Health

Summary

Mr C complained about the care and treatment provided to his mother (Mrs A) at Biggart Hospital. Mr C complained that his mother was not provided with adequate care and treatment, specifically that alternative diagnoses to delirium were not considered and the delirium care pathway was not followed. Mr C also complained that Mrs A had wrongly been assessed as having the capacity to make decisions about her ongoing care, and that staff had acted unreasonably by failing to provide Mr C and his family with information about Mrs A whilst she was in hospital.

We took independent advice from a consultant physician and geriatrician. We found that the clinical care and treatment provided to Mrs A was of a reasonable standard. We noted that Mrs A was reviewed on at least a weekly basis, and that her physical and mental health were considered in detail throughout her stay. We also noted that alternative diagnoses were reasonably considered and that the care provided to Mrs A was in line with the board's delirium care pathway. We found that the board's assessment of Mrs A's capacity was reasonable. We also found that Mrs A's wishes regarding the sharing of her health information were documented several times throughout her admission and the board had acted reasonably in keeping information about her health confidential in line with her wishes. However, we did consider that the board could have communicated information regarding a second opinion from another clinician more clearly, and that it may have been useful for board staff to direct Mr C to an organisation that could provide him with advice and support.

Mr C also complained about the board's handling of his complaint. We found that whilst the target time for a response was not met by the board, they kept him informed of the delay and explained why it had occurred. We found this reasonable. We did not uphold any of Mr C's complaints, but we did make some recommendations.

Recommendations

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

• Communication with families around second opinions should be clear.
• When appropriate, staff should consider directing families to organisations such as the Mental Welfare Commission for advice and support.

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 GP practice had unreasonably delayed in informing him that he had a stroke diagnosis. Mr C presented at the emergency department with symptoms that were initially considered to be consistent with Bell's Palsy (weakness down one side of the face sometimes due to nerve damage). Mr C had a history of labyrinthitis (inflammation of the inner ear) and was also vomiting and dizzy when he presented to the emergency department. Staff were satisfied that Mr C had responded well to treatment/medication at that time. Mr C was seen about four months later at the ear, nose and throat department (ENT) when a scan showed what appeared to be a lacunar infarct (a type of stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked).

The practice printed the results of the scan but assumed that the ENT department would follow up the diagnosis and the results with Mr C. However, the registrar who had seen the scan had missed the significance of the diagnosis. Mr C was advised of the diagnosis two months later after asking at his practice why he was eligible for a flu jab. He complained that the practice had unreasonably delayed in informing him of the diagnosis after printing the results of the scan.

We took independent GP advice. Despite the practice stating in their response to Mr C's complaint that they accepted they were partially responsible for following up the scan results due to the abnormalities identified (although they felt that ENT should have followed up on the results with him), we found that the practice could not be held responsible for the failure of the ENT department to follow up on the scan results or the failure to refer management of the findings back to the practice.

As a result, we did not uphold the complaint by Mr C although we did make a recommendation.

Recommendations

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

• The findings of this investigation should be shared with the board.

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 on behalf of her late husband (Mr A) about the orthopaedic care he received at the Royal Infirmary of Edinburgh and about the length of time it took for the board to respond to the complaint. Mrs C complained that the board unreasonably failed to offer Mr A the opportunity to obtain a second opinion within the NHS, that they unreasonably failed to arrange a scan and that they failed to respond to complaints in a timely manner.

We took independent advice from an orthopaedic adviser. Although the board had said that Mr C had preferred to be seen privately for a second opinion, we did not identify sufficient evidence to indicate whether any discussion had taken place around the option of an NHS referral for a second opinion. We upheld this aspect of the complaint.

We considered that the standard of Mr C's assessment by the orthopaedic staff at the hospital was of an entirely reasonable standard where an accurate diagnosis was reached without the need to perform a scan to confirm this. We did not uphold this aspect of the complaint.

We found that the board had appropriately apologised for the time taken to respond to the complaint and have since accepted the delay was unreasonable. We also identified that they did not provide proactive updates regarding the delay or inform Mr C of his right to contact this office after the 20 working day response time was exceeded. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to demonstrate that discussion took place with Mr A about a second NHS opinion.
• Upon submission of the appropriate invoice, reimburse Mrs C for the cost of the private consultation for a second opinion.

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

• The orthopaedic doctor involved should be reminded of the importance of record-keeping.
• Staff who deal with complaints should reflect on and learn from Mr A's experience.

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 said that although he attended his medical practice concerning his back pain on a number of occasions over a period of two months, doctors failed to note his deteriorating condition. He said that he was given increasingly strong painkillers which failed to work and that although he was exhibiting 'red flag' symptoms, he was not referred for further investigation or imaging. Mr C said that it was not until he attended with his son that he was taken seriously and admitted to hospital as an emergency. He required an immediate operation.

Mr C complained to the practice who said that while they noted that he was in significant pain, Mr C did not show any symptoms or clinical signs that would have triggered an immediate referral for surgery (there were no red flags). They believed that he had been treated appropriately and in accordance with guidance.

We took independent advice from a GP and found that the practice had carried out appropriate examinations. Mr C's pain was regularly reviewed and his painkillers were increased accordingly. They repeatedly checked Mr C for red flag symptoms and an appropriate referral was made for him when his symptoms changed. We therefore did not uphold Mr C's complaint.

Summary

Miss C complained about the care her mother (Mrs A) received at the medical assessment unit at the Western General Hospital. Mrs A was admitted to the hospital after her GP noted that she had a low pulse.

Miss C raised a number of concerns about the nursing care her mother received. In particular, Miss C complained about the cleanliness of the cubicle where her mother was assessed, the delay in providing a bed, the lack of provision for Mrs A to raise her legs, the uncertainty of nursing staff in relation to cardiac monitoring and a delay in nursing staff inserting a cannula (a very small tube which is placed into a vein, usually in the back of a patient's hand or in their arm). We took independent advice from a nursing adviser and a medical adviser. We found that the board had apologised to Miss C for a number of failings and had identified actions to improve care. The nursing adviser considered that the board should take further steps to improve care. We upheld this complaint and made a number of recommendations.

Miss C also raised concerns that there had been a delay in doctors prescribing her mother intravenous medication. We found that Mrs A had been prescribed oral medication on the day of admission and that the following day she had been prescribed intravenous medication. The medical adviser considered that the doctor's decision to prescribe oral medication rather than intravenous medication on the day of admission was reasonable. The adviser concluded that Mrs A received good overall care, and said she did not have a life threatening degree of heart failure to justify the need for immediate intravenous treatment. We did not uphold this complaint.

Recommendations

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

• Documentation of cannula care should be carried out in accordance with national guidelines.
• Systems should be in place to monitor the number of complaints concerning chair and trolley allocation to identify whether this is an ongoing problem within the department.
• The impact of changes that the board has made, including changes to the cleaning schedule, should be monitored to ensure progress is made towards quality improvement.

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 provided to her mother (Mrs A) by her GP practice. A GP visited Mrs A's home and following an examination, the GP considered that Mrs A had an upper respiratory tract infection. Her condition did not improve following the GP's visit and her family took her to hospital. Further examinations in hospital identified that Mrs A had pneumonia, and she died a number of days following admission.

Ms C raised a number of concerns about the home visit carried out by the GP, and felt that an x-ray should have been arranged and antibiotics prescribed. We took independent GP advice and found that the GP's assessment was reasonable. We noted that the GP had documented a detailed history and examination of Mrs A, and that their observations were consistent with a viral infection such that antibiotics were not necessary at that time. The adviser also said that there was no clinical indication for a chest x-ray as Mrs A's symptoms and signs were not consistent with a likely diagnosis of pneumonia. The adviser noted that the GP had also provided advice on what to do if Mrs A's condition became worse. Overall, we found that the GP had provided reasonable care and treatment. We did not uphold this aspect of the complaint.

Ms C also expressed concern that the GP failed to arrange hospital admission given Mrs A's symptoms. While we noted that Mrs A was subsequently admitted to hospital where she was diagnosed with pneumonia, the adviser did not consider that Mrs A's recorded symptoms at the time of the GP visit were consistent with pneumonia, and did not consider that there was an indication that Mrs A needed to be admitted to hospital at this time. We did not uphold this complaint.

Summary

Mrs C complained to us that that the board had delayed in diagnosing that she had Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system). Mrs C had significant symptoms of abdominal pain, diarrhoea and significant and progressive weight loss and had undergone a number of tests arranged by the board in relation to this. No diagnosis was made and Mrs C asked for a second opinion. She was referred to Wishaw General Hospital. Further tests were carried out, but it was not considered that there was evidence to support a diagnosis of Crohn's disease. Mrs C then attended a private hospital, where a diagnosis of Crohn's disease was made. Mrs C told us that a surgeon at the private hospital looked at a scan carried out at Wishaw General Hospital and found that it showed she had an abnormality in her bowel, which had not been identified by the board.

We took independent advice from a gastroenterology consultant and from a consultant radiologist. We found that the investigations carried out by the board in response to Mrs C's symptoms had been appropriate, thorough and timely. Although one of the tests had not been fully completed, it had been reasonable not to repeat the test, as other appropriate tests had been arranged. The scans carried out by the board did not show any significant abnormalities. We considered that the actions of the board had been reasonable and that there was no clear evidence of any failings or undue delays. We did not uphold Mrs C's complaint.

Summary

Ms C complained about the care and treatment provided to her brother (Mr A) for pain and other symptoms he reported in his legs. Mr A had been attending the practice about these issues. The practice referred him to a community clinic and deep vein thrombosis (DVT) service at the local NHS board during the period covered by this complaint. He was diagnosed with severe critical limb ischemia (obstruction of the arteries that reduces blood flow to the extremities) and later required amputation of his leg above the knee. Ms C was concerned that there was an opportunity to diagnose Mr A's condition earlier and that this could have resulted in a different outcome.

After taking independent medical advice from a general practitioner, we did not uphold Ms C's complaint. The advice we received was that appropriate timely referrals had been made for Mr A and that the practice had reasonably explored potential causes of his symptoms. We found that there could have been more information included in one of the referrals that had been made for Mr A, however, the advice we received was that this did not have any impact on Mr A's case. We made a recommendation in connection with this for learning purposes.

Recommendations

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

• Referral letters should include information in line with General Medical Council 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 raised a number of concerns about the care and treatment provided to his father (Mr A) whilst he was a patient at Hairmyres Hospital. Mr A had prostate cancer and was admitted to the hospital with symptoms of abdominal pain and diarrhoea. Mr A received treatment from the hospital's palliative care team and input from physiotherapy, occupational therapy and dietetics as staff sought to progress him towards discharge. Mr A's condition deteriorated throughout the admission and he died whilst an in-patient.

Mr C complained that staff did not provide Mr A with appropriate pain relief. We took independent advice from a nursing adviser and a medical adviser. The nursing adviser was satisfied that nursing staff monitored Mr A's pain in accordance with relevant guidance. However, they considered that the response to his pain, including prompting Mr A to use additional medications as required, was lacking on occasions. The medical adviser found that, for certain periods, medical staff had not achieved a good combination of painkillers for Mr A, and considered that there had been a delay in recognising that Mr A was reluctant to request additional medications when he felt he required them. We upheld this complaint and made a number of recommendations.

Mr C also raised concerns that staff inappropriately considered Mr A as being suitable for transfer to a care home. We found that the decision to transfer Mr A from hospital changed after his condition deteriorated. However, the medical adviser considered that it was appropriate for the board to have referred Mr A for transfer based on his condition at the time of the referral. We could not conclude that the board acted inappropriately in relation to plans to transfer Mr A to a care home and we did not uphold this complaint.

Mr C further complained that staff did not discuss the decision to give Mr A hormone therapy for his prostate cancer with Mr A's family. Having reviewed the records, the medical adviser considered that Mr A had the capacity to decide about further treatment for his cancer. The adviser explained that it was therefore reasonable for staff not to have discussed this decision with family members first. We did not uphold this complaint.

Finally, Mr C raised concerns that staff failed to communicate with Mr A's family about a DNACPR decision (do not attempt cardiopulmonary resuscitation – a decision taken that means a healthcare professional is not required to resuscitate the patient if their heart or breathing stops). We found evidence that a doctor discussed DNACPR with Mr C's wife, who is Mr A's daughter-in-law. The medical adviser said that the conversation about DNACPR should have been with Mr C or Mr A's wife, who were Mr A's next of kin. The adviser did consider that it was pragmatic to discuss goals of care and DNACPR with the most appropriate person available at the time, and noted that this was Mr C's wife. However, the adviser did not find evidence that doctors discussed DNACPR with Mr A and noted that there had been a delay in the senior clinician completing the DNACPR form. On balance, we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to appropriately manage Mr A's pain.

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

• Nursing staff should be aware of the mental health changes associated with pain, as well as the observational changes with pain, so that patients are prompted to use pain relief when appropriate.
• Medical staff should recognise when a patient is reluctant to request pain relief and provide timely management to ensure that the patient receives appropriate pain relief for the recorded levels of pain.
• Communication and decision making surrounding DNACPR should be in accordance with the latest 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 there was an unreasonable delay in the board providing him with treatment on his right eye. Mr C is diabetic and was referred to Gartnavel General Eye Hospital when he began having problems with the vision in his right eye. Mr C was seen by the vitreo-retinal (relating to the back of the eye) unit at the hospital eight weeks after the initial referral was made, and it was determined that he needed surgery on the eye. Surgery was carried out around three weeks later, and afterwards Mr C was told that he would not regain sight in the eye. Mr C complained that in the time he had to wait for an appointment at the hospital he went from being able to see to losing sight in his right eye.

In response to our enquiries, the board explained that when Mr C's referral to the hospital was made, it was not logged in the normal way on the electronic system and therefore was not given a clinical priority. The board apologised for this and said that they had taken measures to prevent the likelihood of this reccurring in the future.

During our investigation, we took independent advice from a medical professional who is an ophthalmologist. We found that, given the symptoms that were recorded in the referral, Mr C should have been given clinical priority and an urgent appointment. We found that the delay between Mr C being referred to the vitreo-retinal unit and being seen by them was unreasonable. We also found that had surgery been carried out at an earlier point, Mr C would have had more of a chance of maintaining a better level of vision. Therefore, we upheld his complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the delay in providing treatment for his right eye.

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

• Consultants should be aware that one of the biggest determinants of visual outcome following retinal surgery is the visual acuity when surgery is carried out.
• Referrals to the vitreo-retinal service should be appropriately logged.

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.