Scottish Public Services Ombudsman

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  • Case ref:
  • Date:
    February 2016
  • Body:
    Ayrshire and Arran NHS Board
  • Sector(s):
  • Subject:
    clinical treatment / diagnosis
  • Outcome:
    Some upheld, recommendations


Mr C was concerned about the care and treatment given to his son (Mr A) by the University Hospital Crosshouse immediately before his death. Mr A had recently been diagnosed with terminal and inoperable cancer. He was told that his time was short. He was admitted to the hospital as an emergency with increasing pain and sickness but he died a few days later. Mr C complained to us that he had not been told how advanced his son's illness was; that his son had no treatment plan; that his son was treated without dignity or privacy; staff were inflexible about visiting times; and that communication was poor.

We took independent advice from a consultant clinical oncologist and from a nurse practitioner. We found that while Mr A's medical care and treatment had been reasonable, there had been poor communication by staff. Mr C should have been informed that Mr A was extremely ill and had very little time. We also found that while arrangements were confirmed with Mr C that he and his wife were able to visit on a more flexible basis, this instruction was not passed to all staff involved. In light of this, we upheld two of Mr C's complaints.


We recommended that the board:

  • make a formal apology for their communication shortcomings;
  • remind the medical team involved in Mr A's care and treatment of their obligations to keep families and carers informed particularly at the end of life; and
  • confirm to us that they are satisfied that such an occurrence would not occur again.

Download case 201500916 as a PDF (13.06 KB)

Updated: February 17, 2016