Health board investigates case of patient forced to endure constant pain because of administrative blunders

Martin Shipton

A health board has launched an investigation into the case of a 30-year-old man with a rare medical condition that causes him to suffer excruciating pain in his hips with every movement.

The patient, who doesn’t wish to be named, has found himself trapped in a bureaucratic nightmare since being diagnosed with “severe avascular necrosis of both femoral heads”.

His wife has written a 12-page letter of complaint on his behalf to Cwm Taf Morgannwg University Health Board, cataloguing a series of apparent administrative blunders that have added to her husband’s suffering.

The patient, Mr A, was diagnosed with the condition by his GP on July 28 2024, and it was confirmed by an orthopaedic consultant two weeks later.

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Debilitating pain

His wife’s letter of complaint states: “Since then, due to prolonged delays and repeated communication failures, [his] condition has significantly deteriorated. He now lives in constant, debilitating pain and is entirely dependent on high doses of morphine and other medications. His mobility has been severely compromised, and with it, he has lost his independence, mental wellbeing, and sense of hope.

“[The health board] allowed [his] health to deteriorate over a six-month period—deterioration that is now clearly evidenced by the X-ray taken on 20 May 2025 at Princess of Wales Hospital. Since his referral to Cwm Taf Morgannwg UHB on September 6 2024 and his pre-assessment in January 2025, his condition has significantly worsened, with marked deterioration of his femoral heads. The health board had the opportunity and responsibility to intervene, yet chose instead to delay. How will Cwm Taf Morgannwg UHB give back that lost time—those months of avoidable pain, fear, and physical decline—that [he] will never recover? The decision to allow his condition to worsen cannot be excused or reversed, but it must be acknowledged, investigated, and rectified through urgent redress and meaningful accountability.

“This is not a hypothetical risk—it is the lived reality (he) faces every single day. The damage caused by inaction and mismanagement is not just medical; it is emotional, psychological, and personal. The toll on his wellbeing—and on our family—has been devastating.

“This complaint is not motivated by anger, but by necessity. (He) cannot continue to wait in pain, uncertainty, and silence. The time for oversight has passed; what is required now is urgent, coordinated, and accountable action.”

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Bilateral hip resurfacing

A consultant based at the Princess of Wales Hospital in Bridgend wrote to Mr A’s GP stating: “This young gentleman has very severe excruciating pain in both hips… He really needs bilateral hip resurfacing as a matter of great urgency. I have added him to my waiting list for simultaneous bilateral hip resurfacing/replacement, aiming to carry this out within the next three months. If resurfacing is not possible due to bone collapse or sizing issues, we will proceed with a total hip replacement using ceramic bearings.”

On January 7 2025, [Mr A] attended his pre-assessment at Princess of Wales Hospital and was medically cleared for surgery. The absence of a confirmed surgery date despite this clearance constitutes a serious breach of duty of care under the NHS (Wales) Act 2006, which mandates prompt, equitable, and effective health service delivery.

“This prolonged delay raises significant concerns under the General Medical Council’s Good Medical Practice guidelines and Healthcare Inspectorate Wales standards, including:

* Patient safety and harm prevention

* Maintaining professional accountability

* Ensuring timely access to appropriate treatment

“Furthermore, the delay appears to breach the Duty of Candour (Wales) Regulations 2023, requiring openness and honesty where care has caused or may cause significant harm. [My husband’s] worsening condition and functional decline unequivocally represent such harm.

“The critical three-month target for surgery from December 2024 has now been exceeded without explanation, and (his) condition has deteriorated severely:

* He suffers constant, agonising pain, unable to walk, dress, shower, or sleep.

* He is unable to perform daily religious prayers due to physical incapacity.

* Each step causes unbearable pain in his hips and knees.

* The burning sensation in his hips is intolerable.

“At 30 years old and previously healthy, this level of suffering is inhumane. [The health board’s] continued inaction has caused profound physical, emotional, and psychological devastation. This constitutes negligence with serious implications for [his] welfare and wellbeing.”

The complaint goes on to state: “Repeated attempts to obtain clear information and progress updates have been met with inadequate, inconsistent responses and administrative inertia.”

Delays

In addition to the inordinate delays, two additional elements added to the couple's concern.

The complaint quotes from a letter written by the health board to Julie Morgan, the couple’s MS. It read: “Regrettably, there appears to have been a miscommunication in the advice (the patient) and his family have previously been in receipt of. He was originally listed for resurfacing for avascular necrosis (AVN), however in accordance with National Institute for Health and Care Excellence (NICE) guidelines, resurfacing hip arthroplasty is specifically contraindicated in AVN cases. Unfortunately, on this basis, this treatment option is something that cannot be offered to (him) under the care of CTMUHB. Regrettably, the health board are unable to make exceptions in this case.

“As you are aware, there is a finite resource available to Health Boards. Within CTM’s boundary, we allocate funds for the provision of local healthcare services according to the population needs within their respective boundary. Unfortunately, this particular treatment falls outside our service funding scope.

“We understand that this is very disappointing news, and apologise for this not being made clear from the outset.”

U-turn

Mr A and his wife were upset both by the U-turn that prevented him having the previously prescribed treatment and by the decision to notify Ms Morgan of this before telling Mr A himself,

As a result he has been referred back to Cardiff and Vale university Health Board. His wife’s complaint concludes “Following the devastating news on May 23 2025 that [he] is being transferred back to Cardiff and Vale for total bilateral hip replacement, his mental state has deteriorated further. In December 2024, he was told he would receive surgery within three months as a clinical priority. Now, he is left with no clear timeline or hope.[He] is overwhelmed by anxiety, isolated, and unable to cope with the uncertainty around when—if ever—he will receive the surgery he desperately needs.

“As his wife, it is deeply distressing to witness a once healthy 30-year-old man now living in relentless, excruciating pain. [My husband] relies on morphine four times a day, in addition to other powerful medications, just to cope – but even then, the relief only ever so slightly touches the surface. How much longer is he expected to suffer like this? When will he be given a definitive date for his surgery in Cardiff?

“... The urgency of his condition demands immediate action, meaningful redress, and a clear commitment to ensuring that no other patient is subjected to similar neglect.”

Responding to the complaint, a spokesperson for Cwm Taf Morgannwg University Health Board said: ““While we are unable to comment on the care received by individuals, we are concerned to hear about [Mr A’s] experience, and can confirm that we have been in contact with [him] and his family, and that this matter is being investigated by the health board.”