Decision Report 201706928

  • Case ref:
    201706928
  • Date:
    March 2019
  • Body:
    Grampian NHS Board
  • Sector:
    Health
  • Outcome:
    Some upheld, recommendations
  • Subject:
    clinical treatment / diagnosis

Summary

Ms C, an advocacy and support worker, complained on behalf of her client (Mrs  A) about the medical and nursing care and treatment Mrs A received when she was admitted to Aberdeen Royal Infirmary. Ms C also complained about Mrs  A's discharge, delays in receiving a neuropsychology (the study of the relationship between behaviour, emotion, and cognition on the one hand, and brain function on the other) assessment and neurosurgery (surgery on the nervous system, especially the brain and spinal cord) follow-up and that the board had failed to respond to her complaint in a reasonable way.

We took independent advice from a consultant neurosurgeon and a nursing adviser. We found that both the medical and nursing care and treatment given to Mrs A was reasonable. We did not uphold these aspects of Ms C's complaint.

In relation to Mrs A's discharge, we found that Mrs A had been medically fit for discharge and that nursing staff had reasonably managed the discharge planning. However, the board accepted that there had been a failure to provide appropriate information and literature to Mrs A and her family on discharge and had taken action as a result of these failings. We upheld this aspect of Ms C's complaint.

In relation to Mrs A's neuropsychology assessment, we found that there had been a delay in arranging this. We also found that Mrs A was not advised of the progress of her neurosurgery follow-up appointment when the timescale was not met. Therefore, we upheld these aspect of Ms C's complaint.

Finally, we found that the board had failed to comply with their complaints handling procedure and we upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

  • Apologise to Mrs A for the delay in providing a neuropsychology assessment, failing to update her on her neurosurgery review appointment and for the failings in complaint handling. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

  • Patients should receive a neuropsychology assessment, as part of post head injury follow-up, in a timely manner.
  • Patients waiting on review appointments with the neurosurgery department should be updated on the progress of their appointments.

In relation to complaints handling, we recommended:

  • Complaints should be dealt with in accordance with the complaints process, including that all issues raised in complaints should be addressed.

Updated: March 20, 2019