Health

Summary

Mrs C raised a number of concerns about the care that her mother (Mrs A) received from her medical practice. Mrs A had been diagnosed with terminal pancreatic cancer and was receiving care in her home from a multi-disciplinary team including her GP, district nurses and a Macmillan nurse. Once Mrs A's care needs increased, her GP referred her to a specialist palliative care facility, where she died.

We found that in response to Mrs C's complaint, the practice had reflected on the care they had provided to Mrs A and had identified a number of learning points to take forward and act on. We took independent advice on the case from a GP adviser who noted Mrs C's concerns about communication, but did not find evidence that the practice had communicated unreasonably with Mrs C or Mrs A. The adviser was satisfied that the practice had provided appropriate care and treatment for Mrs A's symptoms, and that the GP's role in an investigation into potential diabetes was reasonable. The adviser did not consider that the GP unreasonably delayed visiting Mrs A after she suffered a fall, and considered that the assessment performed at the subsequent home visit and referral to a specialist palliative care facility were reasonable. We did not uphold this complaint.

Mrs C also expressed concern about the level of support and information the practice provided to her in her role as a carer. We found that the practice did not send Mrs C the range of leaflets and resources that they usually send to individuals who have been identified as carers in terms of the practice's protocol. The adviser did not consider that this was unreasonable as it was the responsibility of Mrs C's GP, rather than Mrs A's GP, to provide this information. The adviser noted that the practice had provided some information at a late stage to Mrs C and considered the practice might want to consider taking steps to ensure that any information that is provided in these circumstances is provided at an earlier stage. We did not uphold this complaint, but made a recommendation.

Recommendations

We recommended that the practice:

• feed back the findings of this investigation to practice staff to ensure that information for carers is provided at an early stage.

Summary

Mrs C raised a number of concerns about the palliative care that her mother (Mrs A) received. Mrs A had been diagnosed with terminal pancreatic cancer and was receiving care in her home from a multi-disciplinary team including her GP, district nurses and a Macmillan nurse. Once Mrs A's care needs increased, she was referred to a specialist palliative care facility, where she died. Mrs C also complained about the way her complaint was handled by the board.

Mrs C complained about the nursing care her mother received. We took independent advice from a nursing adviser and a consultant geriatrician. Although we found that a number of aspects of the nursing care were reasonable, the nursing adviser was critical that nurses did not record the assessment of Mrs A's pressure areas for a number of months. We were also critical that although staff had ordered a pressure-relieving cushion for Mrs A, this was not delivered and the order was not followed up by nurses. We upheld this part of Mrs C's complaint.

Mrs C was also concerned about the level of input provided by a dietician. We found that the dietician had visited Mrs A on one occasion, and we were satisfied that the dietician had made a number of attempts to contact Mrs A following this. The geriatrician adviser also felt that Mrs A had received appropriate dietetic input whilst an in-patient at the palliative care facility, and both advisers felt that the board had responded reasonably to this aspect of Mrs C's complaint. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained about the communication with her about the reasons for her mother's admission, as well as the communication with her during her mother's admission. We noted that the Macmillan nurse specialist took a different view about the purpose of admission to that of Mrs A's GP, who had referred Mrs A. The nursing adviser said that staff were entitled to take different views, and did not consider that the Macmillan nurse took an unreasonable view. Regarding the communication during admission, we found that the documentation in relation to communication with Mrs C was not sufficiently detailed. Therefore it could not be determined whether staff had ensured that Mrs C had a full understanding of Mrs A's condition. We upheld this part of Mrs C's complaint.

Mrs C also expressed concern about the level of support and information she was provided with as a carer for Mrs A. We found that the Macmillan nursing records showed reasonable care and support. Mrs C was concerned that staff failed to explore whether she would have been able to care for her mother if her mother was discharged. We found that staff had discussed plans to discharge Mrs A and had referred her to social work, which the geriatrician adviser considered appropriate, as a carer assessment would have taken place. As Mrs A died before discharge was progressed, it was not possible to say what kind of carer assessment would have been undertaken. In response to Mrs C's complaint, the board undertook to explore carer support opportunities within palliative and frail elderly services. We did not uphold this complaint, but we considered that it would have been appropriate for the board to inform Mrs C about what steps it was taking in relation to carer support.

In relation to complaints handling, we noted that the board had not met the 20-working-day target for responding to complaints. However, Mrs C's complaint was detailed and involved multiple departments. We were therefore not critical that the board took longer than this and we found that Mrs C had been kept informed about the delay. We considered that the board's response was reasonable and we considered that the learning points that had been identified by the board were appropriate. We did not uphold this complaint.

Recommendations

We recommended that the board:

• feed back the findings of this investigation to the nursing staff involved in Mrs A's care to ensure that each request for equipment is followed up and to ensure that patients' pressure areas are monitored appropriately;
• take steps to ensure that conversations with patients and their families are recorded in detail in the clinical notes; and
• provide Mrs C with information about the steps taken to explore carer support opportunities within palliative and frail elderly services.

Summary

Mr C complained about various aspects of the treatment he received at the prison health centre. He complained that the board failed to carry out an appropriate assessment of him, and failed to adequately manage his pain. During the course of our investigation, Mr C was liberated from prison. He did not provide us with a forwarding address so we were unable to communicate with him. In the circumstances, we discontinued our investigation.

Summary

Ms C complained about a transvaginal ultrasound scan (an internal pelvic scan used for examination of a woman's reproductive organs) carried out at Dumfries and Galloway Royal Infirmary. Ms C complained that she was kept waiting unnecessarily, that inappropriate and unclean equipment was used and that the procedure was carried out in an overly rough manner which she felt led to vaginal and bladder infections. Ms C also complained about the way her complaint was handled.

During our investigation we took independent medical advice from a consultant obstetrician and gynaecologist with a special interest in ultrasound scanning.

We found that a member of staff should have checked on Ms C's wellbeing while she waited for her scan so we upheld that aspect of her complaint. We found that there was no evidence that the equipment was inappropriate or unclean so we did not uphold those aspects of the complaint. We found that while these types of scans can sometimes cause vaginal or bladder infections, this would not necessarily indicate that the scan was carried out improperly or in too rough a manner, so we did not uphold this aspect of the complaint.

In relation to complaints handling, we found that there was a delay in responding to Ms C's complaint which the board did not acknowledge, and we therefore upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for not updating her on the delay in her appointment and not checking on her wellbeing while she waited for her scan. Further apologise for the delay in acknowledging Ms C's complaint. These apologies should comply with 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:

• Patients should be kept updated if appointments for scans are delayed and it should be explained to them why they are waiting longer. Staff should check that patients are comfortable and should tell the sonographer is a patient is in discomfort or is highly anxious.
• The board should consider providing patients with an information leaflet in advance of their appointment. It should include information about what to expect on the day and warn about the possibility of delay. It should also detail the staff help and support available on the day, how patients can raise any concerns at the time, the clothes changing facilities available and the small risk of infection for all invasive procedures.
• Patients should be asked if they are feeling ok after the scan has started as some patients may not express concern unless prompted.

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 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.