Not upheld, recommendations

Summary

Mrs C complained that an orthopaedic consultant at Raigmore Hospital did not examine her, and instead transferred her care to a different orthopaedic doctor. Mrs C acknowledged that there had been electrical power loss at the hospital affecting the ability to carry out an x-ray of her painful foot. However, she felt that the doctor could have assessed her, given her medical records were available.

We took independent medical advice from an orthopaedic consultant. We were unable to clearly determine whether the doctor had access to all of the relevant electronic medical records and previous x-rays taken, given the power loss. We considered that it was reasonable for the doctor to rearrange the appointment and transfer Mrs C's care to the orthopaedic consultant who had previously treated her. However, we were critical that Mrs C had to wait a further three months to be reviewed. We considered this wait to be unreasonable. The board have since taken steps to address the delays by employing more staff.

Mrs C also complained that the board's response to her complaint was delayed and contained inaccurate information. We did not identify evidence to support her concern that the board's response was inaccurate. In addition, we found that although there was a delay in the board replying to the complaint, this was not unreasonable given that Mrs C was kept informed about the progress of the board's investigation in accordance with national complaints handling guidance.

Recommendations

We recommended that the board:

• issue a written apology to Mrs C for the additional delay in being reviewed.

Summary

Mr C complained about the way his medication was handled by the prison health centre, in particular that his medication was changed and that his complaints about pain had been ignored.

We took independent GP advice. We found that, when reviewing Mr C's medication, the prison health centre had acted in line with the General Medical Council guidelines on prescribing. We also found that the care provided to Mr C in terms of his pain management was reasonable. We therefore did not uphold the complaint.

Mr C also complained that a doctor based at the health centre had inappropriately stated that he hated migrants. We found no evidence to support Mr C's allegation and were satisfied that the allegation had been investigated by the board, including speaking to the doctor involved. However, we noted that there was no written record of the discussions with the doctor as part of the investigation. We were also satisfied that the decisions made in relation to Mr C's clinical management were based on the advice available to clinicians. As such we did not uphold this aspect of Mr C's complaint.

Mr C was also unhappy with the handling of his complaint. We were satisfied that the board had handled Mr C's complaint in line with the complaints process and therefore did not uphold this complaint.

Recommendations

We recommended that the board:

• provide an update on the action taken to ensure that relevant staff keep a written record of conversations held with clinicians as part of a complaint investigation.

Summary

Mr C complained about the care and treatment provided to his father (Mr A) at Victoria Hospital. Mr A was admitted to A&E after suffering a transient ischaemic attack (TIA, a mini stroke caused by a temporary disruption in the blood supply to part of the brain). Mr A underwent a brain scan. The doctor discussed Mr A's case with a stroke consultant and Mr A was discharged with planned follow-up in the TIA clinic.

Following discharge, Mr C had a stroke and was re-admitted to hospital later the same day.

Mr C complained that staff had failed to take into account that Mr A's wife had recently died and that he would be returning to an empty home on discharge. The board acknowledged that aspects of the communication during the admission were poor, but maintained that the decision to discharge Mr A was appropriate and in accordance with the protocol.

The board apologised to Mr C for the communication failings and outlined steps for improvement. In particular, the board said that they would discuss the issues with staff involved and that a newsletter would be introduced to A&E to share learning. We made a recommendation in relation to this.

We took independent advice from an adviser in emergency medicine. The adviser considered that the doctor's assessment of Mr A was of a good standard and overall they were satisfied that Mr A was appropriately managed in accordance with the board's TIA protocol. The adviser noted that the doctor who assessed Mr A received input from a stroke consultant before discharge and they were satisfied that the decision to discharge Mr A was reasonable. In view of this, we did not uphold Mr C's complaint.

Recommendations

We recommended that the board:

• provide an update on the production of the newsletter.

Summary

Mr C complained about the care provided to his mother (Mrs A) at Victoria Hospital. Mrs A had recently had a heart attack and had received treatment for this from another health board. Less than two weeks later, Mrs A attended the A&E department at Victoria Hospital and was assessed by a consultant cardiologist. The cardiologist suspected that Mrs A had aortic valve disease (the narrowing of the main valve through which blood is pumped out of the heart to the rest of the body), and decided to withdraw one of the medications Mrs A had previously been prescribed and introduce a beta-blocker (a medication used to treat various conditions including those of the heart). After a period of monitoring took place following the first dose of the beta-blocker, it was decided that Mrs A could be discharged. However, at the point of discharge, Mrs A collapsed and required assistance. Mrs A was readmitted overnight and, after further monitoring took place, she was reviewed by the cardiologist the following day. The cardiologist decided that Mrs A should remain on the beta-blocker and prescribed a further medication used to lower blood pressure, before discharging Mrs A later that day.

Following discharge, Mrs A's condition deteriorated. Mr C then arranged a cardiology review appointment with Mrs A's local health board. At this appointment, a different consultant cardiologist changed the beta-blocker medication to a different medication. Mr C noted that Mrs A's condition quickly improved as a result. Mr C complained to the board that it was inappropriate that Mrs A had been given the beta-blocker medication and felt it had caused the deterioration in her condition. We took independent advice from a consultant cardiologist. The adviser said that the beta-blocker was one of the recommended medications for patients who have had a heart attack, and said it was reasonable that it was given to Mrs A. The adviser was unable to conclude that the medication had affected Mrs A adversely, but, in any case, said that an adverse reaction to the medication could not have been reasonably foreseen. We did not uphold this complaint.

Mr C also raised concerns that the beta-blocker medication given to Mrs A was not re-evaluated prior to discharge, and said that he was not informed of the potential side effects of this medication. The adviser reviewed the records, and found evidence that staff had appropriately monitored Mrs A's blood pressure and heart rate in the period between Mrs A's re-admission and her discharge the following day. The adviser noted that there was no evidence that Mrs A was not fit for discharge, and concluded that the decision to discharge was reasonable. However, based on the records available, the adviser was not able to determine whether the potential side effects of the beta-blocker, together with the benefits and risks of any alternatives, had been discussed with Mrs A. The adviser said that this was a discussion that should have been documented, and was critical of this omission. While we did not uphold this complaint, we made a recommendation to address the issue highlighted by the adviser.

Recommendations

We recommended that the board:

• feed back the adviser's comments to the cardiologist who assessed Mrs A to ensure that potential side effects of medications and the benefits/risks of alternatives are appropriately discussed and documented.

Summary

Mr C complained about the care received by his sister (Miss A) at University Hospital Ayr, in particular that there was a delay in her being scanned and a delay in transferring her to the Beatson West of Scotland Cancer Centre, which is in another board area. Miss A had a history of Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system) and became unwell. Further tests showed that Miss A had tumours in her liver and bone marrow. She died two days after being transferred to the centre.

We took independent medical advice and found that Miss A had been reviewed urgently when abnormalities were identified. We found that she was offered admission to hospital to undergo further tests including a specialist scan. However, it appears Miss A opted to wait for an out-patient appointment. Whilst cancer was not initially suspected we found that the time taken to carry out a specialist scan was reasonable. We concluded that Miss A's care was reasonable and did not uphold Mr C's complaint.

However, we were critical of the board's communication about Miss A's transfer to the centre, which caused Miss A and her family additional distress. The board apologised for this and we made a recommendation to identify any further learning and improvement.

Recommendations

We recommended that the board:

• evidence that they have liaised with Greater Glasgow and Clyde NHS Board to identify any possible learning and improvements in relation to the delayed transfer to the centre.

Summary

Mrs C's mother (Mrs A) was admitted to Queen Elizabeth University Hospital. Mrs A had a number of health conditions and had recently been treated with antibiotics for infected leg ulcers and had chronic leg swelling.

Mrs A spent two months in the hospital and was discharged after clinical staff considered that she was medically stable. Shortly after discharge, Mrs A had a fall at home and was re-admitted to hospital.

Mrs C complained that the board did not provide appropriate pressure ulcer care for Mrs A. In particular, Mrs C said that staff left wounds on Mrs A's legs undressed for a number of hours and failed to appropriately elevate Mrs A's legs to promote healing.

We took independent nursing advice. We found no evidence in the records that failings in care had occurred. For this reason, we did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that staff inappropriately discharged Mrs A from hospital. Mrs C specifically raised concerns about the level of physiotherapy input, Mrs A's nutritional status, that a home visit was not carried out prior to discharge and the medication with which Mrs A was prescribed on her discharge.

We took independent advice from an specialist in geriatric medicine. The adviser considered that Mrs A had received an appropriate level of therapy from a range of specialties before discharge and considered that the decision to discharge was reasonable. The adviser had no concern about the medication prescribed at discharge and was satisfied that the board's considerations in relation to a home visit were reasonable.

In relation to nutrition, the adviser considered that Mrs A had received appropriate care from dieticians, but noted that the board had mischaracterised Mrs A's nutritional status in their complaint response. We did not uphold this aspect of Mrs C's complaint, but we made a recommendation in respect of their complaints handling.

Recommendations

We recommended that the board:

• apologise to Mrs A's family for the inaccuracy in the board's complaint response letter.

Summary

Ms C complained that the board failed to provide her with appropriate orthopaedic surgery. She also complained that they did not provide her with appropriate clinical treatment when she reported health problems following the surgery.

Ms C had an initial operation to treat a bunion affecting her right foot. The operation was not successful and she elected to undergo further (revision) surgery. Following this surgery, Ms C's condition appeared to improve. However, over the subsequent years she experienced further problems with her foot, including pain and discomfort. Ms C also felt that this triggered other health problems. During this time, the board attempted to treat these problems with orthotics (supports) and also referred Ms C to their pain management clinic.

Ms C raised concerns about the revision surgery, including that the surgeon had left a bone in her big toe too short. Ms C also said the surgeon did not provide appropriate care when the problems arose with her foot, that they were unresponsive, and did not communicate with her about her situation. The board said that the shortening of the bone in Ms C's foot was inevitable as a result of the two operations, and within reasonable limits. They considered the surgery had been performed appropriately. The board also said they considered the follow-up care was reasonable.

After receiving independent advice from an orthopaedic surgeon, we did not uphold Ms C's complaints. We found that the evidence did not suggest there had been a failure in the operation. We also found that the medical records suggested timely care with appropriate review from the clinicians involved in Ms C's care. We noted the difficulty of judging communication from paper records, but considered that there were no failings evident in respect of this aspect of Ms C's care.

During the course of this investigation, we noted that the board's consent documentation, while appropriate by the standards of the time, would not comply with contemporary practice. We also noted some limitations in record-keeping by the board. We made recommendations to address this.

Recommendations

We recommended that the board:

• remind staff of the importance of adequate record-keeping; and
• review the relevant consent form to ensure it is appropriate.

Summary

Mrs C complained on behalf of her mother-in-law (Mrs A) and her sister-in-law (Ms B) about the Crofting Commission's handling of an assignation application for the croft tenancy. The tenancy was held by Mrs A to be assigned to Ms B, who wished to take on the tenancy. Mrs C said that the commission made a number of errors in the processing of the application, which led to a delay in the completion of the assignation process.

Our investigation found that errors were made by the commission in their handling of the assignation application, but that these did not appear to have led to a delay in the processing of the application. We noted that the commission had already acknowledged these errors and that in general they appeared to have taken appropriate remedial action to address these. We therefore considered that the commission did not take unreasonably long to process the assignation application and we did not uphold Mrs C's complaint.

In recognition of costs involved in preparing Mrs C's complaint about areas where they had acknowledged failings on their part, the commission offered Mrs A a payment. The commission said that it was their understanding that the surveying costs and legal consultancy costs which Mrs C said Mrs A incurred were not as a result of the mistakes made by the commission. However, we considered that the breakdown of the costs submitted by Mrs C to the commission contained entries detailing extra work done which did not appear to relate solely to the preparation of the complaint about the commission's errors and made a recommendation in relation to this.

Recommendations

We recommended that the commission:

• review the breakdown of costs Mrs C submitted to them and reconsider their offer of compensation in line with the terms set out in our decision and provide us with a copy of their findings.

Summary

Mr C raised a number of concerns about the condition of his property on taking up his tenancy. He maintained that the property had not been in a suitable standard to re-let and that the council had delayed in conducting repairs to bring the property up to a habitable standard and in removing rubbish.

During our investigation the council provided evidence that Mr C had inspected the property prior to accepting the tenancy, agreeing that the property was in a re-let standard. The council also provided details of the repairs carried out prior to Mr C's tenancy to bring it up to the re-let standard. In addition they provided details of the repairs reported by Mr C and while the council accepted that not all the repairs met the target date for completion, their position remained that the repairs did not render the property uninhabitable. They also said that the work required would not have prevented Mr C moving into the property. We did not uphold Mr C's complaint. However, the council had acknowledged and apologised for a delay in removing rubbish from the property and we therefore made a recommendation regarding this.

Recommendations

We recommended that the council:

• apologise to Mr C for the delay in completing the works to remove rubbish from the property.

Summary

Mr C raised concerns about a decision by the council to reduce an award of discretionary housing payment (DHP).

Mr C complained that the council had unreasonably based their decision on the length of time he had been receiving the award, rather than on his individual circumstances. Mr C also complained that in making the decision, the council had acted unreasonably by failing to consult their policy on the prevention of homelessness.

We considered that, taking account of the relevant Department of Work and Pensions (DWP) guidance and their own DHP policies, the council had a wide discretion to reach a decision on Mr C's DHP application. We considered the council could take into account the length of time Mr C was in receipt of an award of DHP. We found no evidence that in making their decision, the council had not followed DWP guidance.

We also found no indication in Mr C's DHP application form that he would be under threat of homelessness were his application not successful, which could have prompted specific consultation on the council's homelessness policy. We did not find that Mr C was made homeless by the decision to reduce his award of DHP. However, we considered the council should ensure their relevant housing team and revenues and benefits team liaise with each other in cases where a claim for DHP is being considered and which may involve the loss of a tenancy and possible homelessness. We made a recommendation in relation to this.

Mr C sought a review of the council's decision. Mr C complained the council had acted unreasonably by allowing a manager to review a decision in which they had already taken part and by basing their decision during the review process on cash limits rather than a holistic approach required by council policy. We considered that the council officer was only restating the decision which had already been reached on Mr C's review request. We were also satisfied that the DHP fund was cash limited and considered that the council were reasonably entitled to take this into account. We did not find that the council had failed to take account of the DWP guidance and their DHP policies when reviewing Mr C's claim. We therefore did not uphold Mr C's complaint.

Recommendations

We recommended that the council:

• ensure the relevant housing and revenues and benefits teams liaise with each other in cases where a claim for discretionary housing payment is being considered and which may involve the loss of a tenancy and possible homelessness.