Not upheld, no recommendations

Summary

C, an advocacy worker, complained on behalf of their client (A) about the care and treatment provided by the board during a four day admission to hospital. A, a type 1 diabetic (a condition where blood glucose levels are too high because the body cannot make the hormone insulin), was admitted for lower abdominal pain. A received an ultrasound scan on the following day which proved inconclusive. The next day A received a CT scan which showed free fluid, in keeping with a burst ovarian cyst. A was discharged the following day.

C complained that A was discharged, having received no treatment, in pain, and without follow-up referrals. C complained that as a type 1 diabetic, A’s diabetes and food intake had not been correctly managed. The board said that treatment, discharge, and diabetes management were appropriate. The board apologised for not offering meals after breakfast on the day of discharge.

We took independent advice from a gastrointestinal and general surgeon (specialist in the digestive system). We found that A’s nutritional intake had been appropriately restricted due to investigations which were necessary to rule out surgery. A's diabetes had been appropriately managed via an insulin infusion called a sliding scale. We found that no treatment or follow-up care would be indicated for a burst ovarian cyst as this would usually resolve itself. We found that prior to discharge, A’s pain had reduced such that they were able to manage it with paracetamol alone and that discharge was therefore appropriate. Therefore, we did not uphold this part of C's complaint.

C also complained about the quality of complaints handling. We found that although there was a delay in providing a complaint response, this was because a meeting was being organised and that C was appropriately informed of the delays. Post decision correspondence was also delayed. However, this did not breach the Model Complaints Handling Procedure, which does not specify timescales for post decision correspondence. As the board had already increased administrative staff, improved procedures and apologised, we did not uphold this part of C's complaint.

Summary

C complained about the care and treatment provided to their late parent (A) by the practice in the months prior to A’s death in hospital. C complained that the practice failed to look at A’s leg and foot pain and that A was only prescribed water tablets. C also said that no home visits were arranged for A, that they were informed that A had a hiatus hernia (when part of the stomach moves up into your chest), and that A’s family did not receive a telephone call back when promised.

We took independent advice from a GP. We found that there was no failure on the part of the practice to look at A’s leg and foot pain or that A was prescribed water tablets. We also considered that there was no need for home visits in the time specified and that A had been diagnosed with a hiatus hernia in hospital. Finally, we considered that the practice had provided a reasonable explanation in relation to not phoning the family back given that A’s family had called an ambulance for A by the time in question, so a telephone consultation was no longer required. Therefore, we did not uphold C's complaint. We did provide feedback to the practice that they may wish to remind staff of the importance of keeping clear documentation for every home visit.

Summary

C complained about the partnership’s social work department in relation to their assessment for a Self-Directed Support budget for their child (A).

C complained to the partnership that their Children’s Resources Panel (CRP) had failed to adequately consider C’s funding request for after school care for A, and that they failed to adequately considers A's needs, A's carers needs or gather sufficient information to adequately consider the request. The partnership did not identify any failings.

We took independent advice from a social worker. We found that the CRP did adequately consider the needs of A and their carers, based on the information and circumstances presented to the panel. Therefore, we did not uphold the complaint.

Summary

C complained to the board about the treatment that they received from the board when they attended A&E on the advice of their GP. C had informed the GP that their back pain of three months had worsened over the week.

C reported concerns about the on-call doctor’s manner toward them. C also complained about the assessment and clinical decisions made, particularly that they were sent home despite experiencing a significant level of pain. C was later diagnosed with Cauda Equina Syndrome (CES, a collection of neurological symptoms caused by compression of the nerves at the end of the spinal cord) and required emergency surgery.

Summary

C complained about the care and treatment that their parent (A) received from the board.

A and their partner (B) both contracted Coronavirus (COVID-19). A had a history of diabetes and had previously had a stroke. After contracting COVID-19, A began to display signs of delirium. Concerned for A’s welfare, B contacted the GP who in turn arranged for the COVID-19 team to visit at home. The COVID-19 team attended and recommended that A be admitted to hospital for review that day. A was discharged the same day.

A’s condition worsened at home and the COVID-19 team was called back to visit. A was readmitted to hospital, where their condition continued to deteriorate. A was transferred to the Intensive Care Unit (ICU) where they later died. C considered whether it was appropriate for A to have been discharged home after the first hospital visit given the extent and nature of A's condition.

In response to the complaint, the board believed that the plan of care for A was appropriate, but recognised that communication with A’s family could be improved with respect to arrangements for A’s discharge.

Following the complaints response, C and family members met with representatives of the board to discuss concerns. The note of the meeting records shows that the board acknowledged and apologised that no phone call was made to obtain information about A’s circumstances at home. The board also recognised that the decision to discharge may have been queried had a consultant understood B was unwell at home. C disputes the account of the meeting and believed all present agreed with the position that A should not have been discharged.

We took independent advice from a geriatrician (doctor who specialises in treating older patients). We found that it was reasonable to determine that A was clinically fit for discharge. We noted that this was a complex situation and A had not stated concerns about the decision to discharge. We also noted that there was no indication in the records that, at the time of discharge, A’s family were unhappy with the decision made at the time. We therefore did not uphold the complaint. We did, however, provide some feedback to the board with respect to their complaints handling in this case.

Summary

C complained about the care provided to their late parent (A).

The practice visited in the morning and found them to be coherent and capable of declining a full examination. A's carers left around midday and did not have any specific concerns about A. By the evening, A's condition had deteriorated and they were taken to hospital. A died two days later.

We took independent advice from a GP adviser. We found that there was evidence of appropriate communication between the GPs and other professionals and agencies involved in A’s care. Therefore, we did not uphold the complaint.

Summary

C complained about the care and treatment a close family member (A) had received from the practice. A was admitted to hospital having suffered a heart attack and stroke. On further investigation masses were found on both of A’s ovaries, later confirmed to be ovarian cancer. A died a short time later.

C complained to the practice that they had not given proper consideration to A’s presenting symptoms and had missed opportunities to identify A’s cancer and start treatment sooner. C also complained that the practice had not given appropriate consideration to the family’s history of breast cancer or undertaken CA125 testing (blood test to check for raised levels of a protein called CA125, which is linked to ovarian cancer).

The practice apologised for being unable to detect A’s cancer at an earlier stage, noting ovarian cancer often only presents at a very advanced stage which had been the case for A. They explained a CA125 test had not been checked as the clinical information available at that time had not suggested malignancy. They also noted that a family history of breast cancer would not directly predispose to a risk of ovarian cancer in the absence of evidence of BRCA gene (specific mutations to this gene increase lifetime risk of cancer) positivity. They did not identify any substantive failings in A’s care and treatment, but agreed to use A’s case for reflective learning.

To investigate the handling of this complaint, we sought independent advice from a GP. We found that CA125 testing is not an effective screening tool for ovarian cancer. While A’s initial presentation at the practice had met the National Institute for Health and Care Excellence (NICE) criteria for considering checking CA125 levels, A had undergone further gynaecological review a few months later, which had suggested no evidence of an abdominal pelvic mass. Overall, we considered that the practice had not acted unreasonably in not identifying A’s malignant diagnosis prior to their presentation with a heart attack and stroke. Therefore, we did not uphold C’s complaint.

We did, however, provide feedback to the practice. We asked the practice to ensure relevant staff were familiar with the NICE criteria for considering checking CA125 levels, as well as the significant limitations of this test.

Summary

C complained to us about the medical and nursing care their late parent (A) received. A attended hospital for a bronchoscopy (a procedure to look directly at the airways in the lungs using a thin, lighted tube) and a biopsy (a medical test to determine the presence or extent of disease). A became unwell and was admitted. The biopsy result confirmed that A had cancer. It was considered A was not fit for treatment and a palliative approach to care was recommended. A’s condition worsened and they died in hospital.

C complained about aspects of A’s care and treatment. C also complained about the communication from medical staff. The board did not uphold C’s complaint but apologised because they felt that communication had been poor. C remained unhappy and escalated the complaint to us.

We took independent advice from a specialist in general medicine and in acute nursing. We found that A’s care and treatment was reasonable. We also found that the communication with C and A was reasonable. Therefore, we did not uphold C’s complaints. However, we did provide the board with feedback on telephone updates to patient’s families.

Summary

C complained about the length of time taken by their housing association to carry out repairs on their property and of them subsequently being substandard. C was concerned that the types and number of repairs required were indicative of subsidence and caused the property to fall below the tolerable standard for living. C also complained that the housing association had failed to take these matters into account when assigning points for their housing transfer application. On requesting a review of their transfer application by another organisation, C complained that their housing association failed to handover all of the necessary information.

We found that the housing association made reasonable attempts to timeously carry out the repairs on C’s home and had offered solutions to work around the needs of the tenants. To ease C’s concerns about subsidence, the housing association offered to request an independent survey of the property, however we found that this was not progressed due to difficulties agreeing a suitable time to access C’s home. We did not uphold this aspect of the complaint.

We also found that the housing association awarded points for their transfer request in accordance with their policies, and that they appropriately shared the necessary information with the other housing association. As such, we did not uphold these complaints.

Summary

C complained about the care and treatment that their grandparent (A) received at the Royal Infirmary Edinburgh (RIE). A was admitted to the RIE following a fall. Following a period of recovery, A was discharged to their home. A was subsequently readmitted to the RIE a short time later and died in hospital following this second admission.

C complained to the board about aspects of A’s care during their first admission to RIE, including the board’s management of A’s nutrition and hydration, the physiotherapy A received, and the planning for A’s discharge, but the board did not identify any failings.

We took independent advice from a geriatrician adviser. We found that the management of A’s nutrition and hydration, the provision of physiotherapy to A, and the planning for A’s discharge was reasonable. We did not uphold C’s complaints.