AN ELDERLY woman living with dementia was effectively left housebound for the last eight years of her life due to surgical delays in the treatment and management of her severe rectal prolapse, an Ombudsman investigation has revealed.

Mr A complained about the care that his late mother Mrs B, received at Betsi Cadwaladr University Health Board’s (BCUHB) Glan Clwyd Hospital.

He said that when it came to the management and care of his mother’s severe rectal prolapse, there had been surgical delays by the Colorectal Department going back to 2011.

Mr A queried the adequacy of the inpatient medical care provided by a Care of the Elderly Consultant during Mrs B’s admission in May 2018 and had concerns about a delayed diagnosis of his mother’s terminal ovarian cancer during this admission.

Mr A was also dissatisfied with the robustness of the health board's complaint response.

The investigation found consistently from 2011 onwards, that in terms of Mrs B’s rectal prolapse management, the clinical decision-making and rationale shown by the colorectal surgeons was not in keeping with accepted clinical practice.

More straightforward surgical rectal prolapse repair options, including less invasive procedures, were discounted in favour of high risk, unconventional and in one case (which would have involved the complete removal of Mrs B’s rectum and possibly her anus), extreme treatment options, which would have provided Mrs B with little or no clinical benefit.

Mrs B was initially reluctant to have either a colostomy, or a complete removal of her rectum. As these procedures were the only rectal prolapse treatment options offered to her from 2011 onwards, this was a further factor in the delay.

The Ombudsman was critical of the lack of clinical clarity demonstrated in Mrs B’s case.

The reports states that mixed messages given to Mrs B, concerning the benefits of a colostomy, meant it was only on the day of the operation, in March 2018, that she was told definitively the procedure would not benefit her prolapse.

Mrs B decided not to go ahead with the operation.

The report states that the offer of only the "extreme treatment option" caused long term harm and significantly affected Mrs B’s quality of life.

As a result of the failings, Mrs B had to cope with the considerable and ongoing indignity caused by a severe and symptomatic prolapse which included double incontinence.

Mrs B’s worry about “being caught short” because of her incontinence meant she did not want to risk going to social events or the pensioner social group recommended by the dementia Memory Clinic. It also affected Mrs B’s relationship with her family and the quality of time they spent together.

Although it is not open to the Ombudsman to say that there has been a breach of an individual’s human rights the Ombudsman’s investigation identified that human rights, and in particular Article 8, (relating to the right to family life and personal identity) was engaged, as the failings had such a significant impact on Mrs B’s end years and the time that the family had with her.

BCUHB has agreed to a number of recommendations including a full apology to Mr A and an invitation to engage with an equivalent to the Putting Things Right Redress process. It also agreed to share the points of clinical learning from the case and to review how its Colorectal team carries out rectal prolapse procedures.

Nick Bennett, Public Services Ombudsman for Wales said: “The lack of clinical clarity and the mixed messages given to Mrs B concerning the benefits of a colostomy meant it was only on the day of the operation, in March 2018, that she was told definitively the procedure would not benefit her prolapse. Mrs B decided not to go ahead with the operation.

“As a result, Mrs B had to endure years of indignity on a daily basis as she dealt with her condition and the longstanding physical and mental impact the failings had on her and her family.

“It is clear that there was a significant injustice in this case.

"As Ombudsman, given the failings that happened here, it is right that I take a stand on driving forward improvements in care and service delivery, given the effects such failings have on individuals like Mrs B, her family and their human rights.”

The following recommendations were made to the health board, to be carried out over a three month period:

(A) The health board’s Chief Executive should apologise to Mr A, on behalf of the family, for the clinical and complaint handling failings identified.

(B) The health board should invite Mr A and his sister to engage with an equivalent to the Putting Things Right Redress process via its Legal and Risk Services Team.

(C) The health board should review how its Colorectal team carries out rectal prolapse procedures.

(d) The health board should share the points of clinical learning from this case at an appropriate colorectal clinical forum.

BCUHB has agreed to implement the above recommendations.

Jo Whitehead, chief executive of Betsi Cadwaladr University Health Board, said: “We offer our sincere apologies for the failings found in this report, including the delay in offering surgery, the distress this has caused and the mishandling of the complaint investigation.

“We have considered the Ombudsman’s report very carefully and we accept the findings, which has identified areas for improvement to ensure patients receive better and more timely care.

"We will now implement the Ombudsman’s recommendations and we will write to the family to apologise for the identified failings and to discuss the matter further.”