‘Loving’ mum, 38, died of ‘aggressive’ cancer after ‘unacceptable’ NHS delays, coroner blasts
AN URGENT warning has been issued after a "loving, funny and generous mum" died of womb cancer following "unacceptable" waiting list delays.
Coroner Samantha Goward has hit out at "lengthy" NHS waiting lists and said they will lead to more women dying from cancers that affect the female reproductive system.
Carla Smith was suffering from an "aggressive" form of womb cancer but by the time she was diagnosed it was too late to treat her.
Ms Goward, the area coroner for Norfolk, said women in the UK are at risk of succumbing to the same fate as Ms Smith and are "significantly deteriorating" and "losing treatment options" because waiting lists are so long.
Worryingly, at Ms Smith's inquest it was heard that women now wait for up to seven months (30 weeks) for an urgent referral and almost 14 months (60 weeks) for a routine referral.
Ms Goward said one NHS consultant confessed "they do not know how they can catch up with this backlog".
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In a Prevention of Future Deaths report, Ms Goward has written to the government calling for a response.
"Loving, funny and generous" Ms Smith, from Hunstanton, Norfolk, died in June 2023 having been diagnosed with womb cancer in April 2023.
It was heard she first went to her GP with concerns nearly a year before.
Ms Goward's report said: "Carla Smith had a history of excessive vaginal bleeding.
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"She first attended her GP surgery in July 2022 and an ultrasound scan was arranged.
"The report received August 23, 2022, showed a thickened endometrium of 22 millimetres. This should have led to a referral to the gynaecology team.
"After a review by a different GP and a discussion with Carla on September 27, 2022, an urgent referral was made with an anticipated wait of four to six weeks.
"When triaged by specialists at the hospital, the referral should have been upgraded to a two week wait pathway.
"Carla was not seen until January 31, 2023.
"A biopsy on that day was marked as routine instead of two week wait.
"There was a delay in the sample being processed and this was chased after Carla attended hospital again as an emergency on April 15, 2023 due to ongoing heavy bleeding.
During the course of the inquest, it was apparent that there were a number of missed opportunities to refer Carla for treatment
Samantha Goward
"A CT scan showed signs suggestive of advanced endometrial malignancy with disseminated metastasis.
"This prompted a report on the January biopsy, which was said to show grade one womb cancer at that time."
It continued: "After a further biopsy and investigations in April 2023 it was felt that Carla had stage four cancer.
"While an initial plan was made for surgery, due to the unusually aggressive nature of the cancer, Carla rapidly deteriorated and was sadly not suitable for surgery and palliative care commenced. She died on June 7, 2023.
"During the course of the inquest, it was apparent that there were a number of missed opportunities to refer Carla for treatment and to use the correct pathway to do so and there were also significant delays in receiving results from the laboratory and due to lengthy waiting lists, even for urgent referrals."
Ms Smith was treated at the Norfolk and Norwich Hospital in Colney and the Queen Elizabeth Hospital in King's Lynn.
The cause for concern is that some patients may significantly deteriorate while on such lengthy waiting lists
Samantha Goward
Ms Goward said: "I heard from Consultants at two hospitals, and read evidence from others.
"The evidence I heard is that, at that time there were significant waiting lists, even for those on an urgent pathway.
"I heard that these issues persist and that, in relation to gynaecology referrals which was the subject of this inquest, where the expected waiting time would previously be four to six weeks for an urgent referral, one hospital has a waiting time of 18 weeks, the other 30 weeks (and 60 weeks for routine).
"I was advised by one Consultant that they do not know how they can catch up with this backlog.
"I am aware that this is not a problem that is unique to just the two Trusts from whom evidence was heard."
"The cause for concern is that some patients may significantly deteriorate while on such lengthy waiting lists.
"In some cases, this may mean that they lose some treatment options due to their condition advancing. This leads to a risk of future deaths.
"The other concern I have following the evidence heard, is that if someone is on a routine or urgent waiting list, there is no requirement or system in place to monitor their progress.
"I was advised that those referred under a two week wait (which I am now advised has been changed to a 28 day wait) for suspected cancer, will be monitored to ensure that the timescale is met.
"There is no such requirement for the other waiting lists.
"This may lead to patients being left waiting for excessive periods, without any requirement for their case to be reviewed to ascertain if it remains suitable for such a lengthy wait, or if a new referral needs to be made on a different pathway."
After the inquest, chief executive of the Queen Elizabeth Hospital, Alice Webster, publicly apologised for the errors in Ms Smith's care.
Main symptoms of womb cancer to spot
WOMB cancer is cancer that affects the womb (uterus) and is most common in women who've been through menopause.
The main symptoms can include:
- bleeding or spotting from the vagina after the menopause
- heavy periods that are unusual for you
- vaginal bleeding between your periods
- a change to your vaginal discharge
Other symptoms that may occur are:
- a lump or swelling in your tummy or between your hip bones (pelvis)
- pain in your lower back or between your hip bones (pelvis)
- pain during sex
- changes to how often you pee and poo (this can be either more, or less, than usual)
If you experience any of theses symptoms, see your GP.
Source: NHS
Ms Webster admitted: "The delays and errors in the care provided were unacceptable."
Ms Smith was described by her partner Linda Baldry as the "most loving, funny and generous girlfriend" who will be "missed forever".
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Her mother Caroline said she was "greatly loved and a very happy person" who "smiled her smile until the end".
Ms Goward's report was sent to the Department of Health and Social Care, which has until March 26 to respond.