Upheld, recommendations

Summary

Mrs and Mrs C complained about a delay in diagnosing their child (child A) with autism spectrum disorder (ASD). In particular, they complained that an autism diagnostic observation schedule (ADOS) was not carried out. Child A was subsequently diagnosed with ASD after an ADOS was carried out.

The board did not consider there was an unreasonable delay in diagnosing child A with ASD. They also explained that their ASD assessment pathway has developed since the events complained about occurred.

During our investigation we took independent advice from a consultant paediatrician. The adviser considered that child A should have been referred for a multi-disciplinary ASD assessment, given their family history, their symptoms and Mr and Mrs C's strong concerns. The adviser explained that an ADOS is not a requirement to diagnose ASD but that it can be a helpful tool. In light of the failure to refer child A for a multi-disciplinary ASD assessment, we upheld the complaint and made recommendations in light of our findings.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr and Mrs C for not referring child A for a multi-disciplinary autism spectrum disorder assessment. The apology should comply with the SPSO guidelines on making an apology, available at: www.spso.org.uk/leaflets-and-guidance.

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

• Parental concerns should be taken into account when deciding if a child should be referred for an autism spectrum disorder assessment, in line with the relevant guidelines, as should any reported symptoms and family history of learning difficulties.

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 developed a lump on his ear and his GP referred him to Hairmyres Hospital for investigations. Mr C was seen at the dermatology clinic at the hospital six weeks after his GP referral. He was diagnosed with squamous cell carcinoma of the ear (a type of cancer in the skin's cells). Mr C was routinely referred to the hospital's plastic surgery department for treatment and he was offered a plastic surgery appointment around two months later. In the meantime, Mr C contacted the dermatology clinic, as the lump on his ear was increasing in size daily. Mr C's referral to the plastic surgery department was upgraded to urgent and he was offered an appointment a week later. When Mr C attended that appointment, he confirmed that he had already arranged private surgery to treat his squamous cell carcinoma, as he felt the treatment time at the hospital had been too long. Mr C complained to us about delays in diagnosing and treating his squamous cell carcinoma.

We took independent advice from a consultant dermatologist. We found that there was no unreasonable delay in the hospital diagnosing Mr C's squamous cell carcinoma. However, we found that squamous cell carcinoma on the ear is considered a high-risk site, as it has the potential to spread around the body. Therefore, we considered that Mr C should have been urgently referred to the plastic surgery department after his diagnosis. We found that it was unclear whether Mr C would have been treated within the 18 week referral to treatment standard, which applies to 90 percent of all routine surgeries in Scotland. We considered that this standard may not have been met, given how complex the surgery would be and how long Mr C's clinical journey had already taken. We recognised that it is not a 100 percent standard, but given the level of risk of having squamous cell carcinoma on the ear, we considered that Mr C should have been treated within that timescale. For this reason, we upheld Mr C's complaint. However, we did not recommend that Mr C's private treatment costs be refunded. This is because we noted that he had arranged private surgery before he received a date for surgery from the hospital. Although we had concerns that the hospital may not have met the 18 week standard, we were unable to say with certainty they would not have done so, and so we did not consider it to be reasonable to recommend that the board reimburse Mr C's private treatment costs.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for referring him to plastic surgery as a routine referral when his squamous cell carcinoma was on a high-risk site. The apology should meet the standards set out in the SPSO guidelines on apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• Patients with squamous cell carcinoma should receive the appropriate treatment, from the correct clinician(s), at the appropriate time, taking into account the relevant clinical 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

Mrs C complained that the practice unreasonably removed her from the patient list. Mrs C had been expecting to receive a call from the receptionist about whether her adult son could have an appointment with a GP to discuss blood test results. Mrs C had earlier tried to speak to a GP by phone to see about an appointment for her son but was told that the GP would not speak to her. Mrs C left her contact details and asked that the practice return her call with details of an appointment time. Mrs C then received a phone call from the practice manager who said that the decision had been taken to remove her from the patient list. Mrs C could think of no reason why she had been removed from the patient list.

We took into account the contractual regulations and relevant guidance regarding the removal of patients from the practice list. This sets out that, other than in cases involving violence or aggression, a patient whose behaviour is giving cause for concern should be given a written warning informing them that they will be removed from the practice list if they do not alter their behaviour. The warning should last for 12 months. While the practice did provide us with two examples of why they had concerns about Mrs C's actions, staff did not formally bring them to Mrs C's attention in line with the regulations and guidance and therefore she was unaware of the practice's concerns. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for unreasonably removing her from the practice list. The apology should comply with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• Staff should be aware of and comply with the guidance and regulations where there are concerns about patient behaviour.

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 raised concerns about the way hospital nursing staff arranged a care package with the council for her late father (Mr A) upon his discharge from Glasgow Royal Infirmary. Mr A's discharge from hospital was delayed as Ms C was told that the care providers were closed over the holidays. After being discharged no carers arrived to assist Mr A. Ms C contacted the hospital but was told nothing could be done as it was the weekend and there was no out-of-hours service. Ms C complained that the board failed to ensure that a package of care was in place for Mr A on his discharge from hospital and that she was not provided with an out-of-hours emergency phone number for the care provider.

We considered that there was a failure to reasonably ensure that the council was contacted to put a package of care in place. We found that there was contradictory information regarding how the package of care had been arranged and who within the nursing staff had arranged it with the council. It was not possible to determine with any certainty who arranged this and what was arranged. We upheld this aspect of the complaint.

We also found that nursing staff were not aware of the fact that an out-of-hours number was available and could be called at the weekend and on public holidays. We found that it was possible that Mr A could have been provided with a package of care over the holidays or at the weekend if the out-of-hours service had been contacted by the nursing staff or if Ms C had been provided with the number. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to ensure that a care package was arranged with the council for Mr A's discharge from hospital.
• Apologise to Ms C for not calling the out-of-hours phone number for packages of care and for not providing Ms C with this number. The apology should meet the standards set out in the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• All nursing staff should be aware of the requirement to record who contacted the council to arrange a package of care; the name of the person this was arranged with; the date the care package would start and any discussion regarding the care the patient would require at home.
• All nursing staff should be aware of the out-of-hours contact phone number for packages of care for public holidays and weekends. Staff should contact this number where appropriate to do so. The number should be provided to families where appropriate to do so.

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, who works for an advocacy and support agency, complained on behalf of her client (Mr A). Mr A had been on a waiting list for a prostate operation for severe incontinence for a number of months and, despite several letters from the board saying that he would undergo the operation within weeks, he was still waiting when Ms C made the complaint to us, approximately nine months after Mr A was first put on the waiting list. Ms C said this was contrary to the treatment time guarantee (12 weeks) and did not take into account Mr A's clinical need. She also noted that Mr A was willing to travel to any hospital in the UK to undergo the operation. Ms C told us that Mr A's operation had been cancelled on three occasions at the very last minute and said that, as a result of the board's failings, his physical and mental health had deteriorated.

We took independent advice from an adviser who specialises in urology. We found that the board's failure to meet the treatment time guarantee or consider other healthcare providers meant that Mr A suffered severe lower urinary tract symptoms unnecessarily for an unreasonable number of months, with significant implications for his physical and emotional health as a result. In relation to communication, we also found it unreasonable that, at times, Mr A had to take the initiative to find out what was happening once the 12 weeks treatment time guarantee period had passed. We were not satisfied from the evidence available that the board had reasonably had regard to the legislation concerning the treatment time guarantee, and we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for failing to provide treatment within a reasonable time.

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

• Review their process and patient letters to ensure that they comply with the treatment time guidance, including considering alternative providers and communication with patients.
• Reflect on this case in relation to whether opportunities to reassess Mr A's clinical priority were missed and report back to us on the findings.

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 on behalf of her son (Mr A) about the care and treatment provided to him by the board in relation to his Crohn's disease (a chronic inflammatory disease of the intestines). Mrs C had a number of concerns, including that one of the medications he was prescribed resulted in him developing steroid-induced diabetes and that this had not been monitored appropriately. She was also concerned that Mr A was not appropriately prepared prior to surgery to remove the colon. Mrs C felt that Mr A should have been offered support and counselling on the seriousness and potential consequences of the surgery.

We took independent advice from a gastroenterologist, a GP, and a colorectal surgeon. We found that there were aspects of Mr A's care that were reasonable, including the care provided to him prior to his surgery. However, we found that there was a failing of a consultant to clearly delegate the monitoring of Mr A's blood sugar levels to his GP. We also found that the board had not followed the UK Inflammatory Bowel Disease standards when managing Mr A's care in that they did not discuss him at a multi-disciplinary meeting. Therefore, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for failing to provide reasonable clinical treatment. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

• Any instructions from a consultant to a GP should be communicated to the GP in a clear manner.
• The board should consider adopting the UK Inflammatory Bowel Disease standards in the management of similar patients.

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 about the standard of pressure area care which his mother (Mrs A) received while she was a patient in Woodend Hospital. Mrs A was in hospital for a number of months and, due to her reduced mobility, developed a grade two pressure ulcer which progressed to a grade four pressure ulcer. A grade four pressure ulcer is the most severe kind, and people with grade four pressure ulcers have a high risk of developing life-threatening infections.

We took independent advice from a nursing adviser who noted that appropriate risk assessments were not carried out and incorrect equipment had been used in an effort to prevent the development of and healing of pressure ulcers. While the staff had taken action to change Mrs A's position in bed and when she was sitting in a chair, these were not changed frequently enough. There was also a delay by the staff in referring Mrs A for an assessment by the tissue viability service. We upheld the complaint.

However, we did note that the board have since carried out an investigation and audit which identified learning opportunities for staff in regards to knowledge and awareness of pressure area care.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A for the failings in pressure area care. The apology should meet the standards set out in the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-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

Mrs C complained about the medical treatment and nursing care that her late mother (Mrs A) received at Victoria Hospital. Mrs A had been diagnosed with advanced lung cancer and was admitted to hospital with symptoms of nausea and persistent vomiting. The issues Mrs C raised concern about related to a lack of blood testing to monitor Mrs A's kidney function as she had chronic kidney disease, that no intravenous (IV) fluids were given over two specific days and that fluids were not appropriately monitored, that there was a delay in a urinary catheter being inserted and that communication with the family was poor.

We took independent advice from a consultant in respiratory medicine and from a nurse. We found that there were a number of unreasonable delays in relation to Mrs A's medical care and treatment. We considered that if IV fluids had been administered in a timely manner, this may have delayed or prevented the development of an acute kidney injury (the inability to turn waste material into urine) and may have allowed Mrs A to spend more time with her family. We upheld Mrs C's complaint about medical care and treatment.

In terms of the nursing care, we found that there was a lack of comprehensive monitoring of Mrs A's fluid intake and urine output which the board's complaint investigation did not identify. We considered that such monitoring may have helped assist medical staff identify issues with urinary output sooner. We upheld Mrs C's complaint about nursing care.

We noted that the board had accepted that there were problems with the way in which staff had communicated with Mrs C and the family. Therefore, we have asked the board to provide evidence of the action that they said they would be taking to address this. However, we also recommended that the board take further action to address how they review the care and treatment of patients as their response to the complaint contained inaccurate information.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings in Mrs A's medical and nursing care, and for the fact that the board's complaints investigation was not thorough enough.

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

• Review by a senior doctor for patients admitted as an emergency should be carried out in a timely manner.
• Difficulties with IV access should be escalated in an appropriate and timely manner.
• Fluid balance charts should be fully completed when indicated.
• Appropriate clinicians should be involved in the review of patient care to ensure that comprehensive responses to complaints are provided.

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 about the care and treatment she had received from the board. However, during our investigation we were advised that Mrs C had commenced legal action against the board. We must not investigate any matter which has been, or is being, considered in a court of law. Therefore we did not take these aspects of Mrs C's complaint forwards.

Mrs C also raised concern about the board's handling of her complaint. We found that the board failed to provide updates and delayed in advising Mrs C that her complaint was out of time and would not be investigated, in line with the complaints procedure. We upheld this aspect of Mrs C's complaint.

Recommendations

In relation to complaints handling, we recommended:

• The board should review their arrangements for assessing new complaints to ensure that, where a complaint is out of time, this is identified in line with the model complaints handling procedure. Guidance and standards for good investigations are set out in the SPSO Investigations toolkit, available at http://www.valuingcomplaints.org.uk/learning-and-improvement/best-practice-resources/decision-making-tool.

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 that she had been unreasonably withdrawn from her university course due to lack of attendance at classes. She also complained that communication before and after her withdrawal was unreasonable in that it was confusing and unclear.

We found that the university's procedure for withdrawing students for non-engagement was not sufficiently robust. We found that evidence to support their decision to remove Ms C from the course was unsatisfactory. We also found that, when she appealed the decision, Ms C was disadvantaged by the poor explanation for their decision to withdraw her. We upheld both of Ms C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Reconsider Ms C's appeal of the decision to withdraw her.

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

• The university should have a robust process which gives students clear information about their attendance requirements and warnings when their attendance falls below an acceptable level. Responses from students should be followed up and support and advice should be offered.
• Decisions to withdraw a student for non-engagement should be noted and key evidence should be retained.

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.