Health

Summary

Mr C complained that the board failed to provide reasonable care and treatment following his report of concerns about his testicular health. He also complained that the handling of his complaint about these concerns fell below a reasonable standard.

We took independent advice from a GP adviser. They noted that the actions taken by the doctors who saw Mr C had been in keeping with the appropriate guidelines relating to problems with the testicles. Mr C had been appropriately referred for review by a specialist, although his case did not meet the threshold for an urgent referral. We found that although Mr C had experienced a delay in receiving assessment by a specialist at hospital, this was not the fault of the GP who referred him. When Mr C complained about the delay, the GP contacted the appropriate hospital department and requested an update on Mr C's appointment. We therefore did not uphold Mr C's complaint about the care and treatment provided to him.

In terms of the handling of Mr C's complaints, we found that although the board had exceeded their 20-day target for responding, they kept Mr C informed of the progress of their investigation. We found that the handling of Mr C's complaints was reasonable. We therefore did not uphold this aspect of Mr C's complaint.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Mr A) that he was unreasonably discharged from an ophthalmology clinic at Wishaw General Hospital. Mr A believed he should be reviewed regularly with an ophthalmologist, rather than being seen by his local optometrist.

We took independent ophthalmological advice and found that due to Mr A's late stage glaucoma (a condition where the optic nerve is damaged that can cause blindness) and other underlying health issues it was reasonable for the board to state that there was no further surgical intervention that could be taken. We found that Mr A's optician would be able to review and manage his eyes and that it was not necessary for Mr A to continue to be reviewed at the ophthalmology clinic. Therefore, we did not uphold this complaint.

Summary

Mrs C complained about the care and treatment provided by the board in relation to her varicose veins. She also complained about the board's communication with her.

Mrs C attended an appointment at Wishaw General Hospital with a vascular surgeon to discuss a procedure to treat her varicose veins. She understood she was to undergo a procedure called vein stripping (where the vein is pulled out from under the skin with minimal incision). However, the procedures, performed at Hairmyres Hospital, were radiofrequency ablations (where the vein is heated with radiofrequency energy causing the vein to contract and then close) and stab avulsions (where several tiny incisions are made in the skin through which the varicose vein is removed). Mrs C complained that she should have undergone the vein stripping procedure. Mrs C also raised concerns about the post-operative advice and care provided by the board, in particular concerning dressing and travel.

After receiving independent advice from a vascular surgeon,we upheld Mrs C's complaints concerning communication and post-operative advice. We found that a number of the board's staff gave Mrs C confusing and incorrect information. However, we did not uphold Mrs C's complaint that she should have received the vein stripping procedure. Rather, we found that the procedure performed was the appropriate one for a patient in her circumstances.

Recommendations

We recommended that the board:

• ensure that supporting staff in the vascular surgery department are aware when procedures are updated or changed; and
• ensure that there is a standardised approach to post-operative advice and care for patients following varicose vein surgery.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A) about the care and treatment she had received at Wishaw General Hospital. Ms A suffered a stroke-like episode and was taken to hospital by ambulance. Following medical investigation, Ms A was discharged a few days later with a probable diagnosis of multiple sclerosis (MS). Although her discharge documents detailed this probable diagnosis, Ms A complained that a doctor had made a specific diagnosis of MS and that this was not in line with national guidance which states that MS should not be diagnosed in a general hospital setting. Ms A was also concerned that the medical investigations that were carried out and the delay in referring her to neurology were unreasonable. We also considered whether the handling of and response to the complaint was reasonable.

After taking independent advice from a consultant physician, we did not uphold the complaints regarding medical investigations or neurology referral. We found that the investigations were timely and appropriate for the symptoms that Ms A presented with. We found that board staff had a different recollection of Ms A being advised of the outcome of the medical investigations and that while Ms A was certain that a definitive diagnosis had been provided, staff maintained that this had been probable only. We were unable to determine what had been said at the time in question but found that the medical records made reference to a probable diagnosis of MS. The advice highlighted that Ms A was referred to neurology following discussion with the neurology department which is based at another NHS board. No delay in referral was identified and the board had no control over waiting times for appointments, given that the service is provided out with their area. We did make a recommendation around communication as we found that there were a number of differences between the board's and Ms A's understanding.

Although we found that the board's response to Ms A's complaint addressed the points raised, a failing in the board's investigation was identified. We found that a member of staff that had been present when Ms A was advised of the outcome of the medical investigations had not provided comments before the final decision was issued. While this did not affect the outcome in this case, we considered that the board should have ensured all necessary comments were obtained before reaching a conclusion on the complaints.

Recommendations

We recommended that the board:

• use this case to highlight the importance of clear, effective communication with patients.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of Ms A about a GP home visit when Ms A reported severe dizziness and staggering. Ms A was diagnosed with labyrinthitis (an inflammation of the inner ear), but it was later discovered that she had suffered two minor strokes. Mrs C said that the GP should have considered the possibility of a stroke and admitted Ms A to hospital by ambulance. Mrs C also said that it was unreasonable for the GPs at the practice to prescribe statins (medication used to lower cholesterol in the blood) to Ms A.

We took independent advice and found that the care and treatment provided to Ms A at the home visit was reasonable. It was appropriate to diagnose labyrinthitis and there was no clinical evidence at this point to suggest that Ms A had had a stroke. However, there was an unreasonable delay in making a referral to a stroke unit, and there was a failure to carry out a particular examination which would have been reasonable in light of Ms A's symptoms, which included hypertension. In relation to the prescription of statins, we found that this was reasonable in the circumstances.

Recommendations

We recommended that the practice:

• ensure their systems for sending hospital referrals are such that referrals are sent within a reasonable time, and there is no recurrence of unreasonable delays;
• ensure the relevant GP familiarises themselves with guidelines for the management of hypertension; and
• apologise for the failings identified in this investigation.

Summary

Mrs C complained about the care that her late husband (Mr A) received at Monklands Hospital after attending the emergency department. Mr A was to be admitted to a private room but none was available. He remained in A&E until a suitable room was found. Mr A was later moved to a different area in the hospital, where he fell while in the toilet.

Mrs C complained that Mr A waited in A&E for too long. She was also concerned that the toilet where he fell was not properly equipped and that staff had not taken reasonable steps to help him afterwards. Mrs C also considered that his risk of falls had not been assessed and that the recording and investigation of the incident had not been carried out properly. Finally, Mrs C complained that Mr A's bed was not adjusted for his height quickly enough.

After taking independent advice from a consultant in emergency care, we upheld the complaint about Mr A's wait in A&E. We found that he had waited longer than was reasonable in the circumstances and that the board had already apologised for this. We recommended a review of their policy for escalating cases like Mr A's.

We took independent advice from a registered nurse in relation to Mrs C's other concerns. We did not uphold the complaint regarding a falls assessment as the advice we received was that this had been carried out in A&E with no risk identified. We also did not uphold Mrs C's concerns about the toilet facilities as we received advice that these were reasonable. We found that there were two different accounts of events around Mr A's fall and we were unable to determine exactly what had happened within the scope of our investigation, therefore we did not uphold this element of the complaint. We did, however, uphold the complaint about the initial investigation of the fall. The advice we received was that although it was appropriately recorded, there were missed opportunities to resolve Mrs C's concerns locally. We made two recommendations to address this.

Finally, we upheld Mrs C's complaint about the failure to adjust Mr A's bed. The advice we received was that this was unreasonable in the circumstances and the adjustment can be made easily. We made two recommendations to the board in light of this.

Recommendations

We recommended that the board:

• review the escalation procedure for individual patients awaiting specific beds, taking into account the adviser's comments;
• review the training they have in place for early resolution of concerns and complaints;
• ensure mechanisms are in place for staff to access support from more senior colleagues in the ongoing resolution of complaints;
• apologise for the failure to take the falls assessment into account and adjust the bed in a timely manner; and
• ensure staff are aware of the appropriate considerations when making adjustments to beds.

Summary

Ms C, an advice and support worker, complained on behalf of Ms A. Ms A had developed mobility problems and, after an episode of severe dizziness, was admitted to Hairmyres Hospital and discharged a week later. She then attended the movement disorder clinic for further tests and investigations.

Two months later, Ms A was readmitted to Hairmyres Hospital before being discharged the following week. She was referred to community physiotherapy and visited by them on a number of occasions. She was then referred to out-patient physiotherapy.

Ms C said that had Ms A been allowed to stay as an in-patient for longer and been provided with sufficient support and treatment (as both an in-patient and out-patient), she would have recovered her ability to walk.

We took independent advice from specialists in physiotherapy and in care of the elderly. We found that the standard of physiotherapy provided during both Ms A's admissions to hospital was reasonable, and that the follow-up care was reasonably provided for the second admission. However, there was an unreasonable failure to refer her for appropriate physiotherapy services when she was first discharged from hospital. We found that while the decision to discharge her was reasonable, there were failings in the discharge planning in relation to the provision of physiotherapy in the community. We also were satisfied that the decision to discharge Ms A from her second admission to hospital was reasonable.

Recommendations

We recommended that the board:

• take steps to ensure that all in-patients receiving physiotherapy are appropriately reviewed by the service and, where appropriate, referred for community physiotherapy prior to discharge home;
• bring the failings identified to the attention of the relevant physiotherapy and medical staff involved; and
• apologise for the failings identified.

Summary

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly.

We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint.

Summary

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly.

We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint.

Summary

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly.

We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint.