Health

Summary

Mr C complained about a delay in being referred for psychology treatment. He was referred to the community mental health team and was seen initially by a consultant psychiatrist and a community psychiatric nurse (CPN). He continued to see the CPN over the following months but it was deemed that no psychiatric follow-up was necessary. However, the CPN subsequently discussed Mr C with the psychiatrist when the Mr C had reported experiencing vivid dreams, and the psychiatrist recommended a referral to psychology. Mr C raised concerns that he was not seen by a psychologist until several months later, when he considered that he should have been referred directly after his initial appointment.

We obtained independent advice from a senior mental health nurse, who did not consider that there was any indication for a psychology referral initially and deemed it reasonable for this to have been proposed when it was. However, the adviser noted that the CPN did not make the referral until almost three months later, despite having indicated that she would progress this. While Mr C was seen by a psychologist within the national 18 week waiting target from referral to treatment, the adviser considered that the delay in making the referral was unreasonable. We were critical that the board did not identify the delay when investigating this complaint and their response inaccurately indicated that the referral had been made around the time it was first proposed. We upheld this complaint.

Mr C also raised concerns about the contribution of a medical secretary at a meeting he attended with the psychiatrist and clinical director to discuss his complaint. He complained that the secretary inappropriately intervened to speak on the psychiatrist's behalf. The minutes of the meeting and the board's response to the complaint confirmed that this happened, although not to the extent described by Mr C. Nonetheless, the adviser considered that the secretary's documented input was inappropriate, noting that she was at the meeting solely as minute taker and should have left any explanations and/or apologies about care and treatment to the professional clinicians in attendance. We also upheld this complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for the delay in referring him to psychology;
• ask the staff involved in Mr C's care to reflect on the findings of this investigation and take steps to ensure that psychology referrals, once deemed appropriate, are progressed without any avoidable delay;
• highlight to complaints handling staff the importance of establishing the facts and accurately reflecting them in complaint responses;
• apologise to Mr C for the psychiatry secretary's inappropriate contributions at his complaint review meeting; and
• ensure clear directions are given to administrative staff taking on the role of minute takers at meetings, setting out the limitations of their role in this regard.

Summary

Mr C complained about the care and treatment he received from the medical practice. In particular, he raised concerns about a specific consultation where he felt that he should have been referred to a psychiatrist due to him suffering from severe depression. He was not referred to psychiatry until around a year later and he considered this to have been to the detriment of his mental health in the interim period. He also complained that the practice had increased his dosage of antidepressant medication to what he considered to be an unsafe level.

We obtained independent medical advice from a GP. They noted that details of the consultation in question had not been recorded and they were, therefore, unable to assess whether a referral to psychiatry was indicated at that time. While they did not consider that there was any indication for a referral at subsequent consultations six and eight months later, due to the fluctuating nature of Mr C's mental health difficulties we could not conclude that the same applied at the time of the relevant consultation. With regard to Mr C's medication, the adviser noted that it was prescribed at dosages within recommended levels and they could find no evidence of unsafe prescribing.

In light of the identified record-keeping failure, we were unable to evidence that Mr C had been appropriately assessed and, in turn, whether the decision not to refer him to psychiatry was reasonable. Therefore, on balance, we upheld the complaint and made some recommendations to the practice relating to record-keeping.

Recommendations

We recommended that the practice:

• apologise to Mr C for the identified record-keeping failure; and
• reflect on the identified record-keeping failure and seek to ensure compliance with the relevant General Medical Council guidance at all times.

Summary

Mr C was experiencing pain in his left knee and was referred to Raigmore Hospital by his GP. Mr C was seen by specialists at a number of appointments over the following two years as his symptoms worsened and began to affect other areas including his back. Mr C complained that the staff caring for him at the board had failed to pick up on his spinal problems or investigate appropriately.

After taking independent advice on this case from a consultant orthopaedic surgeon, we did not uphold Mr C's complaint. The advice we received was that Mr C had appropriate treatment for his symptoms and that thorough clinical investigations had been carried out.

However, we found that after one of his appointments, no clinic letter had been issued (a letter that would be sent from a hospital specialist to the patient's GP). The adviser did not consider that this had any impact on the care provided in Mr C's case, but as this could potentially be significant in other cases, we did make a recommendation to the board about this.

Recommendations

We recommended that the board:

• take steps to ensure that clinic letters are appropriately issued following out-patient appointments.

Summary

Miss C complained that doctors at her GP practice had failed to refer her for appropriate tests in order to diagnose a tumour in her bowel.

After taking independent advice on this case from a GP adviser, we did not uphold Miss C's complaint. The advice we received was that the appropriate guidance had been followed and that there had been no delay in referring Miss C for further investigations.

Summary

Mr C complained about the time he had to wait for a gastroscopy procedure (a procedure where a thin, flexible telescope called an endoscope is used to look inside the gullet and stomach) at Raigmore Hospital. Mr C was referred for the procedure by his GP after he complained of symptoms of indigestion. Mr C was offered an appointment 16 weeks after referral, but when he attended the appointment the procedure could not go ahead as the endoscopy department did not have the required equipment available. Mr C complained to the board about the delay and expressed concern that the anticoagulation medication he was taking (treatment with drugs that reduce the body's ability to form clots in the blood) could have posed a risk to his health in the period while he waited for the procedure. The board apologised to Mr C and noted that the equipment was not available at the previous appointment because of a delay in the return of endoscopes following decontamination.

We took independent medical advice from a consultant physician who was critical that the time between referral and the procedure exceeded the target waiting time set by the Scottish Government. The adviser also noted that the appointment booking process should not have required two interventions from Mr C's GP. The adviser concluded that because of the delay in the procedure, Mr C suffered from his symptoms longer than was necessary, which was unreasonable. In view of this, we upheld this complaint and made two recommendations.

Mr C also complained that the board did not fully address the concerns he raised in his complaint and had exceeded their complaint response time target. The board acknowledged that a letter explaining the delay was not sent in this instance, and stated that staff have since been reminded about the requirement to send holding letters when appropriate. We were critical that, once they had received Mr C's complaint, the board failed to quickly offer Mr C an appointment, and therefore an opportunity was missed to reduced Mr C's waiting time for the procedure. We therefore also upheld this complaint and made four recommendations.

Recommendations

We recommended that the board:

• advise us of the action taken to address the waiting time delays for the endoscopy procedure identified in this case;
• provide evidence that quality improvement work regarding increasing turnaround time for decontamination has taken place;
• feed back our findings in relation to the handling of Mr C's complaint to relevant staff; and
• provide Mr C with an apology for the failings identified in this investigation.

Summary

Mrs C complained about the care and treatment provided following an injury to her shoulder. Mrs C complained that A & E staff at Raigmore Hospital failed to promptly diagnose that she had multiple fractures to her arm. Mrs C also raised concerns that on her subsequent attendance at the fracture clinic, staff failed to carry out a CT scan (a scan which uses x-rays and a computer to create detailed images of the inside of the body) as a matter of urgency. Mrs C complained that the board failed to ensure that she received surgery for her shoulder within a reasonable timescale. Mrs C linked these concerns with subsequent complications in her shoulder, which led to further surgery. Mrs C complained that the board failed to provide reasonable care and treatment at the further operation she received approximately nine months after her shoulder injury. Mrs C also raised concerns about whether the board appropriately investigated her complaints.

The board said A & E had assessed and managed Mrs C appropriately. The board also considered Mrs C received a CT scan within a reasonable timeframe. The board said emergency admissions impacted on the timescale for Mrs C's surgery; however, they said she ultimately received treatment within an appropriate timescale. The board said the timescales did not impact on Mrs C's recovery. The board did not comment on Mrs C's concerns about the care and treatment provided at the second operation.

After receiving independent advice from an orthopaedic surgeon, we did not uphold Mrs C's complaints about her care and treatment. We found the A & E diagnosis had been reasonable as documented in the medical records. We found the timescales for receiving the CT scan and the surgery were reasonable. We found that it was not likely that these timescales caused Mrs C's slow recovery. We also found that the care and treatment provided at the second operation was reasonable.

We upheld Mrs C's complaint about the board's handling of her concerns. We found that, given the nature of the concerns raised, the board should have investigated further. We recommended that the board apologise to Mrs C, and remind staff of the requirements of the Scottish Government's 'Can I help you?' guidance.

Recommendations

We recommended that the board:

• apologise for the failings identified by this investigation; and
• remind relevant staff of the complaints handling requirements under the 'Can I help you?' guidance.

Summary

Mr C has suffered from spondylolisthesis (where a bone in the spine slips out of position, either forwards or backwards) for a number of years. After his lower back pain became worse his GP referred him for physiotherapy. Mr C attended an appointment with a physiotherapist and was told to self-manage his condition by undertaking core stability exercises and maintaining posture awareness. Mr C had previously found massage therapy to be beneficial to him and he was unhappy that this treatment was not offered to him despite his requests. Mr C had previously obtained massage therapy privately but no longer had the resources to do so.

Mr C wrote to the board to complain that the exercises recommended by the physiotherapist were not helping his condition. Mr C stated that he had obtained private treatment (for massage therapy) on occasion, and that he believed that this treatment should be offered by the NHS. The board investigated Mr C's complaint and concluded that whilst massage therapy can help lower back pain for short periods of time, the exercise programme recommended to Mr C was the most appropriate for managing his condition.

After taking independent medical advice from a musculoskeletal out-patient physiotherapist, we did not uphold Mr C's complaint. The adviser concluded that it was reasonable of the board to refuse Mr C massage therapy as there was limited evidence to support the effectiveness of the treatment in managing chronic lower back pain. The adviser also thought that the exercise programme treatment that was recommended to Mr C was reasonable. In view of this, there was no evidence that the board had unreasonably refused to offer Mr C massage therapy and we did not uphold the complaint.

Summary

Mrs C complained about care she received from the medical practice when she attended with an injury to her toe. Mrs C has diabetes which makes foot complications more common and harder to treat. Mrs C had been prescribed an antibiotic to treat the infection but she had returned to the practice around a month later as she was still in pain, at which point she was referred to hospital. She had to have emergency surgery, resulting in the amputation of her big toe. Mrs C said that she had attended the practice three times before being referred to hospital and that the amputation could have been avoided if the practice had provided appropriate care and treatment when she had first attended.

The practice said that they had conducted an audit and could not find any evidence that she had attended on the first occasion. We took independent advice from a GP adviser. The adviser considered the records available and found the treatment Mrs C was given was appropriate, and that Mrs C's GP could not have foreseen that Mrs C's condition deteriorated or recurred between the point at which she was prescribed antibiotics and being referred to hospital. We also found no evidence of the initial appointment that Mrs C referred to. We did not uphold Mrs C's complaint.

Summary

Ms C, a voluntary agency worker, complained on behalf of Mr A that the dental care and treatment he had received had been inadequate. We took dental advice which stated that the care and treatment had been appropriate. It noted Mr A had not attended regular dental reviews, which had contributed to the damage to his teeth.

We found that the dentist had acted reasonably and that the care they had provided was appropriate, and we therefore did not uphold this complaint.

Summary

Ms C, a voluntary agency worker, complained on behalf of Mr A that the dental treatment he had received was inadequate. Ms C said Mr A believed the treatment he had received had contributed to tooth decay in his mouth. Mr A asked for compensation for the treatment he said he received.

We took independent dental advice, which stated that Mr A had not received the appropriate dental treatment. The advice noted that Mr A had been fitted with a bridge which had only been partially attached, as it had been supported by only one tooth, rather than two, as would normally be the case. The advice said the bridge was, therefore, always likely to fail. The advice noted, however, that Mr A had not maintained the appropriate level of oral hygiene or attended review appointments which were essential for preventing tooth decay following the fitting of bridge work. The advice stated that on balance, Mr A's dental treatment had been unreasonable, since a bridge should only have been fitted if it could be fully attached.

We found that Mr A's treatment was unreasonable, and he should, therefore, have the cost of his dental treatment refunded.

Recommendations

We recommended that the dentist:

• refund Mr A the cost of the dental treatment;
• provide evidence that the dentist has reflected on the failures in Mr A's care identified in the investigation; and
• apologise for the failings identified in this report.