Not upheld, no recommendations

Summary

C complained to us about two matters relating to the partnership. Firstly, they were concerned about an occupational therapy assessment carried out to identify appropriate adaptations for a new property they were being offered, as they did not consider the adaptations made met their needs as a disabled person. Secondly, they were also concerned about a decision made to remove direct payments for support that they had been receiving, as they disputed the partnership's view that these had been improperly managed.

We took independent advice from an occupational therapy adviser, who confirmed that the adaptations made to the new property were appropriate, based on the needs assessments completed. We also found that the records of audits carried out into C's management of the direct payments reasonably evidenced the improper management alleged by the partnership. We considered that the partnership had managed both matters appropriately and did not uphold C's complaints.

Summary

C complained to us that the partnership had unreasonably decided that the overnight support for their relative (A) could be provided by technology in A's home. This had previously been provided by a carer.

We took independent advice from a social work adviser. We found that the partnership had reasonably assessed A's needs; had reasonably addressed the concerns raised by the family; and had reasonably decided to replace the overnight sleepover support with enhanced telecare. We did not find evidence that the partnership had failed to pay adequate attention to human rights considerations. In particular, we were satisfied that they had appropriately considered A's needs and outcomes along with the views of A's family, previous respite carers and appropriate professionals. We did not uphold the complaint.

Summary

C complained on behalf of their client (B) in relation to the care and treatment provided to B's partner (A) whilst A was a patient at Western Isles Hospital.

C complained that the board failed to provide A with reasonable care and treatment whilst A was a patient in the hospital. In particular, C is concerned that venous thromboembolism (referring to blood clots in the veins) testing (VTE) was not carried out and that there was a delay in coagulation screening (screening laboratory tests which allows an initial broad categorization of haemostatic problems). C considered that if reasonable care and treatment had been provided, A may not have died. C also believed that the board did not reasonably respond to their complaint about this matter.

The board noted that whilst a VTE assessment was not performed, and there was a delay in coagulation screening, this would not have altered A's clinical management or have changed the outcome, as A was extremely ill. The board stated that they considered they had reasonably responded to C's complaint.

We took independent advice from an appropriately qualified adviser who determined that although the overall care and treatment offered to A was reasonable, there was learning for the board.

We found that the board had failed to conduct a VTE assessment and had failed to administer a prophylactic dose of heparin on the evening of A's admission which was unreasonable. However, even if a VTE assessment had been carried out, and a prophylactic dose of heparin given, it would not have altered the clinical outcome in this case. We also found that the board's reason for a delay in coagulation screening was reasonable. We, therefore, did not uphold this complaint. Furthermore, we found that the board had reasonably responded to C's complaint. We identified learning for the board which was provided by way of feedback.

Summary

C complained that the Scottish Ambulance Service made the decision that their headache was due to a less serious cause (rather than the serious diagnosis that was later identified), which did not require urgent assessment at A&E. C was also concerned that they were taken to the out-of-hours GP rather than to A&E.

We found that the there was no evidence in the records that the ambulance crew made any decisions about the cause of C's headache. The records indicate that the crew considered the symptoms C was experiencing required hospital assessment.

The records also indicated that a handover was given to a nurse within A&E at the hospital and that the nurse was advised that C had a two day history of headaches. It appeared that the decision to transfer C to the out-of-hours service was made by staff within the A&E department, rather than by the ambulance crew.

We did not uphold C's complaint.

Summary

C complained about the actions of Scottish Ambulance Service (SAS) staff when they attended to their adult child (A) following an epileptic seizure (bursts of electrical activity in the brain that temporarily affect how it works and can cause a wide range of symptoms). A was moved onto a chair to be taken out of the house to an ambulance. When A arrived at hospital they were found to have broken vertebrae (individual bones that interlock with each other to form the spinal column). C complained about the manner in which staff had transferred A and about their clinical assessment of A.

SAS said that staff carried out a risk assessment on how to get A to the ambulance; the moving and handling skills applied were based on the clinical assessment of A and access difficulties at the scene.

We took independent advice from a paramedic. We found that the history assessment and energy involved with A's mechanism of injury made it extremely unlikely to cause a significant spinal injury. Given the age and medical history obtained, there were no risk factors which would lead the paramedic to suspect spinal injury. This, coupled with the restricted space within which they were working, made the use of a carry chair a reasonable means of transferring the patient. Therefore, we did not uphold this complaint.

In relation to the clinical assessment, we found that while A complained of back pain, this was not considered to be a spinal injury. We considered the assessment and management were reasonable for a patient suffering a 'seizure now stopped'. We noted that the paramedic used the finding of motor, sensation and circulation of lower limbs in their risk assessment to help rule out/in spinal injury. Given the history and assessment findings, we considered the care provided was reasonable. As such, we did not uphold this complaint.

We noted there had been complaints handling issues, but SAS had taken appropriate steps to address this and had apologised to C.

Summary

C underwent an emergency caesarean section (an operation to deliver a baby. It involves cutting the front of the abdomen and womb). Following this, the stitches holding C's wound together failed. C believed they had not been properly cared for after their surgery. They said they had experienced abnormal levels of pain and discomfort. These had been incorrectly attributed to other causes such as constipation, but C believed they were a sign their wound closure was failing. C also noted significant amounts of fluid had leaked from the wound. C felt this was excessive, but that it had not been properly considered by nursing or medical staff. C said the experience had been very traumatic for them and for their spouse.

The board had conducted an internal review into the failure of the stitches. C felt they had not been properly involved in this and that it had not recognised properly the seriousness of the incident, or the implications of its conclusion that incorrect suture material was used.

We took independent medical advice which stated the complication suffered by C was rare. C's condition was monitored appropriately postoperatively, including escalation for medical review due to the concerns about wound leakage and pain levels. Although the documentation was poor, there was no evidence of operator error, or that the specific suture material used had contributed to the failure of the wound. We found C's care and treatment had been of a reasonable standard. Therefore, we did not uphold the complaint.

The board had acknowledged there had been confusion between the complaints process and the serious adverse event review process and that this had led to delays and poor communication with C. We found that the board's handling of the complaint had been unreasonable, but they were able to demonstrate that they were taking steps to address this issue.

Summary

C complained that they were unreasonably discharged from the pain clinic on two occasions. C had their first session with the pain clinic and then their first telephone session with a nurse the following month. In the interim, C was admitted to hospital for their mental health. At a multidisciplinary team meeting (MDT) it was decided to discharge C from the pain service due to their psychiatric admission.

C was later reinstated to the pain service and was offered an appointment but later complained about the service. C was discharged from the service again because of a statement they made in their complaint which led the board to believe C did not want any further contact from the pain service. C complained about both decisions to discharge them from the pain service.

We took independent advice from a consultant psychiatrist. We found that it is routine management to prioritise one acute (immediate) health issue over other longer term issues. Those longer term issues may complicate the management of the immediate health issue. In this case, that would have been C's recent mental health admission. We also noted that the board had acknowledged and apologised for communicating their decision about the first discharge poorly. We found that C had said in their complaint to the board that they did not want the services of the pain clinic anymore. While it would have been good practice to clarify what the patient truly wanted before discharging them from the service, it was not unreasonable to take C's statement at face value. We did not uphold C's complaints.

Summary

C complained that the actions taken in initiating a child protection assessment following an attendance at A&E at Raigmore Hospital with their young child (A) were unreasonable and excessive. A attended with an oral wound and head injury following a fall. During the attendance C also raised concerns about A bruising easily, which prompted the child protection assessment.

We took independent medical advice from an emergency medicine consultant. We considered that the actions taken were reasonable; both in relation to the presenting injury and the concerns surrounding bruising. We noted that medical staff had a professional obligation to report any child protection concerns, and considered they took appropriate action in this regard.

We also took advice from a paediatric consultant regarding the actions following A's admission to the children's ward. We considered that the actions taken were reasonable and in line with relevant guidance. However, we found elements which could have been better, particularly surrounding the communication with C. There was no evidence of medical staff having discussed with C some of the recorded bruises. We noted that clear communication should take place with parents regarding any injuries that cause concern, so that an explanation can be sought to clarify concerns. We fed this back to the board. However, on balance, we did not uphold this complaint.

Summary

C complained on behalf of their spouse (A) about the care and treatment A received from the board. A has Parkinson's disease (a condition in which parts of the brain become progressively damaged over many years, causing physical and neurological symptoms). A was admitted to the Queen Elizabeth University Hospital with a suspected clot. Staff thought that A had suffered a stroke and physiotherapy was arranged as part of their recovery. Following an MRI, it was found that some of A's vertebrae (the bones of the spine) were displaced and were compressing the spinal cord. A was transferred to a consultant neurosurgeon (specialist in surgery of the brain or other nerve tissue).

We took independent advice from a consultant geriatrician (a doctor specialising in medical care for the elderly) with a special interest in Parkinson's disease. We noted that A had had Parkinson's disease for 15 years. They had also had surgery to their neck and lumbar stenosis (narrowing of the bone spaces where the nerves leave the spine in the lower back). A was reviewed by the Parkinson's specialist who suggested that a CT brain scan be carried out. This showed a minor change in the brain which could have been consistent with a small stroke. However, a later scan ruled this out. An MRI scan was ordered of the spine and it was following this scan that A's condition was diagnosed.

We noted that A had a complex medical condition and the symptoms they were exhibiting could have come about by a number of different causes. We found that the board worked through reasonable diagnoses and requested appropriate medical imaging. Therefore, we did not uphold the complaint.

Summary

C complained that their partner (A) was inappropriately prescribed a strong opiate painkiller by their GP, that they developed severe mental and physical health problems as a result of being kept on this medication for too long, that A was not appropriately reviewed while on this medication, and that their requests for help were not acted upon.

We took independent advice from a GP, who considered whether the prescribing to A was reasonable in the circumstances. They found no evidence to support that the long-term prescribing of the medication contributed to the deterioration in A's mental and physical health. They noted there was evidence of regular review and discussion of A's pain and pain relief. We accepted this advice and did not uphold this complaint.

However, we noted some complaint handling issues. The practice did not initially request consent from A to enable them to take C's complaint forward. Additionally, there were subsequent delays in preparing their response and they did not keep C updated or agree an extension to the target timeframe. We advised the practice to review their handling of C's complaint and ensure mechanisms are in place to ensure compliance with the NHS Scotland Complaints Handling Procedure.