Not upheld, no recommendations

Summary

Ms C complained that staff at a physiotherapy department failed to adequately manage her symptoms of severe back pain and limited mobility. Staff initially examined her and determined that she should be given conservative management (medical treatment avoiding radical therapeutic measures or operative procedures) of her pain with physiotherapy and acupuncture before she was referred for a magnetic resonance imaging scan (MRI - a scan used to diagnose health conditions that affect organs, tissue and bone). She then had a number of appointments with a physiotherapist and acupuncture was arranged. Ms C felt that her pain had continued to get worse. She then elected to have an MRI scan carried out privately. The scan showed that a surgical procedure was needed, and Ms C had this procedure privately.

Ms C complained that the physiotherapist did not refer her for an MRI scan. We took independent advice from one of our medical advisers who specialises in physiotherapy. She reviewed the board's policy for referral for an MRI scan and Ms C's clinical records. The adviser said that the treatment Ms C received was appropriate and that it was reasonable that she was not referred earlier for an MRI scan. She also confirmed that the physiotherapist followed the appropriate protocol for referring Ms C.

Summary

Miss C complained that GPs failed to carry out appropriate investigations into the symptoms her late mother (Mrs A) was presenting with from November 2010. Mrs A was diagnosed with lung cancer in May 2011 and died in August 2011. Before she was diagnosed, Mrs A had been treated and monitored for breathlessness which was not resolving with the treatment provided. The family told us that they felt that the GPs were treating Mrs A as if her symptoms were psychological and that as a result there was a delay in diagnosing the cancer.

When Mrs A (who was a smoker) first complained of breathlessness, various tests were carried out. Her chest x-ray and blood tests were reported as being normal. Mrs A continued to suffer breathlessness, however, and was reviewed regularly in the practice by the nurse. She was also seen by GPs and the

out-of-hours service. In March 2011 Mrs A was diagnosed with a chest infection and prescribed antibiotics (drugs to treat bacterial infection). When the condition persisted, she was referred for a further chest x-ray. This x-ray was reported as abnormal and Mrs A was referred urgently for a CT scan (a special scan which uses a computer to produce an image of the body), after which she was diagnosed with lung cancer.

Our investigation, which included taking independent advice from a medical adviser, found that the care and treatment provided to Mrs A was reasonable, and in line with the national and local guidance on investigating, managing and treating lung cancer. Although Mrs A had been referred for counselling from the community psychiatric nurse, we found no evidence that the GPs considered Mrs A's symptoms were psychological. The adviser said that the GPs clearly took note of Mrs A's physical symptoms and investigated them in a reasonable and timely manner, and in line with national guidance.

Summary

Mr C complained about a wide range of issues concerning aspects of his mental health care by the board over a number of years. However, on investigation, we considered that the board had done all they could reasonably have been expected to do in respect of his mental health. For example, he had been seen by a number of appropriate clinicians, there had been very thorough assessments, and he had had appropriate treatment. We acknowledged that Mr C wanted more from the board but were satisfied that the board could not reasonably have been expected to have provided more.

Summary

Mrs C complained that her mother (Mrs A) had mobility problems, which caused her great difficulty in attending the medical practice. Mrs C wanted an assurance that the GPs would make non-emergency home visits to Mrs A if required. The practice explained that there would have to be a clinical need for a GP to make a home visit and that they thought that Mrs A could manage to attend the practice.

Our investigation found that on one occasion when a home visit was requested, a GP did attend. However, the following week a home visit was requested and a GP refused to attend as there was no clinical need and said that Mrs A would have to attend the practice. We did not uphold the complaint but we found that the GP should have involved Mrs A more in the discussions rather than correspond with Mrs C.

Summary

Mr C complained about the care and treatment that his late wife (Mrs C) received at the medical practice over a three month period. Mr C was unhappy that the practice did not carry out relevant investigations of Mrs C's persistent and severe abdominal pain. He told us that he felt that doctors at the practice did not listen to their concerns, and that there was a lack of support. After Mrs C was admitted to hospital, further investigations showed that she had pancreatic cancer, and Mrs C died a few weeks later.

We did not, however, uphold Mr C's complaint. Our investigation found clear evidence to show that the practice had carried out appropriate and reasonable investigations to try to diagnose the cause of Mrs C's ongoing pain. They had also referred Mrs C to a specialist for further investigation. We noted that a CT scan (a special scan using a computer to produce an image of the body) had been carried out two months before her diagnosis, but had not shown any abnormalities. Our independent medical adviser also explained that pancreatic cancer tends to present late, often with non-specific symptoms, and has some of the lowest survival rates of all cancers.

Summary

Mr C had a left knee and hip replacement several years ago. He attended the hospital's orthopaedic clinic (clinic for conditions involving the musculoskeletal system) around a year ago because he continued to have pain in his left leg and difficulty walking. He was discharged from the clinic, but was diagnosed around a year later with neuro-sarcoidosis (a chronic disease of unknown origin characterised by the enlargement of lymph nodes in many parts of the body along with nerve tissue dysfunction). Mr C complained that, despite his ongoing pain and difficulty walking, the orthopaedic consultant discharged him from the clinic without referring him to a neurologist (a specialist in the science of the nerves and the nervous system, especially of the diseases affecting them).

After taking independent advice from one of our medical advisers, we found that there was evidence that the consultant carried out appropriate assessments to test Mr C's reflexes and there was no clear indication of a neurological abnormality. Referral to a neurologist would not, therefore, have been necessary at that time. In addition, we considered that it was reasonable for them to have discharged Mr C, as it was not unusual for a man of Mr C's age to experience unsteadiness following knee and hip operations.

Summary

Mr C, who is a prisoner, complained because he was unhappy with the prison's decision to remove his community access.

The prison took the decision to remove Mr C's community access because they had received intelligence (adverse information obtained by SPS that affects an individual prisoner) about him. Our investigation satisfied us that the prison had used their judgement in taking the decision to remove Mr C's community access. In doing so, they took a discretionary decision (a decision that they were entitled to make). We cannot question such a decision unless there is evidence of poor administration in taking it. As this was a decision that the prison were entitled to take, and there was no evidence of anything wrong in the way it was made, we did not uphold Mr C's complaint.

Summary

Mr C, who is a prisoner, complained that the prison inappropriately failed to hold sub-group meetings as agreed by the risk management team (RMT). The purpose of those meetings was to obtain consistent information from Mr C in relation to the circumstances of his offence. Mr C believed this was holding him back from progressing to less secure prison conditions.

Our investigation found that the RMT discussed Mr C's case in March 2012 and agreed that he would be reviewed monthly by a sub-group for a period of not less than four months. The prison confirmed that sub-group meetings were held to discuss Mr C in June, September and November. Because of that, we were satisfied the prison held the relevant sub-group meetings and we did not uphold Mr C's complaint.

Summary

Mr C, who is a prisoner, complained to the prison about a risk management team (RMT) meeting that was held to discuss his management in prison. Mr C complained that he was inappropriately denied the opportunity to submit representations to or attend the meeting. He also complained that he was unreasonably denied a copy of the minute (note) of the meeting and the prison was inappropriately monitoring his correspondence.

We did not uphold Mr C's complaints. Our investigation found nothing in the relevant Scottish Prison Service (SPS) guidance to suggest that a prisoner is entitled to attend such a meeting. Rather, the guidance says that an appropriate member of staff will attend the meeting, and that this individual is responsible for ensuring that the prisoner is told about it. In addition, the guidance confirms that a prisoner will only be entitled to make written representation when their case has been referred to the RMT for progression purposes (progression is when a prisoner moves through the prison system to less supervised conditions). Mr C was not referred for that purpose and, so was not entitled to make written representations. We noted that, following Mr C's complaint, he was provided with a copy of the final RMT minute.

In relation to Mr C's complaint about his correspondence being monitored, the prison confirmed that steps were being taken to manage his correspondence with SPS more appropriately. The evidence suggested that Mr C was bypassing relevant members of staff and processes when raising issues and complaints. Because of that, staff were not able to deal with matters properly and were not being given the chance to try to resolve problems. The prison had, therefore, put in place an arrangement whereby Mr C's SPS correspondence would be managed more effectively to ensure that the issues he raised were passed to the relevant members of staff to deal with. In deciding this, the prison took a discretionary decision (a decision that they were entitled to make). We cannot question such a decision unless there is evidence of poor administration in taking it, and, in Mr C's case, there was not.

Summary

Mr C, who is a prisoner, complained that the programmes case management board (PCMB) inappropriately considered historical information relating to his offending behaviour before deciding that he should participate in the violence prevention programme and the substance related offending behaviour programme. The PCMB are responsible for deciding what programmes individual prisoners should participate in.

In investigating this complaint, we reviewed all the information considered by the PCMB before they reached their decision. Before the PCMB will consider what programmes a prisoner should participate in, the prisoner is first generically assessed. We also reviewed the Scottish Prison Service (SPS) generic assessment guidance manual, which provides guidance to prison staff involved in the assessment process.

We did not uphold Mr C's complaints. In deciding that he should participate in these programmes, the PCMB took a discretionary decision (a decision that they were entitled to make). We cannot question such a decision unless there is evidence of poor administration in taking it. Having reviewed all of the evidence available in Mr C's case, we were satisfied that the information the PCMB considered about him was appropriate and relevant. It was also clear from the information in the SPS manual that the PCMB were entitled to consider the information they did.

In addition, Mr C complained that the SPS inappropriately ignored recommendations of the parole board for England and Wales. We found that parole boards (in both England and Wales and Scotland) cannot tell the SPS how to manage a prisoner, although they can make recommendations about an individual prisoner's sentence management. The management of prisoners is the direct responsiblity of the SPS.