Health

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.

Summary

Mr C, who is an MSP, complained on behalf of his constituent (Mr A). He said that the board had failed to provide Mr A with reasonable care and treatment in relation to blisters, fluid, diabetes, constipation and ventilation whilst he was in Hairmyres Hospital. Mr C also complained that that the day after Mr A was discharged, he was admitted to another hospital with renal failure.

We took independent advice from a consultant in acute medicine and from a nursing adviser. We found that Mr A did not develop renal failure as a result of the treatment he had received in hospital. He had chronic kidney disease and this was a longstanding problem that was worsening. Based on his blood tests on admission and discharge as well as what was documented in the notes, we found that it had been likely that he would end up on dialysis (a form of treatment that replicates many of the kidney's functions). That said, Mr A did not seem to be fully aware of this and we brought this to the board's attention.

We also found that the care and treatment Mr A received in relation to blisters and fluid management was reasonable and that there was no evidence in the records to indicate that he was ignored by staff when he informed them of developments regarding his health. In their response to Mr A's complaint, the board had apologised that he was given sugar with his drinks and had stated that they had asked the hostess to review her protocol in relation to this. They had also apologised that one of Mr A's laxatives was not prescribed, although we found that Mr A had received other laxatives and that his constipation had been alleviated. In addition, the board had apologised that he found the temperature in the ward uncomfortable.

On balance, we did not consider that the overall care and treatment provided to Mr A in the hospital had been unreasonable, particularly in relation to the most severe areas such as renal failure. We accepted there were some areas of care that the board acknowledged fell short of expectation, particularly in how some aspects of his care were communicated, but we considered that the board's response to these was reasonable and the steps they took to address the issues were what we would have asked them to do to prevent recurrence. On balance, we did not uphold Mr C's complaints.

Summary

Ms C complained on behalf of her daughter (Miss A) about the care and treatment she received from her psychiatrist. Miss A has a diagnosis of bipolar affective disorder (a mental health condition marked by alternating periods of elation and depression) and received care and treatment from the board's Child and Adolescent Mental Health Services for a number of years. Miss A was later transferred to general adult services under the care of a consultant psychiatrist, who met with Ms C and Miss A on three separate occasions. Ms C complained that the treatment Miss A received during this period was unreasonable. Ms C's concerns related in particular to treatment decisions, management plans, communication and attitude.

We took independent advice from a psychiatrist. We found that the consultant acted reasonably in relation to treatment decisions and management, and that, while there was evidence that one of the consultations was challenging for all concerned, there was no evidence that communication was of an unreasonable standard. Therefore, we did not uphold this complaint. However, we made recommendations to the board in regards to record-keeping and the transition from adolescent to adult services.

Recommendations

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

• The board should ensure that adequate records are made of important meetings and filed in patients' medical records.
• The board should improve communication by providing more information about frequency of reviews and expectations, and consider scheduling more frequent reviews to help patients adjust to adult services in similar cases.

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, an advocacy worker, complained on behalf of her client (Mr B) regarding the care and treatment of his late father (Mr A). During an admission to Hairmyres Hospital, Mr A was assessed and deemed not to meet the criteria for hospital-based complex clinical care (HBCCC), as it was considered that his needs could be met in a nursing home. He was transferred to Stonehouse Hospital for interim care while awaiting completion of a community care assessment. Before a transfer to a nursing home could be arranged, Mr A died. Mrs C complained that the decision to transfer Mr A to another hospital was unreasonable as he was not well enough and that the hospital was not equipped to meet his needs. Mrs C also complained that the decision that Mr A was fit to be discharged to a care home was unreasonable. Finally, Mrs C felt that communication with Mr B surrounding the transfer and fitness for discharge decisions was poor.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that the hospital was equipped to meet Mr A's need and that the need for acute hospital care was not indicated. In particular, we noted that the medical input into Mr A's care following the transfer was reasonable. Therefore, we did not uphold this aspect of Mrs C's complaint.

In regards to the decision to discharge Mr A to a care home, we found that a second opinion was arranged by the board. This was followed by a formal appeal of the decision, both of which maintained that the criteria for HBCCC was not met. We found that this decision was reasonable. We did not consider that Mr A's subsequent deterioration and death suggested that there had been a requirement for HBCCC. Therefore, we did not uphold this aspect of Mrs C's complaint.

Finally, we found that there was appropriate communication with Mr B in advance of Mr A's transfer between hospitals. We noted that the initial communication following the transfer was good, with medical staff having met with Mr B to explain the HBCCC criteria and their views on why Mr A did not meet this. However, while the outcome of Mr B's subsequent appeal was verbally communicated to him within a reasonable timescale, he had to request formal written confirmation of this and there was an unreasonable delay in this being provided. We considered that the board need to clarify their process for formally communicating the outcome of HBCCC appeals. Therefore, we upheld this aspect of Mrs C's complaint.

Recommendations

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

• The board's HBCCC appeals process should make clear how decisions will be formally communicated to appellants, including the timescale for doing 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 complained about the care and treatment she received at Wishaw General Hospital. Her concerns included that the consultant failed to initially list her for a colonoscopy (examination of the bowel with a camera on a flexible tube) as intended, and she was subsequently listed for a gastroscopy (examination of the gullet and stomach with thin, flexible telescope) in error. Ms C said that this error was not identified until the day of the procedure, despite her having called up in advance to query it. She said that the consultant did not contact her at any stage with an explanation of her results or treatment plan. Ms C also said that the consultant discharged her from their care as a result of her having submitted a complaint to the board. Although Ms C was later advised that they would arrange for one of their colleagues to see her instead, she heard nothing further.

We took independent advice from a consultant gastroenterologist (a doctor who specialises in the digestive system). We found that the board failed to list Ms C for a colonoscopy and later listed her for a gastroscopy in error. We also found that this error was not identified until the day of the procedure. We noted that a letter from the consultant to Ms C, requesting a stool sample, failed to explain the reasoning behind the request and inform Ms C of the findings and of a further management plan.

We also found that the consultant unreasonably discharged Ms C from their care and failed to ensure safe transfer of the necessary information on her case to a colleague, in line with the correct guidelines. We considered that the board then failed to take appropriate action when this was raised with them. Therefore, we found that the care and treatment Ms C received was unreasonable and upheld her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for sending a letter requesting a stool sample that contained inadequate information; unreasonably discharging her from their care; and failing to ensure safe transfer of the necessary information on her case to a colleague.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 should be accurately listed for endoscopic procedures and the steps for this process documented. Phone contact by patients about listed procedures should be documented, tracked, and where appropriate, acted on.
• Essential patient information on care and treatment should be provided to the patient. Patients should be discharged from care in line with the correct guidelines. Patients should have the safe transfer of the necessary information on their case to another consultant.

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 and Miss B complained to us about the care and treatment their uncle (Mr A) had received from the board. Mr A had been admitted to Monklands Hospital with shortness of breath. He was discharged from hospital three weeks later. Miss C and Miss B complained that it had been unreasonable to discharge Mr A at that time because of his immobility and a lack of adequate discharge arrangements.

We took independent advice from a consultant in acute medicine. We found that Mr A had been medically fit for discharge, although there were some concerns about how he would manage. Although we found that, ideally, there should have been additional support in place for Mr A when he was discharged, we did not consider that the discharge arrangements the board put in place were unreasonable. On balance, we did not uphold this aspect of the complaint.

Miss C and Miss B also complained about the care and treatment Mr A received from both medical and nursing staff at his home when his condition deteriorated. We found that the care and treatment provided to Mr A, including treatment for an infection, had been reasonable. We did not uphold this aspect of the complaint.

Mr A was subsequently readmitted to hospital and died there two days later. Miss C and Miss B complained to us about the standard of care and treatment provided to Mr A in hospital before his death. We found that there had been a short delay in communicating Mr A's deterioration to his family and that the timing in relation to asking the family to complete a document about his interests and preferences at the time he was deteriorating was inappropriate and insensitive. However, we found that the care and treatment provided to Mr A had been reasonable and appropriate. It was also reasonable that he was not transferred to the intensive care unit. In view of this, we did not uphold this aspect of the complaint.

Summary

Mrs C, who works for an advocacy and support agency, complained about the care and treatment that her client (Mrs B)'s adult son (Mr A) received from the board's mental health services. Mrs B and Mr A had been told that Mr A had an assumed borderline personality disorder and that, as part of his treatment, he would attend a specified cognitive behaviour therapy programme. However, the decision was taken that Mr A should attend another course which caused Mr A and his family great distress and they felt that the staff had not diagnosed his condition appropriately. Subsequently, Mr A was reassessed by a consultant psychiatrist as having an Emotionally Unstable Personality Disorder (EUPD) and was placed on the original specified cognitive behaviour therapy programme. The family felt that there was an undue delay in the diagnosis of EUPD.

We took independent advice from two mental health advisers and found that Mr A had been seen by a number of clinicians in mental health over an extended period of three years. We found that, although Mr A had displayed some traits of EUPD, no formal structured assessments had been completed which would have led to an earlier diagnosis of EUPD. We found that this was contrary to national and local guidance. The assessments which were carried out during the period lacked detail and consistency. They concentrated on current symptoms, rather than someone taking on collective responsibility and arriving at a diagnosis of EUPD by carrying out a structured assessment using recognised tools. We also found that there was a failure by the board in arranging for Mr A to receive a second medical opinion which had been requested by one of the consultant psychiatrists. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B and his family for the unreasonable delay in reaching a diagnosis of EUPD and for not arranging a second medical opinion. 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 familiarise them themselves with relevant guidance for personality disorders.
• Staff should ensure that requests for a second medical opinion are actioned.

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.