NHS Fife ordered to pay up for private surgery after refusing to operate

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An NHS board has been told to cover some of the costs of a patient's private surgery after refusing to operate on them despite two emergency admissions to hospital.

NHS Fife said it had been "reasonable" to postpone surgery on the patient's gallbladder because it had been inflamed.

However the individual, named as "C" in public documents, said they were left in "chronic and excruciating pain" after being refused surgery on two occasions, with no follow-up forthcoming from the health board.

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After waiting what they considered was an unnecessary amount of time, C eventually had the surgery carried out privately - and filed a complaint with the Scottish Public Services Ombudsman (SPSO) after finding the NHS response to their grievance unsatisfactory.

NHS Fife has been ordered to pay for the surgery done privatelyNHS Fife has been ordered to pay for the surgery done privately
NHS Fife has been ordered to pay for the surgery done privately

The public service watchdog carried out an investigation into the failure to operate, consulting independent health experts.

It concluded that C should have been treated as a high priority case due to not just one but two emergency admissions, and should have given them an early appointment for surgery when the swelling had passed.

However, it found that "administrative errors" disrupted the process: the board failed to to follow-up with C after the first admission and did not prioritise them on the waiting list after the second.

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It has ordered the board to reimburse the complainer up to the value of the public cost of the surgery had it been done on the NHS, in order to help them cover some of the costs of going private.

Victoria Hospital, KirkcaldyVictoria Hospital, Kirkcaldy
Victoria Hospital, Kirkcaldy

"We found that C should have been regarded as a high priority case given their symptoms had led to two emergency admissions and, after each admission, they should have been offered an early appointment for surgery once the inflammation settled," the SPSO said in a statement.

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"We found that the board had failed to arrange C's gallbladder surgery within a reasonable timeframe and, therefore, we upheld C's complaint.

"We took into account that the cost of the private treatment was partly due to the board's failings and also partly due to a private decision by C.

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"In the specific circumstances, we recommended that C be reimbursed to the extent which the surgery would have cost the board."

The watchdog has also set out a deadline for the NHS to compensate the C - with interest chargeable if the board does not meet the target.

NHS Fife confirmed it has apologised to the patient and acted on the ombudsman's recommendations.

Director of nursing Janette Owens said: “Our aim is always to provide patients in Fife with the best possible care and treatment, however, in this instance we recognise that we fell short of these standards.

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"We accept the findings of the Ombudsman and have enacted their recommendations, including apologising formally to the individual involved.

"Measures have also been put in place to limit the opportunity for the issue being repeated in future, particularly in more complex cases such as this.”

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