Sandwell and West Birmingham Hospitals NHS Trust

4. Miss T complains that the first surgery carried out by the ENT team in January 2022 to rectify her deviated septum was carried out poorly, meaning it was not successful. Miss T says that the internal graft placed in the first surgery caused her right nostril to be obstructed and left her unable to breathe properly.

5. Miss T also complains she did not receive corrective ENT surgery quickly enough following her surgery in January 2022. She says the subsequent delays to correct the first surgery meant that she experienced prolonged distress and her nighttime breathing difficulties continued.

6. Miss T complains that the second surgery carried out in July 2024 to correct her right-hand side airway was not planned or carried out correctly. She says the failure of the second surgery left her with an unsatisfactory aesthetic appearance, continuing nighttime breathing difficulties, having to use nasal dilators, and emotional distress.

7. She also told us following her second surgery, the original surgeon sent a routine, rather than urgent, referral to another ENT surgeon and to a surgeon who was not appropriately specialised to correct the second ENT surgery. She says the delays to be seen by an appropriate specialist after the second surgery have meant she is still waiting for her third corrective ENT surgery.

8. She claims that the impact of delays has been cumulative and have caused her physical discomfort, emotional distress and means she experiences poor sleep, fatigue, and reduced quality of life.

9. Miss T is seeking an acknowledgment and explanation of delays and mistakes in her care and a financial remedy to pay for specialist private surgery.

10. Miss T had a septorhinoplasty surgery on her nose in January 2022. This is an operation combining two procedures, where the nasal septum is straightened and the outside parts of the nose are moved to reshape its external appearance. The septum is the thin wall of cartilage and bone between the right and left sides of the nose.

11. Miss T had three follow up appointments to her surgery during 2022 and was expecting a date for a second, revision surgery in December 2022. Because Miss T did not receive a date for this surgery she complained to the Trust in March 2024.

12. Miss T saw an ENT consultant in March 2024. They listed her for the second surgery and booked an appointment for her with her original ENT surgeon. In April 2024 the original surgeon noted Miss T was not happy with the surgery done in January 2022 and made a plan for the second surgery. ENT stands for Ear, Nose and Throat, a surgical specialty involving the diagnosis, and medical and surgical management of problems affecting these areas.

13. Miss T had the second surgery in July 2024. She says that after this surgery, she was still unable to breathe.

14. She complained to the Trust in April 2025 because of the waiting time and her ongoing symptoms.

15. At an appointment in May 2025 an ENT consultant suggested a surgical plan based upon their examination of Miss T and referred her to a colleague at the same Trust for this surgery.

16. A week later, Miss T had an appointment with two surgeons who discussed surgery and treatment options with her.

17. Miss T was not happy with the proposed plan and requested a third opinion. The original surgeon referred her to a colleague at another hospital in another trust and discharged her.

22. Before we decide if we should investigate a complaint in more detail, we look at a few different factors. We consider whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen. If what happened fell far short of what should have happened, we call this a failing.

23. In this case there was no indication that anything went wrong. We hope our decision helps reassure Miss T that she received appropriate treatment and the waiting times did not affect her outcomes.

Surgery in 2022

24. Miss T said the septorhinoplasty surgery carried out in January 2022 to rectify her deviated septum was carried out poorly, meaning it was not successful. She says that the internal graft placed in the first surgery caused her right nostril to be obstructed and left her unable to breathe properly.

25. Clinical guidance to say exactly how to carry out septorhinoplasty surgery does not exist. We have therefore considered the opinion of our adviser and the clinical evidence to take a view on whether or not the surgery was carried out poorly.

26. Miss T was diagnosed with having an anterior nasal valve weakness, a deviated nasal septum to the left, and a concha bullosa on the right side. The nasal valve is the narrowest part of the nasal passage and regulates the airflow through the nose into the lungs. The nasal septum is the thin piece of cartilage and bone between the right and left sides of the nose. A concha bullosa is an air filed cavity in the turbinate and can cause a sinus blockage and affect breathing. Turbinates are like shelves in the side of the nasal cavity and help moisten and warm the air moving through the nose to the lungs.

27. Our adviser explained that the surgical plan was appropriate because it was designed to address the above issues.

28. Our adviser told us the operation notes indicate that the surgeon carried out the plan as agreed to address the structural issues identified when the surgery was discussed. The ENT surgeon remarked upon nothing unusual in the notes from the January follow up appointment.

29. At the clinic in April Miss T complained of right-hand nasal blockage and excessive mucus. The consultant observed that the septum was within normal limits. Our adviser told us none of these indicate that the surgery had been done incorrectly.

30. Information from ENT UK and the British Association of Aesthetic Plastic Surgeons (BAAPS) note that complications after such surgery can include long term breathing issues. We understand that Miss T continued to experience difficulties with her breathing however we hope to reassure Miss T that we cannot attribute to this to the surgery. Rather, on balance, it appears that this was more likely an unfortunate complication of the surgery she had.

31. We consider there is nothing to indicate that the surgery was carried out poorly. It is of course unfortunate that it did not improve Miss T’s symptoms in the way she had hoped, but regrettably, it appears that this can happen, even when the surgery is done as it should have been. We will therefore not be looking at this part of the complaint further.

Wait for surgery in 2024

32. Miss T complains she did not receive corrective ENT surgery quickly enough following her surgery in January 2022. She says the subsequent delays to correct the first surgery meant that she experienced prolonged distress and her nighttime breathing difficulties continued.

33. The Trust said it acted to ensure Miss T was seen by a consultant in a timely manner and she subsequently underwent a further nasal procedure. It also said it had been dealing with a significant backlog, which was exacerbated by the Covid pandemic. It explained that the ENT department had been working hard to increase its clinic and theatre capacity and it was still working towards reducing waiting lists.

34. In June 2022 the original ENT surgeon saw Miss T and listed her for a revision septorhinoplasty surgery due to her persistent right side nasal obstruction. Miss T thinks she should have been listed for surgery urgently, rather than routinely. 1.2.1 of Good Surgical Practice says that surgeons must ensure that patient treatment is prioritised according to clinical need. Urgent listings should be reserved for time critical conditions such as cancer or a nasal septal haematoma, which is a potentially dangerous blood accumulation in the nose. Miss T did not have such a condition, and this means that the specialist was right to list her routinely.

35. There is no evidence to support Miss T’s belief that surgery would be done by December 2022. However, we considered whether, despite this, the time she waited was reasonable.

36. Our adviser explained it is widely advised that revision nasal surgery should not take place for at least a year after the original surgery to allow time for all of the postoperative swelling to go down and everything to settle.

37. Information from BAAPS supports the view that a safe time interval between such surgeries could be over 12 months because it can take that long before all swelling subsides and the nose is settled. We think this means that Miss T should have had her second surgery no earlier than January 2023. Clearly, it did not take place until some time after that.

38. In March 2024, a consultant reviewed Miss T in clinic. She was still on the waiting list for the revision surgery at this point and the consultant arranged an appointment with her original surgeon as Miss T requested.

39. The original surgeon saw Miss T the next month and made a plan for the revision surgery. She had this surgery in July, which was two and a half years after her first surgery.

40. Our adviser explained that they have seen no evidence to suggest any additional delay affected her eventual outcome. But, we appreciate that this must have felt like a long time to Miss T, who was continuing to experience problems and hoped for swift resolution.

41. It is of course incredibly unfortunate that these events took place not long after the Covid pandemic. This had an enormous impact on the NHS’s ability to work at pre-pandemic levels and meant that wait times went up across the country. The Trust acknowledged the long waiting time and is working to reducing waiting lists by increasing its clinic and theatre capacity. We recognise it was unfortunate that Miss T was waiting a long time for her surgery. It is likely that she was in no different position than any other patient awaiting ENT surgery at the Trust. Her care did not warrant an urgent priority status and so unfortunately, it appears that her wait was unavoidable.

42. We conclude that while the waiting time for second surgery was longer than ideal, for the reasons outlined above, this timeframe does not in itself indicate a failing in care. We will therefore not be taking any further action on this part of the complaint.

Surgery in 2024

43. Miss T complains that the second surgery carried out in July 2024 to correct her right-hand side airway was not planned or carried out correctly. She says the failure of the second surgery left her with an unsatisfactory aesthetic appearance, continuing nighttime breathing difficulties, having to use nasal dilators, and caused her emotional distress. She believes she should have been listed for ‘corrective’ surgery, rather than ‘revision’ surgery.

44. The Trust explained to her that the outcome of any procedure such as nasal surgery cannot be accurately predicted, and the results may not be satisfactory. It also said it was unable to provide specific details regarding the ongoing right nasal obstruction Miss T was experiencing.

45. It is important to note that there is no difference between corrective and revision surgery. Both terms imply a surgery to revise or correct a previous surgery. This surgery planned was referred to as ‘revision septorhinoplasty’ on Miss T’s consent form.

46. Clinical guidance to say exactly how to carry out a revision septorhinoplasty surgery does not exist. We have, again, considered the evidence, including the opinion of our adviser to take a view on whether or not the surgery was carried out poorly.

47. 1.2.1 of Good Surgical Practice says surgeons must construct and discuss with the patient a diagnostic and treatment plan based on clinical evidence and investigation findings. It states surgeons must ensure they follow current clinical guidelines in their field. We think this means the surgeon should have planned Miss T’s surgery based on clinical findings and in line with ENT UK guidance.

48. The surgery plan on the consent form dated 2 April 2024 was detailed as a septorhinoplasty and correction of the anterior nasal valve.

49. Our adviser confirmed the second surgery was planned appropriately based on Miss T’s presentation at clinic on 2 April and appears to follow Good Surgical Practice.

50. The operation notes indicate that the findings during the surgery were an anterior dislocation of the septum causing anterior nasal valve collapse, which means that the side walls of the nose were found to be weak and likely more mobile and less supported than normal.

51. Notes also indicate that the surgery included anchoring the septum, which, our adviser explained, is a standard procedure to correct the position of the septum.

52. Our adviser told us that the notes indicate that some cartilage was removed and it is not clear whether this was the misplaced batten graft (a piece of cartilage put in place to support the nasal wall or valve) or the deviated part of the septum cartilage. We understand, either way, this would not in itself alter the outcomes from this surgery.

53. From the advice, we conclude the surgery was appropriate based on Miss T’s clinical presentation. The operation notes indicate the surgeon performed it correctly with no obvious complications, in line with the standard surgical procedure for that operation.

54. We understand Miss T’s concern that something must have gone wrong given she continues to have breathing difficulties.

55. Our adviser explained that the complications Miss T experienced following the surgery (subsequent movement of the septum and nasal valves) can occur slowly or quickly and this is due to the inherent flexibility and mobility of cartilage. These unfortunate events do not necessarily mean that the surgery itself was not carried out correctly.

56. Having considered the evidence and advice provided, we are satisfied there are no indications that Miss T’s surgery was planned or performed poorly. We will therefore not be looking at this part of the complaint further.

Referral after second surgery in 2024

57. Miss T told us following her second surgery, the original surgeon sent a routine, rather than urgent, referral to another ENT surgeon and to a surgeon who was not appropriately specialised to correct the second ENT surgery.

58. She says this means she is still waiting for her third corrective ENT surgery.

59. The Trust told Miss T that how quickly she is seen is dependent upon the other trust and the doctors at the other trust who triage her referral.

60. For the same reasons as before, Miss T did not meet the criteria for an urgent referral. We acknowledge that she has waited a long time. Unfortunately, that is the situation across much of the NHS at the moment and many people are waiting much longer than they should.

61. Miss T believes that because the specialist she was referred to in turn referred her on to another specialist, this meant the original referral was not appropriate.

62. 1.2.1 of Good Surgical Practice says, when appropriate, surgeons should transfer the patient to another colleague or unit where the required resources and skills are available. This is what happened in Miss T’s case when the surgeon referred her to another trust.

63. We consider the referral was made appropriately to a colleague. Because the next referral was at another local NHS trust, it is beyond the scope of this investigation, as are any subsequent delays in her treatment and care.

64. We consider that the referrals were appropriate and the delays Miss T feels she experienced, whilst regrettable, are not an indication of a failing. So we will not take further action on this part of the complaint. We nonetheless acknowledge the frustration felt by Miss T, especially with her ongoing symptoms and breathing difficulties.