Health

Summary

Mrs C complained about the care the board provided to her late husband (Mr C) when he attended the Western General Hospital for a scan. Mr C suffered from terminal cancer and had widespread pain which severely restricted his mobility. Mrs C said that Mr C's consultant had recommended he be transferred to hospital with specialist equipment which she said had not happened. She also complained that the mobile scanning unit was not suitable for Mr C due to his restricted mobility and that it did not have appropriate lifting equipment; and that a record was not made of Mr C having fallen in the mobile scanner unit.

We took independent advice from our nursing adviser and found that, although the consultant did not specify any specialist equipment, he had indicated an ambulance would be appropriate to transport Mr C to the mobile scanning unit, so we upheld Mrs C's complaint that this did not happen. We also found that the board had accepted that Mr C's mobility needs could not be met at the mobile scanning unit because it did not have the equipment he needed for being mobilised. However, we did not identify clear evidence to show that Mr C had fallen, so we did not uphold this aspect of the complaint.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings identified; and
• provide evidence that the learning from this case has been discussed at a multi-disciplinary meeting and fed back to staff.

Summary

Mrs C attended the emergency department at Edinburgh Royal Infirmary with severe back pain and difficulty in walking. She complained that she should have had an urgent scan which would have identified that she needed to be referred for surgery. Mrs C also felt that the examination by the emergency doctor was inadequate.

We took independent advice from one of our advisers who is a consultant in emergency medicine. We found minor shortcomings with some aspects of Mrs C's examination. However, as there was no evidence of major motor weakness, we found that there was no failure in not arranging a scan at that time. We concluded that it was reasonable to discharge Mrs C from hospital with the advice to see her GP for a follow-up.

Summary

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his daughter (Miss A). He said that the practice had failed to act on Miss A's symptoms despite a history of abnormal smears and his view was that there was a delay in diagnosing cancer. Mr C also complained that during her treatment Miss A was asked to re-register with another practice as she had moved home and had therefore moved out of the practice catchment area. The practice had reasoned that Miss A may have needed access to district nurses which they would not have been able to provide if Miss A was outwith their area. Mr C felt this was insensitive.

The practice provided records that showed that they had issued an urgent referral and their view was that they had taken appropriate action. We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. The complaint about treatment was not upheld. The adviser also said that although under the General Medical Services contract the practice had the right to ask Miss A to re-register with another GP as she had moved out of their catchment area, it was inappropriate to ask her to do so given that she was undergoing treatment and that she would be unlikely to need the services of district nurses. Therefore, we upheld the complaint about the timing of the practice’s request to re-register.

Recommendations

We recommended that the practice:

• provide Miss A with a written apology for the timing of their request that she re-register with another practice; and
• review their policy to ensure that any administrative request takes account of the clinical care and any treatment that the patient is undergoing.

Summary

Mrs C complained that her mother (Mrs A) did not receive adequate care during two admissions to hospital. Mrs A underwent surgery in Monklands Hospital to repair a fractured hip, before being transferred to Wester Moffat Hospital for rehabilitation. Mrs C complained that her mother had not been provided with reasonable nutrition at Wester Moffat Hospital, and that there had been a failure to take the appropriate steps in either hospital to prevent the development of pressure ulcers. Mrs C also felt an unacceptable standard of catheter care had been provided at Wester Moffat Hospital and that the board had taken an excessive and unreasonable length of time to respond to her complaint.

We took independent advice from our nursing adviser. The advice we received was that the evidence showed a reasonable standard of nutritional care was provided. Although there were gaps in the records, the board had recognised this failing and taken steps to address it. These gaps were not sufficient to show inadequate nutritional care. The advice said, however, that the standard of skin care was inadequate and nursing staff had failed to implement fully the recommendations of the specialist review of Mrs A's pressure ulcers. This represented an unacceptable standard of care.

Our investigation found that the standard of nutritional and catheter care was reasonable, but the standard of skin care was not. We also found the board's response was unreasonably delayed due to the reduced availability of a key member of staff, and a failure to progress the complaint in their absence.

Recommendations

We recommended that the board:

• apologise for the failings identified;
• provide evidence that the findings of the investigation have been shared with senior staff and the failure by the board to identify inadequacies in the nursing care discussed;
• provide evidence of the on-going SSKIN education and training (a care plan for pressure ulcer prevention) being provided to nursing staff; and
• remind all nursing staff of the importance of responding fully to complaints.

Summary

Mrs C complained about a delay in providing treatment in the ear, nose and throat (ENT) clinic at Wishaw General Hospital. Her GP referred her with a suspected acoustic neuroma (a benign tumour on one of the nerves connecting the inner ear to the brain) and she was frustrated at having to attend multiple appointments before receiving a diagnosis. She was seen first by audiology, then an ENT doctor reviewed her and she attended again for a scan, before being seen by ENT again to discuss the results. These four separate attendances occurred over a five-month period. Her scan result was normal and confirmed that she did not have an acoustic neuroma.

The board treated the audiology and ENT appointments as separate specialist referrals and, therefore, as two separate events for the purposes of treatment time targets. This meant that, in their view, the relevant waiting targets had been met. They noted that referrals to ENT were vetted and, if patients met certain criteria, they were sent to audiology. They advised that audiology can often meet patients' clinical needs and, where this is the case, no onward referral to ENT is necessary.

We took independent advice from both a GP adviser and a consultant ENT surgeon. It was noted that Mrs C's GP had referred her specifically to ENT with a particular concern. We were advised that a direct appointment to audiology was common practice and in line with relevant guidance. However, the board's vetting criteria did not appear to match up with this guidance. The advice we received indicated that it would only be appropriate to treat an audiology appointment as a separate specialist referral if audiology were able to fully investigate and decide on treatment for the concern in question. This was not the case with Mrs C and it appeared that it was always going to be necessary for her to see an ENT doctor in order to be fully assessed. As such, the audiology appointment appeared to be a routine precursor to the ENT assessment and should not have been viewed as a separate event. We concluded that Mrs C's overall wait within the ENT clinic system was unreasonable and we upheld the complaint.

Recommendations

We recommended that the board:

• take steps to ensure that ENT waiting times are accurately categorised and provide us with details of the action taken;
• review their ENT and audiology referral process to ensure it is reasonable and takes account of relevant guidance;
• consider introducing a system of writing to patients when assessment results are normal, to avoid causing unnecessary anxiety for them while waiting for a follow-up appointment to discuss these results; and
• issue a written apology to Mrs C for the failings we found.

Summary

Mrs C's father (Mr A) was diagnosed with cancer, and underwent surgery followed by a course of chemotherapy. About six months later, Mr A began experiencing new symptoms, and a scan was arranged. Mr A was told that the scan showed 'no evidence of recurrence', and he was discharged (with a follow-up planned for four to six weeks). However, Mr A's symptoms continued and he was admitted as an emergency a few days later, and underwent further surgery. While Mr A thought the surgery was to address symptoms resulting from his previous surgery, the surgery found that Mr A's cancer had returned and he was given a purely palliative procedure. Mr A passed away a few months later.

Mrs C was concerned that her father was told he was 'all clear' after the chemotherapy, only to find out his cancer had returned six months after this. Mrs C was also concerned that her father was not given regular scans, and she queried how the scan he was given could show no return of the cancer, when Mr A was found to have cancer just a few days later.

After taking independent medical advice, we upheld Mrs C's complaints. While we found no evidence Mr A was given incorrect information about being 'all clear' from cancer following chemotherapy, there was also no evidence that he was offered information about his prognosis and the high possibility of recurrence at this time. In relation to Mrs C's concerns about scans, we found that the board had undertaken reasonable follow-up of Mr A, consistent with national guidance (which did not require regular scanning). However, we found that, although the scan showed a possibility that the cancer had returned, the consultant surgeon did not share this with Mr A, which was unreasonable.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings our investigation found;
• feed back our findings on the lack of communication and record-keeping about post-treatment prognosis to the surgical and oncology staff involved in Mr A's care; and
• ensure the consultant surgeon involved reflects on the findings of our investigation as part of their next annual appraisal.

Summary

Ms C complained about the care and treatment her late father (Mr A) received at the Royal Northern Infirmary. She said the board failed to provide adequate nursing care for her father and unreasonably failed to diagnose his broken collarbone and stroke.

We obtained independent advice on the case from a nurse adviser and a GP adviser. Our nursing adviser said Mr A's fluid balance and food intake, repeat fall assessments and care planning fell short of what should have been in place. However, she said that even if these areas of Mr A's care had been up to standard, the outcome may not have changed. Our adviser said the board's response to Ms C's complaint was poor and she would have expected the board to have recognised their shortcomings, and to have apologised and ensured lessons had been learned.

Our GP adviser said there was documented evidence in Mr A's medical records of a review of his condition after each of his falls by a clinical member of staff. She noted that the documentation of the examination and assessment was thorough and of a reasonable standard. She said the doctor who attended to Mr A noted his on-going confusion, poor mobility and number of recent falls. The doctor identified that Mr A's condition had deteriorated and arranged transfer to Raigmore Hospital for further investigation. The doctor also identified that Mr A may have had a stroke and correctly referred him to Raigmore Hospital for a scan. Our adviser said this was reasonable management and was in accordance with relevant guidelines.

Recommendations

We recommended that the board:

• feed back our decision on this case to the nursing staff involved;
• remind their nursing staff about the importance of falls assessment and care planning; and
• provide Ms C with a written apology for the failings identified.

Summary

Mrs C complained that the board had neither diagnosed nor treated her eye condition reasonably. She also felt they had not given her sufficient information about medication she was prescribed previously (Mrs C felt she should have been made aware of the possible visual side effect, as her medication was ultimately thought to have contributed to her subsequent eye condition). She was also unhappy with the board's response to her complaint.

Mrs C's complaint made it clear how strongly she felt about this matter and how much her condition had affected her. Although we recognised that and took it into account, our role was to consider whether the board's steps were reasonable in the circumstances at the time. We took independent medical advice from three advisers – a GP, an ophthalmologist (a doctor who examines, diagnoses and treats diseases and injuries in and around the eye) and a rheumatologist. They all thought that medical staff had, overall, taken reasonable steps to diagnose and treat Mrs C's condition. This included the steps taken at her medical practice and also at Raigmore Hospital.

In terms of Mrs C's historic medication, our medical advice was that the side effect she highlighted and appeared to have suffered was very rare and, in addition, it was associated with a pre-existing medical condition Mrs C had. The evidence indicated that she was given the standard information leaflet at the time she was prescribed her medication. Although we recognised that this leaflet may not have been as detailed as Mrs C may have liked, we did not consider this meant that clinical staff had acted unreasonably. In terms of the board's response to Mrs C's complaint, we had to consider whether any inaccuracies, viewed as a whole and within context, were enough to make it unreasonable. Our medical advice was clear that Mrs C had suffered from a rare and complicated condition and this was reflected in the detailed correspondence. Although we recognised that any discrepancies would be frustrating we felt, on the whole, that the board reasonably sought to address Mrs C's queries. We did not uphold this complaint.

Summary

Ms C complained about the standard of nursing care provided to her mother (Mrs A) during an admission to Glasgow Royal Infirmary. Ms C felt her mother had been over-sedated with morphine when she was not in pain; was denied food; and that staff had labelled Ms C as being abusive towards them. The board felt that Mrs A received appropriate nursing care but were aware that Ms C found the situation difficult.

We took independent advice from one of our nursing advisers. Our adviser was satisfied with the level of nursing care provided in relation to the morphine and nutrition issues. It was also recorded that the staff found Ms C to be distressed. We did not uphold the complaint as the nursing care was appropriate and was in line with what the board had explained. However, we acknowledged that Ms C had found the situation distressing.

Summary

Ms C complained that a GP and a nurse had acted unreasonably by failing to provide treatment to remove ear wax. Ms C had attended the practice on three occasions with compacted wax. Initially, her ears were not syringed as it was suspected she may have had an infection. On the third occasion, she was referred to a community-based NHS treatment area for ear irrigation, however, there were no appointments available in the following month. We sought independent advice from one of our nursing advisers. Our adviser found that the evidence indicated that the care and treatment was reasonable and in keeping with best practice. We did not uphold the complaint.

Ms C also complained about the way the practice had handled her complaint. Specifically, she was unhappy that there had been a delay in responding to her complaint, and that the response she received to a 16-page letter was inadequate. Ms C sent two letters - the first was responded to within 20 working days. The second (which raised some new issues) took three months to respond to. We recommended that the practice apologise to Ms C for the delay in responding to her second letter. Following careful review of the practice's response to Ms C's 16-page letter, we concluded that the response was appropriate and adequate. We considered that the overall handling of the complaint was reasonable and, therefore, we did not uphold the complaint. However, as the practice's complaints handling procedure was not in line with Scottish Government guidance, we made a recommendation to address this.

Ms C also complained that a member of reception staff failed to tell the truth about what had happened when Ms C returned to the practice after visiting the NHS treatment area. She was also unhappy that the receptionist discussed confidential information in the waiting room in front of other patients. There was no objective evidence to support Ms C's version of events and, therefore, we could not uphold the complaint. We were pleased to note that the practice had issued reminders to staff about patients not being led to believe that discussions have occurred when they have not. The practice had also reminded staff that discussion of sensitive and confidential information should take place in a private area of the practice.

Recommendations

We recommended that the practice:

• ensure the complaints handling procedure is fully compliant with the Patient Rights (Scotland) 2011 Act and the Scottish Government's 'Can I help you?' guidance; and
• apologise to Ms C for the delay in responding to her second letter.