Not upheld, recommendations

Summary

Mr C saw a dentist at the practice. Arrangements were made for future treatment and Mr C attended a further appointment a few weeks later. In the interim, ownership of the practice had changed and Mr C was seen by a new dentist. He complained that the practice had not advised him of this change. The practice responded to Mr C's complaint and explained that they had been assured by the previous owner that all patients would be advised of the changes prior to the transfer. They also advised that no other patients had reported problems with this and that they were reassured that it had been an isolated incident.

After investigating Mr C's complaint, we accepted his position that he was not made aware of the upcoming changes at the practice. However, as the practice expected all patients to have been informed of this by the previous owner, we considered it was reasonable that they did not take steps to separately advise Mr C of the changes. Consequently, we did not uphold this complaint. We made a recommendation to the practice that they review their complaints handling procedure as, during our investigation, it was noted that some parts were not in line with Scottish Government guidance on NHS complaints.

Recommendations

We recommended that the practice:

• review their complaints procedure to ensure that it reflects the requirements of the Scottish Government's 'Can I help you?' guidance.

Summary

Mr C complained about the care and treatment provided by the practice. Mr C had attended the practice over the course of approximately three months with symptoms including weight loss, diarrhoea and vomiting. He was ultimately diagnosed at A&E with an intussusception of his small bowel (a condition in which a part of the intestine folds into another section of the intestine). Mr C raised concerns about the time taken to diagnose his condition, including whether appropriate investigations (including a CT scan, which uses x-rays and a computer to create detailed images of the inside of the body) were arranged. He also raised concerns that a GP had identified he had signs of an intussusception but did not appropriately treat this as an emergency.

The practice said Mr C's symptoms were fully and appropriately investigated. They observed that Mr C was referred for specialist investigation at an early stage which provided an alternative explanation for his symptoms. They also said intussusception is a very rare condition in adults. The practice said the medical records did not indicate the GP had diagnosed an intussusception.

After receiving independent advice from a GP, we did not uphold Mr C's complaint. The adviser agreed that there were complicating factors in the diagnosis. The adviser considered that the investigations arranged were appropriate in the circumstances, and found no evidence that a GP had diagnosed an intussusception prior to Mr C's admission to A&E. While we found Mr C's care and treatment was reasonable in the circumstances, we recommended that the practice use this case to consider and share any learning on the presentation and causes of intussusception in adults.

Recommendations

We recommended that the practice:

• use this case to consider and share any learning on the presentation and causes of intussusception in adults.

Summary

Mr C complained that the board refused to fund his stay at a residential facility for patients receiving cancer treatment at Aberdeen hospitals. He attended Aberdeen Royal Infirmary for radiotherapy every weekday for around seven weeks but only received funding for the last two weeks of his stay. He complained that he was initially given the impression that his full stay would be funded and he said that he did not find out this was not the case until a few days into his stay.

The board confirmed that funding is available for patients from Orkney and Shetland, and also those with an IV postcode. As Mr C's postcode lay outwith these areas, he did not meet the main criteria for a fully-funded stay. The board advised that there is provision for funding patients from other postcodes where their physical condition makes it impossible for them to travel long distances. Mr C did not suffer from any of the listed qualifying conditions, except for radiotherapy-induced incontinence which automatically qualifies patients for funding for the last two weeks of their stay only. Mr C received this funding.

As it appeared that Mr C's funding application was appropriately assessed in line with the board's normal criteria, we focussed on whether the position was made clear to him in advance of his stay. We found no evidence of Mr C being incorrectly advised that he would receive funding for his entire stay. Therefore, we did not uphold the complaint. However, we noted that the board did not have a formal policy in place setting out their qualification criteria for funded places. We considered that such a policy would be helpful for staff and patients alike and we made a recommendation in this regard.

Recommendations

We recommended that the board:

• develop a formal policy, clearly setting out their criteria for funding accommodation at the residential facility involved in this complaint, and ensure this policy is communicated to relevant staff.

Summary

Mrs C's GP referred her urgently to University Hospital Crosshouse in April 2014 as it was suspected that she had breast cancer. However, after examination and ultrasound, her tests were found to be normal. She was told that everything was satisfactory but, because of a family history of breast cancer, she would be referred to the genetics department for risk assessment. Mrs C said that she was never contacted by the genetics department and because of her results, she said she was unconcerned.

In November 2014, Mrs C was re-referred to hospital. She had a breast lump and breast cancer was confirmed. Mrs C complained that her illness should have been diagnosed earlier. She said that because it was not, her cancer had grown and she required to have a double mastectomy. She said that insufficient investigation was made in April 2014. She complained to the board who said that as no abnormality had been found initially, at either the scan or on examination, there had been no clinical indication to refer her for a mammogram and there was no abnormality to biopsy.

We took independent advice from a consultant breast surgeon and we found that, in view of her presenting symptoms, Mrs C had been treated reasonably and appropriately. She had been examined and assessed in terms of best clinical practice. Nevertheless, despite this, it was likely that her breast cancer had been missed the first time. There was nothing the board could have done to have prevented her delayed diagnosis. For this reason, the complaint was not upheld. However, it had been intended to see Mrs C in the genetics department for a risk assessment but it appeared that a letter inviting her to provide information about her family may not have been sent. Accordingly, the board were asked to apologise although, even if the letter had been sent, Mrs C's outcome would have been unchanged.

Recommendations

We recommended that the board:

• make an appropriate apology to Mrs C.

Summary

Mrs C complained about the care and treatment provided by the practice. Mrs C raised concerns that the practice did not provide a reasonable standard of care when she presented with symptoms of bowel discomfort and diarrhoea over a period of several months. In particular, she was concerned the practice failed to diagnose her colonic cancer at an early stage. Mrs C also raised concerns about timeliness of blood tests, the antibiotics prescribed, and her concerns that the practice was dismissive of her symptoms. She also complained the practice unreasonably failed to provide a letter of referral she asked for in order to arrange a private scan.

The practice said that Mrs C's treatment had been reasonable. In particular, they noted that Mrs C had attended a colonoscopy (an examination of the bowel with a camera on a flexible tube) two months prior to the period in question, which had shown no signs of cancer, but provided an alternative explanation, which was consistent with her symptoms. The practice said that the GP in question understood Mrs C had requested a scan, and had arranged appropriate investigations.

After receiving independent advice from a GP, we did not uphold Mrs C's complaint. We found that the practice had acted reasonably in the circumstances, based on the result of the colonoscopy, the alternative diagnosis, and the nature of the symptoms Mrs C experienced. We also considered that the practice provided appropriate care and treatment in relation to blood tests, prescription of antibiotics, and was responsive to her symptoms. We also considered the actions of the practice in relation to the scan were reasonable in the circumstances.

During the course of our investigation, we noted aspects of the practice's complaints procedure did not comply with the Scottish Government's 'Can I help you?' guidance, so although we did not uphold the complaint, we made a recommendation about this.

Recommendations

We recommended that the practice:

• review their procedure to ensure that it reflects the requirements of the Scottish Government's 'Can I help you?' guidance.

Summary

Shortly after the end of his course, Mr C contacted staff to complain that other students had been excluding him and had made offensive and racist comments on social media. Staff arranged a meeting with Mr C and explained that they could not take action under their bullying policy, as the incident had occurred after the course ended and those involved were no longer students. The college said staff told Mr C they would speak with those involved when they returned to college for a new course the next year. However, Mr C said staff told him they would take no action, as they did not wish to lose students. Support staff continued to meet and correspond with Mr C over the summer break, to support him with his concerns about this and other matters. However, Mr C said this support was not helpful, as the support officer made impractical suggestions (for example travel or course options that he could not afford).

After investigating these issues, we did not uphold Mr C's complaints. We found that there was evidence that staff handled Mr C's complaint reasonably, including agreeing to speak with the students involved at the start of the next academic year and providing ongoing support. We did not agree that the support was impractical, as there was evidence that staff gave Mr C advice and support on a range of options, including several that he took forward.

We also found that the college's written response to Mr C's complaint was reasonable, although they could have explained the basis for their decision more clearly. However, we were concerned that the college's complaints policy did not comply with the Model Complaints Handling Procedure, as it set out a three-stage (rather than a two-stage) procedure and did not ensure that people are informed of their right to approach our office. Although we did not uphold Mr C's complaint, we did make a recommendation reflecting our concerns about the college's complaints process.

Recommendations

We recommended that the college:

• review their complaints policy to ensure it is consistent with the Model Complaints Handling Procedure.

Summary

Ms C is a council tenant, as is her neighbour who lives above her. Ms C's complaint about the council arose from continuing noise issues she was experiencing with her neighbour. Ms C complained that the council had not acted reasonably in response to her ongoing reports of anti-social behaviour.

After investigating, we did not uphold Ms C's complaint. We found that the council had taken action following the various incidents she reported and that they had taken steps to find solutions, although it was acknowledged that these were perhaps not as successful as was hoped. During our investigation, the council advised us that they had taken the majority of actions available to them in relation to the noise issues. While we did not uphold the complaint, we did recommend that the council consider the remaining minority of actions to determine whether there were any further steps that would be appropriate to take. As Ms C had indicated at points during the case that she would consider moving, we also recommended that the council look at this and, if Ms C wishes, determine how a move can be facilitated. Finally, Ms C highlighted some concerns about the way her case had been written about in internal documents by council staff. We agreed that some of the terms used were inappropriate and made a further recommendation to address this.

Recommendations

We recommended that the council:

• consider if there are any further actions available to them that would be appropriate to implement in this case, including any follow-up noise monitoring;
• consider how they can work together with Ms C to determine if she does currently wish to move to a new property and how this can be facilitated; and
• make staff aware of the importance of their choice of language in case notes and correspondence.

Summary

Mrs C was referred to the Royal Infirmary of Edinburgh for a coronary angiogram and percutaneous coronary intervention (a procedure to examine the coronary arteries, and if narrowing or blockages are found, to stretch these to enable blood to flow properly). Following the procedure, Mrs C had a bleed from her femoral artery (a large artery in the thigh), and it was necessary to carry out emergency surgery to stop this.

Mrs C was concerned there was a lack of due care during the procedure, and said she had been traumatised by the procedure and suffered from flashbacks and memory loss. The board wrote to Mrs C to explain what had happened, and offered to meet with her, but she declined. The board said the bleed Mrs C experienced was a recognised complication of the procedure.

After taking independent medical advice, we did not uphold Mrs C's complaint. We found that staff carried out the procedure reasonably, and the bleed Mrs C suffered was a recognised complication of the procedure, with staff taking reasonable and appropriate action in response to this. However, the adviser noted that staff did not complete the board's pro formas for the procedure, and we were critical of this, so we made a recommendation to the board.

We also noted that the consent documentation showed Mrs C was not keen to read the information about the procedure, and there was no record that this information was given to her verbally or the key risks of the procedure discussed. While we acknowledged that Mrs C also had responsibility to ensure she understood the risks of the procedure before agreeing to it, we found that staff should have offered Mrs C the relevant information verbally (and documented this) before continuing with the procedure, so we also made a recommendation about this.

Recommendations

We recommended that the board:

• take steps to ensure the NHS Lothian pro formas for Diagnostic Cardiac Catheterisation and percutaneous coronary intervention are completed; and
• feed back our findings regarding informed consent to the staff involved.

Summary

Mrs C complained of continual abdominal pain and she had a scan. The scan showed a rotation in her gut and, as it was unclear whether or not this was the cause of her pain, it was agreed that she should have a diagnostic laparoscopy (a surgical procedure to access the inside of the stomach and pelvis through a small hole in the skin). This confirmed the mal-rotation but nothing to establish the pain Mrs C was experiencing.

However, Mrs C remained in severe pain after her operation and because of this and the diagnostic uncertainty, the procedure was carried out again but, once more, no new abnormalities were identified. It was concluded that further surgery would be unlikely to help Mrs C but because of her continuing pain she was admitted to a critical care bed for observation. Mrs C later complained that she had not been provided with appropriate medical treatment.

We obtained independent advice from a consultant general surgeon. We found that in view of Mrs C's chronic abdominal pain, all the investigations and procedures carried out were reasonable and that she had been provided with appropriate medical treatment. For this reason, the complaint was not upheld. However, our investigation also showed that there was no record of the reasoning for a second laparoscopy, discussions with Mrs C, or a copy of her consent. There was no evidence that Mrs C had been given an appropriate explanation for what had happened to her. As a consequence, we made recommendations to the board.

Recommendations

We recommended that the board:

• apologise for the shortcomings identified;
• emphasise to the clinical staff concerned the necessity of following good practice by appropriately recording consent and completing records clearly, accurately and legibly; and
• remind clinical staff of the importance of good communication.

Summary

Mr C complained that the prison health centre unreasonably failed to prescribe him with appropriate pain medication. We reviewed his clinical records and we took independent advice from a GP adviser. The information available confirmed that Mr C was caught concealing his medication and because of that, the decision was taken to stop his pain medication. However, he was prescribed an alternative and referred to the pain clinic. The adviser said the decision to stop his pain medication was reasonable given that Mr C was caught concealing his medication. The adviser also confirmed that, in their view, Mr C had been prescribed an appropriate alternative medication for his pain.

Mr C also complained that there was an unreasonable delay in the health centre removing an item from his ear. In their response to his complaint, the board said they checked Mr C's records and they could not see anything about him raising concerns about something being stuck in his ear. Following our review of Mr C's record, it appeared that the board's response was incorrect. We noted that a nurse had recorded in Mr C's clinical record that he had approached her about having something stuck in his ear. The nurse also recorded that she successfully removed the item the same day as Mr C reported it to her by flushing his ear. In light of this information, we did not uphold Mr C's complaint, but we did make a recommendation relating to the way the board responded to his complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for failing to respond appropriately to his complaint.