Not upheld, no recommendations

Summary

C complained about the board regarding treatment provided to their late spouse (A) at the end of their life. C was concerned that the board had failed to provide A with reasonable care and treatment, and failed to manage their diet appropriately. C was also concerned about the board's recording of an incident where A fell and broke their hip, as well as that the board refused to allow A to attend a relative's funeral.

We took independent advice from an appropriately qualified clinician. We found that the board had provided reasonable care and treatment throughout, including managing A's diet appropriately and keeping a reasonable record. There was no record in the clinical notes that the board had refused to allow A to attend a relative's funeral.

Given these points, we did not uphold C's complaints.

Summary

C is the owner of a 'four-in-a-block' flat and the other three properties in the block are owned by the council. The council undertook a programme of external works in C's local area to upgrade the properties that they owned. The council told C that the works were required and C's share of the cost would be £14,127.44.

C felt that the amount they were expected to pay was too high. C told the council that they did not consent to the works proceeding. C asked for the option of their property being excluded from the works as C felt other homeowners had been given this option.

The council said that they carried out a consultation and that C had the opportunity to vote against the works, provide their own quotes, and appeal the decision to proceed. The council gave C extra time to appeal against their decision. No appeal was submitted to the courts and the council proceeded with the works.

C complained that, despite their objections, the works went ahead, that the council did not explain what they meant when they mentioned C's title deeds, that the council appeared to have an inconsistent approach, and that they communicated unreasonably with C.

We found that the council took reasonable action in line with the title deeds and their own procedures. Whilst it appeared some other properties in the area had not had works completed, we did not find evidence to suggest that the council had an inconsistent approach. The way in which the council made the decision to proceed with works was reasonable.

We also found that, whilst there were two occasions where the council failed to respond to C and one where the response was sent to a councillor, in general, the council communicated reasonably. They explained the process, provided additional advice on where to find financial support, directed C to seek legal advice, and extended the timescale for C to submit an appeal to the court if they wished. On balance, we found that the council's communication with C was reasonable.

As such, we did not uphold C's complaints.

Summary

C complained to the practice about a delay in prescribing them with medication for high blood pressure, and as a result C suffered a heart attack. C said that they had attended the practice on a number of occasions within a few months with recurring chest pains, breathlessness and dizziness. C had their blood pressure read and electrocardiograms (ECGs) taken a number of times. C saw a GP and reported chest pain and dizziness. The GP put this down to muscle spasm and arranged another ECG and blood pressure reading. C was then given tablets for their blood pressure. The following day, C was admitted to hospital to have a stent inserted as they had suffered a heart attack.

The practice explained that C had had a number of contacts within a few months, and was seen by 11 GPs. Most of the contacts related to C's respiratory problems of Chronic Obstructive Pulmonary Disease (COPD). C's blood pressure was discussed with a GP and further readings were arranged either at the practice or read by C at their home and telephoned to the practice. It was when C reported chest pain a few months later that further investigations were conducted and the decision was taken to provide antihypertensive medication (used to lower high blood pressure).

We took independent clinical advice from a GP. We found that the practice had provided a reasonable standard of treatment to C. Their blood pressure readings were monitored both in the practice and at home and subsequently, arrangements were made to prescribe medication when it was appropriate to do so. We did not uphold the complaint.

Summary

C was a patient of the practice for a number of years where they were treated for thyroid (a gland in the front inside area of the neck) problems and anaemia (a deficiency in the number or quality of red blood cells in the body). C began to experience changes in their behaviour. Following an incident, the police and social work became involved and C was admitted to hospital. C was discharged the following day after a psychiatric assessment. However, C subsequently had to attend court. When gathering information for their court appearance, C obtained a copy of their medical records from the practice. Upon reviewing these, C considered that there had been failures to diagnose deficiencies of vitamin B12 and vitamin D. C also considered that there had been issues with the practice's management of their anaemia and thyroid problems and the long-term prescription of a proton-pump inhibitor (a class of medications that cause a profound and prolonged reduction of stomach acid production).

C submitted a formal complaint to the practice regarding their care and treatment and their handling of C's medical records. C said that, whilst the practice responded to their concerns about the medical records, they did not address the complaints about C's care and treatment due to the time that had passed.

We took independent advice from a GP. We found that, whilst C did have some abnormalities in their blood tests, these were relatively minor and would not have caused the behavioural changes C experienced. We found that the long-term proton-pump inhibitor prescription was reasonable and that C's thyroid problem was routinely monitored and managed. We found that the practice failed to notify C of their low vitamin D results, but concluded that the implications of this oversight were minimal. We did not uphold this aspect of C's complaint.

With regard to the practice's handling of C's complaint, we found that that their decision to rule the complaint as outwith the time limit was reasonable in the circumstances and in line with their complaints handling procedure. We did not uphold this aspect of C's complaint.

Summary

C complained that they had been unreasonably removed from the practice list without prior warning due to alleged verbal abuse.

We reviewed the guidance provided by the General Medical Council (GMC), British Medical Association (BMA) and the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018. We took independent advice from a GP. While we appreciated that C disagreed that their behaviour was inappropriate, this is how the staff at the practice perceived the behaviour. This was also supported by extracts from the contemporaneous records detailing that the practice found C's behaviour to be abusive and upsetting.

The Regulations and the guidance from the GMC and the BMA indicate that a warning should be given to the patient, giving the reasons for the possibility of removal from the practice list. The only exceptions to the requirement to give a warning appear to be on the grounds of violence where the police and/or the procurator fiscal are involved, or where the practice believes that issuing the warning would put the safety of members of the practice or those on the premises at risk or it is, in the GP's opinion, not otherwise reasonable or practical for a warning to be given.

The practice decided that a warning letter did not apply due to how upset a staff member was. We found that the practice appeared to have taken the view that issuing a warning to C would not be appropriate due to the impact of this incident on the member of staff. We found that the practice acted reasonably (by requesting C's immediate removal from the practice list) and within established rules for removing a patient from the list.

We did not uphold C's complaint.

Summary

C complained to the practice about the lack of treatment when they attended two consultations reporting a breast lump. C felt that the GPs they saw gave them false reassurance that there was nothing to worry about. C then attended the hospital specialists for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body), biopsy (tissue sample) and mammogram (an x-ray of the breast) and received results which showed evidence of a cancerous lump which required chemotherapy (a treatment where medicine is used to kill cancerous cells) and surgery.

We took independent advice from a GP. We found that the GPs involved carried out appropriate examinations and that it was appropriate to refer C to the hospital specialists for further examination.

We did not uphold the complaint although some feedback was provided to the practice in an effort to improve learning.

Summary

C complained to us on behalf of their child (A) about the care and treatment A received from child and adolescent mental health services (CAMHS). Specifically, C complained that A was unreasonably discharged from CAMHS.

We took independent advice from a child and adolescent psychologist and also from a mental health nurse. We found that there was a delay in CAMHS offering A video appointments following the COVID-19 lockdown but we found that the delay was not unreasonable, as they needed time to set up the necessary IT systems. We also found that all relevant information was taken into account about A's condition before CAMHS decided to discharge A. Therefore, we did not uphold the complaint.

Summary

C complained about care and treatment provided to their parent (A) by a district nurse from the partnership.

A was fitted with a catheter. C contacted a community nurse team to raise concerns that A's catheter was draining slowly and that there was blood in their urine bag.

The district nurse visited A later the same day. C was present during this visit. The district nurse assessed A, changed their catheter bag and provided advice. After the visit, the district nurse discussed their actions with a GP. The GP agreed with the district nurse's actions and their assessment of A. The district nurse called C afterwards to inform them of this and to reiterate their earlier advice.

Later that evening A's catheter blocked. C called 111 and A was subsequently admitted to hospital. A was diagnosed with urosepsis (a serious infection of the urinary tract). A subsequently died in hospital.

C complained to the partnership about A's care and treatment, but they failed to identify any failings. C remained unhappy and asked us to investigate. C complained that the district nurse had failed to provide A with appropriate care and treatment despite knowing that they had a urinary tract infection.

Following investigation, and receipt of independent advice, we found that the district nurse had acted reasonably. We found insufficient evidence to illustrate that the district nurse knew that A had a urinary tract infection. We found that the care and treatment provided was reasonable in light of the information available at the relevant time. We did not uphold C's complaint.

Summary

C complained about care and treatment provided to their parent (A) by a duty general practitioner (GP) at the practice.

C contacted a community nurse team to raise concerns that A's catheter was draining slowly and that there was blood in their urine bag.

A nurse visited A at their home later the same day. They changed A's catheter bag and provided advice. After they had left A's home, the nurse discussed their actions with the GP. The GP agreed with the nurse's actions and their assessment of A.

Later that evening A's catheter blocked. A was subsequently admitted to hospital and diagnosed with urosepsis (a serious infection of the urinary tract). A subsequently died in hospital.

C complained that the GP had failed to visit A despite being provided with information indicating that they had a serious infection. C also complained that the GP failed to provide A with medical treatment.

We took independent advice from a GP. We found that the GP acted reasonably and noted that they were not provided with information indicating that A had a serious infection. We found that the GP’s agreement with the treatment and advice provided by the nurse was reasonable in light of the information available to them at the relevant time. We did not uphold C’s complaints.

Summary

C's parent (A) was admitted to Raigmore Hospital following a fall at home. A was diagnosed with delirium. After six weeks on the ward, A was discharged home with a package of care. A required readmission shortly after discharge and their condition deteriorated further. C complained that A's food and fluid intake were inadequately monitored during this period. C complained that the concerns they raised about their parent's physical and mental health were ignored.

C also complained about the hospital discharge process. C held Power of Attorney (POA) in respect of A and complained that the board did not have due regard to that. C complained that the board did not appropriately involve them in planning for A's discharge.

We took independent nursing advice. Although we were critical of aspects of the board's communication with A's family, we noted that on the whole, A's care and treatment were of a reasonable standard. We therefore, did not uphold the complaint. We were critical of the board for their delay in referring A to a dietitian, but we noted that the board had apologised for this and confirmed learning.

We considered that A's family could have been involved at an earlier stage when plans were being made for discharge. Overall, however, we noted that the discharge planning was reasonable, involving appropriate assessments and discussion with C. We did not uphold this complaint.