Overview
The complainant (Mr C) raised a number of concerns against Highland NHS Board (the Board) that if a small mass found on his kidney in December 2005 had been regularly and appropriately checked, the delay to diagnose his renal cancer could have been prevented. Mr C also complained about the inadequate manner the Board dealt with his complaint about this.
Specific complaints and conclusions
The complaints which have been investigated are that the Board:
- (a) delayed to diagnose Mr C's renal cancer (upheld); and
- (b) failed to address his complaint appropriately (upheld).
Redress and recommendations
The Ombudsman recommends that the Board:
- (i) ensure that measures are taken to feedback the learning from this event to all medical staff, to understand the importance of avoiding similar situations recurring;
- (ii) review how hospital teams ensure that the results of patient investigations received after discharge are read and acted upon;
- (iii) conduct a Significant Events Review of this case;
- (iv) review their Complaints Management Procedures to ensure compliance, with reference to sections 5, 6 and 7; and
- (v) apologise for the failures identified in the report.
The Board have accepted the recommendations and will act on them accordingly.