Health

Summary

Mr C complained that the medical practice unreasonably failed to offer his son (Mr A) a referral for varicose vein surgery. Mr C was concerned that this was affecting Mr A's mental health. He was of the view that the practice were refusing to refer him for surgery because of Mr A's mental health problems.

We took independent clinical advice. We found that the practice had carried out a proper examination of Mr A and had noted that his varicose vein was not causing him discomfort. As a result of this, the practice were correct in following the board's guidance on the treatment of varicose veins which said that in instances such as this, varicose veins should be treated conservatively and surgical referrals should not be made. As a result, we did not uphold Mr C's complaint.

Summary

Mr C was referred by his GP for a possible hernia operation. Mr C complained to us that the board failed to arrange his operation within the 12-week treatment time guarantee under the Patients Rights (Scotland) Act and that they failed to advise him of his rights under that Act. He also complained that they failed to arrange his treatment at another health board.

We found that there was a delay in Mr C's case, though this was in arranging his out-patient appointment rather than the operation. We therefore did not uphold Mr C's complaint. However, the board failed to meet the 12-week waiting time target for out-patient appointments but apologised and explained this was because of staff shortages which had now been addressed.

We found delays in the handling of Mr C's complaints to the board and we therefore upheld this aspect of his complaint. The board apologised to Mr C and said they are taking steps to address future delays.

Summary

Miss C complained that her dentist failed to provide her with appropriate dental treatment. Miss C was advised by her dentist that she needed a crown on one of her teeth. She subsequently suffered problems with her tooth and had to receive further treatment. She questioned the advice to place the crown. Miss C also complained about subsequent treatment and the management of her pain during this time as well as the dentist's handling of her complaint.

After receiving independent advice from a dentist, we upheld Miss C's complaints. We found that the dentist failed to provide Miss C with appropriate options, including risks and benefits, and therefore failed to get informed consent. We also found that placing the crown was not the best option, given Miss C's periodontal (gum) disease. Finally, we found that the dentist failed to respond to Miss C's formal complaint in line with the NHS complaints procedure.

Recommendations

We recommended that the dentist:

• review their consent process regarding treatment options, risks and benefits in line with General Dental Council (GDC) standards;
• apologise for the clinical failings identified by this investigation;
• refund the cost of either root canal treatment and a new crown or, if necessary, replacement by means of a denture or bridge on receipt of an appropriate invoice when treatment has been completed;
• refund Miss C the cost of treatments for the crown and x-rays;
• review the complaints handling requirements under the Scottish Government's 'Can I Help You?' guidance; and
• apologise for the failings in complaints handling identified by this investigation.

Summary

Ms C complained to us about the care and treatment she received when she was admitted to the Royal Infirmary of Edinburgh with significant pelvic girdle pain (a collection of uncomfortable symptoms that can cause severe pain due to a misalignment or stiffness of the pelvic joints at either the back or front of the pelvis) in the late stages of pregnancy. She also complained that the board did not reasonably respond to her complaints.

We took independent midwifery advice. We found that the care and treatment provided to Ms C in relation to pelvic girdle pain and pitting oedema (a build-up of fluid under the skin that holds the imprint of a finger when pressed) had been appropriate. We also considered that the pain relief provided to her was appropriate, although we acknowledged that pelvic girdle pain is difficult to manage in severe cases. Ms C's pressure areas had been frequently checked in the hospital and the steps taken once the sore skin on her inner thighs had been noted was appropriate and timely.

However, we found that the board had not followed the guidance from NICE (National Institute for Health and Care Excellence) on caesarean sections as they had not provided her with information in order for her to make an informed choice on her mode of delivery given her concerns and anxiety about childbirth at that time. The delivery plan should have been reassessed when Ms C was admitted to hospital with excessive pain and mental health concerns. There was also a delay in providing her with a swivel turntable and other disabled-friendly equipment and the nursing records indicated delays in emptying her catheter. In addition, Ms C should have had an occupational health review prior to discharge to ensure she was safe to manage and care for her baby at home and had the assistance she required. We therefore upheld her complaint.

We found that there was a delay in the board responding to Ms C's complaint. We therefore upheld this aspect of Ms C's complaint.

Recommendations

We recommended that the board:

• ensure that relevant staff in the maternity unit are aware of our decision on the complaint;
• take steps to ensure that the staff are aware of and understand the NICE guidance in relation to requesting a caesarean section;
• provide evidence that steps have been taken to ensure that moving and handling equipment is easily accessible for staff;
• review the maternity ward to ensure that there is suitable disabled access;
• review the discharge arrangements for women with pelvic girdle pain;
• issue a written apology to Ms C for the failings identified; and
• make the staff involved in the handling of Ms C's complaint aware of our decision.

Summary

Mr C complained to us about the care and treatment his wife (Mrs A) had received from the board. Mrs A had been diagnosed with functional disease (where the functioning of the body is disturbed in the absence of any disease). Her condition deteriorated significantly and she died. A post mortem was carried out and it was found that she had motor neurone disease (a rare condition that progressively damages parts of the nervous system). Mr C complained to us about the care and treatment provided to Mrs A and about the failure to diagnose motor neurone disease.

We took independent advice from a consultant neurologist and a general medical adviser. We found that the initial diagnosis of functional disease had been reasonable and the care and treatment Mrs A had received in relation to this had been excellent. However, when Mrs A then displayed other symptoms that were not typical of functional weakness, staff failed to reasonably investigate these symptoms. It was likely the further tests would have led to a diagnosis of motor neurone disease, although this could not be proved. In view of this, we upheld Mr C's complaints that the board did not provide reasonable care and treatment to his wife and that they failed to diagnose motor neurone disease.

Mr C also complained that the board failed to arrange a package of home care for Mrs A. We found that the actions of staff had been reasonable given Mrs A's initial diagnosis. The correspondence from the board had set out the type of support she would require in the future. We could not say definitively that a diagnosis of motor neurone disease would have been made had the relevant tests been carried out. On balance we did not uphold this aspect of the complaint.

Finally, Mr C complained about the board's handling of his complaint. We did not find failings by the board in relation to the issues Mr C had raised and we did not uphold this aspect of his complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the failings identified;
• ensure that relevant staff are aware of the latest National Institute for Health and Care Excellence guidance, 'Motor neurone disease: assessment and management', which was published in 2016; and
• ensure that relevant staff are aware of the motor neurone disease red flag diagnosis tool.

Summary

Miss C attended her dentist and reported mild discomfort in an upper tooth. Following an examination including x-rays, Miss C was advised that she required either extraction or root canal treatment of the tooth. Miss C chose to proceed with the root canal treatment which was carried out a few weeks later. Afterwards, Miss C experienced pain and swelling that resulted in her attending at the local out-of-hours service, where she received antibiotics for an abscess. Miss C returned to the dentist and was unhappy with the follow-up service.

After taking independent dental advice we did not uphold Miss C's complaint. We found no failings in the care and treatment that Miss C was provided with. The advice we received was that the treatment provided was appropriate and that the risk of the abscess had been covered in the risks and benefits information provided to her.

Summary

Ms C was diagnosed with breast cancer. Following treatment, she decided to have reconstructive breast surgery. Ms C was placed on a waiting list and was told that the Patient Rights (Scotland) Act 2011 applied, which meant that her treatment would start within a maximum of 12 weeks. After 12 weeks, Ms C contacted the board and found out they could not meet the treatment time guarantee. Ms C complained that the board acted unreasonably by failing to meet the 12-week waiting time; that they did not acknowledge her request to meet with the chief officer or medical director; and that they failed to respond to her complaint within a reasonable time.

We took independent advice from a specialist in plastic surgery. We found that the lack of expertise available at the private-sector service provider chosen by the board was a reasonable reason for Ms C not being treated elsewhere. However, it appeared that the board had not taken sufficient steps to consider the provision of treatment by other NHS providers throughout the UK who may have had the required expertise. We determined that the board did not reasonably take into account their statutory responsibility to take all reasonable and practical steps to arrange treatment with other service providers. Also, while the board explained satisfactorily the reasons why Ms C's surgery could not be provided within the 12-week treatment time guarantee, it was unacceptable that she had to take the initiative to find out what was happening once the 12 weeks had passed. We were also concerned about the lack of information provided to us about arrangements the board have in place when they cannot meet the treatment time guarantee within their own area to arrange the provision of treatment by alternative service providers. The board apologised that a meeting was not arranged to address Ms C's complaints. We also found that there was an unreasonable delay in providing a response to Ms C's complaint.

Recommendations

We recommended that the board:

• revise their plastic surgery waiting list letter so that any potential breach of the 12-week treatment time guarantee is made clear to patients;
• inform us of action taken (or that will be taken) to reduce waiting times for breast reconstruction patients;
• inform us of arrangements in place to provide treatment by alternative service providers when they cannot meet the treatment time guarantee for breast reconstruction patients;
• apologise to Ms C for the failings identified in this investigation;
• offer Ms C a meeting with the chief nurse and/or relevant medical director; and
• inform us of the actions taken to deal with complaints in a reasonable time.

Summary

Mr C attended his medical practice with a persistent cough. He was referred for a chest x-ray and breathing tests. His x-ray was clear but he was unable to complete the breathing tests. Mr C's symptoms worsened so he made a further appointment and was prescribed an inhaler. His symptoms further worsened so he made another appointment and was prescribed a different inhaler.

Mr C began to experience hoarseness and a feeling of blockage in his throat. He made an appointment with a different GP, who requested blood tests and x-rays and made an ear, nose and throat (ENT) referral. A biopsy confirmed Mr C had throat cancer. Mr C complained that the initial GP had failed to provide him with appropriate treatment in view of his presenting symptoms.

We sought independent medical advice. They found that the care provided by the practice was of a reasonable standard and was in line with national guidelines. We accepted the adviser's view and did not uphold Mr C's complaint.

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.