountable, setting out what happened and whether mistakes were made. It should set out how the organisation is accountable and take action to make sure any learnings are identified and used to improve services.

44. We consider the response from the Trust appears to be in line with the NHS Complaint Standards. It acknowledged it made mistakes, and it was accountable for them. It apologised to Mrs L for the impact its actions had caused, and it identified learning and set out actions taken to improve services.

45. We recognise that the way this information was communicated left Mrs L feeling uncertain about what had happened during the operation and what would happen next. Given the concerns she already had about her health, we understand why this was particularly distressing. We think the Trust has already done enough to put things right here, and we will not consider this part of Mrs L’s complaint further.

1. We have carefully considered Mrs L’s complaint about Shrewsbury and Telford Hospital NHS Trust (the Trust). We are sorry to hear about Mrs L's experience and the distress, worry and uncertainty these events have caused her. We recognise that living with ongoing symptoms, undergoing surgery and facing uncertainty about a possible diagnosis would have been difficult.

2. We have not seen an indication of a failing in the Trust’s decision to conduct a laparoscopy, or in the communication of her possible diagnosis prior to the surgery. We have seen an indication of a failing in the communication she received immediately following her surgery. We think the Trust has already done enough to put this right.

3. Because of the reasons set out above, we have decided not to take further action on Mrs M’s complaint. We recognise the importance of these matters for Mrs M. We hope our explanation below provides her with some reassurance.