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Cancer scan snub complaint upheld Cancer scan snub complaint upheld
(20 minutes later)
A woman refused funding for a scan and told she would have to have a major op instead, has had her complaint upheld.A woman refused funding for a scan and told she would have to have a major op instead, has had her complaint upheld.
Health Commission Wales (HCW) has been told by the Ombudsman to apologise to Yvonne Thomas, from Newport, and has been accused of maladministration. Health Commission Wales (HCW) has been told to apologise to Yvonne Thomas for the "perverse" decision which the ombudsman said was maladministration.
After a lump beside her lung was found Ms Thomas was told she needed an £800 PET scan to check for cancer. Mrs Thomas was told she needed an £800 PET scan to check for cancer after a lump was found beside her lung.
But Health Commission Wales refused funding and said she could have surgery instead - costing much more. But Health Commission Wales refused funding and said she could have surgery instead - costing the NHS more.
HCW has been ordered to reimburse the cost of the scan and pay an extra £500 for worry and distress, the assembly government has said. HCW has been ordered to reimburse the cost of the scan and pay an extra £500 for worry and distress, the assembly government said.
When the lump was first discovered, Mrs Thomas' consultant wrote to HCW to request funding for a PET scan - which uses radiation to produce a three-dimensional colour image - to determine whether it was malignant. When the lump was first discovered, Mrs Thomas' consultant wrote to HCW to request funding for the scan - which uses radiation to produce a three-dimensional colour image - to determine if the lump was malignant.
But HCW refused the request on the grounds that Mrs Thomas did not have a proven case of lung cancer and therefore did not qualify. But the request was turned down on the grounds that Mrs Thomas did not have a proven case of lung cancer and therefore did not qualify.
The only other option available to Mrs Thomas was to have a thoracotomy - an operation which would have cost three or four times more than the PET scan and which, because of the location of Ms Thomas' lump, was described as a "tricky" procedure by a surgeon.The only other option available to Mrs Thomas was to have a thoracotomy - an operation which would have cost three or four times more than the PET scan and which, because of the location of Ms Thomas' lump, was described as a "tricky" procedure by a surgeon.
I really was dumbfounded at the logic behind it... especially because the cost to the NHS of this procedure was three or four times as much as a PET scan Yvonne ThomasI really was dumbfounded at the logic behind it... especially because the cost to the NHS of this procedure was three or four times as much as a PET scan Yvonne Thomas
But the cost of thoracotomy would not have come out of HCW's budget, the report by Public Services Ombudsman Adam Peat found. The cost of thoracotomy would not have come out of HCW's budget, the report by Public Services Ombudsman Adam Peat said.
The lump did not prove to be cancerous but Mrs Thomas, 52, said she was shocked by the way she was treated. In thend the lump did not prove to be cancerous but Mrs Thomas, 52, said she was shocked by the way she was treated and complained the public services ombudsman.
She said: "It seemed ludicrous. It (the PET scan) could have put my mind at rest much sooner because I waited a very, very long time to know that I was clear of cancer. "It seemed ludicrous," she said. "It [the PET scan] could have put my mind at rest much sooner because I waited a very, very long time to know that I was clear of cancer.
"I think the most shocking thing is that they were prepared to put me through a major operation."I think the most shocking thing is that they were prepared to put me through a major operation.
"I really was dumbfounded at the logic behind it... especially because the cost to the NHS of this procedure was three or four times as much as a PET scan.""I really was dumbfounded at the logic behind it... especially because the cost to the NHS of this procedure was three or four times as much as a PET scan."
In his report, Mr Peat said it was "absurd" for a Welsh Assembly Government agency to take funding decisions which were wasteful of NHS resources and that the commission appeared to be "driven by a desire to protect HCW's own budget".In his report, Mr Peat said it was "absurd" for a Welsh Assembly Government agency to take funding decisions which were wasteful of NHS resources and that the commission appeared to be "driven by a desire to protect HCW's own budget".
"Worry and distress""Worry and distress"
He recommended that HCW apologised to Mrs Thomas, reimbursed her the £800 she paid for the private PET scan and that it paid an additional sum of £500 "to reflect the worry and distress which its flawed decision-making also caused her".He recommended that HCW apologised to Mrs Thomas, reimbursed her the £800 she paid for the private PET scan and that it paid an additional sum of £500 "to reflect the worry and distress which its flawed decision-making also caused her".
HCW should also review its PET scan policy to ensure that applications falling outside the criteria would be considered on their individual merits, said Mr Peat. He also said HCW should also review its PET scan policy to ensure that applications falling outside the criteria would be considered on their individual merits.
He also called on the Welsh Assembly Government to "urgently review" the operation of HCW with a view to optimising the use of NHS resources. As well as that he recommended the Welsh Assembly Government should "urgently review" the operation of HCW with a view to optimising the use of NHS resources.
In the report, Mr Peat said the assembly government had seen a draft of the report and had agreed to implement all his recommendations. The assembly government had seen a draft of the report and had agreed to implement all his recommendations.
Mrs Thomas said she would accept an apology on condition that HCW reviewed the criteria they used to exclude people from PET scans.Mrs Thomas said she would accept an apology on condition that HCW reviewed the criteria they used to exclude people from PET scans.
She said: "To me, the criteria was so specific that it appeared that it was designed to exclude as many people as possible as opposed to including as many people as possible."She said: "To me, the criteria was so specific that it appeared that it was designed to exclude as many people as possible as opposed to including as many people as possible."
HCW is already under a review announced by Health Minister Edwina Hart last week.HCW is already under a review announced by Health Minister Edwina Hart last week.
Professor Mansel Aylward, of Cardiff University, who's also chairman of the Wales Centre for Health, will carry out the review.Professor Mansel Aylward, of Cardiff University, who's also chairman of the Wales Centre for Health, will carry out the review.
Responding to the ombudsman's report, he said: "I think his recommendations are just and I'm very pleased the Welsh Assembly Government have accepted them. Quite clearly the decison reached by the ombudsman is the right one and is something that will clearly have to inform the review I'm about to undertake."