Health

Summary

Mr C complained on behalf of his mother (Mrs A) regarding cataract surgery (surgery which involves replacing the cloudy lens inside the eye with an artificial one) she received at Hairmyres Hospital. Mr C stated that the board failed to give his mother the appropriate priority for surgery and failed to provide surgery within a reasonable period of time.

We took independent advice from a consultant ophthalmologist (a specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye). We found that the categorisation of non-priority was reasonable according to nationwide practice. However, when Mr C notified the board that Mrs A's condition had deteriorated whilst she was on the waiting list for surgery, no further review of her condition was offered. This meant that there was no opportunity to assess if Mrs A required to move up the waiting list. Therefore, we upheld this aspect of Mr C's complaint.

In relation to the surgery waiting time, we found that Mrs A was referred for an out-patient appointment outside the NHS target times. We noted that Mrs A could not be referred for surgery elsewhere in order to cut down on her waiting time due to her condition and the density of her cataract. However, Mrs A was given surgery 22 weeks after being listed for surgery which was outside the NHS treatment guarantee time of 12 weeks. We upheld this aspect of Mr C's complaint. However, we acknowledged that the board had apologised for this delay which reflects the current situation nationwide due to the demand on the NHS for eye surgery.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C and Mrs A for the failure to re-assess Mrs A whilst she was on the waiting list to establish if her priority for surgery had changed. 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:

• Where the patient, relative or GP notifies the board of rapid deterioration, steps should be taken to re-assess the patient to establish if their prioritisation for surgery has changed.

Summary

Mr C complained about the care and treatment his late father (Mr A) received during his two admission to Wishaw General Hospital. Mr A was diagnosed with bowel cancer and Mr C complained that the board failed to provide Mr A with appropriate medical and nursing care and treatment.

We took independent advice from a consultant in acute medicine, a consultant in colorectal surgery (a specialist in disorders of the rectum, anus and colon) and a nurse. In respect of Mr A's first admission, we considered that Mr A's underlying issues were all reasonably investigated, treated and resolved. In respect of Mr  A's second admission, we found that all appropriate investigations were carried out and that, overall, Mr A received appropriate medical treatment. However, we noted that there was an unreasonable delay before Mr A was seen by the speech and language therapy service (SALT) given that there was concerns regarding his ability to swallow. Therefore, we upheld this aspect of Mr  C's complaint.

In relation to the nursing care, we found that there was no evidence to indicate any failings in nursing care and that the nursing records were of a reasonable standard. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the board failed to communicate appropriately with Mr  A's family regarding his condition at a meeting. In particular, that only two family members were allowed to attend the meeting when there were twice as many hospital staff in attendance and that he was not allowed to record the meeting. We considered it was unreasonable that Mr C had been restricted to two family members while double the number of hospital staff attended the meeting. Mr C also appeared to have been open with hospital staff that he wanted to record the meeting and the reason for this. Therefore, we considered it would have been reasonable to have allowed him to record the meeting. We upheld this aspect of Mr C's complaint. We also noted that that these issues could have been avoided if the board had a policy that ensured both parties were aware of the ground rules for such meetings in advance. We made a recommendation to the board in light of this finding.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the unreasonable delay by hospital staff in referring Mr A to SALT, for restricting the number of family members who were permitted to attend the meeting and not allowing the meeting to be recorded. 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:

• Patients with impaired ability to swallow should receive an appropriate and timely referral to SALT.
• Both staff and patients and/or their families should be clear about what to expect in advance of a meeting.

Summary

Mrs C complained about the treatment she received from a podiatrist (a medical professional who specialises in the feet and ankles) when she attended a consultation to remove some hardened skin around her toe. Mrs C believed that the podiatrist had removed too much skin as her toe became painful and she was subsequently diagnosed with an infection.

We took independent advice from a podiatrist. We found no evidence from the clinical records that there was a problem for the podiatrist when treating Mrs C's toe. We noted that they gave Mrs C appropriate advice on changing the type of footwear she wore as this would have contributed to her foot problems. We also found that Mrs C had other health conditions which may have contributed to her being susceptible to skin infections. We did not uphold the complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mrs B) about the care and treatment provided to Mrs B's late husband (Mr A) at Belford Hospital. Mr A was admitted to hospital on a number of occasions over a short period of time for breathlessness and chest pain. Ms C complained about the clinical care and nursing treatment provided to Mr A, the board's communication with Mrs B about her husband's deterioration, and the post-mortem care (care after death) provided to Mr A.

We took independent advice from a consultant physician and from a nursing adviser. We found that there were a number of failings with regards to the clinical treatment provided to Mr A, and we upheld this aspect of the complaint. However, we found that the nursing care had been reasonable and so we did not uphold this part of the complaint.

Regarding communication, we found that there was a failure to discuss Mr A's deterioration with Mrs B in a timely manner, and so we upheld this part of the complaint.

We found that the post-mortem care provided to Mr A was reasonable, and we did not uphold this aspect of the complaint. However, we found that the board had not addressed Ms C's concerns around post-mortem care in their original complaint repsonse. We, therefore, made a recommendation regarding this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs B for the failure to provide Mr A with reasonable clinical treatment, and for the failure to communicate reasonably with her about Mr  A's deterioration. 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:

• Patient care should be in line with the Scottish Intercollegiate Guidelines Network guideline 139: Care of the Deteriorating Patient, and Healthcare Improvement Scotland guidance on Structured Response to the Deteriorating Patient.

In relation to complaints handling, we recommended:

• All issues raised in complaints letters should be addressed.

Summary

Mrs C complained about the treatment which her late husband (Mr A) received during attendances at the out-of-hours service at the Vale of Leven Hospital. Mr  A had attended on three occasions over a period of 15 months with chest pains and numbness, where staff repeatedly told him he had a trapped nerve and prescribed painkillers. Mr A subsequently died of a heart attack a month following the last hospital attendance. Mrs C felt that the board had not carried out sufficient examinations to have ruled out the possibility of Mr A having heart disease.

We took independent advice from a GP adviser. We found that the GPs who saw Mr A had carried out appropriate assessments and obtained a reasonable history based on his reported symptoms. It was reasonable that the GPs had each arrived at a working diagnosis of musculoskeletal symptoms as a result of a trapped nerve. There also was no clinical evidence that Mr A required to be referred to a hospital specialism, such as cardiology (the area of medicine which deals with the heart and circulatory system). We did not uphold the complaint.

Summary

Mr C complained about the treatment he received from an emergency nurse practitioner (ENP) when he attended Stobhill Hospital. Mr C had injured his hand a number of weeks previously and other health professionals had said he had suffered some soft tissue damage. Mr C told the ENP that he thought he had perhaps broken a bone in his hand. He said that they did not listen to him and as a result arranged for him to have a standard x-ray which was not appropriate for identifying a fracture in the specific bone he thought was broken (the hamate bone - located on the outside of the wrist).

We took independent advice from an ENP. We found that hamate fractures are rare and difficult to diagnose. There was some disagreement between the ENP and Mr C about what was actually discussed during the assessment. There were aspects of the ENP's record-keeping which were not to an appropriate standard in that they lacked detail about the exact physical examination which had taken place. However, they had taken a reasonable history from Mr C and we felt that, due to the low suspicion of a bone fracture, it was appropriate to direct Mr C to his GP should the problem persist. Emergency departments would not have access to the specialist x-ray which would have identified a hamate fracture and this would come under the remit of specialist hand or orthopaedic surgeons (surgeons who specialise in the musculoskeletal system). We did not uphold the complaint.

Summary

Mrs C complained to us about the failure of staff at A&E at the Queen Elizabeth University Hospital to arrange a x-ray when she reported that she had hurt her back. Mrs C was given painkillers and encouraged to mobilise before being discharged home. Mrs C asked whether she should have an x-ray, but was advised that it would be unlikely to show anything and that she had probably torn muscles in her stomach and back. Mrs C was subsequently referred to physiotherapy by her GP and, after a few months, the physiotherapist sent her for a x-ray which revealed that she had suffered a fracture of her back. Mrs C felt that an x-ray should have been arranged at the initial hospital presentation and that, if this had happened, she may have avoided months of pain.

We took independent advice from a consultant in emergency medicine. We found that Mrs C had had a thorough examination on attendance at A&E and that it was appropriate to have prescribed her painkilling medication for suspected torn muscles in her stomach and back. Mrs C was encouraged to mobilise and given advice to contact her GP if the symptoms persisted or deteriorated. It is a matter of clinical judgement whether an x-ray should have been taken, but we considered that it was not unreasonable for the staff not to have arranged an x- ray in the circumstances, given Mrs C's presenting symptoms. It was also noted that, had an x-ray been arranged on initial presentation, then the treatment plan would not have altered. We did not uphold the complaint.

Summary

Miss C complained to us that the practice had failed to provide appropriate care and treatment to her mother (Mrs A). She said that her mother had reported symptoms of severe pain in her back and shoulders to GPs over a two month period, and they increased her painkilling medication and made a referral to the Elderly Care Clinic. Mrs A was subsequently diagnosed with bone and lung cancer. Miss C felt the GPs should have taken additional action to investigate the cause of her mother's pain.

We took independent advice from a GP adviser. We found that the practice had provided a reasonable level of care. The GPs had taken a thorough medical history from Mrs A and examined her appropriately, including taking blood samples and making a referral for a hospital opinion. Mrs A's back pain had been present for two months and the shoulder pain for three weeks which was not a long presentation. It was appropriate for the GPs to have altered Mrs A's painkilling medication while waiting for the hospital referral and to chase up the referral when Mrs A had not heard from the hospital. The blood test results did not show significant abnormalities or signs suggestive of cancer. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received at Royal Alexandra Hospital following the birth of her daughter. Ms C felt that staff did not provide her with advice on breastfeeding techniques. She also raised concern that staff denied her a medical review, despite the fact that she felt she had suffered a lot of blood loss. As a result of her dissatisfaction with the care provided, Ms C discharged herself from hospital against medical advice and put her care in the hands of the community midwife team instead.

We took independent advice from a midwife. We found that, although there was evidence that Ms C had received some advice and support regarding breastfeeding, it was not to the standard expected in the board's breastfeeding policy. There was also a lack of entries in the records regarding communication in the immediate post-natal period. From a clinical perspective, there were no concerns about the amount of blood which Ms C had lost, and we found that she was kept under appropriate medical review. On balance, given the failings in record-keeping and communication, we considered that there was a failing in care and we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to provide her with breastfeeding advice and support in line with the board's policy. 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:

• Staff should be aware of the board's breastfeeding policy in order that appropriate advice and support is provided to new mothers.

Summary

Ms C complained about the care and treatment provided to her late mother (Mrs  A) by the practice. Mrs A reported hip and back pain to her GP, and was later found to have breast cancer which had spread to her stomach and bones. Ms C complained that the practice failed to identify that Mrs A's back and hip pain was due to cancer in her bones.

We took independent advice from a GP adviser. We found that, when Mrs A presented with back pain she was directed to physiotherapy, which was reasonable, and that there were no signs or symptoms of cancer at this point. We found that the practice provided reasonable care and treatment to Mrs A for her back and hip pain, and we did not uphold the complaint.

Ms C also complained about the way the practice handled her complaint. We found that the practice had not handled her complaint in line with the model complaints handling procedure and, therefore, we upheld this part of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to respond to her complaint in a reasonable manner.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:

• 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.