Health

Summary

Mr C said that the board failed to follow Scottish Government procedures on NHS continuing healthcare which resulted in his father (Mr A) not being assessed for continuing healthcare when he should have been. Mr C said that if an assessment had been carried out, Mr A would have had care provided by the NHS and would not have had to pay around £45,000 for residential care in a private nursing home.

We took independent advice from one of our medical advisers, who specialises in care of the elderly. We found that Mr A did not meet the criteria for continuing care. Having said that, the process was not as clear as it should have been to Mr C. The board accepted that the decision about whether or not to provide NHS continuing care should be fully explained to the family at the time of an assessment. The board took this issue forward with healthcare staff. Given that the guidance has been superseded and the process changed since June 2015, and that the communication issue had been taken forward by the board, we made no recommendations.

Summary

Mr C received treatment from the board's mental health team over a number of years. He complained to the board about the accuracy of his diagnosis and about frequent changes to his medication. He also questioned whether he should have been prescribed anti-psychotic medication as he felt this had an adverse effect on his condition.

The board met with Mr C to discuss his concerns, but they did not respond to him in writing due to concerns about the impact this may have had on his mental health. Mr C complained about the lack of a formal response to his complaint. He also asked us to investigate his concerns about his medication regime.

We sought independent advice from a medical adviser who is a mental health specialist. We found that the board appropriately assessed Mr C's symptoms and took into account information provided by him when prescribing medication. His medication was altered on a number of occasions as a result of this, but in each case we were satisfied that the board worked in line with national guidance.

We were critical of the board's handling of Mr C's complaint. We acknowledged their concerns about the impact of a written response on his mental health, but we found their approach to be inconsistent because Mr C's consultant had written to him with a detailed report on his condition. We felt that a formal response from the board would have been appropriate and that their communication generally could have been better.

Recommendations

We recommended that the board:

• review their practices for monitoring side effects for patients being treated for schizophrenia and ensure that they are working in line with national standards;
• apologise to Mr C for their poor handling of his complaint; and
• review their handling of Mr C's complaint with a view to improving the quality and consistency of their communication with patients with mental health issues.

Summary

Mr C complained because he felt the care and treatment he received from the prison health centre was unreasonable. In particular, Mr C said that since taking his prescribed methadone he had been feeling ill. Mr C said a doctor concluded that he should not be prescribed methadone and made arrangements for an alternative medication to be prescribed. However, before that happened, Mr C was reviewed by another doctor who decided that the prescription for methadone should continue. Mr C was unhappy with that decision because he felt he was allergic to the medication.

The board explained to Mr C that, following review, the doctor considered the symptoms he had were not because of the methadone and there were other potential causes that needed to be excluded. The doctor suggested Mr C undergo further assessment with the mental health team, and offered treatment to reduce the symptoms he was suffering, which Mr C declined. In addition, the doctor concluded that Mr C's symptoms were not severe enough to justify changing treatment.

We took independent advice from one of our GP advisers and asked for their view on whether the care and treatment provided to Mr C had been reasonable. Our adviser considered that Mr C had been thoroughly assessed by the doctor. She also reviewed Mr C's medical records and noted he had a long history of multiple drug misuse. Our adviser commented that, in her view, with Mr C's history of multiple drug misuse and then stopping all drugs in favour of methadone, his symptoms could reasonably be interpreted by the doctor as having been related to drug withdrawal. As such, she said that the options offered to him – mental health assessment and a trial of allergy medication – and the reasons for not prescribing the alternative medication were reasonable. Our adviser commented that she could see no evidence that Mr C was not adequately assessed by an appropriate professional or that the treatment offered was inappropriate.

In light of the evidence available in Mr C's case and our adviser's view, which we accepted, we did not uphold the complaint.

Summary

Ms C, who is an advice worker, complained on behalf of her client, whose husband (Mr A) had died following two hospital admissions at Perth Royal Infirmary a short period apart. Mr A had suffered two strokes in quick succession. Ms C complained that he had not been diagnosed quickly enough with a stroke on his first admission. On his second admission, Ms C complained that Mr A was not provided with medical review quickly enough and that nursing staff were slow to address his obvious pain and distress. As a result, although the family accepted that his second stroke was terminal, Ms C said that they were subjected to an unnecessarily distressing and undignified experience.

We took independent advice from a nursing adviser and a medical adviser. The medical advice stated that Mr A had received the appropriate medical care on both admissions. On his first admission, he had presented with a complex combination of medical problems, including pneumonia and infection. The decision had been taken to stabilise his condition, which was reasonable in the circumstances. Our adviser said that his stroke had been diagnosed inside a reasonable time-frame. During his second admission, we found that Mr A had been provided with a medical review within the limits imposed by the responding doctor's clinical commitments. Our nursing adviser said there were shortcomings in the nursing care provided to Mr A, but that the board had recognised and apologised for these. The board had provided an action plan, which our adviser felt addressed the shortcomings identified and were able to evidence that it was being put into action.

We found that Mr A had received reasonable medical care, although his nursing care had fallen below a reasonable standard. In view of the actions already taken by the board, however, we made no recommendations.

Summary

Mr C complained about the care and treatment that his wife (Mrs C) had received from the GP practice before her death from bowel cancer. Mr C said that Mrs C had attended the practice on a number of occasions over a three-year period with abdominal pain. He said that the practice had failed to provide Mrs C with appropriate treatment and had delayed in referring her to a specialist.

We took independent advice on Mr C's complaint from one of our medical advisers, who is a general practitioner. We found that Mrs C had initially attended the practice on a number of occasions with heart burn/dyspepsia (persistent or recurrent abdominal discomfort or pain located in the upper abdomen). Heart burn/dyspepsia are not clinical symptoms identified in patients presenting with bowel cancer and Mrs C had received appropriate treatment for this.

Mrs C had subsequently attended the practice with symptoms of abdominal pain, change in bowel habit and anaemia. She was then urgently referred to the colorectal service in line with the relevant guidelines and was diagnosed with bowel cancer. We found that Mrs C had attended the practice with two different sets of symptoms, which were not related. The practice had provided a reasonable standard of care to Mrs C and we did not identify any failings. We did not uphold the complaint.

Summary

Ms C complained to us on behalf of her partner (Mr A), who had a history of gastroenterological problems (problems with the digestive system). Ms C had previously complained to the board about the care and treatment that Mr A was receiving from them. Ms C then made a second complaint which was considered during this investigation. Ms C complained that the board had not provided reasonable care and treatment to Mr A in the period covered by the complaint. Ms C was dissatisfied that they had been unable to reach a diagnosis for Mr A's condition, and was also concerned that her previous complaint had impacted on the subsequent care that Mr A received.

After taking independent advice from one of our medical advisers, who is a gastroenterology consultant, we did not uphold this complaint. The adviser considered that, overall, the care and treatment provided by the board was reasonable. We did find that the doctor/patient relationship with one of the consultants who had been treating Mr A had broken down. Following this, although a letter was sent to Mr A's GP explaining the situation, the consultant did not arrange a referral to another consultant. The adviser said this had no impact on Mr A as the GP made a referral instead, but we have made a recommendation to draw this point to the attention of the relevant consultant. We found no evidence that Ms C's prior complaint had affected the medical treatment provided to Mr A.

Recommendations

We recommended that the board:

• bring the adviser's comments about onward referral when the doctor/patient relationship has broken down to the attention of the relevant consultant.

Summary

Ms C complained to the board but was unable to obtain a reply. A short time after we approached the board on her behalf, the board replied to her, and Ms C told us she therefore wished to withdraw her complaint, given that the board's reply had been very detailed and helpful.

Summary

Ms C's child was born with a number of unexplained clinical concerns and a series of tests were undertaken to establish their cause. The child was referred to the department of clinical genetics. Ms C complained about the care and treatment her child received there, in that staff were slow to give her an appointment and then to provide her child's test results. She maintained that little time was taken to explain the disorder or to get to the bottom of the problem. No follow-up appointment was made.

We took independent advice from a consultant clinical geneticist and we found that the child was seen within seven weeks, well within the recommended time frame (of 18 weeks). We noted that the appointment lasted 75 minutes and it was explained that although the test results had been inconclusive, other appropriate steps had been taken. A chromosome test was taken from Ms C and similar testing was recommended for the child's father, and Ms C was given comprehensive information which was later confirmed in a letter. No further appointment was made for the child pending the results of parental testing. While Ms C regularly phoned the department asking for the test results these were not available and the child's father had not been in touch to be tested.

While we acknowledged Ms C's anxiety about her child, there was no evidence to suggest that the care and treatment given were unreasonable, and, accordingly, we did not uphold her complaint.

Summary

Mrs C's late husband (Mr C) was receiving treatment for prostate cancer and had a history of severe allergic reactions. Mrs C complained that, when his condition deteriorated, specialists at the Western General Hospital failed to take into account concerns that the medication to treat the cancer was the cause of the problems. Mrs C said doctors did not listen to her concerns; she said Mr C rapidly deteriorated and then died following a heart attack caused by an allergic reaction to the medication. Mrs C said that she and her husband were not warned about possible side effects of the medication and staff failed to take reasonable action to resolve matters.

We took independent advice from one of our medical advisers. We found that the care and treatment provided to Mr C was reasonable overall and, in particular, that the treatment decisions and management were reasonable. We also found that Mr C died because of heart disease, and there was no evidence that he sustained allergic reactions to the medication prescribed. However, we found that there was a lack of evidence showing that possible side effects of the medication was explained to Mr C at the outset of the process, and so we made a recommendation.

Recommendations

We recommended that the board:

• bring the failing in record-keeping to the attention of the healthcare professionals involved.

Summary

Mrs C complained about a lack of communication from clinical and nursing staff when her late father (Mr A) was admitted to Wishaw General Hospital. Mr A was 95 years of age and along with other health problems, he suffered from dementia. Mrs C had power of attorney (a legal document appointing someone to act or make decisions for another person) for her father. Mrs C complained that she was not allowed to remain with Mr A when he was initially admitted to hospital and that staff did not ask her for information about his medical history or the symptoms which he presented with. Mrs C also complained that staff failed to inform the family of the seriousness of Mr A's condition and that a Do Not Resuscitate form had been completed for him.

The board maintained that the level of communication from staff was appropriate and that he received a good standard of clinical treatment and nursing care.

After taking independent clinical and nursing advice from a consultant geriatrician and a senior nurse, we upheld Mrs C's complaints about the lack of communication from staff towards Mr A's family: we found that this had had a detrimental effect on the level of clinical treatment and nursing care which he received. We found that Mrs C would have been a valuable source of information to the clinicians and nurses and that would have assisted in the delivery of appropriate care and treatment. Generally, the level of clinical treatment and nursing care which was provided was appropriate for a patient with complex health issues but integral to this is a need for good communication to ensure that staff were aware of Mr A's symptoms and medical history, and that the rationale for their decision-making is communicated to relatives. We also found that there was some confusion between staff about the care and treatment planned for Mr A.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings in communication which would have improved their ability to provide Mr A with appropriate clinical treatment;
• ensure that the contents of our investigation are shared with relevant clinical staff in order that they can reflect on their actions and discuss it during their appraisal process;
• apologise to Mrs C for the failings in communication which would have improved their ability to provide Mr A with appropriate nursing care;
• ensure that the contents of this investigation are shared with relevant nursing staff in order that they can reflect on their actions;
• apologise to Mrs C for the failings in general communication from staff regarding Mr A's clinical condition and prognosis; and
• provide an action plan which evidences that lessons have been learned from this complaint.