Health

Summary

Mrs C complained about the care and treatment she received in relation to a range of unexplained neurological (relating to the nerves and nervous system) symptoms. During our consideration of the complaint, Mrs C advised that she had decided to pursue the matter by other means. We decided, in the circumstances, and under the provisions of the Scottish Public Services Ombudsman Act 2002, that we would not consider the matter further.

Summary

Mrs C complained about the standard of treatment her father (Mr A) received from the practice in the final months of his life. Mr A had been diagnosed with bladder cancer in 2012 and had received radiotherapy treatment for this. He remained under the care of a urologist (doctor who specialises in disorders of the urinary tract) and his cancer remained under control until January 2013. At that point, Mr A’s condition deteriorated, and he experienced weight loss and significant pain. At a follow-up urology appointment in August 2013, he was found to have developed untreatable cancer that had spread to his bones and spine. He was admitted to a hospice for palliative care (care provided solely to prevent or relieve suffering) shortly afterwards.

Mrs C complained that her father’s blood sugar levels were not adequately monitored, and that his pain was not managed effectively by the GPs at the practice between early 2013 and September 2013.

We obtained independent advice from one of our medical advisers. We accepted their view that the practice had managed Mr A’s pain in line with national guidance for the control of pain in adults with cancer. We acknowledged that Mr A had experienced significant pain which would have been distressing for him and his family. However, we recognised that pain management in cancer patients can be complex, and it is not always possible to achieve immediate or complete pain relief.

We were also satisfied that Mr A was referred for appropriate specialist investigation and that the practice referred him to the hospice appropriately.

Summary

Miss C raised a number of issues about the time taken by the health board to arrange her appointment for day surgery and that, when it eventually took place, it was outwith the timescales for the Treatment Time Guarantee (TTG) of 12 weeks. Miss C also mentioned that she had told staff she was willing to take a cancellation if that meant earlier surgery but that this was not noted in her records. She was also dissatisfied with the time taken to deal with her formal complaint.

We found that the board had in fact noted that Miss C was willing to take a cancellation and that they had arranged for an earlier admission which would have met the TTG but that it had to be cancelled due to the unavailability of a bed. We found that the board were taking action behind the scenes but this was not adequately communicated to Miss C. We also found that there were delays in the complaints handling and that there was a failure to keep Miss C updated on developments. Therefore, we upheld Miss C's complaints.

We were also concerned to note that the board said that, according to their access policy, they would not routinely contact another health service provider should they not be able to meet the TTG. However, there is a requirement for boards to contact alternative health service providers when they are not able to meet the TTG. We also made a recommendation to the board in this regard.

Recommendations

We recommended that the board:

• apologise to Miss C for the failure to communicate with her adequately about the date for surgery;
• review its access policy to take into account the requirements in the Patient Rights (Treatment Time Guarantee) (Scotland) Regulations 2012; and
• apologise to Miss C for the failings in the way her complaint was handled.

Summary

Mr C underwent an x-ray to investigate back pain he was experiencing. The report of this x-ray also recorded the possible presence of an aortic aneurysm (swelling of the main blood vessel that leads away from the heart and down the body). The report recommended that Mr C's GP arrange for him to be sent for a further ultrasound to assess it further. Mr C was not informed of the presence of the aortic aneurysm and no ultrasound was arranged. Mr C complained that this was unreasonable.

We found that the practice had recognised the error, which occurred because the GP who recalled Mr C for an appointment was not the GP who saw Mr C. In order to prevent this happening again the practice had altered their report handling procedures. The practice apologised to Mr C.

We took independent advice from one of our GP advisers. The adviser confirmed that the practice should have arranged for an ultrasound to be carried out. The adviser was satisfied that the action taken by the practice since the error was brought to their attention was reasonable and sufficient.

We upheld this complaint. However, in light of the action already taken by the practice we had no further recommendations to make in that regard. As their complaints handling procedure was not in line with government guidance, we made a recommendation to address this.

Recommendations

We recommended that the practice:

• ensure that the complaints handling procedure is fully compliant with the Patient Rights (Scotland) 2011 Act and the Scottish Government 'Can I help you?' guidance.

Summary

Mr C's daughter (Ms A) was an in-patient at the Royal Edinburgh Hospital's Child and Adolescent Mental Health Services In-Patient Unit. He raised a number of concerns about the care she received as an in-patient and also the steps taken around her trial return home.

Mr C was unhappy that Ms A had been left unobserved for a period of time that allowed her to self-harm whilst an in-patient, with the level of nursing care that was to be provided for the home trial, and also with the nursing care that his daughter then received at home. As part of our investigation we took independent medical advice from an experienced mental health nurse. Looking at Mr C's complaint about Ms A's care whilst an in-patient, our adviser outlined the importance of taking an effective approach to risk, but said he could not confirm that had happened in this case. The adviser explained that staff had a difficult balancing act in using the least restrictive means necessary when providing care and he said there may have been a phased plan to have reduced observation of Ms A. Although, for that reason, we could not say it had been unreasonable to have reduced Ms A's observation in the unit, we shared the adviser's concerns about the record-keeping and the fact that we could not identify the board's rationale for their actions. Although we did not uphold that specific complaint, we took this into account with our subsequent recommendations.

Mr C also complained that the transition plan for Ms A's trial return home lacked detail and was prepared hurriedly. Our advice largely reflected Mr C's concerns about the plan's lack of detail and we upheld Mr C's complaint. We also upheld his complaints about the lack of clarity regarding the planned level of nursing for Ms A's first day home, and about the nursing care that was ultimately received (the nurse had arrived at Mr C's house considerably later than had been arranged, in which time Ms A had taken action that may otherwise have been avoided). We made five recommendations in total.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified in our report;
• remind staff of the importance of logging incidents - including near misses - on the relevant system in line with their policy;
• take steps to ensure that future transition care planning is done effectively to minimise the risks and maximise recovery for the individual;
• take steps to ensure that future transition care planning is communicated adequately to all relevant stakeholders; and
• remind staff of the importance of accurate record-keeping, in line with the relevant Nursing and Midwifery Council guidance.

Summary

Mr C complained that when he attended the practice in February 2015 for dental treatment he was told that he would have to agree to a new treatment plan as the previous one had lapsed. This meant that Mr C would have to pay additional costs for his dental treatment. However, Mr C said that his costs under the previous treatment plan had been capped and that he had reached the limit and, as such, the outstanding dental treatment should be provided at no extra cost to himself. He maintained that at no time was he told that there was a time limit to complete a course of treatment.

The practice maintained that the previous treatment plan began in August 2013 and that they had to repeatedly send reminders to Mr C to attend for further appointments under the treatment plan. Mr C last received treatment under the plan in October 2014 and the practice wrote to the health board in December 2014 and asked that the treatment plan should be deemed to be closed. The practice maintained that their staff verbally advised Mr C to attend regular appointments in order to complete the treatment plan.

We sought independent dental advice from two advisers. They confirmed that there was no obligation on dental practices to provide written information to patients with advice that should they fail to attend regular dental appointments under an agreed plan then the plan would be closed.

We did not uphold the complaint as we felt on balance that the practice staff had verbally encouraged Mr C to make regular appointments and that there was also an obligation on him to contact the practice if he had difficulty in being available for appointments. It was also noted that the practice now provide patients with written advice about the importance of attending regular appointments to complete an agreed treatment plan.

Summary

Mrs C complained about the treatment received by her late father (Mr A) during two admissions to Hairmyres Hospital and at an interim out-patient appointment. During his first admission, Mr A was diagnosed with cirrhosis of the liver (scarring of the liver). He was then seen by a nurse specialist in an out-patient clinic. He was re-admitted via A&E two days later and was treated for sepsis, but his condition declined rapidly and he died the following day.

Mrs C complained that adequate investigations were not carried out during Mr A's first admission. We obtained independent advice from one of our medical advisers, who considered that Mr A had been appropriately assessed. We did not uphold this complaint. Mrs C also raised concerns that the discharge was not discussed with her family and they were not given information regarding Mr A's new diagnosis. The board agreed that more could have been done and they agreed to discuss this at a forthcoming nurse debrief meeting. However, the adviser noted that this failing still needed to be addressed from a medical point of view. We upheld this complaint.

Mrs C was unhappy that the nurse specialist did not arrange to re-admit Mr A. The adviser said re-admission should have been arranged when results from blood tests taken at the out-patient clinic became available. This did not happen and we upheld this complaint. Mrs C also complained that there was a delay in admitting Mr A when he subsequently attended A&E. The adviser confirmed that Mr A received appropriate treatment during his wait and we did not uphold this complaint. Finally, Mrs C complained of a delay in releasing Mr A's body to the undertaker. We considered that this had been arranged within a reasonable timeframe and we did not uphold this complaint.

Recommendations

We recommended that the board:

• review the communication by medical staff surrounding Mr A's discharge, with a view to making improvements, and report back to us with their findings;
• draw this decision to the attention of the nurse specialist and develop an action plan to address the concern that admission was delayed in this case. They should notify us when this has been done; and
• apologise to Mrs C and her family for the identified delay in arranging to re-admit Mr A to hospital.

Summary

Mrs C complained about the care her late mother (Mrs A) received in Wishaw General Hospital following her hip replacement. Mrs C had been concerned that Mrs A – who had advanced dementia - had become dehydrated while in the hospital, that it had taken too long for her to be discharged and that her urine infection was not treated properly.

Our role was to assess whether the evidence indicated that Mrs A's treatment was reasonable in the circumstances. We took independent medical advice from a geriatrician and a nurse, both of whom felt that clinical staff had been aware of the possibility of dehydration. The medical advice we received was that staff had responded to Mrs C's concerns and had given Mrs A a fluid drip, even though there was no evidence of significant dehydration. Taking everything into account, we did not uphold Mrs C's first complaint.

Both advisers explained that it can take time to make the necessary arrangements to discharge a patient. However, our geriatrician adviser felt that the time taken between the necessary equipment being put in place in Mrs A's home and her being discharged from hospital was too long. We upheld this complaint and made one recommendation. Finally, the medical advice we received explained the difficulty in diagnosing a urinary tract infection. It also outlined the balance to be struck between not over treating somebody with antibiotics and not missing a chance to provide appropriate treatment (the adviser felt that balance had been struck appropriately for Mrs A). While we took account of Mrs C's concerns, we did not uphold her complaint about this.

Recommendations

We recommended that the board:

• remind staff, in circumstances where appropriate arrangements have been made for a patient's discharge, of the importance of taking a proactive approach.

Summary

Mr C complained to the health board that a staff member accessed his patient record without authorisation. Mr C complained to us about the time taken for the board to deal with his complaint, and that the board's response did not answer his concerns.

In replying to our enquiry, the board acknowledged failings in how they had handled Mr C's complaint. Board staff failed to recognise that the internal disciplinary process about the staff member involved was a separate issue from providing a response to Mr C's complaint; this failure led to the delay in responding to Mr C. In addition, the board should have provided Mr C with a clear explanation of how these matters were being dealt with, and that they could not tell him the outcome of the disciplinary process, much sooner than they did. We upheld Mr C's complaint.

Recommendations

We recommended that the board:

• provide us with confirmation that the staff who dealt with Mr C's complaint acknowledge where things went wrong, so they will not repeat these errors in future.

Summary

Mr C raised numerous concerns about the way that the practice dealt with an incident when he attended the practice. There was a difference of opinion between Mr C and the staff about what had occurred. Mr C subsequently had a meeting with the practice to discuss his concerns and he was accompanied by an independent witness. Mr C complained to this office that the practice had failed to provide a note of the meeting or provide specific information relevant to the practice's investigation into his complaint. In particular, he wanted to know whether the practice staff had been spoken to prior to the practice contacting the Medical and Dental Defence Union of Scotland (MDDUS) for advice.

We found that although the practice were trying to be helpful in arranging the meeting, they did not provide all the information which was requested. This appeared to be the result of a misunderstanding by the practice staff. The information would have assisted Mr C in determining whether he was going to consider further action in an effort to resolve his concerns. We also found that the practice had failed to include our contact details in their final letter of response which is a requirement under the NHS complaints procedure. We upheld Mr C's complaints.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings which have been identified in this investigation;
• respond to the issue as to whether staff were spoken to prior to contact with MDDUS; and
• remind staff who are responsible for responding to formal complaints to remember to include our contact details in their final response letters.