Health

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A). Mr A said that his medical practice had not provided him with reasonable care and treatment regarding blood tests and referral for specialist opinion. Mr A attended the practice from 2011 with a low platelet count and a lymphocyte (a type of white blood cell) count that was intermittently rising but still within the range that would be considered normal.

Mr A was referred to the haematology department in 2012. He then attended the practice for blood tests several times from 2012 to 2015. The practice had requested advice from haematology in relation to follow-up and further tests but had not received this advice. The results of the blood tests carried out at the practice were similar to those in 2011 until 2015 when the lymphocyte count increased and tests indicated possible lymphoma (a type of cancer).

We took independent medical advice from a GP adviser and found that the practice had acted reasonably in relation to blood taken and analysed at the practice, so we did not uphold the complaint.

The practice had carried out an analysis of the events surrounding Mr A's case. The outcome of this was that advice requests to specialists would now be made in a way that would ensure a response regarding follow-up and advice.

Recommendations

What we asked the organisation to do in this case:

• The practice should issue a written apology to Mr A for failing to refer him to haematology to investigate abnormalities in blood test results.

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 about the care he received at a prison healthcare centre after he was diagnosed with diabetes. Mr C was concerned that he did not receive appropriate medical care and treatment or support in relation to his diabetes. He also complained that there had been a delay in providing treatment for thrush, and complained that when he was admitted to hospital, staff at the prison health centre had not informed his next of kin. Finally, Mr C felt that his complaint had not been dealt with appropriately.

After taking independent GP advice, we upheld Mr C's complaint about medical care and treatment. While we found that most aspects of his diabetes care and treatment were reasonable, the adviser highlighted two separate days following hospital discharges where Mr C had not received his prescribed medications. We made recommendations to the board to address this.

We found that the board had taken reasonable steps to provide help and support to Mr C for his diabetes and identified no delays in the provision of thrush treatment. Consequently, we did not uphold these elements of Mr C's complaint. We also did not uphold his complaint about the health centre staff failing to inform his next of kin when he was admitted to hospital as we found that this was a matter for the Scottish Prison Service.

Finally, we upheld Mr C's complaint about the board's handling of his complaints as we found that they had not addressed all the issues raised. We made a recommendation to address this failing.

Recommendations

What we asked the organisation to do in this case:

• Apologise in writing to Mr C for failing to give him his prescribed medication on two dates.
• Apologise in writing to Mr C for failing to address one of the concerns of his complaint.

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

• Medications that have been prescribed to a prisoner in hospital should be made available following discharge.

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 about the way his medication was handled by the prison healthcare centre, in particular that his medication had been stopped, the board had stopped his medication before investigating his complaint about the medication and that the board did not reinstate his medication.

We took independent GP advice. We found that the decision to stop Mr C's medication was taken in line with the board's and the General Medical Council's guidance on safe prescribing. Mr C had signed an agreement before starting the medication which set out the circumstances under which the medication could be stopped. We were satisfied that the decision to stop the medication was taken in line with this agreement. The evidence demonstrated that when Mr C's medication was being stopped, he was reviewed by a doctor and was offered support in line with policy. The advice we received was that the decision to not restart Mr C's medication was reasonable and in line with policy. We did not uphold these complaints.

Mr C was also unhappy with the handling of his complaints, in particular that there had been an unreasonable delay by the board in dealing with his complaint. He also said that the investigation of his complaint had been inadequate, and that the response to his complaint was unreasonable. We decided to consider these issues together. We were satisfied that the board had handled Mr C's complaint in line with the complaints process and therefore did not uphold his complaint about delay. We were also satisfied that the board had adequately investigated his complaint and did not uphold that complaint. Finally, we were satisfied that the board's response to Mr C's complaint was reasonable and did not uphold his complaint.

Summary

Ms C complained that GPs at her medical practice had misdiagnosed her after she attended several appointments complaining of earache. Ms C was later found to have chronic tonsillitis. She complained that the GPs had not diagnosed this when she presented with her symptoms. She also complained that she was not prescribed anything for her pain during this period.

We took independent medical advice and found that the GPs assessed and treated Ms C appropriately and in line with her symptoms. An appropriate referral had been made to the ear, nose and throat department. In relation to the matter of pain relief, the practice pointed out that Ms C was already on a number of strong painkillers for other conditions.

Ms C complained that the practice's handling of her complaint was unreasonable. We found that their response to her complaint was not professional and lacked objectivity. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• The practice should apologise to Ms C for the poor quality of the written response to her complaint. The apology should comply with SPSO's 'Guidance on Apology', available at www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• Responses to complaints should use professional and objective language, demonstrating an understanding of the complainant's position and taking into account the practice's responsibilities within the NHS Complaints Handling Procedure.

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 prison healthcare centre's decision not to prescribe him a medication used to treat insomnia was unreasonable. Mr C said that he had been prescribed the medication in his previous prison, but when he transferred to a new prison, his prescription was stopped which he said caused him significant problems. Mr C also raised concerns that this decision had been taken before he had had a chance to discuss his condition with a psychiatrist and before the prison healthcare centre had access to his community medical records. Mr C wanted to be prescribed the medication again as he felt this would improve his sleep, keep him safe, and reduce the chance that he would be put in an observation cell.

We reviewed documents provided by Mr C and the board, and we took independent advice from a psychiatric adviser. We found that the decision to stop the medication was reasonable. However, we noted that Mr C had been on this medicine for some time and that it may have been hard for him to understand why it was suddenly stopped. We found that national guidance said it should only be given for short periods and that it was therefore reasonable to stop it when there was no clear need for it. We were critical that Mr C did not get a full explanation from medical staff about why the medication was stopped, but were satisfied that it was a reasonable decision and we did not uphold the complaint.

We noted that the board did not respond well to Mr C's initial complaint as their initial response was inaccurate. We also noted that this response did not signpost Mr C to us if he was still unhappy. The board also only gave a full response to Mr C's concerns when we became involved. We were therefore critical of the board's complaints handling and we highlighted this to them.

Summary

Mr C complained about the care and treatment provided to his late wife (Mrs A) at Golden Jubilee National Hospital. Mrs A had been diagnosed with bladder cancer by another health board, but before being able to receive treatment for the cancer had suffered a heart attack. She was referred to the hospital for cardiac surgery. Mrs A was to receive treatment for the bladder cancer after having cardiac surgery. However, by the time she had recovered sufficiently from the cardiac surgery, the cancer had progressed and curative treatment was no longer possible. Mr C said that there had been unreasonable delays in Mrs A undergoing cardiac surgery, that informed consent had not been obtained for Mrs A's cardiac surgery, and that there had been unreasonable failings in communication between the specialists treating Mrs A.

We took independent advice from a cardiac surgeon. The adviser commented that the hospital could have considered treating Mrs A as an in-patient at an earlier point, as this may have been a more holistic approach given her co-existing cancer diagnosis. However, we found that although Mrs A's cardiac surgery had been postponed several times, it was still carried out in a reasonable and appropriate timeframe from a cardiac point of view.

Mr C had been concerned that staff at the hospital were aware that Mrs A would not be able to undergo treatment for her bladder cancer and therefore her consent to undergo cardiac treatment, which had been based on her understanding that without it she would not be able to have her bladder cancer treated, was not fully informed. Our investigation found that throughout Mrs A's patient journey at the hospital, all staff had been working under the impression that her bladder cancer was operable. We did not uphold this aspect of Mr C's complaint.

We found that after Mrs A's cardiac surgery, staff at the hospital failed to send a discharge letter to the other health board to inform them that the surgery had been successfully carried out. We found this to be unreasonable. We upheld this aspect of Mr C's complaint, but considered that the hospital had already taken steps to address this issue and therefore made no further recommendations.

Recommendations

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

• Treatment for patients that require heart treatment prior to cancer treatment should be planned holistically.

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, a prisoner, complained about how her complaints were being responded to by the board. The board had written to Ms C informing her that the volume of complaints, comments and feedback she was submitting was putting a disproportionate strain on their resources and impacting on their ability to assist other people. They asked Ms C to adjust her behaviour. They said they were taking action under their Unacceptable Actions Policy and would be limiting the responses they gave to her complaints, focusing only on those they deemed most significant and which had not been resolved at the time.

Ms C continued to submit complaints.

We found that the board's policies on restricting contact were confusing and that clearer information could have been given to Ms C regarding the board's expectations and what they would do to manage Ms C's behaviour if she continued to submit high volumes of complaints. For that reason we upheld the complaint and made a recommendation to address it. We did not recommend an apology for Ms C as, although there had been a lack of clarity on the board's part, Ms C was well aware of the impact her actions were having on the board and did not take the opportunity to modify her behaviour.

Recommendations

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

• The board should have a clearer policy for unreasonable or unacceptable actions, to enable them to efficiently manage unreasonable actions.

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 on behalf of her daughter (Miss A) about the care provided to her at Forth Valley Royal Hospital following an ultrasound scan which confirmed that she had lost her baby. Ms C was concerned that a sonographer, rather than a midwife, had told Miss A that the baby had died, and that she then had to wait for 45 minutes to see the doctor and midwife. She was also concerned that her daughter was not given a full explanation of the medication she would receive and of the process which would lead to the birth of her baby. She felt that the level of support and information provided to her daughter was inadequate. Ms C was also unhappy with what happened when her daughter returned to the hospital two days later to give birth to her stillborn baby. She felt that the support provided by the midwife was poor and this meant that her daughter eventually gave birth without the midwife being present. She was also concerned about the level of pain relief provided, documentation which suggested the baby would be cremated when this was not the intention of the family, and that the time of the birth was misreported in the records.

We took independent advice from a midwifery adviser. We found that it was appropriate for the sonographer to report the ultrasound findings to Miss A. We noted the subsequent delay in seeing a doctor or midwife, but we did not consider that this delay was unreasonable for the hospital at that time. We were satisfied that the records showed that Miss A was provided with a reasonable level of support and advice and that she was given the opportunity to ask any questions she had at that time about medication or the birth process. Following her attendance at hospital two days later, we were satisfied that the level of support provided to Miss A was reasonable. We noted the issues with the form suggesting cremation, but we also noted that the board had agreed to review this literature when they responded to Ms C's complaint. As we were satisfied that the level of care and support provided was reasonable, we did not uphold these complaints. However, we did highlight to the board the importance of ensuring that their record-keeping is accurate as we did note a discrepancy in the times recorded in the midwifery records.

Summary

Mr C complained about the care and treatment provided to his late father (Mr A) at Forth Valley Royal Hospital.

Mr A was referred to the board and diagnosed with prostate cancer. At a multi-disciplinary team (MDT) meeting, a decision was made to adopt a watchful waiting approach (an approach used in prostate cancer management in men with few symptoms). Mr A attended an appointment approximately six months later, then another twelve months after that. At that point, it was found that Mr A's prostate specific antigen (an indicator of prostate cancer or other prostate conditions) had risen. Following a further MDT meeting, he was seen by an oncologist who felt that he was suitable for radical radiotherapy. In the following months, Mr A's condition deteriorated and he died.

Mr C complained that staff failed to provide Mr A with appropriate clinical treatment. He questioned the decision to place Mr A on watchful waiting programme, and the level of review he received. The board partially upheld Mr C's complaint on the basis that communication could have been better. In particular, they acknowledged that it would have been appropriate for Mr A to have been seen by a consultant at the time the decision was made to put him on watchful waiting. The board advised that they had taken action as a result of Mr C's complaint, and that patients would be seen by a consultant following a decision to place them on watchful waiting.

We took independent advice from a consultant urological surgeon and an oncologist. We found that the board followed guidelines and reviewed Mr A at reasonable intervals once watchful waiting was decided on. However, we found that the watchful waiting decision should not have been made without clinical assessment by a consultant, which may have led to a decision to offer radiotherapy. We noted that Mr A's cancer followed a path that was significantly worse than could have been expected, and that a decision to offer radiotherapy would not necessarily have prevented this. On balance, we upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to arrange a review with a consultant for Mr A when the decision was made to take a watchful waiting approach. The apology should comply with SPSO guidelines on making an apology, available at 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

Mrs C complained about the care and treatment provided to her daughter by staff at the Victoria Hospital. Mrs C complained that when they arrived at the hospital, the nurse was unwelcoming and did not acknowledge how ill her daughter was. Mrs C also said that throughout the admission, nursing staff did not carry out appropriate observations. Mrs C went on to complain that when her daughter was assessed by medical staff, she was not thoroughly examined and a diagnosis of viral infection was made without full consideration of her symptoms and condition.

We took independent advice from a paediatric nurse and a paediatrician. We found that nursing staff did not provide Mrs C's daughter with appropriate nursing care, with failings identified in taking observations, record-keeping, and using the Children's Early Warning Score chart (CEWS chart - a set of patient observations to assist in the early detection and treatment of serious cases and support staff in making clinical assessments). We found that national guidance on children with fever was not appropriately followed by nursing staff. We also found that, whilst the examinations carried out by clinical staff were appropriate, they did not give enough consideration to the possibility of a serious illness. We upheld both aspects of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to provide her daughter with appropriate nursing care and clinical treatment. 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:

• Paediatric nursing staff should be knowledgeable and proficient in undertaking nursing assessments, observations, and using CEWS, and be able to act quickly on these observations.
• Parents/guardians should be given written information on warning symptoms and how further healthcare can be accessed if a child who had suffered from fever symptoms is discharged without diagnosis.
• Clinical staff should give consideration to the possibility that a child that has symptoms of a viral infection may have a more serious illness, and should be aware of the National Institute for Health and Care Excellence Fever guidelines.

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.