The Dudley Group NHS Foundation Trust

6. Miss Q complains about aspects of care and treatment her father, Mr Q received from The Dudley Group NHS Foundation Trust (the Trust) between September 2024 and March 2025. Specifically, she says, the Trust failed to appropriate investigate, diagnose or treat potential symptoms of cancer from September. She also says the Trust failed to send a referral/appointment to the rapid access team for several weeks.

7. As a result, she says the Trust denied her father access to treatment, which tragically led to his death. She says this had devastating impact on her and her family.

8. She is seeking an acknowledgment of failings, service improvements, an apology and a financial remedy.

9. On 11 September 2024, Mr Q presented at the Trust via an ambulance, following a fall at home. The Trust subsequently admitted Mr Q into hospital as an inpatient.

10. The Trust carried out a CT scan of the lumbar spine on 12 September, and it identified bilateral hydronephrosis (where one or both kidneys become stretched and swollen as the result of a build-up of urine inside them) with distended trabeculated urinary bladder (where the bladder wall becomes thickened).

11. The urology team then reviewed Mr Q, and no concerns were identified at this time.

12. The Trust then arranged for Mr Q to have a trial without catheter (TWOC) in the community, a flow scan in four months, followed by an appointment in the outpatient clinic in six months' time.

13. On 14 September 2024, Mr Q experienced some haematuria (blood in the urine). The Trust carried out a bladder washout, and the plan was for him to undergo a flexible cystoscopy (a short outpatient procedure used to examine the bladder lining and urethra for abnormalities) as an out-patient.

14. The Trust subsequently transferred Mr Q to ward C1. During this time, Miss Q raised concerns about her father’s weight loss. Mr Q also complained of pain in his bladder region.

15. On 16 September 2024, the Trust arranged for an echocardiogram (ECG) to be carried out for 28 September 2024.

16. On 2 October 2024, the Trust discharged Mr Q with the plan for an outpatient echocardiogram and CT urogram (a specialised imaging test that uses X-rays and contrast dye to produce detailed, three-dimensional images of the kidneys, ureters, and bladder).

17. On 10 October 2024, the Trust carried out the CT urogram (imagining of the bladder and kidney and tubes that connect them). Mr Q’s bladder appeared ‘grossly’ abnormal.

18. On 10 November 2024, Mr Q attended his urology outpatient appointment for a diagnostic flexible cystoscopy (procedure using a thin, camera-equipped tube to examine the urethra and bladder lining).

19. The Trust did not deem Mr Q to be fit enough to have surgery, so it trialled him on tamsulosin (an alpha-1 blocker used to treat symptoms of an enlarged prostate). The plan was made for the hospital to home team to carry out a TWOC in two to four weeks' time.

20. On 15 January 2025, the Trust carried out a chest X-ray after a referral was made by Mr G’s GP. The Consultant Radiologist who reported on this X-ray completed a referral to the rapid access team (on 16 January 2025) as there was some new right lung pathology and pulmonary nodules seen. A CT scan was carried out on 24 January 2025 which was suggestive of progressive bladder pathology (involves structural and functional deterioration over time, often driven by chronic outlet obstruction (BPH), chronic infection, or invasive cancer).

21. On 28 January 2025, Mr Q was seen in the urology clinic when it was noted he had failed the TWOC. The Trust discussed surgery for bladder neck incision (procedure used to relieve urinary obstruction) at this point and subsequently added Mr Q to the waiting list.

22. Following this appointment there was subsequent communication on 7 February 2025, between the respiratory and urology teams to highlight abnormal CT scan findings. It was found that the contracted bladder was very abnormal with left wall mass like solid cystic change. The Trust suspected cancer.

23. The Trust informed Mr Q of the suspected cancer, and the plan for the Trust to carry out a repeat cystoscopy on 15 February 2025. However, this was carried out on 5 March 2025. The plan was made for Mr Q to undergo a Transurethral Resection of Bladder Tumour (TURBT -a surgical procedure used to diagnose and treat bladder tumours). The Trust also requested an MRI scan of the bladder.

24. The Trust took pre-operative bloods on 7 March 2025 which it says showed, Mr Q’s renal function as declining.

25. On 11 March 2025, Mr Q had an ultrasound scan of the urinary tract. This showed bilateral mild-moderate hydronephrosis and a thickened bladder wall. Following this scan, the Trust admitted him to hospital via the Emergency Surgical Hub (ESH) and seen by the consultant urologist. Bilateral nephrostomies (placing thin tubes through the skin into both kidneys to drain urine directly into external collection bags) were requested.

26. On 14 March a bladder and pelvic MRI scan was carried out which sadly revealed a large bladder tumour, with significant muscle invasion. This was later categorised as stage four high grade sarcomatoid muscle invasive bladder Transitional Cell Carcinoma.

27. On 3 April 2025 Mr Q sadly died.

31. 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 also consider whether it looks like the mistake caused suffering, or affected someone in another way, and whether more needs to be done to address this.

Investigating, diagnosis and potential treatment of cancer

32. Miss Q says the Trust failed to investigate/diagnose/treat her father cancer sooner. She explained that following his fall at home in September 2024, the Trust failed to detect the cancer which tragically led to his death six months later.

33. We discussed this with our urologist who explained when Mr Q was admitted to hospital following his fall at home, it does not appear he had any blood in his urine.

34. The evidence suggests the Trust carried out the CT scan primarily due to Mr Q suffering a fall. Our urologist explained the CT scan showed swelling to both of his kidneys. As such, he was sent to the urology team for further investigation.

35. Our urologist explained that had Mr Q had blood in his urine when he was admitted, that would have triggered an early cystoscopy but as he did not, one was not required.

36. The Trust subsequently, catheterised Mr Q and it then appears he developed blood in his urine three days later. However, our urologist has explained that this could have been for several reasons. Mr Q was on blood thinners and had a catheter put in which can also cause blood in the urine.

37. Based on the advice we have received, we are satisfied the Trust appropriately investigated Mr Q’s symptoms. It carried out a CT urogram in October 2024 to help establish why there was blood in his urine and later carried out a cystoscopy as an outpatient in November 2024. This is in line with NICE, bladder cancer; diagnosis and management guidance, which states; ‘do not substitute urinary biomarkers for cystoscopy to investigate suspected bladder cancer or for followup after treatment for bladder cancer.’

38. Our urologist explained the cystoscopy was performed by a consultant and the evidence suggests there was no obvious tumour at the time. However, there was evidence of a high and slightly narrow bladder neck, which could have been restricting urine flow.

39. The Trust felt Mr Q was not fit enough to undergo surgery, so it advised him to monitor his symptoms of light headedness, and a plan was made for him to trial tamsulosin. The Trust also planned for the home team to carry out a TWOC in two to four weeks' time.

40. Again, given our urologist said there was no indication of cancer at this stage. The actions of the Trust appear to be clinically appropriate.

41. After Mr Q’s GP made a referral for a chest X-ray due to weight loss, a cough and poor appetite the Trust completed a referral to the rapid access team on 16 January 2025. This was due to some new right lung pathology and pulmonary nodules (abnormal growth on the lungs). This led to a CT scan being carried out on 24 January 2025 which appears to suggest progressive bladder pathology.

42. Our urologist explained that the CT scan results were the first indication of an abnormality in Mr Q’s bladder. The Trust subsequently arranged for another cystoscopy and biopsies (TURBT). Again, this is in line with NICE, bladder cancer guidance which states the care provider should consider carrying out TURBT after a CT scan or MRI imaging.

43. The Trust carried out another cystoscopy, this time under general anaesthetic on 5 March 2025. It then planned for Mr Q to undergo the TURBT.

44. The Trust also carried out an MRI scan which our urologist explained was the appropriate thing to do and again in line with NICE guidance. The scan on 14 March identified a large bladder tumour. The Trust categorised this as stage four high grade sarcomatoid muscle invasive bladder transitional cell carcinoma. Sadly, Mr Q died not long after.

45. Our urologist explained Mr Q had an extremely rare form of cancer and identifying the tumour would have been difficult. Typically, the form of cancer Mr Q was eventually diagnosed with affects between 0.1% to 0.5% of all patients who are diagnosed with bladder cancer.

46. Our urologist explained that this type of cancer would have been extremely difficult to pick up. Everything can look normal when you investigate or examine the bladder when doing a cystoscopy, due to it being hidden in the muscle tissue and not on the surface lining of the bladder. This means the cancer may be at an advanced stage before it is even identified. The evidence we have seen indicates the Trust carried out the appropriate tests and investigations to identify the tumour and diagnose Mr Q as soon as possible. It is extremely unfortunate that Mr Q had such a rare form of cancer which was very aggressive.

Failure to send a referral/appointment to the rapid access team for several weeks

47. Miss Q has explained in November 2024, the Trust carried out a chest X-ray and CT scan on her father. She says her father’s health continued to deteriorate to a point where he was no longer eating, driving and spent most of his time in bed. She says a chest X-ray showed nodules on his lungs and a referral to the rapid access team (a fast-track route to see an NHS specialist, typically within 1-2 weeks) was initiated. Miss Q said this appointment never came through.

48. As mentioned in paragraph 41 of our report the records indicate the Trust carried out the chest X-ray on 15 January 2025 and not in November 2024 as Miss Q believes. Following the X-ray the Trust completed the rapid access referral the following day, as it identified nodules on her father’s lungs.

49. A CT scan was carried out eight days later on 24 January 2025. This was within NICE, suspected cancer two-week referral wait time on seeing a specialist or being scheduled for a diagnostic test and does not indicate a delay.

50. In summary, as the Trust has already explained, sadly Mr Q had an extremely rare and aggressive form of cancer. From the evidence we have seen we are satisfied the Trust did everything it could to try and investigate Mr Q’s symptoms and acted in line with the relevant guidance, with no delays in referrals.

51. We hope our consideration of Miss Q’s complaint gives her the explanations she is seeking and will help bring her some closure.

1. We have carefully considered Miss Q’s complaint about the Trust.

2. We understand this was a tragic experience for Miss Q and are sorry to hear of the distress and upset she has been caused due to the circumstances surrounding her father’s sad death.

3. From the evidence we have considered, we have identified the Trust acted appropriately and in line with guidance when investigating and diagnosing Mr Q’s symptoms.

4. We are also satisfied the Trust acted in line with the relevant guidance when referring Mr Q through the rapid access referral.

5. For these reasons, we do not propose to investigate further. We hope that Miss Q is reassured by what we have seen.