Some upheld, recommendations

Summary

C, a support and advocacy worker, brought a complaint on behalf of their client (A). A was concerned that the Child and Adolescent Mental Health Service (CAMHS) did not follow the correct process regarding a childhood autism assessment and about the communication from CAMHS about the process for getting an autism assessment.

We took independent advice from a registered mental health nurse. We found that it was reasonable for CAMHS to conclude that A would have to access an autism assessment through their GP because A was over 16 years of age at the time. We also found that the board had communicated reasonably with A and A's parent about the process of getting an autism assessment. We did not uphold these aspects of C's complaint.

C also complained about the way the board handled the complaint. We found that there was a delay in responding to C's complaint and that they were not kept updated on the progress of their complaint or provided with a revised timescale for the response. We upheld C's complaint that the board had failed to handle the complaint reasonably. The board have already apologised for this failing but we have made a further recommendation for learning and improvement.

Recommendations

In relation to complaints handling, we recommended:

• 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.

Summary

Mr and Mrs C complained on behalf of their daughter (Ms A) that the care and treatment Ms A received from practice was unreasonable. Mr and Mrs C said that the practice sought to reduce Ms A's prescriptions for morphine and diazepam when she joined as a new patient. Mr and Mrs C further complained that the doctor who saw Ms A did not give adequate reasons for why the medications were being reduced. We took independent advice from a GP. We found that it was reasonable for the practice to seek to reduce Ms A's medications. We also found that the doctor provided a clear explanation to Ms A, and Ms A's clinical records showed that she had received the same explanation on multiple occasions from other medical professionals involved in her care who had sought to reduce her medication doses. Therefore, we did not uphold this complaint.

Mr and Mrs C further complained that Ms A was unreasonably removed from the practice list. We found that it was reasonable for Ms A to be removed from the practice list as the doctor/patient relationship had broken down with all the partners in the practice, and while the relevant legislation states that a warning should be given within 12 months, that a warning does not need to be given if the GP does not feel that it is reasonable or practical to do so, which was the case here. Therefore, we did not uphold this complaint.

Mr and Mrs C also complained that the practice's handling of her complaint was unreasonable. We found that the practice's complaint responses did not adequately address the issues raised and the practice failed to signpost to this office. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr & Mrs C for the complaint handling failures identified. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/informationleaflets.

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 that there was an unreasonable delay in being seen by neurological (relating to the anatomy, functions, and organic disorders of nerves and the nervous system) services after being referred with back and leg pain; and that when they were seen the care and treatment provided was unreasonable. C also complained that the communication from the board in relation to these matters was unreasonable.

We took independent advice from a neurologist. We found that the timescale for C's neurology appointment was unreasonable as it did not meet the NHS Scotland timescales. We upheld this aspect of C's complaint.

We considered that whilst the care provided to C at their appointment was of a good standard, and it was reasonable to conclude that no further neurological input was required, the timeframe between the appointment and the eventual decision was over ten weeks and we considered this to be unreasonable. We therefore upheld this aspect of C's complaint.

Finally, in relation to communication, whilst we fed back to the board that they may wish to reflect on how they communicate timescales for appointments, we noted that once the decision not to provide further treatment to C had been made this was communicated in a prompt manner. We therefore did not uphold this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the unreasonable delay in providing C with an appointment following their referral to neurosurgical services, the unreasonable timeframe between the consultation and eventual decision, and that the Advanced Physiotherapy Practitioner did not have appropriate and timely access to a consultant opinion. 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:

• 95% of patients referred to neurosurgery should receive a first out-patient appointment within 12 weeks.
• Clinics being run by a non-consultant grade practitioner should have prompt access to a consultant or nominated deputy in order for decisions to treat or discharge to be made promptly.

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, a support and advocacy worker, complained on behalf of their client (A) regarding the care and treatment they received at the Queen Elizabeth University Hospital both before and after surgery to remove anal skin tags and banding of haemorrhoids. In particular, A was concerned that they were not properly consented for the surgical procedure; that the surgery and aftercare were not of a reasonable standard; and that information about a post-operative clinic consultation was shared with the operating surgeon.

The board investigated the complaint and apologised for the delay in A receiving pain relief after the operation; for the surgical wound area not being visually checked for signs of inflammation; and for the discharge letter having incorrectly advised A that they would be followed up post-surgery.

We took independent advice from a consultant in colorectal and general surgery. We found that informed consent had not been properly obtained from A prior to the surgical procedure being undertaken. We upheld this complaint.

We considered that there was no evidence to support that the surgery and aftercare were of an unreasonable standard. Therefore, we did not uphold this complaint.

We did not find evidence of failings regarding the sharing of information between surgical staff regarding a post-operative review appointment that took place relating to ongoing pain and bleeding that A was experiencing. Therefore, we did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for failing to adequately obtain their informed consent to surgery. 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:

• Surgeons should obtain a patient's consent for surgery in line with General Medical Council guidance.

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 medical and nursing care she received at Queen Elizabeth University Hospital in relation to idiopathic (of unknown cause) intracranial hypertension (a condition associated with raised fluid pressure around the brain). The main medical points of concern related to the lack of pain relief in relation to a lumbar puncture (a procedure in which fluid is removed from the spinal canal for diagnostic testing or treatment); discharge from hospital without proper monitoring of the medication she was prescribed; and the lack of pain relief following a surgical procedure to drain fluid. The main nursing points of concern included refusal to remove a cannula (a tube that can be inserted into the body, often for the delivery or removal of fluid); the refusal of pain relief following the surgical procedure and the need to await a doctor; that she was not allowed to leave the ward; and was not assisted with either her personal care, eating nor drinking. Miss C also complained that the board did not respond to all the points of concern that she had raised in her complaint correspondence.

We took independent advice from a consultant neurosurgeon and a registered nurse. In terms of the medical care, we found that the pain relief prescribed both at the time of the initial lumbar puncture and following the surgical procedure were reasonable and appropriate; and that it was reasonable to discharge Miss C with medication pending further specialist review. We, therefore, did not uphold this complaint.

In terms of the nursing care, we found that there was insufficient evidence to support Miss C's concerns about removal of a cannula or that she was advised not to leave the ward. We found that there was evidence to support that Miss C's pain monitoring was reasonable and appropriate given her pain score was regularly assessed, her pain escalated to medical staff where appropriate and her pain management reviewed by pain specialist staff. We also considered that there was a lack of evidence to show that there were failings in the nursing care in relation to Miss C's personal care, eating or drinking. Therefore, we did not uphold this complaint.

We did, however, uphold Miss C's complaint that the board failed to provide a full, objective and proportionate response to her complaint in terms of the NHS Scotland Complaints Handling Procedure. We made a learning and improvement recommendation to the board in September 2019 as a result of a similar complaint about failing to provide a full, objective and proportionate response and have followed up on this recommendation to ensure its implementation.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for failing to respond to all of the points of concern that she raised. 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

Mr C made a number of complaints to us about care and treatment he had received after he attended the Royal Alexandra Hospital with back pain. He was subsequently diagnosed with metastatic prostate cancer. He was transferred to the Beatson West of Scotland Cancer Centre and was given radiotherapy (a treatment using high-energy radiation). Mr C considered that the primary treatment at that time should have been surgical.

We took independent advice on the complaints from an emergency medicine consultant, an orthopaedic consultant (a specialist in the treatment of diseases and injuries of the musculoskeletal system), a consultant oncologist (a doctor who specialises in the diagnosis and treatment of cancer) and a neurosurgery consultant (a specialist in the diagnosis and treatment of disorders of the nervous system, especially the brain and spinal cord).

Firstly, Mr C complained that there was a delay in carrying out an MRI scan. We found that he should have had an MRI scan within 24 hours, but there was a delay in carrying this out. We upheld this complaint.

Mr C also complained that when he attended A&E at the Royal Alexandra Hospital, he was inappropriately referred to the orthopaedics team. We found that it had been reasonable to refer him to the orthopaedics team and we did not uphold this complaint.

Mr C complained that there had been a failure to communicate effectively and to discuss the result of the MRI scan with the neurosurgery team. We did not find any failings in relation to this and we did not uphold the complaint.

Mr C complained that he was unreasonably given radiotherapy without consent being obtained for this appropriately. We found that it had been appropriate to give him radiotherapy at that time, given his deteriorating neurological symptom. We did not find any failings in relation to this matter and we did not uphold the complaint.

Mr C also complained that staff failed to communicate reasonably with him. We found that staff had not met his needs in relation to communication and upheld this complaint. However, we noted that the board had acknowledged and apologised for this failing.

Mr C complained that medical staff failed to adequately communicate to nursing staff that he should have been given Clexane (medication that helps to reduce the risk of blood clots) before an operation. We found that it was unreasonable that medical staff failed to communicate this adequately and upheld this complaint. The board said that they had already taken action in relation this complaint and we asked them for evidence of this.

Finally, Mr C complained that there was an unreasonable delay in deciding that surgery should be carried out after the MRI scan was reviewed by a spinal surgeon. We found that the timescale was reasonable and did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the unreasonable delay in carrying out an MRI scan. 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 consider developing a standardised pathway for the management of Malignant Spinal Cord compression based on NICE Guidance and including access to urgent MRI scans within 24 hours. This should also take bank holidays into account.

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, who has diabetes, damaged their foot. C was diagnosed with a broken 4th metatarsal (one of the long bones in the foot). A scan was taken and C was seen at a fracture clinic. C was unhappy with the assessment and the lack of further scans at the fracture clinic appointment.

We took independent advice from an orthopaedic surgeon (a medical expert who treats patients with problems in their muscles, bones, joints and other related structures). We found that, due to C's diabetes, C had a high risk of developing a delayed or non-union of the fracture and that this was not recognised by the doctor. Scans should have been taken at the clinic appointment to monitor healing and C was unreasonably discharged before the fracture was healed. Therefore, we upheld this aspect of the complaint.

C also complained about the management of their diabetes while they were awaiting surgery on their foot. We took independent advice from a nurse. We found that the management of C's diabetes was reasonable. C had a libre device which monitored their blood sugar levels. While the documentation of the management of C's diabetes should have been clearer, it was reasonable for C to continue to monitor their blood sugar levels on the ward and report the results to staff. We did not uphold this aspect of C's complaint.

Lastly, C complained that there was an unreasonable delay in their surgery being carried out. We found that the initial surgery was delayed due to equipment being unavailable. The surgery was a planned procedure and therefore the equipment should have been ordered prior to the day of surgery. When C's surgery was rescheduled, C was unreasonably placed on the trauma list when they should have been placed on the urgent planned list, where there would have been less likelihood C's surgery would be cancelled. We upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings as identified in the appointment and for the delay in carrying out surgery. 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:

• Diabetic fracture healing should be appropriately assessed.
• Ordering/procurement systems are in place to ensure necessary equipment is available in advance of operations.
• Surgery should be scheduled on the appropriate list.

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 both the health visitor and hospital care provided to her child (Child A) in the context of child protection safeguarding. Ms C felt that there had been a lack of action taken by the health visitor when she reported Child A had ongoing diarrhoea and had a hard and bloated stomach. Ms C was also concerned that child protection procedures should not have been instigated and that the process was not properly communicated to her or reasonably followed in terms of the alleged facial markings on Child A.

In responding to the complaint, the board considered that the actions and care provided by staff were appropriate in terms of Ms C's complaints.

We took independent advice from a registered health visitor and from a consultant paediatrician.

In terms of the care provided by the health visitor, we considered that the care provided to Child A was appropriate and that it was correct to instigate child protection proceedings. However, we upheld this complaint on the basis that there was a failure to either reasonably communicate the decision about instigating child protection proceedings to Ms C or to record the decision not to communicate this to her.

We found that the care provided by the hospital was reasonable, therefore, we did not uphold this complaint on the basis that child protection procedures were appropriately followed.

However, we were critical of the board's original complaint response to Ms C as it provided limited detail of their complaints investigation in relation to the actions of the health visitor.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for not following the National Guidance for Child Protection in Scotland. 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:

• Staff should document that they have either communicated the decision to instigate child protection procedures to the family or to record the decision not to do so, in line with the National Guidance for Child Protection in Scotland.

In relation to complaints handling, we recommended:

• Complaint responses should address the issues raised, in line with the 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 complained about a failure on the part of the board to discuss their eye conditions and possible treatments before they were referred to another board for an operation.

We found that, whilst the referral to the other board was reasonable, the fact that C was not involved in a discussion, or advised about possible options for treatment prior to the referral, was unreasonable. Therefore, we upheld this aspect of the complaint.

C also complained about a failure on the part of the board to transfer all relevant medical information to the other board prior to the operation.

We found that it was reasonable practice for the board to state that the other board could contact them for relevant information if they considered it necessary to do so, given they had already met with C and had notes about their condition. We did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for (1) failing to explain to them why the doctor considered it necessary to refer them on to the other health board and (2) failing to send them a copy of the letter to their GP stating why the referral was being made. 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:

• To ensure patients receive information about why a referral has been made for them to see another clinician.

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

Mrs C complained to the board on behalf of her son (Mr A), who had a diagnosis of autism. Mrs C was unhappy with aspects of the care and treatment provided to Mr A by the mental health service at Queen Margaret Hospital.

Mrs C firstly raised concern about the communication surrounding the prescription of a medication. The board upheld Mrs C's complaint and apologised that the information provided about the dose was not clear.We found that Mr A had taken a greater dose than intended; however, the dose taken was still within the safe limits of prescribing for this medication. We concluded that the board had taken reasonable action in light of the matter. We upheld the complaint but did not make recommendations.

Mrs C was also unhappy with the psychiatric care and treatment provided to Mr A more generally. We took independent advice from a consultant psychiatrist. We found that there was a reasonable level of assessment, treatment, and clinical management of Mr A during his consultations with the service. We did not uphold this complaint.

Finally, Mrs C raised concern about some of the language used in the board's complaint response. We considered that the use of one term or another was a matter of preference and we did not conclude that there were failings in the language used. However, we did consider that the time taken for the board to respond to Mrs C's complaint was excessive. On balance, we upheld this aspect of the complaint.

Recommendations

In relation to complaints handling, we recommended:

• In line with the NHS Scotland Complaints Handling Procedure, the person making the complaint should receive a full response to the complaint as soon as possible but not later than 20 working days, unless an extension is required. Delays in the investigation should be minimised.

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.