- Parliamentary and Health Service Ombudsman criticises Barking, Havering and Redbridge Trust
- Pamela North did not have key tests because of staff shortages at hospital in 2015
- She was admitted as an emergency patient in 2016 by which time cancer was inoperable
An NHS trust has paid £10,000 to the family of a woman who died after “delayed and inadequate” investigations left her with terminal cancer.
Staffing shortages meant key tests for 73 year old Pamela North were not carried out by Barking, Havering and Redbridge University Hospitals Trust leading to her avoidable death, a report by the Parliamentary and Health Service Ombudsman has said.
Ms North’s three children have donated the compensation to Saint Francis Hospice in Romford, which cared for their mother in the final weeks of her life.The trust told HSJ in a statement that it was not aware of any other patients ”similarly impacted” by staffing shortages.
The report, published today, said Ms North was diagnosed with cancer nine months later than she should have been. She was referred to the trust in February 2015 with suspected bladder cancer and tests were carried out that identified potential warning signs. A CT scan later confirmed her kidneys were swollen.
Repeat tests were carried out in April and May 2015. The PHSO said the trust planned to review her in six weeks for an X-ray “but this did not happen due to the hospital not having sufficient staff capacity to meet demand”.
Ms North continued to exhibit key signs of cancer, with creatinine levels in her urine rising to 500 mL/min at times, compared with a normal range of 88-128. These were signs her kidneys were failing. She was admitted to hospital in September 2015 but no bladder biopsies were taken despite her undergoing a cystoscopy to examine the kidneys.
She was admitted again in January 2016 where an endoscopy and MRI scan revealed she had advanced cancer. The cancer was too advanced to be removed by surgery and Ms North died in May 2016.
The PHSO report said the trust failed to spot the cancer and its subsequent investigations were “delayed and inadequate”. It added: “A prompt examination under general anaesthetic with biopsies being taken would have enabled the trust to diagnose cancer in March 2015.”
The PHSO said Ms North would have had a 70 per cent chance of survival at that time. It said the nine month delay “meant that Ms North was more likely to die than survive and meant she had to endure painful symptoms of kidney failure. The trust’s investigation did not identify these failings or acknowledge that if it had provided the right care and treatment then she could have survived, causing her son significant distress.”
It recommended the trust pay her son £10,000 due to the “emotional impact of knowing his mother would not have died when she did, had she received the right care and treatment”. It also told the trust to formally apologise and to show the family want changes they had made since Ms North’s death.
James North said: “We donated the money to charity, it was never about the money. We just wanted to grieve but you can’t when you know something has gone wrong.”
Mr North said his family were concerned the trust’s staffing shortages meant other patients may have fallen through the gaps like his mother. “It is a worry and if they don’t learn from these mistakes and deal with pressures like staffing shortages people will suffer,” he said.
Mr North praised the PHSO for the way it had handled the complaint. He said: “They were fantastic. They have been so professional, thorough and quick. They kept me informed throughout.”
A trust spokesman told HSJ it had made “huge progress” in the last two years on its treatment of cancer and that since July 2017 the trust had hit the 62-day target for 85 per cent of patients diagnosed with cancer starting their treatment.
Trust chief executive Matthew Hopkins said: “We accept that we fell short of the quality of care we aspire to, and that the complaints process did not provide them with the appropriate reassurance.
“We have made significant progress in the last two years since these events occurred, and have made substantial improvement to our complaints-handling processes, to ensure we are thoroughly and comprehensively investigating and reviewing any area where we may have fallen short of the high standards we set ourselves.
“We accepted the findings and the recommendation of the PHSO, following its investigation, which we were happy to comply with.”
22 May 2018