Health

Summary

Mrs C had been receiving medication prescribed by her medical practice for around ten years. However, the practice reviewed her medication and decided to stop it. Mrs C complained to us about the decision to stop her medication and the practice’s response to her complaint.

We looked at the practice’s complaints file and Mrs C’s medical records, as well as taking independent advice from one of our GP advisers. Relevant guidance stated that medical practices should review medication periodically. We found that the practice had done so, while also taking advice from appropriate specialists. In addition, the practice had offered Mrs C an alternative, which was to receive her medication on a private prescription.

Although the practice’s response to Mrs C’s complaint could have provided some additional information, it dealt with the key point of why they would no longer prescribe the medication to her, which we decided was reasonable in the circumstances. We did not uphold Mrs C’s complaints.

Summary

Mr C had treatment to extract two teeth. Immediately after the treatment, he complained about the treatment received and that the dentist had failed to take reasonable account of his hearing condition. He complained that his dentist took too long to carry out the extractions and that he did not appear able to carry out the extractions. He also said that he had advised his dentist of his need to lip read in order to fully understand what was being said to him. However, during the procedure, the dentist had continued to speak to him with a mask on.

We took independent advice from our dental adviser, who said that the treatment Mr C received was reasonable and appropriate and that, while the extractions had taken some time, this was reasonable in this case. Our adviser explained that guidance issued by Health Protection Scotland requires dentists to wear full personal protection equipment (PPE), including a mask, during any operative procedure. As such, he considered that it would not have been reasonable to expect the dentist to repeatedly stop the procedure and remove his mask to speak to the patient. This would have required the dentist to remove his PPE, undertake hand hygiene and put on new PPE on each occasion that he stopped to speak to the patient. However, we were mindful of Fife NHS Board's advice that requires staff to respect disabilities. We considered that, in the circumstances, consideration should have been given to offering Mr C the services of an advocate/translator/interpreter or similar. This would have ensured that he fully understood what was being said to him during the procedure.

Recommendations

We recommended that the dentist:

• reflect on this case to guide future practice to ensure that a patient's communication needs are being met. In particular, that in a similar situation consideration should be given to offering a patient the services of an advocate/translator/interpreter or similar who could speak to the patient without wearing a mask.

Summary

Mr C raised concerns about the care and treatment he received when he attended the practice in 2014. In particular, he complained that the practice had failed to take reasonable account of his hearing condition. He said the dental nurse had spoken to him while standing behind him and, as a result, he had been unable to lip read. In addition, she had roughly moved his head. He also complained about the handling of his complaint.

During our investigation we found no evidence that the dental nurse had roughly moved Mr C's head or spoken to him while standing behind him. We were satisfied that, in line with the practice's policy, the dental nurse was required to wear a mask during the treatment. We were pleased that the dental nurse had re-read the relevant guidelines to try to prevent a similar situation occurring in the future. However, we considered that had a translator been present, as detailed in Fife NHS Board's policy, Mr C's communication needs would have been fully met.

We were also critical of the handling of Mr C's complaint and we made a number of recommendations to improve how the practice communicates with patients, and how they deal with complaints.

Recommendations

We recommended that the dentist:

• reiterate the apology offered in a letter to this office to Mr C;
• review the Disability Policy to ensure that the communication needs of patients are being met in line with Fife NHS Board's policy on Equality and Human Rights;
• apologise for the failures identified in this case in relation to complaints handling; and
• review procedures to ensure that the practice deals with complaints in accordance with the NHS complaints procedure.

Summary

Ms C complained about the care she received when she attended A&E at Crosshouse Hospital. She also complained about the care she received from the out-of-hours service at Ayrshire Central Hospital. Ms C presented with abdominal pains and was diagnosed with a viral infection. She was prescribed painkillers and anti-sickness medication, and was then discharged. She was later diagnosed with acute appendicitis (inflammation of the appendix) and underwent surgery to have her appendix removed.

We sought independent advice from one of our advisers who specialises in emergency medicine, and one of our GP advisers. They both noted that appendicitis is difficult to diagnose as the symptoms it often presents with are similar to many other, more common, conditions. The views of the advisers were that, on both occasions, Ms C was examined thoroughly and given the correct advice and medication based on her symptoms at the time. Therefore, we did not uphold the complaint.

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.