Health

Summary

Mr C complained about the way the practice handled his complaint.

We found that the practice failed to adhere to the NHS Scotland Model Complaints Handling Procedure (CHP). In particular they failed to acknowledge Mr C's complaint within three working days, failed to ensure that the complaint response detailed the right to bring the complaint to this office and failed to ensure that the complaint response addressed all the issues raised by Mr C. We upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to handle his complaint reasonably. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• When responding to complaints the practice should follow their complaints handling procedure and all staff should be aware of this and the model CHP for the NHS.

Summary

Mr C complained about the care and treatment he received from the practice. In particular, Mr C complained that the practice did not perform more thorough examinations which he said resulted in a delay in him being diagnosed with cancer.

We took independent advice from a GP. We found that the practice failed to examine and document Mr C's sore throat at a consultation. Therefore, we upheld this aspect of Mr C's complaint. However, we found no evidence that the examination of Mr C's sore throat would have changed the practice's management plan for his symptoms or have an effect on his eventual diagnosis or clinical outcome.

Mr C also complained that the practice failed to handle his complaint reasonably. We found that there was an unreasonable delay in responding to Mr C's complaint and that the practice did not provide a copy of the Complaints Handling Procedure (CHP) to him promptly. Therefore, we upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to examine his sore throat at a consultation, the delay in responding to his complaint and failing to provide the CHP promptly. 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 should receive full and appropriate examinations based on their reported symptoms and these should be documented.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the model CHP. The model CHP and guidance can be found here: www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs.

Summary

Mrs C complained that the board unreasonably refused to offer her a consultation or further treatment to address her facial scarring. The board advised they would not offer Mrs C an appointment as they did not consider her facial scarring would be amenable to treatment.

We took independent advice from a plastic surgeon (a surgeon who repairs or reconstructs missing or damaged tissue and skin). We found that the board wrongly triaged (a process in which things are ranked in terms of importance or priority) Mrs C's referral according to the relevant protocol. We considered that Mrs C should have been offered an out-patient appointment to be assessed more fully. Therefore, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to triage her referral appropriately and for the failure to offer her a face-to-face appointment with a consultant. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.
• Offer Mrs C an out-patient appointment for her to see an appropriate consultant.

Summary

Mr C complained that the care and treatment he received from the dentist was unreasonable. Mr C had a lump on his tongue and was concerned that he was not referred to oral health or a dental hospital which he said resulted in there being a delay in him being diagnosed with oral cancer.

We took independent advice from a dental adviser. We found that the clinical examination carried out by the dentist was reasonable and, given that the dentist suspected that the lump on Mr C's tongue was a result of trauma, it was reasonable that a topical anaesthetic mouthwash was prescribed and an appointment was made to review Mr C. However, we also found that the dentist had not recorded in Mr C's medical record anything about:

• the history of Mr C's complaint, his past dental history, past medical history and social history.

• the diagnosis considered at the time.

As good record-keeping is an important part of a patient's care and treatment, we upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to take a full history of his symptoms and record the diagnosis considered. 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:

• Good record-keeping should include a full history of a patient's symptoms and a record of the diagnosis considered.

Summary

Mrs C complained about the care and treatment that her late husband (Mr A) received at Glasgow Royal Infirmary. Mr A had cancer and was seen at clinic and placed on the waiting list for surgery. However, Mr A began to rapidly lose weight and Mrs C tried to contact the consultant for advice. Mr A was referred for a dietetic assessment and was advised to take nutritional supplements. Mr A was still unable to stop the weight loss and Mrs C again tried to contact the consultant for advice. The consultant was not available and arrangements were made for Mr A to see another consultant at short notice. It was then discovered that Mr A's condition had deteriorated and that surgery was no longer an option. Mrs C felt that action should have been taken sooner to reassess Mr A and that a scan should have been arranged at the clinic appointment.

We took independent advice from a consultant colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that there was no indication that a scan was required at the clinic appointment as a diagnosis had already been reached and Mr C did not report any new symptoms. It was appropriate that Mr A was then directed to a dietetic review in order to treat his poor nutritional intake so that he would be in appropriate health to undergo the planned surgery. There was no indication that a hospital admission was required at the time of the dietetic review. When Mr A saw another consultant, appropriate investigations were carried out although by that stage it was felt that he was no longer fit for the planned surgery. We did not uphold Mrs C's complaint. However, we did note that there was a failing in the passing of information from the secretarial staff to the clinical staff. This would not have affected the outcome and the board have already taken action to ensure that when clinicians are not available the matter should be escalated to another clinician.

Summary

Mrs C had surgery to remove her gallbladder at Queen Elizabeth University Hospital. Mrs C was experiencing severe pain following her surgery and it was subsequently discovered that bile was leaking into her abdomen. Mrs C underwent further procedures to resolve the bile leak. Mrs C complained about the medical treatment she received both during and after her surgery.

We took independent advice from a general surgical adviser. We found that the medical care Mrs C received during her surgery was reasonable and did not uphold this aspect of her complaint. However, we did find that there was an unreasonable delay in recognising that Mrs C's symptoms may have been caused by a bile leak. Therefore, we upheld Mrs C's complaint that the board failed to provide reasonable medical treatment after her surgery.

Mrs C also complained about the nursing care she received after her surgery. We took independent advice from a nursing adviser. We found that there was no pain assessment and care plan completed following her surgery. Therefore, we upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the delay in recognising her symptoms may have been caused by a bile leak and that there was no nursing pain assessment and care plan completed following her surgeries. 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:

• The possibility of a bile leak should be considered by medical staff in patients who do not recover as expected from laparoscopic cholecystectomy (gallbladder removal).
• Post-operative patients should have their pain assessed, recorded and treated by nursing staff in accordance with relevant guidance.

Summary

Mrs C complained about the treatment she received from the orthopaedic service (the service which deals with issues of the musculoskeletal system) at Glasgow Royal Infirmary. She had been referred there by her GP for a suspected torn cartilage. She said that the consultant reviewed her and suggested that she have a hip injection, arranged for her to have a scan and said that the matter would be reviewed. Mrs C then saw another doctor who suggested an alternative treatment plan. Mrs C felt that it was unreasonable that the consultant did not take any further action at the initial appointment.

We took independent advice from an orthopaedic consultant. We found that the consultant had carried out a reasonable assessment in view of Mrs C's reported symptoms and medical history, and that it was reasonable to suggest that she had a hip injection. The fact that another clinician arrived at a different diagnosis was also reasonable in the circumstances. We did not uphold the complaint.

Summary

Mr C was referred by his GP to the board's spinal service at Gartnavel General Hospital for assessment. The referral was vetted on receipt and considered appropriate for a virtual appointment. The appointment took place nine months after the referral was received. Mr C's referral was not considered appropriate for the spinal service and he was referred to the board's back pain service for physiotherapy. Mr C complained that he was unreasonably referred back to the physiotherapy service.

We took independent medical advice from a consultant orthopaedic surgeon (a  surgeon who diagnoses and treats a wide range of conditions of the musculoskeletal system). We found that the response to Mr C's referral was reasonable as the back pain service was the appropriate service for Mr C to be redirected to. We did not uphold Mr C's complaint. However, we noted that there was a delay in recognising that the referral should have gone to the back pain service in the first instance. The board's vetting system did not highlight that Mr  C's referral was not appropriate for the spinal service and we made a recommendation to the board in light of this.

Recommendations

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

• Have systems in place to ensure that inappropriate referrals are identified promptly.

Summary

Mrs C complained about the palliative care and treatment that her father (Mr A) received at Queen Elizabeth University Hospital. Mr A was later transferred to a hospice where he died. Mrs C was concerned about the types and doses of medication prescribed to Mr A and the board's communication with the family about Mr A's condition and the medication he was receiving.

We took independent advice from a consultant in palliative medicine. We found that the majority of the palliative care and treatment that Mr A received was reasonable. However, we found that the handover between the hospital and the hospice could have been better. In particular, the hospice referral letter did not detail all the drugs that Mr A was receiving and it did not explain the reasons for the unusual combinations he was prescribed. Therefore, we upheld Mrs C's complaint about the palliative care and treatment that Mr A received.

In relation to communication from the board with the family, we did not find evidence that this was unreasonable. Therefore, we did not uphold this aspect of Mrs C's complaint.

Mrs C also complained about the nursing care that Mr A received. We took independent advice from a nursing adviser. We found that the majority of the nursing care was reasonable. However, we also found that the Nutrition Profile and Malnutrition Universal Screening Tool were not completed within 24 hours of Mr A's admission to hospital. On balance, we upheld Mrs C's complaint about nursing care.

Finally, Mrs C complained about the way the board handled her complaint. We found that:

• there was a delay in responding to Mrs A's complaint.

• the board did not agree a timescale with Mrs A about when she could expect to receive the minutes of a meeting about her complaint.

• the board's complaint response used generic terms and did not clearly explain what medication Mr A received, why the medication was changed, what the possible side-effects were and how these were monitored.

Therefore, we upheld Mrs C's complaint that the board failed to handle her complaint reasonably.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to clearly document the handover of Mr  A's drug regimen to the hospice, the failure to complete the Nutrition Profile and Malnutrition Universal Screening Tool within 24 hours of Mr A's admission, the delay in responding to Mrs C's complaint, that no timescale was agreed with her about when she could expect to receive the meeting minutes and that the complaint response did not clearly explain what medication Mr A received. 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:

• The handover of patient drug regimens to other care providers should be clearly documented.
• Patients should receive adequate nutritional assessment and care planning in accordance with the relevant standards.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the model complaints handling procedure. The model complaints handling procedure and guidance can be found here: www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs.
• There should be an appropriate level of detail in complaint responses that can be clearly understood.

Summary

Mrs C complained that, despite attending the dentist over the years with tooth pain, the cause of her pain was not identified or treated appropriately. She was ultimately referred to a periodontal (gum) specialist. Mrs C complained that she had not been informed of the presence of gum disease, and that she had to wait several months for this specialist assessment and treatment. Mrs C felt that the lack of earlier treatment had placed her dental bridgework at increased risk.

We took independent advice from a dentist. We found that Mrs C's dental records confirmed discussions having taken place with Mrs C regarding her gum disease. We noted that Mrs C's gum health had deteriorated rapidly at the time she was referred to the periodontal specialist, and we considered this referral was appropriate. We considered that the actions of the dentist were appropriate and did not contribute to the increased risk of Mrs C losing her dental bridge. Therefore, we did not uphold Mrs C's complaint.