Health

Summary

Miss C complained about her labour and delivery at the Princess Royal Maternity Hospital. She said that the labour had been very difficult and that she had not been provided with sufficient pain relief. She also said that she felt the communication had not been reasonable, as she did not recall being offered general anaesthetic and she was unaware that she was going to have a forceps delivery.

During our investigation, we took independent advice from two advisers, an obstetrics adviser and an anaesthetics adviser. We found that the pain relief given to Miss C during her labour and delivery had not followed hospital guidelines, and that this possibly resulted in her having sub-standard pain relief. We found this to be unreasonable care and treatment.

We also found that whilst the record of communication was reasonable, the board had previously acknowledged that the communication was not effective and apologised for this. We upheld Miss C's complaint.

Recommendations

We recommended that the board:

• apologise for the failings in care and treatment identified in this investigation;
• feed back the findings of this investigation to relevant staff, highlighting the importance of following guidelines;
• feed back the findings of this investigation to relevant staff, highlighting the importance of effective communication during labour and delivery.

Summary

Mrs C complained that when she phoned the medical practice for an appointment, she was given neither an appointment nor a phone consultation.

We looked at the practice's records and took independent advice from a GP adviser. As there was no audio recording of the phone calls, we could not determine what was said. There was no evidence that Mrs C was not taken seriously when she was unwell, and we found that she saw a GP the day after she phoned the practice. We did not find that practice staff failed to respond to Mrs C's request for a medical consultation in a reasonable manner and therefore we did not uphold Mrs C's complaint.

Summary

Mr C complained about the treatment he received from his GP practice after a fall in which he sustained a head and neck injury. He thought the practice should have referred him to A&E.

We found the treatment Mr C received was reasonable. He attended the practice without an appointment and was seen by a triage nurse who assessed his injury. He was advised to take pain relief. Mr C later called the out-of-hours service and was given a pain-relieving injection and on-going pain relief. When the medication ran out he went back to the practice, was assessed, and was given more medication.

Mr C returned to the practice and told them he wanted to go to A&E. He attended A&E the same day and had an x-ray, which was clear. He was given advice about lying flat and exercise.

We found the treatment the practice provided was reasonable in the circumstances, given Mr C's presenting symptoms. Mr C's injury was assessed in the normal way by a triage nurse. No serious injury was evident. Mr C was, appropriately, advised to seek further advice should his condition deteriorate. When Mr C was assessed in A&E, no significant injury was found. We therefore did not uphold Mr C's complaint.

Summary

Mr C complained about a nurse in the substance misuse clinic within the prison. Specifically, that when he self-referred, the nurse did not provide him with adequate advice, care and treatment for his reported addiction and self-harm issues. Mr C had particular concerns that he had explained to the nurse that he did not wish to be prescribed methadone (a drug used medically as a heroin substitute) as he had had problems with taking it in the past, and that instead he needed a prescription for a different medication used to treat addiction. He said that the nurse had not passed this information to his psychiatrist. Mr C also said that the nurse had not passed on information about his self-harming to the psychiatrist.

During our investigation, we took independent advice from a mental health nurse. We found that there was no evidence that the information Mr C said that the nurse had failed to pass on to the psychiatrist had ever been disclosed to the nurse. However, we found that no proper assessment and care plan had been completed by the nurse when Mr C attended the substance misuse clinic and considered this unreasonable. We also considered that the nurse's record-keeping was insufficient. In view of these failings, we upheld this aspect Mr C's complaint.

Mr C also complained that the board's handling of his complaint had been unreasonable. We identified that, whilst the board's initial complaint response had been sufficient, they did not investigate Mr C's subsequent complaints. We found that this was unreasonable and not in accordance with national complaints handling guidance. Therefore we also upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• apologise for the failings identified in relation to record-keeping and lack of evidence regarding proper assessment;
• review their process when a prisoner self-refers to the addictions team to ensure adequate assessment and care planning is carried out where appropriate;
• draw the findings to the attention of the nurse;
• apologise to Mr C for not responding to his additional complaints; and
• draw these findings to the staff involved in the local investigation of Mr C's complaint in order to highlight the importance of investigating and responding to all issues complained about in accordance with national complaints handling guidance.

Summary

Ms C had an operation on a toe of her left foot at Forth Valley Royal Hospital. Ms C's foot was put in a plaster cast and when she returned the following month for it to be changed, a member of staff tried to realign the toe contrary to the instructions in Ms C's medical records. We did not take the complaint further because Ms C decided to pursue an alternative way to remedy her complaint.

Summary

Mr C complained about the care and treatment provided to him by the prison health centre. He said that he was not being provided with appropriate pain relief for a number of complex medical problems and his complaints about these issues had not been properly investigated. Mr C said that the GP he saw in prison changed his prescription from that provided to him in the community. Mr C said his mobility and balance had been severely affected.

We took independent medical advice on Mr C's prescriptions. The adviser said that Mr C was properly reviewed and the changes to his prescriptions were in line with national guidance on the management of chronic pain and the prescribing of pain relief within a prison setting. Mr C had been reviewed and his medication discussed with him. The adviser did not find evidence that Mr C had been significantly affected in the ways he described by the changes to his medication.

Our investigation found that Mr C's complaints were responded to promptly and addressed the issues he raised. There was no evidence that complaint procedures were not properly followed.

Summary

Mr C complained about the way the board dealt with his review application for NHS continuing healthcare for his late mother (Mrs A), who was resident in a care home. He also complained about how the board handled his subsequent complaint.

Mr C's application was rejected by the board on the basis that Mrs A did not meet the criteria as set out in the Scottish Government Guidance Circular CEL 6 (2008), the relevant guidance at the time. By the time the board had referred the application to two clinicians for assessment, Mrs A had died. Their assessments were paper based.

We took independent advice from a consultant in medicine for the elderly. They said it could reasonably be interpreted from the wording of the CEL 6 (2008) guidance that a paper based assessment constituted a clinical opinion. The adviser agreed with the findings of the clinicians that Mrs A had not satisfied the criteria for NHS continuing healthcare. The adviser also said that Mrs A's deteriorating health, her admissions to hospital, and the fact that her care home was unable to meet her care needs did not mean that she met the criteria. We accepted that advice.

However, we found that that there were unacceptable and lengthy delays by the board in reaching a decision on Mr C's application, that their review process was slow and disorganised, and that they had not appeared to have taken Mr C's review application and concerns seriously. We also found that there was a failure to communicate effectively with Mr C during the review process. For this reason, we upheld the complaint.

The board had accepted there had been unacceptable delay in responding to Mr C's complaint, for which they had apologised. However, we considered the board's actions were then aggravated by their failure to obtain a suitable person to carry out an independent review of their decision, having said to Mr C that they would do so, which resulted in yet further unreasonable delay.

Recommendations

We recommended that the board:

• issue Mr C with a formal apology for the failings in relation to delay and their communication with him during the review process;
• issue Mr C with a formal apology for their failure to carry out an appropriate independent review and to handle his complaint in a timely manner;
• provide evidence of the review carried out of their patient experience processes in relation to complaints handling; and
• reflect on the comments of the adviser in relation to the need to identify an independent reviewer.

Summary

Mrs C complained that GPs at the medical practice failed to diagnose cholesteatoma (an uncommon abnormal collection of skin cells inside the ear). Mrs C felt the practice had failed to do this over a number of years.

We took independent advice from a GP adviser. We found there was no evidence that Mrs C's consultations with GPs several years ago were linked to her recent consultations in terms of cholesteatoma diagnosis. We also found that the practice's management of Mrs C's case was reasonable during all consultations, and when they noted that her symptoms were not settling they arranged an urgent review with a hospital specialist. There was no evidence of a delay in the referral and we concluded that the care provided to Mrs C was to a reasonable standard given the circumstances at the time. Therefore we did not uphold Mrs C's complaint.

Summary

Mr C complained about the care and treatment he received during a number of admissions to Borders General Hospital.

Mr C was concerned that given previous surgery, he should not have been offered endoscopic retrograde cholangiopancreatography (ERCP, a procedure where a flexible tube is passed into the small intestine). Mr C also complained that the ERCP was not carried out in an appropriate manner and led to the need for further surgery and treatment, which were also not carried out in an reasonable manner.

We took independent advice from a consultant general surgeon. The advice we received was that the care and treatment provided to Mr C was appropriate and reasonable. Mr C suffered a number of recognised complications following what the adviser considered was a reasonable decision to offer him ERCP. The advice we received was that the clinical management decisions made in Mr C's care and treatment were in accordance with accepted good practice. We therefore did not uphold these aspects of Mr C's complaint.

Mr C also complained that he was not given appropriate information about what might happen should the drain fail. We found that the medical records did not detail any discussion held with Mr C about alternatives to ERCP and failed to detail what advice was given to Mr C. We therefore upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• consider reviewing their procedure-specific consent form for ERCP to include a section to record any alternatives to the procedure;
• consider the adviser's comments on the importance of including in the medical records detail of discussions held with patients with regard to treatment options and their potential outcomes and report back to this office on any action taken;
• remind staff of the importance of recording key information given to patients; and
• consider the adviser's comments on the use of a leaflet for patients with information on how to manage surgical drains, including information on what to do if a drain appears blocked and report back to this office on any action taken.

Summary

Mrs C's father (Mr A) was treated with radiotherapy for cancer of the tongue. In the 18 months following his treatment, Mr A received ongoing support from community dieticians and speech and language therapy (SALT), and regular reviews at a joint cancer clinic. During this period, Mr A had increasing difficulty swallowing and suffered from recurrent mouth ulcers and pain. He also had several short hospital admissions with bleeding from the mouth. In June 2014 Mr A was referred back to hospital with weight loss, decreased ability to swallow and stridor (noisy breathing caused by a narrowed or obstructed airway). He underwent endo-tracheal intubation (insertion of a tube to maintain an open airway to the lungs) and was transferred to a different hospital. Mr A passed away about ten days later.

Mrs C complained about the care provided by the practice during this period. She said Mr A's family constantly raised concerns about his weight loss, increasing pain and frailty, but these were not listened to. She said the practice often phoned Mr A (instead of arranging face-to-face appointments) and did not adequately monitor his weight loss and malnutrition. Mrs C was also concerned that the practice did not provide adequate care for Mr A's emotional wellbeing or diagnose him with depression. In addition, Mrs C said the practice refused to refer Mr A back to hospital in late May 2014, and the admission was only arranged when her sister called the specialist nurse directly a few days later.

After taking independent advice from a GP, we did not uphold Mrs C's complaints. We found that the practice provided reasonable care during this period, including responding to Mr A's symptoms (and the adviser noted that many of Mr A's symptoms related to his recent cancer treatment, for which he was receiving specialist care). In relation to emotional support, the adviser said the records did not show any symptoms that should have prompted a diagnosis of clinical depression, and they explained that information on support for cancer patients is normally provided by the hospital (so this is not a specific role for the GP). In relation to Mr A's final hospital admission, we found the practice had arranged appropriate assessments for Mr A and had already begun making arrangements for admission before his daughter called the specialist nurse about this.