Cancer patient died 'without suitable palliative care'
- Published
Mr W died "without suitable end-of-life care," the public services ombudsman for Wales said
A cancer patient died without suitable end-of-life care after surgery, an ombudsman investigation has found.
The wife of the patient, known as Mr W, said he became emaciated, immobile and depressed after surgery for oesophageal cancer in February 2018.
Mr W died in September 2018, with palliative care arranged by the health board only two weeks before his death.
Swansea Bay and Cwm Taf Morgannwg health boards apologised to his family for the distress they experienced.
According to the ombudsman's report some palliative care items, such as a hospital bed and commode, were still in the process of being delivered and installed when Mr W died, so he never got to use them.
The patient's wife said witnessing her husband's slow deterioration and death as his sole carer, and without advice or support, left her with feelings of pure terror and helplessness that would stay with her forever.
She said could not understand why Mr W was not given the help and support that he needed and deserved.
'Deeply shocking case'
The report said there were communication failures around Mr W's diagnosis and prognosis, as well as providing psychological support before and after his surgery.
It added there was no evidence the health board provided adequate and appropriate palliative post-discharge care and support to the patient and his family following unsuccessful surgery.
Nick Bennett, public services ombudsman for Wales, said: "This is a deeply shocking case where a man has died without suitable end-of-life care and, sadly, I think that both Mr and Mrs W's human rights are likely to have been compromised.
"Mr and Mrs W were not given the time to prepare for his eventual outcome, both mentally and with suitable palliative care aids and support. This impacted on Mr W's rights as an individual, and on both his and Mrs W's rights as part of wider family life."
Ombudsman Nick Bennett said Mr and Mrs W's human rights "are likely to have been compromised"
Health boards agree to make changes
Mr W was under the care of the Abertawe Bro Morgannwg University Health Board at the time.
In 2019 services in Bridgend county were transferred to the Cwm Taf health board, creating the Swansea Bay University Health Board and the Cwm Taf Morgannwg University Health Board.
In a joint statement Mark Hackett and Paul Mears, the respective chief executives of Swansea Bay and Cwm Taf Morgannwg health boards, said: "Firstly, we would like to take the opportunity to offer our sincere apologies to Mrs W and her family for the distress they experienced, and to again convey our condolences on their very sad loss.
"We have accepted the ombudsman's findings and agreed to implement the recommendations in full.
"Mrs W's account of their experience is sobering, and there are clearly areas in which the care we provided could have been significantly improved.
"It is evident the couple were not fully supported during Mr W's deterioration, and we sincerely regret that. It falls considerably short of the standard of care we expect all our patients to receive.
"Both health boards have carried out a full review of events to ensure action is taken to improve practice to prevent this happening again."
- Published13 December 2020
- Published9 January 2021
