East Suffolk and North Essex NHS Foundation Trust

2. Mr O complains about the care the Trust provided him between May 2024 to March 2025. Specifically, Mr O says the Trust, • claimed he declined the offer of a surgery date of 6 August 2024, • did not provide him a timely appointment for surgery after referral on 17 July 2024.

3. Mr O told us he was distressed and anxious in the time he waited for a surgery date. Mr O told us the tumour in his leg grew while he waited, so it was too advanced for complete removal by the time he had his surgery on 3 September. Mr O was then left with some tumour remaining in his leg.

4. The Trusts claim Mr O declined an earlier appointment caused him distress as he felt personally blamed for the poor outcome of his surgery.

5. By bringing this complaint to us, Mr O wants the Trust to issue a formal apology for the delay in treatment and the incorrect claim he declined an earlier appointment. He would also like the Trust to review its surgery booking process.

6. Mr O is a patient at the Trust. On 1 May 2024, Mr O had a planned appointment with a plastic surgeon. The Trust found a 1.5cm tumour on his right shin. The Trust decided to perform a biopsy on 15 May 2024. This involved taking a small sample of tissue to be examined under a microscope.

7. The Trust completed a histology of the sample on 21 June 2024. A histology is the study of tissues and cells, and it can identify if something is cancerous. This identified Mr O had squamous cell carcinoma on his leg, a type of skin cancer.

8. Mr O had surgery to remove the tumour from his leg on 3 September 2024. The Trust were unable to completely remove the tumour.

Issue 1 – The Trust claimed Mr O declined the offer of a surgery date of 6 August 2024

13. Mr O disputes the Trusts claim it offered him a surgery date of 6 August 2024, and he declined it. Mr O told us this claim has been distressing, and it has made him feel wrongfully blamed for his unsuccessful surgery.

14. The Trust records show on 31 July it contacted Mr O by telephone. The phone call was 43 seconds long. Due to the Trusts retention policy, there is no phone call recording. There are no records of what was discussed during this call.

15. In the Trusts complaint response, it stated it offered Mr O a surgery date of 6 August in this call. The Trust said Mr O declined this appointment because it was too short notice. The Trust stated it told Mr O the surgeon was on leave after this date, and it offered him the next available date of 3 September.

16. Mr O told us the Trust made no mention of 6 August in this call. He said the Trust only offered him an appointment date of 3 September which he accepted. The Trust told him surgery could not be done earlier because the surgeon was on holiday.

17. Mr O told us he sent a letter to the Trust on 3 August. Mr O’s account has been verified with screenshots of his NHS app showing the uploaded letter from 3 August. In this letter, Mr O said he had been told that week he would not have treatment until 3 September. He said he was concerned as his tumour had increased in size. He asked if the Trust could accelerate the treatment.

18. GMC guidance says Trusts should make sure medical records are clear, accurate and legible. Trusts should include information shared with the patient as well as concerns or preferences expressed by the patient that may be relevant to their ongoing care. Records should include decisions made and actions agreed.

19. We consider, if the Trust had offered Mr O an appointment during the phone call on 31 July, it should have made a record of this because it impacted his ongoing care. Whilst we have not been able to determine what was said during the 31 July call, we have seen indications the Trust did not act in line with GMC guidance as it did not document the actions agreed on 31 July.

20. We consider it is unlikely Mr O would have sent a letter on 3 August after declining an appointment for surgery four days before. This gives weight to Mr O’s account.

21. We can see the Trust did not have the appropriate documentation in line with guidance to support its claim it offered Mr O an earlier appointment. We consider on the balance of probabilities; Mr O was not offered an appointment date of 6 August during the 31 July phone call.

Issue 2 – Mr O says the Trust did not provide him a timely appointment for a surgery to remove the tumour on his right leg after referral on 17 July 2024

22. Mr O complains the Trust did not operate on his tumour in a timely manner. Mr O told us waiting for the surgery date was distressing. Mr O also stated the tumour grew in the time he waited, which meant he was left with some of the tumour in his leg after surgery.

23. Mr O had his biopsy on 15 May. On 17 July, the Trust told Mr O his biopsy showed cancer, and it referred Mr O to have surgery to remove it.

24. On 31 July, the Trust called Mr O. the Trusts complaint response stated in this phone call, it offered Mr O a surgery date of 6 August which he declined because it was too short notice. The Trust stated following this, the surgeon was on leave, and it had capacity issues, so the next available date was 3 September.

25. On 3 September, Mr O had surgery to remove the tumour on his leg. The Trust were unable to fully remove the tumour.

26. Our clinical adviser referred us to NHS guidelines on cancer. NHS guidelines on cancer say cancer should be ruled out within 28 days of referral for investigation. It also says if a patient is already under the care of a Trust, the Trust should start the patient’s cancer treatment within 31 days of the decision to treat the cancer.

27. NHS guidelines on cancer say the clock for a 31-day timeline can be stopped if a reasonable offer of treatment has been declined. What is classed as reasonable depends on the patient, who should be consulted and listened to. It states the clock cannot be stopped due to the practitioner not being available within the period for capacity reasons.

28. The Trust identified the tumour on Mr O’s leg on 1 May. To meet the NHS cancer guidelines, it should have diagnosed or ruled out cancer within 28 days; by 29 May.

29. Mr O was informed of his cancer diagnosis during an appointment on 17 July, 17 days outside of the 28-day diagnosis period. We can see this was not in line with guidance.

30. The decision to treat Mr O’s cancer was made during this appointment on 17 July. To be within the timescale specified by NHS guidelines on cancer, the Trust should have started his treatment within 31 days, by 17 August. The Trust started Mr O’s treatment when his operation took place on 3 September, 17 days outside the recommended wait time.

31. If the Trust had offered Mr O a surgery date for 6 August and he had accepted, the Trust would have met the NHS cancer guidelines. Furthermore, if the Trust had offered Mr O a surgery date of 6 August but Mr O declined it, the ‘clock’ would have paused in line with guidance as this was a reasonable offer of treatment.

32. As we addressed in component one, we consider on the balance of probabilities, the Trust did not offer Mr O an appointment of 6 August during this call. This means the Trust had no reason to stop the 31-day treatment clock, and it should have completed Mr O’s surgery by 17 August 2024.

33. The Trust also stated the surgeon did not have capacity to do the surgery before 3 September. NHS guidelines on cancer state capacity is not an appropriate reason to stop or delay the treatment clock, we can see the Trust did not act in line with guidance by stopping the clock.

34. We have seen indications of failings in the time the Trust took to provide Mr O with a diagnosis and in the time it took to treat him.

Impact

35. We have seen indications of failings in both issues Mr O has brought to us. First, we have considered the delay in the histology report.

36. The Trust acknowledged this delay was not in line with guidance in its final complaint response to Mr O. The Trust have made improvements by hiring locum consultants to aid with workload pressures.

37. We consider these service improvements will be effective in improving the timeliness of cancer diagnosis. For this reason, we have not taken further action on this.

38. We have considered the failing the Trust claimed it offered Mr O an earlier surgery date of 6 August. Mr O told us when he received the Trusts complaint response, he became distressed. He stated he felt blamed for the delayed surgery.

39. We can see this distress was made worse by the Trusts poor record keeping. This meant there was no documentation to help us say what occurred during the 31 July phone call.

40. To put this right, we have approached the Trust and asked if it is willing to make improvements to its record keeping. The Trust have agreed to this resolution.

41. We have also considered the failing the Trust delayed Mr O’s surgery by 17 days between the date he was referred for surgery, and the date of the surgery. Mr O told us the tumour grew in the time he waited for his surgery. This meant the Trust could not fully remove the tumour from his leg.

42. Our adviser told us Mr O was at greater risk of growth and recurrence of cancer because of his weakened immune system after a kidney transplant. Our adviser did not have access the biopsy findings taken after Mr O’s surgery, so they could not advise whether the risk of cancer had been successfully reduced.

43. Our adviser told us even if they had access to this information, they would not be able to say the delay of seventeen days caused this tumour to grow. Mr O told us despite the tumour left in his leg; he did not need any additional invasive treatment that he initially thought he might need. For this reason, we cannot see Mr O suffered a clinical impact of his surgery delay.

44. Mr O also told us he was distressed and anxious waiting for a surgery date. We can see Mr O suffered 17 days of additional stress waiting for a surgery. This additional wait time was not in line with guidance.

45. To put this right, we have asked the Trust to make improvements to its surgery booking process. The Trust have agreed to this resolution.

46. Along with the Trusts service improvements to its record keeping and surgery booking process, it has agreed to apologise to Mr O. The Trust’s resolution demonstrates understanding, learning and willingness to put complaints right in line with the NHS complaint standards. It also meets Mr O’s desired outcomes.

47. We consider the action the Trust has proposed will resolve this complaint for Mr O. For this reason, we will not be taking further action on this complaint.

Conclusion

48. We want to recognise the stressful experience Mr O has been through with his cancer diagnosis. We can see this already stressful time was exacerbated by the issues we have identified. We are sorry to hear Mr O has suffered this distress.

49. We can see the Trust has had a valuable opportunity to reflect on its complaint process. We thank Mr O for bringing this complaint to us. We would also like to thank the Trust for its willingness to listen and put right Mr O’s concerns.

1. We have carefully considered Mr O’s complaint about East Suffolk and North Essex NHS Foundation Trust. We have found there are indications of failings in the Trusts actions. The Trust have agreed to put right the impact of these events. For this reason, we will not be taking further action on this complaint.