Prostate cancer: Apology over failure to monitor patients

Failures by a health board led to eight cancer patients not being appropriately monitored or included in treatment targets after being referred to England, the ombudsman has found.

Of the 16 patients on Betsi Cadwaladr health board's prostatectomy waiting list in August 2019, eight were referred to England for treatment.

None of those treated in England met the health board's targets.

The health board, which covers north Wales, has apologised to the patients.

It said it had accepted the findings of the report and agreed to implement its recommendations.

Welsh Conservatives said it was a "scandal".

The target time for treatment is within 62 days for non-urgent suspected cancer cases and 31 days targets for urgent cancer cases.

The Public Services Ombudsman for Wales said if the patients had been treated in Wales, breaches of the target would have been reported.

By contrast, four of the patients treated by the health board exceeded the cancer waiting time target which led to reviews.

The investigation was launched after a report into the case of a prostate cancer patient raised suspicion there were further incidents.

The investigation found that in 2019, the Welsh policy position was only patients treated in Wales were reported against the Welsh cancer waiting time targets and the health board only produced breach reports and undertook harm reviews for the patients it treated.

Public Services Ombudsman for Wales Nick Bennett said: "Clearly there's consequences for any type of cancer treatment, where people who are treated in England do not receive the same monitoring, do not receive the same harm reviews...

"Going forward, this must never happen again."

He said while there was no requirement to produce reports or carry out reviews for patients treated in England, the "geographical location of treatment should not have left these eight patients in a position where they were denied the harm review process because they were treated outside Wales".

"Regardless of the Welsh policy position at the time, the health board was obliged to undertake appropriate monitoring of the care and treatment of its patients under its commissioning and contracting arrangements.

"It should also have considered the impact of the delay in treatment in these cases. These failures amounted to maladministration," he said.

A new single cancer pathway has now replaced all previous cancer targets.

All patients referred from secondary care for treatment outside Wales for cancer treatment must be included in cancer waiting times and have an internal breach report completed.

Mr Bennett said the health board should now carry out a harm review for the each patients and review its harm review process to ensure it is in line with the requirements of the single cancer pathway.

He said he was concerned "issues relating to capacity and succession planning" within the urology department "seem to be long-standing".

He also recommended the health board referred the report to its board to consider capacity and succession planning for the department.

Russell George, Welsh Conservative health shadow minister for health, said it was "nothing short of a scandal", and accused the Welsh government of compromising waiting times measures.

"Referring patients to England, in itself, is not bad - it could be more convenient for them - but to do so and use it as an opportunity to massage the stats to make the health board look better is utterly contemptible, especially when we are dealing with cancer," he said.

Executive medical director at Betsi Cadwaladr University Health Board Nick Lyons said: "We apologise to all the patients who waited longer than they should have.

"It is not acceptable and we understand the distress and anxiety those waits have caused to those patients and their families.

"We fully accept the findings of the ombudsman's report and are improving our systems to ensure we monitor all patients wherever care is provided.

Plaid Cymru's health spokesman Rhun ap Iorwerth said the situation was of "grave concern".

"While we can take some comfort that the health board has accepted the recommendations made in this report, the fact remains that this is another blow to the already waning confidence the people of north Wales have in their health board," he added.

"It adds to concerns that Betsi Cadwaladr has long been unfit for purpose - that it is too big and cumbersome, its agenda is too centralised for the remote communities it is meant to serve.

"How much more evidence do we need of slipping standards as a result of a maladministration and lack of strategic direction?"