Body:Ayrshire and Arran NHS Board
Outcome:Some upheld, recommendations
Subject:clinical treatment / diagnosis
Mr C made a number of complaints about the care and treatment he received from a prison healthcare centre. In particular, Mr C complained that the board had not provided appropriate care and treatment for a particular medical condition he felt he had, and that they had not communicated with him reasonably about this condition.
We took independent advice from a GP adviser. We found that a number of investigations had been carried out and that none of these had confirmed the diagnosis of the condition that Mr C felt he had. We did not find evidence that the board had failed to provide appropriate treatment for this condition or that communication was unreasonable. We did not uphold these complaints.
Mr C complained further that the board failed to provide timely and appropriate care and treatment for a facial injury he sustained. We took independent advice from a nursing adviser who found that nursing staff failed to carry out a full nursing assessment of this injury and refer the issue to medical staff. We found that Mr C was then assessed by a GP after a two week delay. The GP adviser considered that the GP assessment was appropriate and noted that a timely referral to a specialist was then made. However, in view of the failings in nursing care, we upheld this aspect of the complaint and made two recommendations.
Mr C raised concerns about the pain relief medication he was prescribed and said this was ineffective. The GP adviser found that the medical records showed evidence of pain assessment and the GP's discussion with Mr C. The GP adviser said that they had no concerns about the pain relief provided to Mr C and concluded that this aspect of care was reasonable. We did not uphold this complaint.
Mr C was also unhappy about the way the healthcare centre responded to his concerns about his diet. The GP adviser found evidence that a GP made a request to the kitchens for a high fibre diet for Mr C and also found that Mr C had received dietary advice on a number of occasions. The adviser was satisfied that this dietary advice was appropriate, and overall they considered that the care provided was reasonable. We did not uphold this complaint.
Mr C also raised concern that the board failed to provide appropriate mental health input. We took independent advice from a psychiatric adviser in relation to this complaint. They found evidence that Mr C had a number of contacts with the mental health team and also noted that a mental health assessment was carried out shortly after Mr C's admission to the prison. They did not find evidence that there were delays in Mr C receiving input from a psychiatrist or mental health nurse. The psychiatric adviser concluded that the care Mr C received was reasonable, so we did not uphold this complaint.
Finally, Mr C complained that the prison healthcare centre did not provide him with appropriate treatment for his bowel condition and said that he was not prescribed a medication that helped his symptoms. The GP adviser found that this medication was initially prescribed to Mr C because the prison healthcare centre suspected that Mr C might have irritable bowel syndrome. The GP adviser found that Mr C was subsequently diagnosed with a different medical condition, which meant that this medication was no longer appropriate. The GP adviser was not critical that the prescription of this medication ended and considered Mr C received reasonable care and treatment. We did not uphold this complaint.
What we asked the organisation to do in this case:
- Apologise to Mr C for failing to carry out an appropriate assessment of his facial injury. This should comply with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.
What we said should change to put things right in future:
- Where a patient has sustained an injury, a full nursing assessment should be carried out and medical issues should be referred to medical staff, as appropriate.
We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.