Excessive delay in carrying out hip surgery caused unnecessary pain, distress and frustration

What happened

Miss R was initially investigated for stomach symptoms, which turned out to be a cyst in her hip. She saw a locum consultant who wanted the radiology team to look at her scan results. However, the locum left the Trust and his work was not picked up until Miss R repeatedly followed it up herself. The gastroenterology clinic saw Miss R and referred her to orthopaedics for removal of the cyst. However, the orthopaedic clinic referred her to a consultant radiologist to remove the cyst guided by an ultrasound. There was nothing in the records to show that this procedure took place. Again Miss R followed it up but the Trust told her it could not speed things up for her because she had been waiting less than 18 weeks (the maximum waiting time for referral to treatment). This was incorrect as she had already been waiting 15 months by this time. Miss R said this was the first time she had been made aware of the 18–week referral to treatment rule.

Miss R continued to contact the Trust for updates, and eventually had her surgery in early 2014, 17 months after she was first referred by her GP.

What we found

There was no system in place to pick up work from the departing locum consultant who first saw Miss R. This caused a clear delay in the process; it was three months before Miss R was referred to orthopaedics. Even when she had seen the orthopaedic surgeon, it was then another 21 weeks before she was seen again, and another 15 weeks before she had her surgery.

We found that the Trust breached the national 18–week referral to treatment rule. Miss R's case was a straightforward one, and this was an unreasonable and significant delay. Miss R was 'lost in the system' on more than one occasion, and the Trust's communication with her about what was happening was poor. Had the Trust been proactive about following up her treatment and keeping her on the correct pathway, it is likely she would have had her surgery sooner, and possibly within the 18 weeks set out in The NHS Constitution.

The delay caused Miss R a great deal of frustration and distress, as well as an increasing amount of pain. However, as this condition is caused by degenerative changes to the hip joint, it would have worsened anyway. We did not find that the delay caused Miss R's condition to worsen or impeded her recovery from surgery. But we found that the delay caused her pain for a much longer period than was necessary.

Putting it right

The Trust accepted our recommendation to apologise to Miss R for the failings we found and the impact they had on her. It also paid her £2,500 in light of the distress, frustration and unnecessary pain she experienced.

The Trust also produced an action plan outlining the steps it had taken to improve its services in future, including how it would make sure that it follows up on work from departing clinicians, how it will work to prevent a recurrence of the administrative errors in Miss R's case, and how it will improve communication with patients about the 18–week referral to treatment rules.