An Anglesey man wants to know why it took so long for Betsi health chiefs to start treatment on his “aggressive cancer” – a delay that may have contributed to the cancer spreading. Emlyn Williams, 72, from Penysarn, Anglesey , was referred to the Urology Unit at Ysbyty Gwynedd in Bangor in September 2023 after a PSA prostate test raised concerns. He was reviewed by a consultant urologist the following month and a plan was made for an MRI scan. This was done that November and it found Emlyn was at “high risk of having clinically significant prostate cancer”. He underwent a biopsy in January 2024 and it was reported that cancer has been identified in over half of the biopsy samples taken. The grade of the cancer meant it would likely would grow and spread outside the prostate. A urology multi-disciplinary team reviewed the case in February and further scans carried out. Emlyn chose to undergo a prostatectomy, a procedure to remove part or all of the prostate gland). Arrangements were then made to refer him to a hospital in England. He was told he would require a PSMA PET scan report as part of the referral process but this was not performed until May in Cardiff. It found the Anglesey pensioner had metastatic disease which had spread to the lymph nodes and to his bones. Sign up for the North Wales Live newsletter sent twice daily to your inbox Later that month it was recommended that he should receive hormone treatment, chemotherapy and radiotherapy and the prostatectomy in England was cancelled. He started hormonal therapy in June and he began chemotherapy and radiology treatment in July. The Public Services Ombudsman for Wales launched an investigation after Emlyn complained about the care and treatment he received. In particular, the Ombudsman considered delays in receiving a PSMA PET scan – an advanced imaging test that uses a radioactive tracer to identify and visualise prostate cancer cells. The Ombudsman found that, whilst the care and treatment received overall followed the NHS Wales National Pathway for Prostate Cancer, there were significant delays at key stages. As a result, the patient waited more than three times longer than he should have before his treatment began. It found the delay between the biopsy in January – which indicated that a PSMA PET scan was appropriate – and scan taking place in May was “unacceptable and a clear service failure”. The Ombudsman, said: “Because the scan itself was significantly delayed, Mr C’s hormonal therapy was also delayed unnecessarily. This was an injustice for Mr C (Emlyn Williams), leaving him waiting more than 180 days from the point of suspicion to definitive treatment.” The Ombudsman was further concerned about the Health Board’s failure to recognise the delays when responding to his complaint. Public Services Ombudsman for Wales, Michelle Morris, said: “This is the fourth report issued over nine years by my office about delayed prostate cancer management at this Health Board. In previous reports, we urged the Health Board to fully commit to change and improvement so that men would not need to bring similar concerns to my office again. “It is therefore bitterly disappointing to be reporting once again on failings in the same area. Previous recommendations have not been fully complied with, and the Health Board’s own improvement plan – agreed with the Royal college of Surgeons – has not been completed. A majority of the actions remain outstanding, despite my office having sight of this plan following our last public interest report. “The Health Board cited staff sickness and capacity issues as reasons for the delays – explanations that have also been given in previous investigations by my office. However, these reasons do not fully explain why Mr C waited more than 180 days from the point of suspicion to definitive treatment. “On the balance of probabilities, these delays more likely than not contributed to Mr C’s cancer being more advanced. The uncertainty this creates will sadly be an enduring injustice for Mr C and his family.” Emlyn told BBC Wales he wanted to know “Why the thing took so long knowing that the cancer was an aggressive cancer”. He added: “It took from February until June before any medication which would push back the cancer. “As far as I can see that led to it spreading. When you are told you have an aggressive cancer your brain is all over the place.” He complained there were “little excuses made to make things longer and longer and in my case it has obviously spread between the February scans and being scanned in Cardiff where I had to go in the end. “I am living with terminal cancer, you have to put up with it when you know very well that if people were switched on in the urology department in Bangor hospital you would have had a far better outcome.” The Ombudsman’s Recommendations The Ombudsman made a number of recommendations, all of which Betsi Cadwaladr University Health Board accepted. These included: Apologising to Mr C for the delays and the injustice caused. Sharing the report with the clinicians involved in Mr C’s care so the findings can be considered and discussed, and providing feedback to the Ombudsman on any improvements identified. Auditing patients who have required a PSMA PET scan in the last two years to assess waiting times between the point of suspicion and the start of treatment, and taking appropriate action to ensure patient care aligns with national guidance. Reviewing its local prostate cancer pathways and benchmark it against the National Optimal Pathway and those used by other health boards in Wales, including formal audits before and after any changes. Reviewing Mr C’s case under its legal Duty of Candour to determine how his cancer pathway exceeded 180 days, and reporting the findings to its Quality and Patient Safety and Audit Committees and include its findings in its Annual Report on the Duty of Candour. Reminding complaint handling staff of the need for in-depth and robust investigations. Carol Shillabeer, Betsi Cadwaladr University Health Board’s CEO, said: “We apologise for the unacceptable delays in this patient’s diagnostics and treatment and fully accept the Ombudsman’s findings in this case. We will continue to progress these improvements at pace. “We have already developed a Business Case to transform Nuclear Medicine services and this is now being considered by Welsh Government. Should we be successful, it would start the process of creating a Centre of Excellence, with two Gamma Cameras and one of only three static PET-CT scanners in Wales. “Having our own PET-CT scanner will allow us to more easily re-appoint patients compared to our current arrangement, which relies on an outside provider supplying a mobile PET-CT scanning service. “A Centre of Excellence in North Wales would see Nuclear Medicine services consolidated into a purpose-built centre, allowing us to offer enhanced research facilities and making recruitment into this specialist field more attractive. We believe this will offer a more comprehensive and joined-up service, which will hugely benefit patients in our region.” Join the North Wales Live WhatsApp community group where you can get the latest stories delivered straight to your phone

Original source: gb