Health

Summary

Ms C complained about the care provided to her father-in-law (Mr A) during a call to NHS 24. Mr A reported that he had been suffering with a cold and cough for five days with symptoms including dizziness, pain in the chest area and a fever. He had also been sick and, while he could drink water, he had not taken his medications. The NHS 24 call handler took details from Mr A and passed these on to a pharmacist. The pharmacist recommended that he buy a medicine to help suppress his cough and allow him to take his other medication. Mr A was also advised on what to do should his condition worsen.

Mr A had further contact with the out-of-hours services the following day. He was later admitted to hospital and died as a result of sepsis (blood infection). Ms C complained about Mr A's first call with NHS 24 as she felt that he had not received appropriate advice or care.

We took independent advice from a practitioner experienced in out-of-hours services. The advice we received was that the care and treatment recommended were reasonable on the basis of the information that was available to the call handler and the pharmacist. The adviser considered that appropriate safety advice had been provided by NHS 24 on what to do if Mr A's condition should worsen. No failings were identified in the way that Mr A was managed by NHS 24 and therefore we did not uphold Ms C's complaint.

Summary

Mr C complained to us about the failure of staff at the Royal Infirmary of Edinburgh to identify that he had sustained a fracture of his spine after a fall at home. It was only when Mr C attended an appointment with a clinician six months later that he was told about the fracture. Mr C wanted to know why the fracture was not identified sooner as this would have allowed him to receive additional treatment.

We took independent advice on Mr C's complaint from an adviser in emergency department medicine and an adviser in radiology. We found that the imaging which was carried out when Mr C attended the hospital immediately after his fall showed subtle signs of a fracture of Mr C's spine. However, this was with the benefit of hindsight. We concluded that, due to the subtle findings which were evident, it was not unreasonable for the staff who reviewed the imaging at that time not to have identified the fracture. We did not uphold the complaint.

Summary

Miss C complained to us that, when she attended her local opticians, she reported symptoms of flashing lights in her left eye. The optometrist said there was nothing to worry about and did not offer her a follow-up appointment. When she saw another optometrist six months later, she was urgently referred to the eye hospital where it was discovered she was blind in her left eye. Miss C said that the first optometrist should have taken her concerns seriously.

We took independent advice from an adviser in optometry and concluded that the first optometrist had provided a reasonable standard of care. This optometrist had seen Miss C on two occasions. At the first appointment there was no record that Miss C had reported flashes in her left eye. Her vision had deteriorated from her last annual check-up, however there was nothing to suggest that Miss C should have been referred to a hospital specialist at that time.

At the second appointment two months later, it was noted that Miss C had reported flashes in her left eye and was worried about going blind. The optometrist offered to perform a dilated examination (detailed eye examination following administration of eye drops) but Miss C declined the offer. The adviser noted that although there was no explanation as to what the optometrist felt was the cause of the flashes, there was no clinical evidence of additional problems or a need for a specialist referral. We did not uphold the complaint. However, we found that the first optometrist should have arranged for Miss C to attend an earlier recall for the recent onset of flashes in line with the local referral protocol. This would have resulted in an earlier check-up, which would have been in advance of Miss C's appointment with the second optometrist. We offered some feedback on this to the opticians.

Summary

Mr C complained that the time his son (child A) had to wait to have treatment by the child and adolescent mental health services (CAMHS) was unreasonable. Mr C also complained that the board failed to take into account all of child A's circumstances before reaching a decision to refuse a referral to CAMHS a number of years earlier. Mr C also raised concerns about the board's handling of his complaint.

During our investigation we took independent advice from a CAMHS nurse. We found that whilst waiting times for CAMHS are long nationally, the government's waiting time target is for treatment to begin within 18 weeks of referral. In this case, child A had waited eight months from referral to treatment. We found this to be unreasonable. The board told us that families are encouraged to go back to the referrer whilst they are waiting for treatment if they are worried about a deterioration in a child's condition. However, we found no evidence that this had been communicated to Mr C or child A and we were critical of this. We upheld this aspect of Mr C's complaint.

In relation to Mr C's complaint about the board refusing a referral for his son to CAMHS at an earlier date, we found that the referral letter did not mention any mental health concerns. We found the letter only mentioned issues such as family relations and behavioural problems, which would not normally be treated by CAMHS. We therefore found that it was reasonable for the board not to have accepted a CAMHS referral for child A at that time. We did not uphold this aspect of Mr C's complaint.

We found that the board's handling of Mr C's complaint had been unreasonable. Whilst we considered the board to have taken reasonable steps to ensure patients are aware of the complaints process, we found that the board had failed to meet the 20 working day target for the full response to Mr C's complaint as set out by the Scottish Government's 'Can I help you?' guidance. The board stated that they considered the 20 working days to start running from when they had received child A's consent to investigate. However, this contradicts the guidelines around complaints handling. We upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• provide information on what steps they are taking to meet government waiting time targets for CAMHS;
• give consideration to how they can ensure families are aware that, if they have concerns about increased risk or deterioration of symptoms whilst a child is waiting for treatment from CAMHS, they can go back to the referrer;
• apologise to Mr C for the failings in complaints handling identified by this investigation; and
• feed back the findings on complaints handling to the relevant staff.

Summary

Mrs C's GP referred her to St John's Hospital for a blood transfusion because she was anaemic, had chest pains and was breathless. However, Mrs C said that when she was in the hospital the blood transfusion did not happen. She was discharged and told that an urgent endoscopy (a procedure where a tube-like instrument is put into the body to look inside) and colonoscopy (an examination of the bowel with a camera on a flexible tube) would be arranged for her. Mrs C said that she did not hear anything further and that the following month she was admitted to hospital again. She had a scan which showed a large tumour and she was diagnosed with bowel cancer. Mrs C complained that she was not properly cared for and treated during her first attendance at hospital.

We took independent advice from a consultant gastroenterologist. We learned that Mrs C did not have a blood transfusion because her blood flow was not compromised and she showed no symptoms of active bleeding. While we found it was reasonable to discharge Mrs C home with plans for urgent endoscopic investigations, the board subsequently failed to deal with this as a matter of urgency. We found that this was unreasonable and we upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• apologise to Mrs C for the delay;
• confirm the situation with regards to waiting times for urgent endoscopies; and
• ensure that, in the event that they cannot address the waiting times for urgent endoscopies, alternative scans, such as CT scans on the colon, are made available. This new protocol should be brought to the attention of referring clinicians.

Summary

Mrs C complained to us about the treatment she received when she attended the emergency dental clinic at Wishaw General Hospital. Mrs C was experiencing pain from a left molar tooth and was scheduled to have root canal treatment carried out by her own dentist. Mrs C contacted NHS 24 and explained the problems she was experiencing and they made her an appointment at the clinic the following day. When she attended the clinic she said the dentist read the NHS 24 referral note, asked her a few questions, numbed her mouth, removed a nerve in a tooth, and put in place a temporary filling. When Mrs C returned home, the anaesthetic began to wear off and she looked in her mouth to discover the dentist had treated the wrong tooth and not the one which was scheduled to have root canal treatment. As a result she had to attend another NHS facility for emergency treatment on the correct tooth.

We took independent advice from an adviser in general dentistry and concluded that the dentist had taken note of Mrs C's dental history and the information contained in the NHS 24 referral, and had conducted an appropriate examination of her mouth. We found that the dentist had identified a tooth which was causing pain and that appropriate treatment was provided. We felt it was reasonable for the dentist to have treated the tooth which he had identified as causing a problem. While the tooth which was treated was not the one scheduled for root canal treatment, there was nothing to indicate that the tooth was incorrectly treated. We did not uphold the complaint.

Summary

Miss C's late father (Mr A) had been admitted to Hairmyres Hospital with a suspected mini-stroke and it was decided that he required vascular surgery. However, the vascular surgery was not carried out during that admission of four days, and arrangements were made for him to return to hospital two weeks later. The re-admission date was extended by a further week due to a medical emergency concerning another patient. Mr A suffered a major stroke the day before the planned re-admission date and died before the vascular surgery could be performed. Miss C complained that there was an unreasonable delay in arranging vascular surgery for her father.

We took independent advice from an adviser in vascular surgery. We found that during the initial admission Mr A was not fit for surgery, due to his other health conditions, and that it was appropriate to postpone the vascular surgery for two weeks. When the planned surgery had to be postponed for a further week for another patient who had clinical priority, we found it was appropriate at that time to postpone it. We did not find any evidence of avoidable delays in scheduling Mr A's surgery, and as such we did not uphold the complaint.

Summary

Mr C complained that when he returned to prison having undergone surgery, he was not prescribed with appropriate pain relief.

While in hospital, Mr C had been prescribed dihydrocodeine and paracetamol (pain relief medications). However, on returning to the prison, clinicians prescribed Mr C with co-codamol (a mixture of codeine and paracetamol). The prescription was not issued until after the pharmacy cut-off time and so Mr C only received paracetamol until the following morning when he was given a one-off dose of dihydrocodeine.

We took independent medical advice. The adviser's view was that Mr C had not been provided with sufficient pain relief and that the delay was unreasonable. We accepted this advice and upheld the complaint.

We also found that the board's response to the complaint was contradictory. They had told Mr C at stage one of the complaints process that they would take action to ensure there was not a repeat of the situation. However, when we contacted the board to find out what action they had taken, they said there were no actions taken as the delay was unavoidable. We were critical of this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the delay in prescribing appropriate pain relief and for the contradictory response 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.

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

• Patients should receive appropriate medication when returning to prison after surgery.

In relation to complaints handling, we recommended:

• The board’s decision on a complaint should be clear and, if it differs to the view reached at stage one, this should be explained in the response.

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 and Mrs C complained about the care and treatment the practice provided to their late son (Mr A).

Mr A had a background of autism and other additional needs. He attended the practice with problems including diarrhoea, sickness and weight loss. The practice initially considered Mr A’s bowel upset was caused by antibiotics. After approximately three months, the practice referred Mr A to gastroenterology for investigations. However, his background health problems made these investigations difficult. Mr A’s condition continued to deteriorate and he was taken into hospital approximately four months later. Mr A was diagnosed with Crohn’s disease (a long-term condition that causes inflammation of the lining of the digestive system), and died despite surgical management.

Mr and Mrs C complained that the practice failed to provide Mr A with appropriate clinical treatment. They said his condition deteriorated considerably, and that his family and carers specifically raised concerns that he was suffering from Crohn’s disease. They also raised concerns that the practice did not appropriately take into account Mr A’s additional needs. Mr and Mrs C also complained that the practice unreasonably delayed in referring Mr A for a gastroenterology opinion.

Summary

Mrs C complained about the practice after she required a CT scan to be diagnosed with pneumonia. She told us that she felt an earlier diagnosis should have been possible, based on her medical history and presenting symptoms.

We took independent advice from a GP adviser. We found that the practice did not fail to identify any signs or symptoms that would have led a GP to reach a diagnosis of pneumonia. The adviser considered that the practice carried out reasonable examinations and, when these failed to provide a diagnosis, took prompt and reasonable steps to arrange appropriate tests to investigate further. This involved arranging for an x-ray and then a CT scan, which provided the eventual diagnosis. For these reasons, we did not uphold the complaint.