Health

Summary

Mrs A and her daughters were removed from the GP list following an incident at the practice involving her husband, who was not registered at the practice.

Mrs A's father (Mr C) complained that the decision to remove Mrs A and her daughters from the list was unreasonably severe and lacked transparency and that the removal letter was vague. He also complained that previous problems experienced with a particular receptionist had not been addressed and that the complaints process was lengthy and unclear.

We found that while the decision to remove Mrs A and her daughters from the list was reasonable, the practice did not follow NHS guidance which states that where no warning about the patient's or their representative's behaviour is given within the preceding 12 months, patients can only be removed if the police or the procurator fiscal had been informed of the incident which led to the removal. This did not happen in Mrs A's case. Although we did not uphold this part of Mr C's complaint, we made a recommendation to the practice.

The letter informing Mrs A of her removal reached her on a Saturday and she had an appointment booked at the practice for the following Monday. The letter did not make it clear that this appointment could still go ahead and repeat prescriptions could be issued until Mrs A was registered with a new GP. The practice has now changed the wording of such letters to make the transition arrangements clear. Therefore while we upheld Mr C's complaint in relation to this, we made no further recommendations.

We reviewed the actions taken to address the previous problems that the family had experienced with a particular receptionist and found that these had been appropriately addressed. We did not uphold this part of the complaint.

In relation to the handling of the complaint, we found evidence of delays. Although the delays were not a result of inaction by the practice, Mr C was not kept informed of the reasons or given a timescale by which he could expect their response. We upheld this part of the complaint.

Recommendations

We recommended that the practice:

• remind all relevant staff of the requirements of the NHS guidance on the removal of patients from a GP list;
• ensure that copies of their complaints procedure are readily available to patients and are provided on request;
• remind all staff involved in complaints handling about the timescales set by the NHS complaints handling guidance and provide training if necessary, and that where timescales cannot be adhered to, patients and/or complainants should be provided with meaningful updates;
• reflect upon our view that it was not appropriate to address complaints correspondence to Mrs A when the complaint was being made by Mr C on her behalf and with her consent; and,
• issue a written apology for the failings identified by this investigation.

Summary

Miss C complained about the care and treatment that her partner (Mr A) received at Hairmyres Hospital. Mr A experienced a range of different symptoms and was seen by doctors from various specialisms as a result. He also attended at the A&E department on a number of occasions. Miss C and Mr A were concerned that no diagnosis was reached for Mr A's symptoms and a complaint was made to the board. Miss C was dissatisfied with the response.

After taking advice from a consultant physician and a consultant in emergency care, we did not uphold Miss C's complaint about diagnosis. The advice we received was that the board had carried out all appropriate investigations in the period covered by the complaint and that no physical cause for Mr A's symptoms had been identified.

We also did not uphold the complaint about the board's response to the concerns raised. We found that while this was brief, it addressed the issues raised.

Summary

Mrs C complained about the care her son (Mr A) received at Hairmyres Hospital after he attended the A&E department on three separate occasions. Specifically, that he had a fracture of the scaphoid bone in his wrist which caused him significant pain for over 18 months before it was identified.

In responding to the complaint, the board said that there was a missed opportunity to recall Mr A for a specialist scan which may have diagnosed the fracture.

We took independent medical advice and found failings by staff in A&E and radiology when Mr A attended on the second occasion with ongoing pain over the scaphoid bone. Whilst such fractures can be difficult to diagnose, we considered that the second x-ray showed a mildly displaced fracture which should have been reported by radiology. In addition, we found there was a lack of assessment by a senior member of staff in A&E given the ongoing wrist pain and tenderness over the scaphoid bone.

Recommendations

We recommended that the board:

• apologise to Mr A for the failings identified;
• ensure that the A&E staff involved reflect on the failings identified in this case at their annual appraisal as part of their professional development;
• review their procedures with a view to ensuring there is provision for a senior doctor to review patients who make an unplanned return to the emergency department; and
• share these findings with the radiologists involved in this case and identify any training needs in relation to the reporting of scaphoid fractures.

Summary

Mrs C complained about the treatment she received for her injured hand following a fall. Mrs C attended A&E at Caithness General Hospital. An x-ray was taken the next day and no bone injury found. Further x-rays were taken after Mrs C attended her GP. However, a fracture was only identified seven months later, following a scan. Mrs C complained that she had not been provided with reasonable treatment and that she had not been referred to a specialist within a reasonable timescale.

The board had accepted that they were not meeting the 48-hour target for a formal report to be issued in relation to x-rays and had taken action. They also accepted and apologised for the delay in diagnosing the fracture Mrs C suffered.

During our investigation we took independent advice from three advisers: a consultant in trauma and orthopaedic surgery (adviser 1), a consultant radiologist (adviser 2) and a consultant musculoskeletal physiotherapist (adviser 3).

Adviser 1 noted that the overall orthopaedic treatment Mrs C received was correct but that access to treatment was not as timely as it could have been. This related to the delay in a scan being carried out. However, the adviser also said that the delays experienced by Mrs C would not have altered the treatment or long-term outcome from an orthopaedic point of view.

Both adviser 1 and adviser 2 were of the view that the board's decision to delay carrying out an x-ray until the day after the injury was sustained was not reasonable. Adviser 2 did not agree with the board's policy of waiting on a formal report of an x-ray before taking a further x-ray. The advice we received from adviser 3 was that overall the physiotherapy treatment Mrs C received was reasonable.

The board accepted that they were not meeting the 12-week target for out-patient appointments and apologised that the specialist in this case had been unable to prioritise Mrs C and for the delay in being seen by the specialist. While the board outlined the action being taken, adviser 1 was concerned about the approach being taken by the board to restrict urgent appointments in the orthopaedic clinic and on referring patients to other board areas.

Recommendations

We recommended that the board:

• use the findings of this complaint to develop a multi-disciplinary (orthopaedic, radiology and A&E) action plan;
• feed back the findings of this investigation to the relevant staff;
• consider adviser 1's comments in relation to the approach being taken to restrict urgent appointments in the orthopaedic clinic and on referring patients to another board; and
• provide details of the steps taken/action plan to address how the 12-week target will be met in future.

Summary

Mrs C's mother (Mrs A) was admitted to Raigmore Hospital with a broken arm. Mrs A was transferred to Nairn Town and County Hospital six days later for rehabilitation and discharged home. During this period, Mrs C became concerned that Mrs A had broken her arm again and complained about a number of aspects of the discharge arrangements including the inadequacy of the discharge package. Shortly after her discharge home, staff decided to place Mrs A in a care home because it became apparent that the discharge package was insufficient to help her remain at home safely. Mrs A returned home six weeks later but was later readmitted to Raigmore Hospital, where she died. Mrs C was also concerned that district nursing staff had failed to successfully treat Mrs A's pressure ulcer. Finally, Mrs C complained that the board failed to provide her with a full copy of their internal review of the discharge.

We took independent advice from an orthopaedic adviser and a nursing adviser. We found that the medical care and treatment was reasonable, including the decision to treat the fracture conservatively (giving no medical treatment involving radical therapy or an operation), and that while the fracture did not heal as expected, this did not indicate a further fracture or an unreasonable standard of care. We also found that the pressure ulcer care was reasonable, as was the decision to send a summary of the key findings of the internal review to Mrs C. We therefore did not uphold these aspects of Mrs C's complaints. However, in relation to the discharge we found significant failings around discharge planning and the subsequent package, which meant that Mrs A had to be transferred to a care home for a short period. We therefore upheld this complaint. However, in light of the actions already taken by the board to address these failings, and their acknowledgement and apology to Mrs C, we made no recommendations.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs A about the care and treatment given to Mrs A's husband (Mr A), who had been diagnosed with chronic liver disease. Ms C said that despite regular testing since his diagnosis, there had been a failure to pick up Mr A's deteriorating condition and she was concerned that he had not been offered a liver transplant. Mr A died following discharge from hospital. Ms C also complained about a delay in receiving a response from the board.

We took independent advice from a consultant gastroenterologist (a doctor who specialises in the treatment of conditions affecting the liver, intestine and pancreas). Mr A had been regularly monitored and checked but the nature of his disease was unpredictable and his diagnosis had not always been clear. We also found that Mr A's case had not been appropriate for liver transplant as the severity of his illness (based on an established scoring system) had not been high enough to justify it. We therefore did not uphold this aspect of Ms C's complaint. However, the adviser said that the board should have involved the Macmillan palliative care team at an earlier stage to provide symptomatic help for Mr A and support for his family.

We found that there was an unreasonable delay on the part of the board in responding to Ms C's complaints and in addressing her concerns.

Recommendations

We recommended that the board:

• ensure that the medical staff involved in Mr A's care are informed of the outcome of this complaint;
• review the advice they provide to patients and their families about the hepatocellular carcinoma (liver cancer) surveillance programme and consider providing a relevant leaflet;
• make a formal apology and provide full information of how they intend to address the concerns identified;
• ensure that staff involved in Mr A's care are reminded of the necessity of adhering to the stated complaints policy; and
• confirm to us that they are satisfied that the Macmillan referral process used is fit for purpose.

Summary

Mrs C complained that a dental hygienist carried out a scale and polish procedure inappropriately and that this caused extensive damage to her teeth. We took independent dental advice. We found that there was no evidence to suggest the hygienist failed to carry out the procedure appropriately, or that this had caused damage to Mrs C's teeth. We did not uphold this complaint.

Mrs C also complained that the subsequent treatment and advice she received from a dentist was unreasonable. We were advised that the records indicated that appropriate treatment was provided and correct advice offered. We did not uphold this complaint.

In addition, Mrs C complained about the board's response to her complaint. She felt that they unreasonably disregarded the evidence of the further treatment that she received, which she considered supported her concerns that the scale and polish procedure damaged her teeth. She was also unhappy with the dentist's indication that they offered fluoride treatment for sensitivity when she said it was offered to address the damage to her teeth. We were advised that the further treatment Mrs C required was due to her teeth being worn and not as a result of any unreasonable prior treatment. We were also advised that fluoride treatment is usually offered to treat sensitivity or decay, and not damage to teeth such as that described by Mrs C. We therefore concluded that the board's response was reasonable and we did not uphold this complaint.

Summary

Mrs C complained that when the board decided to change follow-up appointments for some cancer patients from face-to-face appointments to phone appointments, the decision was notified to her in an inappropriate way, that the decision was unreasonable and that there was an unreasonable delay in providing a copy of the discharge letter sent to her GP.

Mrs C received treatment for cancer which was thought to be of low risk of recurrence. She was told she would be followed up for a period of three years at six-monthly clinic appointments. However, before the sixth appointment she was sent a letter informing her that the appointment had been changed to a phone appointment. The letter was undated, on plain notepaper and had no signature or indication of the author.

Our investigation found that the decision to move to phone appointments was reasonable and in line with guidance from the Department of Health. However, the manner in which Mrs C had been notified of this change was unacceptable. The board explained that the consultant in charge of Mrs C's care had drafted a letter to inform patients of the change. It was then circulated to the multi-disciplinary team for review and once approved was sent to Mrs C without being transferred to headed notepaper and having the date, the name of the consultant and their signature added. Since Mrs C's complaint the letter had been amended.

Mrs C did not receive a copy of the GP letter until several weeks after her phone appointment. We considered this and other administrative failures which occurred during the complaints process to be unacceptable.

Recommendations

We recommended that the board:

• issue a written apology for the failings identified during this investigation; and
• review the way complaints correspondence is dealt with to ensure that relevant enclosures are provided and standard letter templates are amended to reflect the situation with the complainant at that time.

Summary

Ms C complained about the care her mother (Mrs A) received from her medical practice.

Mrs A had been experiencing diarrhoea for a number of weeks. The practice had prescribed medication, requested a stool sample and offered referral for a colonoscopy (imaging of the bowel). Mrs A later died in hospital.

We sought independent medical advice. The adviser was satisfied the practice had provided a reasonable standard of care. We therefore did not uphold Ms C's complaint.

Summary

Mrs C complained on behalf of her sister (Ms A). Ms A attended at A&E at Queen Elizabeth University Hospital as she had slumped to the side and had facial weakness. She was discharged with a diagnosis of 'non-organic causes'. Four days later Ms A re-attended the hospital following referral by her GP and at this point was diagnosed with having had a stroke. Mrs C complained that no scan had been carried out on Ms A's first presentation at A&E and that had it been, the stroke may have been diagnosed earlier. Mrs C also complained that staff had relayed to the family that Ms A's symptoms were possibly due to drug or alcohol consumption.

During our investigation we obtained independent medical advice. We found that appropriate tests and assessments had been carried out on Ms A during her first presentation at A&E and that her medical history had been reasonably taken into account. We found that a scan was not clinically indicated at this point and that the likely diagnosis of non-organic causes was reasonable. Overall we found the care and treatment was reasonable. We were, though, critical that staff had relayed to the family that Ms A's symptoms were possibly due to drug or alcohol consumption, however we noted that the board had previously apologised for this. We did not uphold this complaint, but we made a recommendation.

Recommendations

We recommended that the board:

• draw to the attention of A&E staff the importance of not discussing possible causes of symptoms with family whilst investigations within the department are ongoing.