Health

Summary

Mr C complained about the treatment he received form the prison health care service. He reported numerous health problems including persistent headaches, bodily twitching, and concerns about his testicles.

We took independent advice from a GP adviser. We found that Mr C had received a reasonable standard of treatment. He had been referred to urology (the area of medicine specialising in the kidneys, bladder, urinary tract and men's sexual organs) and neurology (the area of medicine specialising in the brain and nervous system) on several occasions, and we considered that the referrals had been made appropriately and in line with clinical guidelines, without any delay.

We found no evidence that Mr C's treatment was not of a reasonable standard. We, therefore, did not uphold his complaint.

Summary

Mr C complained about the care and treatment provided to his father (Mr A) at the Western General Hospital. Mr C complained that there was a delay in the board diagnosing Mr A's non-Hodgkin's lymphoma (a form of blood cancer), and that the board did not follow-up his complaint in a reasonable way.

We took independent advice from a consultant radiologist (a doctor who specialises in x-rays and scans) and from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that there was an error in the reporting of a scan that Mr A had undergone for an unrelated condition, which resulted in a delay in the cancer diagnosis. We found that the board had acknowledged this delay and had taken some action to address this failing, however we made a further recommendation on this matter.

We also found that, after a meeting had been held with Mr C regarding his complaint, there appeared to be some uncertainty within the board as to what action they had agreed to take. We found that they should have contacted Mr C to clarify what outcome he was seeking and the failure to do so meant there were perceived delays in complaint handling.

We upheld both of Mr C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the unreasonable delay in diagnosing him with non-Hodgkin's lymphoma; and apologise to Mr C for failing to follow up his complaint in a reasonable way. 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:

• As far as possible, scan findings should be accurately reported.

In relation to complaints handling, we recommended:

• Where it is not clear what outcome is expected from a complaint, steps should be taken to find out.

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 that the board unreasonably refused to support an out of area referral for a specialist neurosurgical assessment of his chronic migraines. Mr C suffered from chronic migraines for a number of years and had explored non-surgical treatment options but they did not help his situation. He wished to receive a professional opinion on surgical treatment options including occipital nerve stimulation (a procedure where a surgical implant is inserted near the occipital nerve - a nerve in the brain - which can be controlled by the patient to deliver electrical impulses with the aim of masking pain). However, this treatment is not available in Scotland. Mr C saw a consultant neurologist (a doctor who specialises in the brain and nervous system) in another Scottish health board area, who wrote a referral to a specialist centre in England. However, Mr C's consultant neurologist at his local board refused to support such a referral and funding was not approved. The board's view was that there was not a good evidence base for such interventions for patients with migraine. Mr C was unhappy with this response and brought his complaint to us.

We took independent advice from a professor of neurology with specialist expertise in headache disorders. We found that the board's decision was reasonable and was consistent with relevant guidance. Therefore, we did not uphold this complaint.

Summary

Mrs C presented to the practice with weakness and pins & needles in her limbs and head. The practice reviewed her and arranged blood tests. She was informed that these came back normal and no further action was taken. Mrs C's symptoms began to improve over the following months and had resolved by the end of the year. However, her symptoms returned and she presented to the practice again, nearly two years after her initial appointment. She was referred to neurology and, following an MRI scan, was diagnosed with relapsing remitting multiple sclerosis (MS). Mrs C complained that this could have been diagnosed sooner, had she been referred for further tests following her first appointment at the practice.

In responding to Mrs C's complaint, the practice said that the possibility of MS was considered but due to the fact that this was Mrs C's first presentation, that there was a lack of symptoms and that there was an absence of positive family history, they felt that the symptoms were unexplained. They said that the plan was to 'book bloods and review' and they apologised that they did not express clearly enough to Mrs C that she was expected to return for review. They observed that she was referred promptly at her second appointment as this was a second presentation of sensory symptoms, and that she was also exhibiting further symptoms.

We took independent medical advice from a GP, who considered that an appropriate level of assessment and investigation took place for a first presentation of such symptoms. We found that it is generally accepted that MS is suspected if there are two or more episodes of suspicious symptoms. We noted that it would have been reasonable for the practice to have clearly explained to Mrs C that they wished to follow up her symptoms following the blood tests. The General Medical Council's Good Medical Practice (GMC GMP) guidance refers to this as 'safety netting'. However, the adviser did not consider this to be a serious oversight, as it is reasonable for GPs to expect patients to return if their symptoms persist. Mrs C's symptoms subsequently resolved and she did not present again until around 22 months later. We found that the practice acted reasonably and did not uphold Mrs C's complaint. However, we made a recommendation to the practice in light of our findings.

Recommendations

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

• The practice should familiarise themselves with GMC GMP guidelines on 'safety netting' and ensure that they clearly communicate follow-up arrangements to 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

Mrs C complained about the care and treatment her late husband (Mr A) received at the Western General Hospital during two admissions. Mr A had been admitted to hospital with side effects of chemotherapy that he was receiving for plasmablastic lymphoma (a rare and aggressive form of blood cancer). During his first admission, Mr A had a couple of falls and was later discharged. Mr A was then readmitted and died a short time later. Mrs C complained that communication with the family about Mr A's condition was unreasonable and that nursing staff did not administer his medication properly. Mrs C also complained that the medical care and treatment Mr A received was unreasonable and that the board failed to handle her complaint appropriately.

We took independent advice from a consultant haematologist (a doctor who specialises in medicine of the blood) and from a registered nurse. We found that there had been communication failings with the family during Mr A's hospital admissions, in particular towards the frailty of his condition. Therefore, we upheld this aspect of Mrs C's complaint. However, we noted that the board had acknowledged these failings and had apologised.

In relation to Mr A's medication, we could not find any evidence to show that his medication had been administered inappropriately by nursing staff. Therefore, we did not uphold this aspect of Mrs C's complaint.

Overall, we found that the care and treatment Mr A received was reasonable and we did not uphold this aspect of Mrs C's complaint.

Finally, we found that the board's response to Mrs C's complaint was generally of a good standard. However, they had not kept her informed of delays in their response and they did not address a new issue that was raised. On balance, 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 failing to handle her complaint to a reasonable standard. 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:

• There should be proper discussions about advanced care planning with patients and their relatives/carers, where relevant, and these discussions documented clearly.

In relation to complaints handling, we recommended:

• Updates should be provided where the 20 working day timescale for complaints cannot be met; and follow-up correspondence should be carefully reviewed and appropriately responded to.

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 failed to provide appropriate care and treatment to her late husband (Mr A). Mr A, who had type 2 diabetes, had thought he was suffering from a urine infection but the practice dismissed the suggestion and did not provide medication. Mr A subsequently developed chest and back pain over the next week. A house visit was then requested early in the morning but it took until early evening for a GP to visit. The GP felt that Mr A required a hospital admission and an ambulance was called to take Mr A to hospital. He died the following day. Mrs C complained that the practice failed to diagnose that Mr A had a urine infection and that, on the day he was taken to hospital, there was an unreasonable delay in a GP making a home visit.

We took independent advice from an adviser in general practice medicine and found that the practice provided Mr A with reasonable treatment regarding his perceived urine infection. The practice carried out an appropriate assessment, including testing for a urine infection, which was reported as negative. Therefore, we did not uphold this aspect of Mrs C's complaint.

In relation to the home visit, we found that there was an unreasonable delay in arranging the home visit to Mr A as there was a breakdown in communication when the request for a home visit was considered. Initially, it was felt that an advanced nurse practitioner should visit but they felt that it was outwith their remit and there was a delay in the request being picked up by the GP. 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 advising the duty doctor that a home visit had been requested. The apology should meet the standards set out in the SPSO guidelines on apology available at https://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

Miss C was referred for an endoscopy (a camera test into her stomach) by the practice to investigate stomach pain she was suffering from. She complained that this was not appropriately followed up and that further specialist investigation was not arranged. The practice said that all relevant investigations appropriate to Miss C's condition were undertaken by them. Miss C disputed this, noting that her psychiatrist had referred to anticipated follow-up investigation for her stomach issues, in a letter to the practice. Miss C said that this follow-up was not arranged by the practice.

We took independent advice from a GP, who considered that the investigations arranged by the practice were appropriate. We found that the psychiatrist's letter was written in advance of the endoscopy appointment and that it referred to this investigation. It did not suggest that further investigation was expected. Therefore, we did not uphold this aspect of Miss C's complaint.

Miss C also complained that some of her prescription requests were not appropriately responded to and that she had to go for long periods without her pain-killing and anti-anxiety/depression medication. The practice acknowledged that one monthly prescription for Miss C's anti-anxiety medication was missed and they apologised to her for this oversight. They also acknowledged some recording and communication issues, meaning some of Miss C's medication requests were not responded to appropriately. In particular, they recognised that an improved system was required for communicating with patients where medication requests have been declined. We upheld this aspect of Miss C's complaint, however, noted that the practice had appropriately reflected on the communication issues highlighted by this complaint and had instigated a reasonable plan to avoid similar future problems.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the identified failures to clearly communicate with her regarding her medication requests; to issue her with her medication; and to respond to her complaint about her medication. The apology should meet the standards set out in the SPSO guidelines on apology available at https://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

Mr C complained that his late mother (Mrs A) did not receive appropriate physiotherapy and rehabilitation whilst she was a patient at Tippithill Hospital. He was also concerned that the consultant in charge of Mrs A's care had unreasonably refused consent for another doctor to examine her. Mr C also complained that the board's response to his complaint was inadequate.

We took independent advice from a consultant in old age psychiatry. We found that Mrs A had advanced dementia and that she did not have the potential for further rehabilitation as a result. We found that there had been appropriate referrals and assessments for physiotherapy, which took reasonable account of the risks involved in Mrs A's case. We did not uphold Mr C's complaint about physiotherapy and rehabilitation.

We also did not uphold Mr C's complaint that consent had been refused to allow a further doctor to examine Mrs A. We found no evidence that consent had been refused, although it was confirmed that an examination by the further doctor did not take place. The advice we received was that, in the particular circumstances of Mrs A's case, it was reasonable that this examination was not carried out. We found that the doctor in question had previously reviewed Mrs A and did not consider this to have been of any assistance to the management of her care.

Regarding the board's response to Mr C's concerns, we found that they had not directly addressed Mr C's complaint and that, when Mr C alerted them to this, they advised that they had nothing further to add. We considered this response to be inadequate and 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 adequately respond to his complaint. 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 responses should address the key issues raised.

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 to us that she had attended a nurse practitioner for banding of haemorrhoids (treatment to cut off blood supply to swollen blood vessels) but that she continued to be in pain and noticed a discharge from the wound site. She was told it would take time to heal and she attended her GP who advised her that she had an infection and prescribed antibiotics. Miss C was then informed that she had developed an anal fissure (small cut or tear in the anal canal). Miss C complained that the care she received was unreasonable.

We took independent advice from a clinical nurse specialist. We found that the banding of haemorrhoids is an interventional procedure usually performed in an out-patient clinic. The procedure can be carried out by consultants or nurses who have passed a level of competency. The records indicated that Miss C's procedure was carried out without complications, that gel was applied to ease the discomfort of the procedure and that she was provided with an information leaflet. We found that some patients do experience some pain during the following week and are prescribed pain relief. This is a minor procedure and as long as the patient understands the treatment then only informed or verbal consent would be sought. There was no indication from the records that the care which was provided was unreasonable and it was noted that an anal fissure is a common side effect of the procedure. We did not uphold the complaint.

Summary

Mrs C, who works for an advocacy and support service, complained to us on behalf of her client (Ms A) who had concerns that she was inappropriately discharged from the community mental health team (CMHT) following a single consultation with a community psychiatric nurse (CPN). Ms A felt that, as she suffered from depression, she would require on-going professional clinical support. However, the CPN told her that the depression was caused by external situational and societal factors and gave her information on stress control classes, depression management, self help websites, advice regarding job seeking and training, and advice on money matters. Ms C complained that Ms A was unreasonably discharged from the CMHT service.

We took independent advice from a mental health adviser and concluded that the CPN had appropriately assessed that Ms A's mental health status was influenced by a range of social, economic and environmental factors. We found that it was appropriate that the CPN gave Ms A information on support options such as non-medical groups, websites and other resources, which is sometimes referred to as social prescribing. This allows the opportunity to address people's needs in a holistic way rather than resorting to unnecessary medication remedies or clinical solutions which could be disproportionate in relation to the patient's needs. The CPN had also advised Ms A that should her symptoms deteriorate then she should contact her GP who could make a further referral to the service. We found this to be reasonable and we did not uphold the complaint.