Some upheld, recommendations

Summary

Mr C complained that the board had not made reasonable decisions around whether to provide plasma exchanges (a procedure which separates your blood into its different parts: red cells, white cells, platelets and plasma. The plasma is removed from the blood and replaced by a plasma substitute) to his wife (Mrs A) and whether to further explore the possibility of thrombectomy (procedure of removing a blood clot from a blood vessel), or reasonably monitor her levels of consciousness during an admission to hospital following a stroke. We found that the board's decisions around plasma exchanges and the possibility of thrombectomy had been reasonable, but that the board had not reasonably monitored Mrs A's levels of consciousness for a period. This meant that there was a delay to the board providing her with specific treatment. Although this treatment had only a small chance of success, we decided that the board's actions had been unreasonable. Therefore, we upheld this aspect of Mr C's complaint.

Mr C also complained about how the board had responded to his complaint. We found that the board's responses had been reasonable and did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A's family for their unreasonable failure to monitor Mrs A's consciousness levels hourly, which caused a delay in providing reasonable treatment to her. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The board should reasonably monitor patients' consciousness levels.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of their spouse (A). A had a history of metastatic cancer (cancer which has spread to another part of the body). A attended their GP with a sudden on-set headache and was advised to attend the Glasgow Royal Infirmary (GRI). A arrived at GRI as an emergency attendance and was admitted for investigation. Scans were carried out which revealed that A had an intracranial metastasis (a malignant growth that had spread to the brain from a tumour in another organ). C complained that there was an unreasonable delay in the scans being carried out. C also complained that A had unreasonably been advised that surgery was not an option.

We took independent advice from a consultant in acute medicine and from a consultant radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques). We found that there had been an unreasonable delay in the first scan being carried out given A's history, current medications and symptoms. All relevant information was not provided to the radiologist to determine the priority of the scan and, when the scan was not carried out as planned, the board failed to query this with the radiology department when it had not occurred as scheduled. We upheld this aspect of C's complaint.

In relation to the second complaint there was little information available to confirm exactly what was said between the board, C and A regarding the discussion that surgery was not an option for A. We found, based on the information available, that the board had reasonably informed A that curative surgery was not an option in relation to their intracranial metastasis. Therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and A for failing to carry out A's scans in a reasonable timescale. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• All relevant information should be provided to the radiology department when requesting a CT scan.
• Patients presenting with a headache and taking anticoagulant medication should receive appropriate investigations to identify whether an urgent scan is needed.
• The board should carry out scans in the timeframe agreed.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C was referred by her GP to the board's Assisted Conception Service (ACS). At her appointment with ACS months later, she was told that it was too late to proceed with screening/referral to the Assisted Reproductive (ART) Clinic tertiary centre, as the waiting time for an appointment at the ART is five to six months, by which time she would be over the age limit (the upper limit to be eligible for in vitro fertilisation (IVF, a process of fertilisation where an egg is combined with sperm outside the body) treatment on the NHS). Ms C complained that, according to the information on the board's website, she should have been eligible for NHS fertility treatment.

We took independent advice from a consultant gynaecologist (a doctor who specialises in the female reproductive system) and from a GP. We found that the information on the board's website regarding timescales for referral for fertility treatment had originally been incorrect, as it stated that a patient need only be referred prior to their 42nd birthday, as opposed to needing to be screened before their 42nd birthday. However, we found that the board had amended this information in order to ensure it was accurate. Whilst we welcomed this, we were concerned that the incorrect information was not noted by the board until drawn to their attention by our office.

We considered that, whilst changes had been made, the information on the website was still unclear as it did not explain the steps involved in screening, and the waiting times involved in these steps. We also found that the board's position regarding how they communicate this information to GPs is not in line with current primary care practice. We upheld this aspect of Ms C's complaint.

With regard to Ms C's complaint that she was unreasonably denied fertility treatment, we found that Ms C did not meet the criteria, and therefore it was reasonable to deny her fertility treatment. Therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C that the information on their website regarding timescales for referral for IVF is unclear. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The information available to patients and GPs should make clear the referral pathway, screening process, and timescales involved in these steps, are explained clearly; including how long before the patients 42nd birthday they may need to be referred to complete the screening process in time.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C complained about the care and treatment provided to her husband (Mr A) at the Royal Alexandra Hospital when he attended A&E with a headache, nausea, resolved left sided weakness and a facial droop. Mr A underwent medical review and scanning and was admitted into hospital. The following morning Mr A's condition appeared to deteriorate and following a further scan he was found to have had a type of stroke.

We took advice from a consultant in acute medicine, and a consultant radiologist (a specialist in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans). We found that the care and treatment provided to Mr A had been reasonable, with timely assessments and investigations. We did not uphold this aspect of Ms C's complaint.

Ms C also complained about the communication with Mr A's family, particularly when he deteriorated. The board had reviewed Mr A's care and acknowledged that there were failings in communication. Whilst the board had already shared the findings of their investigation widely, we made a further recommendation on this point. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A and Mrs C for the failure to communicate reasonably with Mr A's family. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Communication with families/next of kin should be part of the response to a deteriorating patient.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C, an advocacy worker, complained to us on behalf her client (Mr A) about the care and treatment Mr A received at a consultation when he disclosed details of his mental ill health. Ms C said that the GP did not make eye contact with Mr A and rushed through the consultation. Ms C also complained that Mr A was subsequently removed from the practice list after they submitted a complaint.

We took independent advice from a GP. We were unable to comment on the amount of eye contact made during the consultation as there was no evidence in relation to this. We noted, however, that the GP had stated that they would try to learn from this. The practice had also stated that the consultation took longer than the ten minutes allocated. We found that the practice had a lot of history available for Mr A and the decision to decline referral to psychiatric services was based on their knowledge of Mr A and his medical history. We considered that the care and treatment provided to Mr A at the consultation was reasonable and we did not uphold this aspect of the complaint.

In relation to the complaint that the practice unreasonably removed Mr A from their list, we found that the practice should have issued a warning letter to Mr A before removing him from their list. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the failure to issue a warning before removing him from their practice list. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Consider any application to re-register on the practice list received from Mr A.

What we said should change to put things right in future:

• A breakdown in a doctor/patient relationship should be managed in line with the General Medical Council's guidance and the relevant regulations.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C was referred to the board's plastic surgery department with a suspected sebaceous cyst (a common non-cancerous cyst of the skin) as a routine referral. It was found that C had a squamous cell carcinoma (a type of skin cancer). After diagnosis of the cancer C subsequently underwent treatment to remove it. After surgery the board's district and community nurses managed C's wound in the community. C complained about the treatment provided by the board and subsequent wound care.

We took independent advice from a consultant plastic surgeon. We found that the board's investigation, diagnosis and treatment of C was reasonable and met the waiting times specified by the Scottish Government in 'Better Cancer Care, An Action Plan'. While there had been some communication failings, the treatment provided was reasonable. We did not uphold this aspect of C's complaint.

We took independent advice from a nurse regarding C's wound care. We found that the wound care provided by the board was unreasonable. It was not evidenced that C's wound had been seen and assessed by an appropriate clinician before agreeing how the wound would be cared for. The board accepted there was a lack of documentation relating to C's wound care. We upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide reasonable wound care to them. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Wounds should be assessed by an appropriate clinician before determining the best course of treatment.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained on behalf of his daughter (Ms A) in relation to charges for treatment provided to Ms A in Victoria Hospital. Ms A was visiting the UK from overseas and attended A&E with palpitations (noticeably rapid, strong or irregular heartbeat). Following assessment in A&E, Ms A was admitted to an acute medical ward before she was later discharged. Ms A reattended the hospital the following week for a check-up and at this time an interview to assess charges for overseas visitors was also performed. Ms A subsequently received an invoice for the admission. Ms A had extensive contact with the board's finance and patient feedback teams in relation to the invoice. She remained dissatisfied with the board's final response and Mr C brought the complaint to us.

Mr C firstly complained that the board failed to inform Ms A that she would be charged for treatment when she attended A&E. We found that, due to the timing of the attendance and discharge from the hospital, it was reasonable that Ms A was not informed she would be charged for treatment until the interview performed in the week following the admission. We did not uphold this complaint.

Mr C also complained that the board failed to charge and invoice Ms A appropriately for treatment provided. In response to Ms A's complaint, the board identified and apologised for issues with the invoicing process. We found that the board's documentation of the assessment of liability for charges was poor. We were unable to determine that the board had followed the correct process for establishing liability and fully established that no exemptions applied to Ms A's treatment. On this basis, we upheld the complaint.

Finally, we identified a number of failings in the board's handling of Ms A's complaint. We noted that there had been a delay in signposting Ms A to the complaints procedure; that the board's correspondence contained inaccurate information; and that the final response did not address all the points raised. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for the failings identified in assessment and complaint handling. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Seek further information from Ms A (as needed) and reassess her liability for charges using overseas visitors' liability to pay charges for NHS care and services: a guide for healthcare providers in Scotland – CEL 09 (April 2010). Inform Ms A if she is deemed exempt or liable for charges, and provide a reason for this.

What we said should change to put things right in future:

• Patients from overseas should be assessed for liability for charges in accordance with the board's internal procedure and the Scottish Government guide. An assessment of liability should be recorded in line with the board's procedure.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the requirements of the NHS Scotland Model Complaints Handling Procedure.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C attended an appointment at Victoria Hospital to have a stent (a splint placed temporarily inside a duct, canal, or blood vessel to aid healing or relieve an obstruction) removed. The procedure, scheduled for the morning, was not performed until the evening, and when C was transferred to a ward they had not eaten for over 24 hours or drunk for around 18 hours. The board accepted that C had been fasted of food and liquid for longer than guidelines recommended. The board apologised for this and committed to reviewing their fasting guidelines and discussing these with staff. C had also not received all of their regularly required medication during this time in the hospital. The board apologised for this and explained that a full medication history should have been obtained via discussion with C and took steps to improve medicines management. During the process of complaining about their experiences, C agreed with a patient relations officer that a meeting to discuss their complaints, as offered in the board's first response to them, would be arranged. C subsequently received a second response from the board but no further communication about the expected meeting.

We investigated C's complaints about these matters. We upheld C's complaint about being fasted for an unreasonable length of time and found the actions that the board had committed to had not been undertaken. We upheld C's complaint about the failure to provide their regularly prescribed medication, given these had not been provided and there was no evidence a medication history had been completed as per normal processes. The board explained that they had decided the second response was the appropriate way to provide the clarification that a meeting would have delivered. Given C had reached a similar conclusion and had not pursued the matter further with the board, we did not uphold their complaint about the board's failure to complete the arrangements.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide them with their regularly prescribed medication. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The board to complete a medication history for all patients as per normal processes.
• The board to fulfil their commitment to reviewing fasting guidelines and discussing these with all staff.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Miss C complained about the care and treatment provided to her late father (Mr A). Mr A had been diagnosed with advanced prostate cancer and was admitted to a community hospital for rehabilitation and intensive physiotherapy after he had undergone chemotherapy and radiotherapy. Mr A's care and treatment was provided by a team of medical professionals including a GP and nursing staff. Mr A's condition deteriorated and he died during his admission.

We took independent advice from a GP and a nurse.

Miss C was concerned that there was a failure to diagnose and treat Mr A's lower respiratory tract infection and pneumonia and questioned the administration of an antidepressant medication to Mr A. We found that the infection was identified appropriately and appropriate treatment was provided. In addition, it was reasonable to have prescribed the medication and that there was no connection between this and Mr A's deterioration and death.

Miss C also raised concerns about the physiotherapy and rehabilitation provided to Mr A and the input from the dietician service. We found that the records documented Mr C had received reasonable physiotherapy and dietary care.

In relation to Mr A's end of life care, we found that it was not required that a GP attend Mr A in the 24 hours before he died. We also found that appropriate nursing care was provided to Mr A.

For the reasons outlined above, we did not find evidence of unreasonable failings in the care and treatment provided to Mr A and, as such, we did not uphold this complaint.

Miss C further complained that there was a lack of reasonable communication with her and her family about Mr A's care and treatment. While we found there was evidence of appropriate communication about Mr A's care, including about Mr A's end of life care, we took account of the board's complaint response to Miss C which identified areas for improvement and learning and accepted that unintended distress was caused to Miss C and her family. Therefore, on balance, we upheld this complaint.

Miss C also considered that the board had failed to handle her complaint reasonably. We found that there was a reasonable and proportionate effort by the board to answer the issues raised by Miss C. We noted that the board offered to meet with Mr A's family. As such, we did not find that the board's handling of the complaint was unreasonable and, therefore, we did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C and her family for the failings identified by the board's complaint investigation in communication, in particular, around the end of life care provided to Mr A. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C returned to her GP after being discharged from the board's community psychiatric nursing (CPN) service as she was experiencing coping difficulties and anxiety. A further referral was submitted to the service but was refused. The local mental health team's view was that ongoing support for Ms C would not be appropriate or required because it was unlikely that she would derive any therapeutic gain.

In her complaint to the board, Ms C said she was unreasonably discharged from the service and that this had not been communicated to her clearly. She also complained about the decision to refuse the further referral to the service. The board said that Ms C's discharge from the service was well planned and discussed with her. It was also noted that Ms C had received extensive input from the service so it was felt she would not gain anything further and no plans were made to see her again after her GP referral. Ms C was unhappy with this response and brought her complaint to us.

We took independent advice from a mental health nurse. We found that Ms C's discharge was reasonably planned and phased and took place with her agreement and input. However, we were unable to identify a crisis plan within the records. A plan of this nature would have been helpful to all stakeholders in their efforts to support Ms C when her emotions fluctuate. It was unreasonable that no such plan appeared to be in place for Ms C. With that said, whilst it was clear from the GP's referral letter that Ms C was experiencing an increase in anxiety, there was no evidence to suggest that she was in crisis at that point. Given the evidence available, we concluded that Ms C's discharge from the CPN service was reasonable and that it was communicated to her appropriately. We also found that the local mental health team's response to her GP's referral was reasonable. Therefore, we did not uphold Ms C's complaints.

Ms C also complained that the board failed to handle her complaint reasonably. We found that there were delays in corresponding with Ms C and she was not kept up to date on the progress of her complaint. We also found that the board should have followed up with Ms C following a meeting were a number of action points were agreed. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to handle her complaint reasonably. The apology should meet the standards set out in the SPSO guidelines on apology available at: www.spso.org.uk/information-leaflets.
• Write to Ms C to confirm the steps taken to progress the identified outcomes recorded following the meeting.

What we said should change to put things right in future:

• Complaints should be handled in line with the Model Complaints Handling Procedure (MCHP). The MCHP and guidance can be found here: https://www.spso.org.uk/the-model-complaints-handling-procedures.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.