Health board failures led to 'injustice' for prostate cancer patients

A health board has apologised for the "distress" it caused to cancer patients after referring them for treatment in England and "failing" to monitor them.

Betsi Cadwaladr University Health Board caused “injustice” to eight prostate cancer patients after failing to undertake appropriate monitoring of their care and treatment, according to a new report by the Public Services Ombudsman for Wales.

It was found that referring patients for treatment in England, meant that these patients were then not included in breach reports if they exceeded waiting time targets, nor were assessments completed to see whether harm had been caused to these patients as a result of the long wait.

Of the 16 patients on the waiting list in August 2019, eight were referred to England for treatment. Credit: PA

Dr Nick Lyons, Executive Medical Director at Betsi Cadwaladr University Health Board, 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.

"Since January our policies have been changed to align with new guidance from Welsh Government under the Single Cancer Pathway. This means any patient whose treatment is commissioned by us will undergo a harm review if referral to treatment times exceed 104 days, regardless of where they are treated."

The Ombudsman launched an investigation into Betsi Cadwaladr University Health Board after a report into the case of a prostate cancer patient raised “reasonable suspicion” that there were further incidents of service failure and maladministration linked to other patients on the waiting list during August 2019.

His investigation found that, at that time in question, the Welsh policy position was that only patients treated in Wales were reported against the Welsh cancer waiting time targets. Therefore, the health board only produced “breach reports” and undertook harm reviews for the patients it treated. This process did not apply to patients referred for treatment in England.

Of the 16 patients on the waiting list in August 2019, eight were referred to England for treatment. The Ombudsman’s report found that had these patients been treated in Wales, breaches of the target timescales would have been reported in the cases of all eight patients as they waited longer for treatment than the 62 and 31-day targets for urgent and non-urgent suspected cancer cases, respectively.

By contrast, four of the patients on the waiting list treated by the Health Board in Wales exceeded the cancer waiting time target. These breaches of target timescales were reported, and harm reviews were completed for all four patients.

The Ombudsman’s investigation found that the Health Board failed to monitor the provision of care and treatment for all patients as it should have done under its contracting and commissioning arrangements.

Betsi Cadwaladr University Health Board was taken out of special measures in November 2020:

Public Services Ombudsman for Wales, Nick Bennett, said 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.He added: "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."

After reporting on the Health Board’s urology service several times, he said he is "concerned" that issues relating to capacity and succession planning within the urology department seem to be longstanding.“I have therefore recommended that the Health Board refers the report to its Board to consider capacity and succession planning for the urology department.”

Rhun ap Iorwerth Credit: ITV Wales


Commenting on the revelations, Conservatives' Shadow Health Minister Russell George MS described it as "nothing short of a scandal".

“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.

“Measures regarding waiting times serve an important purpose in identifying best and poor practice that can teach everybody about how best to deliver healthcare. That they have been compromised by the Government is worrying in the extreme and could have repercussions for patient care.

 “I will be exploring all the avenues that could be used to hold the Welsh Government to account, discover how long the policy has been in place for, and if it is still in operation. This amounts to a failure on several fronts and cannot be swept under the carpet.”

Plaid Cymru’s Rhun ap Iorwerth MS has expressed “grave concern” at the findings, having previously called for a “new health and care landscape in the north”.

He said, "Yet again we hear reports of service failure within Betsi Cadwaladr University Health Board while it was in special measures, and receiving additional support from the Labour Welsh Government.

"Wider, equally serious questions remain about capacity and succession planning in the urology department.

"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."