Health

Summary

Miss C, an advocate, complained on behalf of her client (Ms A) that the board had decided, from an urology (the branch of medicine and physiology concerned with the function and disorders of the urinary track) perspective, there was no reason to refer Ms A for an immunology (the branch of medicine and biology concerned with immunity) opinion.

We took independent advice from a consultant urologist. We found that the care and treatment given to Ms A was reasonable, and that appropriate advice had been given in relation to her condition. We also found that Ms A had not completed the investigations necessary to diagnose her condition and that, in these circumstances and from an urology perspective, there was no reason to refer Ms A for an immunology opinion. Therefore, we did not uphold Miss C's complaint.

Summary

Mr C complained about the care and treatment provided by the practice in respect of his ongoing knee pain. He attended two consultations with knee pain and had requested to be referred to the orthopaedic (conditions involving the musculoskeletal system) clinic and for a multi-resonance imaging scan (MRI) to be carried out. However, at the first consultation, the practice prescribed anti-inflammatory medication and provided advice regarding exercise and knee care. At the second consultation, the practice arranged for x-rays to be carried out and advised Mr C to make a self-referral to physiotherapy.

Based on Mr C's presentation, the practice concluded that the source of the pain was likely to be osteoarthritis (the most common form of arthritis, usually occurring in older people, with chronic breakdown of cartilage in the joints leading to pain, stiffness, and swelling or the most common form of arthritis that affects the joints). The x-ray results confirmed this but the results were not relayed to Mr C. Years later, Mr C attended a further consultation and the practice made a referral to the orthopaedic clinic. At the time of making his complaint to the SPSO, Mr C was still on the waiting list to be seen at the orthopaedic clinic. This was partly due to the fact that the practice did not consider it appropriate to make an urgent referral. In Mr C's view, the practice unreasonably delayed in referring him to the orthopaedic clinic and for an MRI scan.

We took independent advice from a GP. We found that Mr C received appropriate care and treatment for his knee pain. This care and treatment was in line with the Scottish National Knee Pain and Management Pathway, produced by the Scottish Government. We recognised that Mr C was concerned that the practice did not contact him following his x-ray or physiotherapy appointment. However, we did not consider this to be unreasonable or out of line with the procedures of other practices. We did not uphold Mr C's complaint.

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 (B), regarding the care and treatment provided to B's late partner (A) when A was admitted to the Royal Alexandra Hospital with back pain. C complained that:

A was inappropriately prescribed Pabrinex (a vitamin infusion injection often given to patients with alcohol dependency);

the Abbreviated Mental Test 4 (AMT-4, a rapid test to detect cognitive impairment) and 4AT test (a slightly longer screening test for cognitive impairment and delirium) were not carried out appropriately;

there was a delay in carrying out an MRI; and

A was treated differently due to the incorrect assumption that they were experiencing symptoms due to alcohol access.

We took independent advice from a consultant in orthopaedics (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that:

the prescription of Pabrinex was unreasonable;

it was unreasonable that the AMT gave a score of zero, which would indicate severe cognitive impairment, but there was no documented action taken as a result of this outcome;

there was no indication that an MRI scan needed to be carried out earlier than it was; and

there was no indication that A was treated differently because of an incorrect assumption that they were suffering from alcohol excess.

We also found that in relation to the AMT score, the board gave inaccurate information to C and B in the complaint responses as they stated that a score of zero indicates no cognitive impairment. We upheld C's complaint about care and treatment.

C also complained that the minutes of the complaint meeting and follow-up actions were unreasonable. We considered that it was clear from the minutes of the meeting that there were several things that the board had committed to during the meeting that then do not appear to have been taken forward. We upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to B for the unreasonable prescription of Pabrinex, the failure to take appropriate action on the AMT score of zero; the inaccurate information in the complaint responses, and failing to take forward actions agreed during the complaint meeting or provide an explanation as to why this was not possible. 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:

• If the AMT gives a score of zero, which would indicate severe cognitive impairment, appropriate action should be taken as a result of this.
• Pabrinex should only be prescribed where clinically appropriate and the reasons for the prescription should be documented.

In relation to complaints handling, we recommended:

• Complaint responses should be accurate.
• During and after complaint meetings, care should be taken to ensure that all agreed actions are documented and either taken forward, or if it is not possible to take forward actions, an explanation is given to the complainant as to why this is.

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 the care and treatment they received from the board during their admissions to Royal Alexandra Hospital and the board's communication with them during and after admission.

C considered that staff did not take into account their medical history or presenting symptoms and failed to offer appropriate treatment or consult relevant medical professionals. C also considered that the board failed to communicate reasonably with them in that staff were dismissive and patronising. C said that they were not given information as available and staff presented as reluctant to provide information. Furthermore, C considered that communication following discharge was unreasonable as C stated that they had been told that a member of staff from the board would contact them with follow-up but C received no further contact.

We took independent advice from advisers in the areas of emergency medicine and general surgery. We found that there had been no failures in the care and treatment provided to C. We found that C received reasonable care and treatment; in particular, their medical history and presenting symptoms were fully considered and appropriate treatment provided.

We found that there was no evidence to support C's assertion that the board's communication with them was below the standard that would have reasonably been expected.

Therefore, we did not uphold C's complaints.

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

Mrs C, a support and advocacy worker, complained on behalf of her client (Miss B). Miss B was concerned that her mother (Mrs A) had been discharged prematurely from Royal Alexandra Hospital. Mrs A had been discharged the day after her admission. Mrs A deteriorated suddenly following her discharge and died the following day.

Miss B believed that Mrs A had not been well enough to be discharged. In particular she felt that her mobility was not properly assessed, as Mrs A was reviewed by medical staff whilst sitting in a chair. Additionally, Miss B had raised concerns with the board about comments made to her and Mrs A about other patients needing a bed, requiring Mrs A's discharge.

We found that the board had already conducted a serious clinical incident review, which had focussed on the issue of comments by nursing staff. Miss B wanted us to review the decision to discharge Mrs A and in particular the assessment of her.

We received independent medical advice. We found that the decision to discharge Mrs A was reasonable and that her deterioration could not have been anticipated. We did not uphold this complaint.

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

C's sibling (A) is a permanent resident of a care home. A was admitted to the Queen Elizabeth University Hospital with a bowel obstruction. A was initially admitted to the acute receiving unit, then transferred to a ward, before being discharged two evenings later. C had concerns about the care and treatment A received, the way the board sought information about A and their decision to discharge A. The board upheld some parts of C's complaint, provided apologies and undertook some process changes to address these matters. However, the board concluded that their actions overall had been reasonable. C was unhappy with the board's response and brought their complaint to us.

We found that the board provided reasonable care and treatment to A, that the prescription and administration of laxatives was reasonable in the circumstances, that the board's seeking of information about A was reasonable and that the decision to discharge A was reasonable. Therefore, we did not uphold C's complaints. However, we were concerned about the board's failure to respond to matters that had been complained about and where their initial failure to respond had been highlighted to them. We made a recommendation to the board in light of this under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Recommendations

In relation to complaints handling, we recommended:

• In line with their Model Complaints Handling Procedure, the board should be clear from the start of the investigation stage exactly what they are investigating.

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.