Some upheld, recommendations

Summary

Mrs C's child had a history of behavioural problems, and was referred to the board's community paediatric department for assessment. A number of developmental disorders were considered and ruled out and a plan put in place to seek further information from the child's school before deciding what follow-up action might be required. Due to staff leaving the department, a period of eight months went by before the case was progressed, and it was a further two months before the board contacted Mrs C telling her that no concerns had been raised about her child, who had been discharged. Mrs C continued to be concerned about her child's behaviour and sought a further assessment. This ultimately led to the child being diagnosed with high functioning autism / Asperger's syndrome.

Mrs C complained to us about the delay in diagnosis and about poor communication from the board. We upheld her complaint about delay. We found that the initial assessment of her child was not in line with national guidance for the assessment of children and young adults with autism disorders. Autism should have been considered and developmental disorders should not have been ruled out before information was gathered from the school. We found the eight-month delay before the case was progressed unreasonable, and there was a further excessive delay after Mrs C's child was referred back to the community paediatric department.

We were critical of the board for not communicating with Mrs C for ten months while the case did not progress, but overall found their communication to be reasonable.

Recommendations

We recommended that the board:

• apologise to the family for the delay in diagnosis;
• draw our findings to the attention of their community paediatric staff and remind them of the relevant guidelines; and
• review their practices for providing staff cover in instances of planned retirement to ensure that services to patients are not unreasonably disrupted.

Summary

Ms C complained that, although she had multiple fractures in her foot, she was not treated appropriately and that this led to her condition deteriorating. She said that there were delays in tests on her symptoms and in telling her of the results, and that she should have had a bone scan earlier . Ms C believed that as a result, she had constant pain with reducing mobility.

Ms C complained to the board, who said that they had done their best to deal with her problems and associated pain, but that stress fractures in feet and heels could be difficult to determine and often no specific intervention was required.

We took independent advice from a consultant in rheumatology and osteoporosis (a condition that affects the bones, causing them to become fragile and more likely to break), after which we upheld MS C’s complaints about delay. We found that while the investigations into Ms C's foot problems were reasonable, there were delays in completing these and in providing Ms C with the outcome of x-rays and scans. This was unreasonable, given that there was a suspicion of a fracture. The delays also led to a delay in making a diagnosis, although the treatment then provided was all reasonable. Ms C also complained about the way her complaint was dealt with, but the evidence showed that the board had followed their usual processes and replied within their timescales.

Recommendations

We recommended that the board:

• formally apologise;
• review their procedures (including in radiology) to ensure that a similar situation would not occur. They should confirm to us that they have done so; and
• apologise for the delay in providing a diagnosis.

Summary

Ms C said that when she changed her medical practice she had to see the practice nurse before she could be seen by a doctor. She said that this registration procedure created delays in her seeing a doctor. She also said that there were obstacles to accessing the medication she needed, and that other medications she was given put her at significant harm because they were contraindicated (should not be given) with drugs she was already taking for her complex health problems. Ms C was also unhappy because she said she had been blamed for an act of vandalism to the practice's premises and information about this had been added to her medical records. She complained about the way in which the practice dealt with her complaints about these matters.

We took independent medical advice from one of our medical advisers, who confirmed that it was not a requirement of the General Medical Council contract for a patient to have a medical with a practice nurse before seeing a doctor, as this could lead to delay in prescribing or seeing a doctor. This was what happened in Ms C's case. When Ms C did see a doctor her initial prescription requests were dealt with appropriately but subsequently there was evidence that she was over-prescribed medication without being properly assessed or reviewed. Finally, the investigation showed that non-medical information had been added to Ms C's records inappropriately and that the practice had not handled her complaint in accordance with required timescales. We upheld all of Ms C’s complaints, except that about the medicines she was prescribed, as we found no evidence that any of these was contraindicated.

Recommendations

We recommended that the practice:

• make a formal apology for the difficulties encountered in obtaining GP appointments;
• review their acute prescription request system in terms of how they respond to patient requests for antibiotics. They should confirm to us that they have done so;
• make a sincere apology for the inappropriate entry in the medical records;
• seek to ensure that an appropriate amendment is made (in accordance with relevant guidance) to the complainant's medical records;
• apologise for the way in which the complaint was dealt with; and
• emphasise to all those staff involved the importance of making full and timely replies to complaints in accordance with stated procedures.

Summary

Mrs C complained about delays in diagnosing and treating her late daughter (Ms A)'s secondary cancer. She also complained that the board failed to appropriately communicate with her daughter and that they had found it difficult to contact someone from the breast cancer team.

We took independent medical advice from a consultant clinical oncologist (cancer specialist) and found that, while there were some short delays, these did not impact on Ms A's clinical outcome. Our adviser said that the secondary cancer Ms A developed was extremely rare and behaved very aggressively. We did not uphold this complaint, as we were satisfied that the team responsible for Ms A's care had responded compassionately, accurately and with due speed.

We upheld Mrs C's complaint about the board's communication, and we pointed out the importance of patients being clear about how to contact the breast cancer team. The board had apologised that their contact process was not fully explained to Mrs C and her family, and had taken action to review their communication channels and processes with a view to identifying how they could improve contact for patients.

Recommendations

We recommended that the board:

• report back to us on the outcome of the review being carried out into communication channels and processes, with particular reference to information that is available about where other sources of support can be found.

Summary

Mr C's wife (Mrs C) had an operation at Gartnavel General Hospital to treat a bunion on her foot, which involved inserting metalwork. Afterwards, she was in pain and could only mobilise with difficulty. The wound was slow to heal and six weeks after the operation she was admitted to a hospital in another board area with a severe infection, which was treated with intravenous antibiotics. At her next review, Mrs C's foot was still swollen and she had pain over her ankle and tenderness in her shin. The metalwork was removed the following month. However, at a subsequent review, she had pain in her heel and a magnetic resonance imaging scan (MRI: a scan used to diagnose health conditions that affect organs, tissue and bone) then showed that she had a tendon condition. Mrs C was reviewed again 14 weeks later, but decided not to have a further operation in light of the terminology the consultant used at that review.

Mr C complained about the care and treatment provided to his wife. He said that her tendon was damaged during the operation, causing pain in her ankle outside the site of injury and that she should not have been discharged so quickly. He also said that her infection was not treated reasonably and that the metalwork should have been removed sooner. Finally, Mr C complained that the injured tendon was not investigated appropriately or within a reasonable time and that there was an unreasonable delay between the scan and the subsequent consultation.

We took independent advice from one of our medical advisers, who said there was no evidence that Mrs C's tendon was injured during surgery. She had a wound that was slow to heal and was complicated by infection, but this was treated appropriately and effectively and the metalwork was removed within a reasonable time. In relation to Mrs C's final consultation, we were unable to reconcile the differing accounts about communication. However, we found that the advice given about the condition and treatment options was reasonable. Having said that, the delay between the MRI and subsequent consultation was unreasonable. Although this had no impact on the outcome for Mrs C, we found that the delay caused her additional uncertainty while she was dealing with a painful condition.

Recommendations

We recommended that the board:

• bring the failings in record-keeping to the attention of the relevant healthcare professional; and
• inform us of the steps taken to ensure there is no recurrence of the delay between the MRI scan and follow-up consultation.

Summary

Mrs C experienced numerous troubling symptoms over a number of years including impaired vision and muscle wasting. She underwent a range of investigations with the board's neurology department to establish the cause of her symptoms. Mrs C then complained about the standard of her care and treatment. She felt that, although her symptoms were getting worse, staff did not take her case seriously, dismissed her as anxious and provided contradictory information. Mrs C told us that she decided to have an MRI scan (magnetic resonance imaging scan: a detailed scan of her brain) carried out privately, which identified a small focal lesion (an area of tumour or other tissue damage) on her brain. She complained that this had been missed in scans taken by the board some years previously.

We took independent medical advice from a consultant neurology adviser, and we found that the focal lesion had been present in the earlier scans, but was not easily identified. MRI scanning technology advanced in the intervening period and the lesion was more readily identifiable in the more modern scan. It was only with hindsight and knowledge of its location that radiology staff could identify it in the earlier scans. We did not find the board's actions to be unreasonable in this respect and were satisfied that a number of relevant and appropriate investigations were carried out to establish the cause of Mrs C's symptoms. Ultimately, we found that the treatment she received was in line with that which would have been provided had her lesion been identified from the outset.

That said, we were critical of the board's handling of Mrs C's complaint and their failure to provide an independent review of her MRI scans, as had been promised during their investigation of her complaint.

Recommendations

We recommended that the board:

• apologise to Mrs C for their inadequate communication about her complaint;
• contact Mrs C as a matter of urgency to discuss possible further actions to be taken to review her MRI scans outside of the board area, or provide us with evidence that this has been addressed; and
• review their handling of Mrs C's complaint to ensure that action points from meetings are properly recorded and followed-up and that the NHS complaints handling procedure is properly followed.

Summary

Mr C operates his business from three units in a business centre. He contacted Business Stream when he moved in and, following a visit, an account was opened and he set up a direct debit to pay monthly bills. He told us that it was agreed with Business Stream that he would be billed for all three premises in one invoice. Some three years later Business Stream invoiced him separately for one of the units but then cancelled this, having been advised by Mr C that he was being billed for all three units. In 2013, Business Stream invoiced Mr C for outstanding services provided to two of his units since 2010. Mr C believed that he should not have to pay for the error in 2010 when his account was set up. He also complained of delay in the handling of his complaint.

From our investigation we found that there was evidence of the account being opened for one unit, but no evidence of an agreement to pay for the three units under one account, so we did not uphold this complaint. However, we did uphold Mr C’s complaint about how his enquiries and complaint were dealt with. We found there were periods when there was no action, updates were not provided, and there was a failure to send a form to Scottish Water within a reasonable time, as well as delay in responding to the complaint.

Recommendations

We recommended that Business Stream:

• formally apologise and credit Mr C's account with a sum in recognition of the poor handling of the matter;
• review their handling and credit Mr C's account with 50 percent of the difference between the unmeasured rateable value water charges and his reassessed charges for the appropriate period, if it is established that there were unexplained delays by them; a
• ensure that lessons learned from review of the case are passed on to staff.

Summary

Mr C complained that he had to pay a service charge while he was in temporary accommodation. He also complained that the council did not process his medical assessment form in line with their procedure, and did not communicate properly with him about an offer of housing.

The council said that the service charge was in line with their policy and is for maintaining temporary accommodation, which has a higher turnover than the main housing stock. They said that they had responded to Mr C about his medical assessment application and explained how medical points are awarded. They also apologised for not being proactive in contacting him about his offer of accommodation.

As we found that the service charge was in line with the council's policy, we did not uphold Mr C’s complaint about this. The level of the charge is a discretionary decision for the council to make. However, we found that the council took longer than the four weeks specified in their policy to process his medical assessment application and did not let him know that there was a delay, so we upheld that complaint. We also found that they had failed to correctly categorise the property Mr C was offered, as empty (void) properties such as that one, which need work that will take more than 15 working days should be recorded as 'not offerable'. They had also allowed Mr C to accept the offer as 'subject to viewing' which contravened their void management procedure. In light of these findings, we also upheld Mr C's complaint about the council's communication.

Recommendations

We recommended that the council:

• issue Mr C with an apology for failing to process his medical assessment application in line with their procedure;
• revisit their policy on processing medical assessment forms and ensure that if they are unable to meet the four week deadline that they advise applicants of the delay;
• issue Mr C with an apology for failing to process his offer of accommodation in line with their procedure; and
• revisit their procedure on void management, and remind all staff that properties requiring works of more than 15 working days should be recorded as 'not offerable' and that properties cannot be accepted 'subject to viewing'.

Summary

Mr C complained to us about the care and treatment his mother (Mrs A) received from the medical practice after a GP visited Mrs A's home as she had abdominal pain. Mr C told us that the GP examined his mother, gave her a injection for pain and called an ambulance. He said that the GP spent approximately 15 minutes with his mother before leaving. Mr C said that the ambulance arrived two and a half hours later and during this time his mother's pain worsened. He said that the ambulance crew expressed shock at Mrs A's condition and gave her more pain medication before taking her to hospital. When he went to the practice to complain, he felt that the GP was aggressive towards him. He also said that he asked for information on making a complaint and was told there were no specific forms and that each practice is different.

The practice said that they provided proper care and treatment. The GP said that as Mrs A had family support and her condition was not considered life threatening, it was appropriate to leave and return to other patients at the surgery. The practice said that Mrs A's family did not call them to say that she was worse. They apologised for confusion about the complaints form and explained that although they do not have such forms they do have a procedure, and complaints can be made in writing. They said that they were not aggressive towards Mr C – they in fact felt that he had been aggressive towards them, and they had sent him a formal warning.

We took independent advice from one of our GP advisers, who said that the GP provided reasonable care. Our adviser was of the view that the pain relief given and the decision to request an ambulance within a two hour window were reasonable. The Scottish Ambulance Service provided evidence during our investigation that their crew that day had no recollection of criticising the GP and or of expressing shock at Mrs A's condition. We did not uphold this complaint.

We did uphold Mr C's complaint about the practice's complaints handling. Although they responded to his complaint well, he had asked for complaints handling information and been told there was none. They should have referred to the NHS Scotland 'Can I help you?' guidance and provided information on the process they would use to deal with his complaint.

Recommendations

We recommended that the practice:

• ensure that all practice staff are aware of the NHS Scotland 'Can I help you?' guidance and ensure that the practice leaflets on the complaints handling process, detailed on the practice website, are available to patients and staff.

Summary

Mrs C complained about the care and treatment that her late husband (Mr C) received at Wishaw General Hospital. Mr C had advanced cancer and was admitted to the hospital because he was vomiting blood. He was in the hospital for about a week before being transferred to a hospice, where he died shortly after. Mrs C complained that the hospital did not adequately assess and treat her husband's bladder and bowel problems and failed to take adequate precautions to prevent him from falling out of bed. She also complained that neither she nor Mr C had been involved in discussions about the withdrawal of his medical treatment and his future management plans.

We took independent medical advice from an experienced hospital doctor, who reviewed Mr C's records. Our adviser said that although it was clear that Mr C was most unwell when he was admitted, there were a number of steps the hospital should have taken sooner. Viewed as a whole, he said that Mr C's care fell below a reasonable standard and we upheld this complaint.

We also took independent advice from our nursing adviser, who said that a falls assessment was completed when Mr C was admitted. This indicated that he was not at risk of falling and, in her view, there was no reason for the hospital to have suspected he might do so. Our adviser said the hospital's assessment was reasonable and the board had acted reasonably, based on the information available at the time. In her view, Mr C's fall could not have been avoided, and we did not uphold this complaint.

In terms of Mrs C's complaint about the lack of discussions, our medical adviser pointed to an apparent lack of clarity around the approach being taken with Mr C's care. He was moved to the hospital's high dependency unit for treatment – despite the notes indicating he would not be moved – but it was then decided to move him onto palliative care (care provided solely to prevent or relieve suffering). Our adviser said that this decision was appropriate but should have been discussed sooner than it was. We took the view that the evidence showed a lack of certainty over the direction of Mr C's care and that his family were given mixed messages. We considered this unreasonable and upheld this complaint.

Recommendations

We recommended that the board:

• discuss this case at the next departmental meeting to ensure early recognition of kidney dysfunction and infection, so appropriate steps are taken in such cases;
• ensure that the failings in care and treatment identified are fed back to the relevant staff;
• provide us with a copy of their local action plan for the relevant Scottish Government guidance and confirm the steps in place in acute wards to support patients and families receiving end of life care including staff communication;
• use this case in Mr C's consultant's appraisal with reflection on the issues identified, including the decision on when to move to palliative care, communication and consultant supervision; and
• apologise to Mrs C for the failings we identified.