Not upheld, no recommendations

Summary

C complained about the care and treatment provided to their late partner (A) who was admitted to hospital with hallucinations and delirium. C complained that hospital staff labelled A an alcoholic and that this negatively impacted the treatment that they received. A was treated for a suspected urinary tract infection (UTI) but died in hospital. C was critical of several aspects of the treatment A received, including concerns about their nutritional intake, the medication they were given and the staff's response to the rapid deterioration of A's condition.

In their response, the board apologised that C had been given the impression that staff felt the only cause of A's delirium was alcohol excess. The board explained A's clinical presentation and the reasoning for treating them for suspected UTI and alcohol withdrawal. The board explained A's condition rapidly deteriorated in hospital and resulted in a cardiac arrest. The board's position was that the care provided was reasonable.

We took independent advice from a consultant in respiratory and general medicine. We found that a reasonable working diagnosis of a possible infection was determined and the treatment plan was appropriate. We considered that the care and treatment provided was reasonable. Therefore, we did not uphold C's complaint.

Summary

C complained about the care and treatment provided to their late parent (A) by the board's out of hours (OOH) service. A was experiencing worsening symptoms of disorientation, fatigue and abdominal pain. C telephoned NHS 24 and received a call back from an OOH GP who arranged for an ambulance to attend A's home. Paramedics examined A and called the OOH service who agreed that an OOH GP would carry out a home visit to A. Paramedics left the house and the OOH GP attended shortly afterwards. Upon examination, A was found to have a mild fever and fast heart rate, with all other observations recorded as normal. The OOH GP prescribed antibiotics. A died a few days later.

We took independent advice from a GP. We found that it was an appropriate course of action to request a paramedic assessment upon receiving C's initial call to the OOH service. We also found that given the observations of the paramedics and the OOH GP, it was appropriate to treat and manage A at home and to take into consideration that A's own GP practice would be open some four hours later. Therefore, we did not uphold C's complaint but did provide feedback to the board in relation to the GP's record-keeping.

Summary

C, an advocacy worker, submitted a complaint on behalf of their client (A). A received treatment from the board for muscular dystrophy (a group of inherited genetic conditions that gradually cause muscles to weaken) over a period of four years. While visiting abroad, A received an alternative diagnosis of polymyositis (a group of rare diseases that involve chronic muscle inflammation and weakness, and in some cases, pain). A complained that their condition was not appropriately investigated or diagnosed, leading to a delay in receiving appropriate care.

We took independent clinical advice from a consultant neurologist (specialist in diagnosis and treatment of disorders of the nervous system). We found that the investigations carried out by the board were reasonable and on receiving further information from an overseas clinician, the board took reasonable steps to consider this information.

We considered that the board reasonably investigated A's symptoms. Therefore, we did not uphold C's complaint.

Summary

C engaged with the board’s mental health services and believed that they had received a diagnosis of Borderline Personality Disorder (BPD, a mental disorder characterised by the instability in mood, behaviour, and functioning). They complained to the board that they had been prematurely discharged from mental health services. They also complained about delays, confusion affecting appointments, as well as a failure from the board to reasonably assess their condition.

The board’s position was that C had been discharged originally due to a lack of response to correspondence. When C was thereafter seen by mental health services they acknowledged some confusion with respect to the arrangement for an appointment. With respect to the subsequent appointments C attended, the board explained that there was evidence of possible BPD, but that a diagnosis had not been confirmed. A further appointment was arranged but C did not manage to keep the appointment. The board considered that the psychiatric consultations, over the telephone, were appropriate and did not uphold C’s complaints.

We took independent advice from a specialist in community psychiatry. We found that it was reasonable to discharge C given the evidence available and that they had received no response to their attempts to contact them. Given attempts were made to contact C, we did not uphold the complaint that C was unreasonably discharged.

With respect to the psychiatric assessment and diagnosis of BPD, we found that the assessments carried out were careful and competent, the diagnostic statement was reasonable and that there was no firm diagnosis made, with reasonable advice and plan for follow up. Whilst it was concerning that C had formed the view that the diagnosis was definite, and it was acknowledged that assessments via Teams were preferred over telephone (as occurred in this case), we found that the assessment of C was reasonable. We did not uphold the complaint.

Summary

C complained on behalf of their parent (A) who was in hospital when they passed away. C complained about the hospitals communication with A and their family during their hospital admission.

We took independent advice from a nursing adviser. We found that there was evidence of a good standard of communication in the medical notes.

Summary

C complained on behalf of their late parent (A) who passed away from cancer. C complained that the practice had unreasonably failed to diagnose A’s cancer. A was suspected of having a chest infection and was given multiple courses of antibiotics. A also had a number of blood tests which C said that A was not always sure what the blood tests were for, nor were they told the results.

We took independent advice from a GP adviser. We found that the blood tests which were carried out were done so for clinical reasons and that there was no error in the taking or analysing of the blood test results. Some of the blood tests were requested by hospital departments. The practice explained that they would not normally contact a patient if the test results were normal. A CT scan carried out by the hospital did not show any malignancy and this would have been reassuring for the GP’s treating A. We did not uphold this complaint.

Summary

C complained on behalf of their late parent (A) that the board unreasonably failed to diagnose A’s cancer, from which they later died.

We took independent advice from a respiratory consultant adviser. We found that clinical management from the respiratory team carried out appropriate investigations.

We found that there was a failure in communication of the CT results to A and their family and that there was also a delay in intervention following the abnormal CT report, that a biopsy could have been carried out earlier, and that there was no need to await review at an MDT.

On balance, we found that there was no evidence of an unreasonable delay in diagnosing cancer, therefore we did not uphold this complaint.

Summary

C complained on behalf of their parent (A) that the board did not provide a reasonable standard of nursing care. A was admitted to hospital with COVID-19 and had to be nursed in isolation due to their COVID-19 positive status.

We took independent advice from a nursing adviser. We found that the majority of the events described by C and A would not necessarily be documented. That in itself was not evidence of a failing, merely that events documented in the notes would be largely clinical in nature rather than communication. Due to the time that had passed since the events complained about, staff did not recall the specific period of care. We found that there was no evidence of unreasonable nursing care or treatment in the medical notes. As such, we did not uphold the complaint.

Summary

C spent time in hospital for their mental health. C complained about how the board had managed their prescriptions and about the lack of treatment for their physical symptoms of migraines and hand/arm injuries.

We took independent advice from a consultant psychiatrist adviser. We found that C’s perspective was recorded in contemporaneous notes, that they had requested a change of medication and that their doctor agreed to the trial of an alternative. C’s consent was regularly sought and this was good practice. The evidence suggested that C’s reports of physical symptoms were also properly investigated and that C was offered appropriate pain relief for their migraines. As such, we did not uphold the complaints.

Summary

C is an adult who requires support with various daily living tasks. C is in receipt of Self-Directed-Support (SDS) payments to enable them to employ personal assistants to help with these tasks. C complained that they were not permitted to employ their family member as a personal assistant. C told us that the partnership did not fully consider C's circumstances or explain the reasons for their decisions.

The partnership said that family members of the supported person may be employed as a personal assistant where this is deemed appropriate, under exceptional circumstances. Ultimately the decision to permit such an agreement is at the discretion of the local authority. The partnership acknowledged the difficult circumstances faced by C, however, they considered that ultimately they did not agree with the request to employ a family member, particularly in light of the dynamics involved with someone being both an employee and a family member.

In response to our enquiries, the partnership further explained that a social worker spoke with C and a family member to explain the reasons for their decision. They said that they considered C's circumstances, but also, that they considered the aims identified in C's support plan and it was their view that the employment of a family member would not be in keeping with C's assessed needs.

We took independent professional advice from a social work adviser with particular experience in Adult Services. We found that decisions like these are discretionary decisions that the partnership is entitled to make. Each of the factors identified by C were considered by the partnership when making their decision.

We found that the partnership made their decision in line with the regulations and reasonably explained their reasoning to C. As such, we did not uphold the complaint.

However, our investigation highlighted a small error whereby the partnership referenced legislation rather than the related regulations. This did not impact the reasonableness of the partnership's position or response, therefore, we provided feedback to the partnership on this point.