Health

Summary

Mr C received treatment from the board over a two-year period for urinary incontinence and erectile dysfunction, which he developed following surgery at the Western General Hospital for prostate cancer. After communicating with the board about his dissatisfaction with his treatment, Mr C obtained penile implant surgery privately abroad and asked the board to reimburse him for the cost of his treatment. The board refused.

Mr C complained that the board acted unreasonably when assessing his request for reimbursement, because they failed to take into account that, despite being aware of his concerns about the delay and his intention to seek treatment privately, they did not properly inform him of the alternative options that were available within the NHS.

We obtained independent advice from a consultant urologist. The adviser said that where a patient raises concerns about delays in treatment and their intention to look for treatment elsewhere, the board should advise the patient of the options to obtain treatment elsewhere in the NHS or the European Union. It was clear that Mr C made the board aware of his concerns about the delays in investigation and treatment of his conditions. However, Mr C advised the board that he had already agreed private treatment with a urologist outwith the UK, that he would be pursuing that course of action and that he did not expect a response from the board on this matter.

The adviser noted that the board said Mr C should have had a full assessment of his urinary incontinence and agreed treatment plan (which had yet to be completed), prior to undertaking any surgery for erectile dysfunction. The adviser said this was entirely reasonable. While we acknowledged the delays in Mr C's treatment, we considered that the board's assessment of Mr C's request for reimbursement was reasonable, as the equivalent treatment in the UK or EU at that time would have been to continue to treat his urinary incontinence rather than perform implant surgery. We therefore did not uphold Mr C's complaint. However, we found that the board did not respond to one of Mr C's letters to them and made a recommendation regarding this.

Recommendations

We recommended that the board:

• apologise to Mr C for failing to respond to a letter during their handling of his complaint.

Summary

Mrs C complained on behalf of her brother (Mr A), that staff at the Royal Infirmary of Edinburgh failed to ensure he was safely transferred to a trolley. In addition, Mrs C raised concern that the incident was not properly investigated, that Mr A was not reviewed following the incident, and that the complaints handling by the board was poor.

We took independent medical advice. We found that Mr A was not transferred to the trolley in accordance with the moving and handling plan that had been put in place following his mobility assessment. Furthermore, when the incident was reported to a nurse later that evening, we were critical that the nurse did not take appropriate steps to formally record the incident on the hospital's system for reporting adverse events. We considered this would likely have resulted in the incident being investigated in a timely manner, and that Mr A would have been reviewed by a doctor sooner. We were also critical of the board's handling of the complaint. Specifically, that they had inaccurately said that a nurse had been present at the time of the trolley transfer for which they apologised. We also found that the board had not acknowledged that the porter's recollection of the transfer was contrary to the manual handling plan documented in Mr A's clinical records. We therefore upheld the complaint.

Recommendations

We recommended that the board:

• apologise to Mr A for the delay in reviewing him after the incident was reported to the nurse;
• share these additional findings with the nurse involved;
• take steps to ensure that porter staff are made fully aware of patients' mobility limitations and needs prior to carrying out inter-departmental transfers; and ensure that nursing staff are available to provide the necessary support indicated in mobility assessments;
• apologise to Mrs C for the additional failings in the complaints handling identified in this investigation; and
• provide evidence of the steps taken to address the issue related to the complaints handling.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Mrs A). She said that an orthopaedic consultant at Hairmyres Hospital should not have referred Mrs A for a Magnetic Resonance Imaging (MRI) scan because she had metal clips in her head from surgery performed in the past.

We took independent medical advice and found that MRI scanning should not be used in patients with metal clips as this can lead to movement of the clips in the strong magnetic field.

We considered that the orthopaedic consultant had not taken an adequate previous medical history when deciding to refer Mrs A for an urgent MRI scan. However, we noted that further safety checks by radiology staff prevented the scan from going ahead. We acknowledged that the board had apologised for the distress caused to Mrs A in relation to the referral but made two further recommendations.

Recommendations

We recommended that the board:

• apologise to Mrs A for the failure to obtain her previous medical history at the time of the consultation and for inaccurately completing the MRI request form; and
• draw these findings to the attention of the orthopaedic consultant for future learning.

Summary

Mrs C complained that the dental practice failed to deal with her complaints in a reasonable manner. We found that the practice had failed to establish in the first instance what Mrs C's complaint involved and that this resulted in a missed opportunity to resolve the complaint at an early stage. We also found that Mrs C's complaint was not acknowledged by the practice within the three working day timescale set out in the Scottish Government's 'Can I help you?' guidance for handling healthcare complaints, and that the practice did not communicate with Mrs C by her preferred method. Finally, we found that the practice's response to Mrs C's complaint was not sent to her within the 20 working day timescale that is set out in the Scottish Government's 'Can I help you?' guidance. We therefore upheld Mrs C's complaint.

Recommendations

We recommended that the practice:

• apologise to Mrs C for the failings identified by this investigation;
• ensure all staff are familiar with the 'Can I help you?' guidance for handling healthcare complaints;
• ensure their complaints policy is in line with the 'Can I help you?' guidance; and
• ensure that their complaint response letters comply with the 'Can I help you?' guidance, and in particular give details for contacting our office.

Summary

Mrs C complained that she had been given a bill by her dentist which included costs for work which was either corrective or had already been paid for. Mrs C also complained that she was being charged for work that had not been carried out. Additionally, Mrs C complained that the dentist had failed to communicate with her about her treatment needs, in particular that she had once been given a treatment plan with no costs on it.

We took independent dental advice. We found that what Mrs C had believed to be a bill was in fact an estimated treatment plan and therefore she was not being charged for work at the time of her complaint. We did not uphold this aspect of Mrs C's complaint. However, we found that it was unreasonable that she had on one occasion been presented with a treatment plan with no costs on it and therefore we upheld this aspect of Mrs C's complaint.

Recommendations

We recommended that the practice:

• apologise to Mrs C for issuing a treatment plan without any costs on it.

Summary

Mr C was referred to a urologist at Raigmore Hospital to have his history of erectile dysfunction and low testosterone investigated. Mr C raised a complaint nine months later as he had not received an appointment and was distressed by his ongoing symptoms.

The board informed Mr C that there was a long waiting list. Mr C raised further concerns that he had not received an appointment, 13 months after his original referral. It took until 19 months after his referral for Mr C to be seen by a urologist.

We took independent medical advice. We found that Mr C's wait to see a urologist was entirely unreasonable and significantly exceeded the Scottish Government's waiting time of 12 weeks for a new out-patient appointment. We were also concerned that the board had not provided evidence to show whether steps had been taken to reduce the waiting time of the urology clinic.

Recommendations

We recommended that the board:

• apologise to Mr C for the unreasonable delay in his receiving a urology appointment; and
• provide clear evidence showing the steps they are taking to meet the 12-week waiting time target for appointments in the urology department at Raigmore Hospital and what they will do in cases where they are unable to meet the target.

Summary

Mrs C complained that an orthopaedic consultant at Raigmore Hospital did not examine her, and instead transferred her care to a different orthopaedic doctor. Mrs C acknowledged that there had been electrical power loss at the hospital affecting the ability to carry out an x-ray of her painful foot. However, she felt that the doctor could have assessed her, given her medical records were available.

We took independent medical advice from an orthopaedic consultant. We were unable to clearly determine whether the doctor had access to all of the relevant electronic medical records and previous x-rays taken, given the power loss. We considered that it was reasonable for the doctor to rearrange the appointment and transfer Mrs C's care to the orthopaedic consultant who had previously treated her. However, we were critical that Mrs C had to wait a further three months to be reviewed. We considered this wait to be unreasonable. The board have since taken steps to address the delays by employing more staff.

Mrs C also complained that the board's response to her complaint was delayed and contained inaccurate information. We did not identify evidence to support her concern that the board's response was inaccurate. In addition, we found that although there was a delay in the board replying to the complaint, this was not unreasonable given that Mrs C was kept informed about the progress of the board's investigation in accordance with national complaints handling guidance.

Recommendations

We recommended that the board:

• issue a written apology to Mrs C for the additional delay in being reviewed.

Summary

Mr C was receiving care and treatment from one of the board's community mental health services. He complained that he was unhappy with aspects of his care and services provided by the board.

We took independent advice from a psychiatric adviser and a mental health nursing adviser. The psychiatric adviser found that Mr C's initial referral to the consultant psychiatrist had been lost, and we were critical of this. However, they were satisfied that Mr C received reasonable treatment from the psychiatrists he saw and considered that it was evident from the records that this treatment had resulted in an improvement in his condition. The mental health nursing adviser was satisfied that, for the period the community psychiatric nurse (CPN) was engaging with Mr C, the CPN's input was reasonable and of an appropriate standard. However, the mental health nursing adviser was critical that, following a referral to a practitioner of CBT (cognitive behavioural therapy), the CPN discharged Mr C from their caseload without waiting to see whether the CBT service would take on Mr C. The mental health nursing adviser considered that this had denied Mr C the opportunity to explore other support, and considered that Mr C's continuity of care had been interrupted and that this was unreasonable. We found that the CPN's clinical correspondence could have been better worded, and although the adviser did not consider that the CPN's actions could be considered to be a breach of professional conduct, they felt that this was a learning point. We therefore upheld this aspect of Mr C's complaint.

Mr C also complained that when the CPN was absent, the board did not provide him with a replacement CPN. We noted that the board had written to Mr C to ask him to call the service if he wanted a different counsellor in the absence of his CPN. The board said that if there was no response to this letter within two weeks, no follow-up letter would have been sent. The mental health nursing adviser considered that asking Mr C to maintain continuity of care was unreasonable, especially at a point when Mr C had not yet been seen by a psychiatrist. They noted that Mr C therefore had no CPN input for four months, which was unacceptable. We upheld this aspect of Mr C's complaint.

Mr C also complained about a weight-loss programme provided by the board. In particular, Mr C complained that he was not provided with recipes as part of the programme, and that the programme was not sufficiently holistic. We took independent advice on this aspect from a nursing adviser. They noted that recipes were not a specific aspect of the programme and considered that it was reasonable for the practitioner to recommend that Mr C use the library to find recipes. They also found that it would not have been appropriate for the practitioner to have supported Mr C with his other issues, including his mental health. We therefore did not uphold this complaint.

Mr C said that whilst the doctors and psychiatrists he saw considered that CBT would be useful for him, when he saw the CBT practitioner, they did not think that it would be suitable. Both the psychiatric and mental health nursing advisers agreed that the CBT practitioner had provided reasonable reasons for their decision that Mr C was not a suitable candidate for CBT. We did not uphold this complaint.

Mr C also complained that the board did not respond reasonably to his complaint. Although we considered that many aspects of the board's complaints handling had been reasonable, we found that it had taken the board a disproportionate length of time to respond to Mr C's complaint. We therefore upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• feed back the adviser's comments to the CPN involved so that the CPN reflects upon their style of report and letter writing;
• take steps to ensure that referrals within the community mental health team are received and appropriately processed;
• review the discharge procedures of the community mental health team, taking into account the adviser's comments;
• review the community mental health team's practice of writing to patients (in similar cases) and giving them two weeks to respond if they wish to have continued community mental health team input; and
• apologise to Mr C for the failings identified in this investigation.

Summary

Mr C, who received treatment for high blood pressure and kidney disease, complained that GPs at his medical practice had not monitored his blood pressure reasonably, and that this had caused damage to his kidneys. In response to Mr C's complaint, the practice said that his blood pressure had been monitored in accordance with the relevant guidelines.

We took independent medical advice. The adviser was satisfied that it was appropriate for the practice to measure Mr C's blood pressure at whatever time he attended for an appointment and noted that there was no requirement in the guidelines stating that blood pressure cannot be taken in the morning, or after a patient's medication has been taken. The adviser considered that both Mr C's blood pressure and kidney function had been monitored with reasonable regularity and in accordance with the relevant requirements. Furthermore, the adviser did not have concerns about the medication prescribed to Mr C by the practice and concluded that there was no evidence that the practice had failed to adequately monitor Mr C's blood pressure or that their actions had contributed to reduced kidney function. We therefore did not uphold this aspect of Mr C's complaint.

Mr C also complained that the practice did not respond reasonably to his complaint. In response to our enquiries, the practice identified that some of the complaint correspondence did not meet a number of the requirements of the Patients Rights (Scotland) Act 2011. The practice told us that the practice manager had undertaken to fully familiarise themselves with the requirements of the Act and that they would update the practice's complaints procedure to reflect the requirements. Although we found that many aspects of the practice's handling of the complaint were reasonable, we were critical that the practice had not followed the guidance in relation to acknowledging complaints and updating complainants after a delay. We therefore upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the practice:

• apologise to Mr C for failing to handle his complaint in accordance with the relevant guidance; and
• provide this office with a copy of their updated complaints procedure.

Summary

Mr C complained about the care and treatment provided to his wife (Mrs A) at Raigmore Hospital. Mrs A needed surgery to dilate and place a stent (a tiny tube inserted into a blocked passageway to keep it open) in the artery in her chest supplying her left arm, to assist with her kidney dialysis. The board were unable to place the stent in a satisfactory position and carried out surgery to remove the stent. This caused internal bleeding and Mrs A was taken to theatre for emergency surgery. The surgery proved too much for Mrs A's vital organs and she died. Mr C raised several concerns about his wife's care and treatment by the board. These included that the board failed to give Mrs A appropriate explanations about the risk of the stent procedure and failed to obtain Mrs A's informed consent for the procedure.

We obtained independent medical advice from a consultant vascular and endovascular surgeon and a consultant interventional radiologist. The board said they did not advise Mrs A of the risk of death, as they consider it to be below the threshold required to be specifically mentioned as a complication. The radiologist adviser said that as Mrs A was unwell and suffered from heart failure and other conditions, the risk that any complication of the procedure would result in very serious consequences for Mrs A was increased. It would, therefore, have been reasonable for the board to have discussed the risk of death with Mrs A. We upheld this part of the complaint.

Both advisers said that the evidence suggested that the board failed to follow their consent procedure, as they only appear to have discussed the stent procedure with Mrs A on the day of the operation. Therefore, Mrs A would not have had adequate time to reflect on the surgical options. We therefore considered that the board failed to obtain Mrs A's informed consent for the procedure. We upheld this part of the complaint.

Recommendations

We recommended that the board:

• feed back our findings on explanation of the stent procedure and informed consent to the staff involved;
• provide us with evidence that a revised consent form has now been implemented;
• ensure that in future, they appropriately advise patients of the risk of death;
• ensure that in future, when they discuss surgical procedures with patients, they give them adequate time to reflect on the information provided before surgery is carried out; and
• provide Mr C with a written apology for the failings identified.