Health

Summary

Miss C complained to us that the time taken by the board to begin an assessment of her son for possible autistic spectrum disorder (ASD) was not reasonable.

Miss C told us that she had raised concerns about her son's development and behaviour with his nursery teacher and her health visitor, and, in particular, her concerns that her son may have ASD. Various referrals for her son to be assessed were then made to the board's community child health services. Miss C considered there was an unreasonable delay by the board in carrying out these assessments.

We took independent advice from our adviser, an experienced paediatrician who specialises in autism and communication disorders, who told us that the community paediatrician involved in assessing Miss C's son and the other professionals involved including speech and language therapy and occupational therapy had provided continued, frequent and supportive contact with Miss C. However, our adviser considered the wait Miss C had for her son's first developmental assessment, a period of ten months, was excessive. Furthermore, our adviser was of the view that it would have been appropriate to consider ASD as a potential diagnosis and to have referred Miss C's son immediately to the board's Autistic Spectrum Community Assessment (the ASCA pathway) at that time.

However, the ASCA pathway was not initiated for four months and, thereafter, Miss C waited another seven months for a diagnostic discussion about her son with the community paediatrician followed by a further lengthy wait for a specialist ASD assessment with the Fife Autism Spectrum Team (FAST), which the adviser considered was unreasonable, particularly in a pre-school child. The adviser also considered that, as a process, the ASCA pathway did not address sufficiently promptly the question of a diagnosis and did not appear sufficiently collaborative with Miss C and her partner as parents.

Although the adviser could not fault the community paediatrician's care of Miss C's son, he was of the view that a multi-disciplinary assessment at an earlier stage would have been helpful, possibly saved time and meant that Miss C and her family would have been better satisfied with the process and the outcome.

In light of the advice we received, we found there was unreasonable delay in the assessment of Miss C's son and, therefore, we upheld the complaint.

Recommendations

We recommended that the board:

• apologise to Miss C for the unreasonable delays identified in this investigation;
• provide evidence of the action taken to address waiting times for assessment and diagnosis for children and young people with suspected ASD; and
• ensure that the comments of our adviser, including the ASCA process, are shared with the relevant staff for consideration.

Summary

Early in 2013, Mr C was seen at Dumfries and Galloway Royal Infirmary as he had been experiencing throat discomfort. The consultant he saw said that no abnormality had been revealed and he discharged him with an assurance that all was well. However, Mr C's throat problems continued and, in July 2013, he found a lump on the side of his neck. His GP referred him urgently to hospital where, on examination, he was found to have throat cancer requiring urgent surgery. Mr C complained to the board who acknowledged that the consultant should have had greater suspicion about Mr C's symptoms and done a more extensive examination. These findings were discussed with the consultant but he remained of the view that it had been appropriate not to diagnose Mr C as having throat cancer.

Mr C complained to us. We investigated and took independent advice from a consultant surgeon who specialised in ear, nose and throat surgery. Our investigation confirmed the board's own findings about Mr C's complaint that the consultant did not show enough suspicion about his symptoms given current accepted risk factors; did not examine him appropriately; and that furthermore, as Mr C's symptoms were untypical of the diagnosis initially given, Mr C should not have been discharged without follow-up. Later, Mr C was not seen within an appropriate timescale as dictated by the urgent GP referral.

Mr C also complained about the board's delay in dealing with his complaints on this matter and we found that this had been the case and that he had not been kept fully updated. In light of this, we also upheld this complaint.

Recommendations

We recommended that the board:

• provide a formal apology for failures in care and treatment;
• ensure that the case is reviewed by the consultant as part of his next appraisal;
• discuss the case at the next Ear, Nose and Throat department's clinical governance meeting so that all members of staff are made aware of the circumstances and can learn from them;
• make a formal apology for the delay and lack of information; and
• consider current complaint response times and assure us that they meet the targets required in stated policy.

Summary

Mr C complained to us that his medical practice had failed to diagnose his heart condition. We took independent advice on this complaint from one of our medical advisers and found that there was no evidence in the medical notes that indicated that the practice had failed to follow up on the symptoms Mr C had reported. There were no recorded symptoms of possible heart problems and so we did not uphold the complaint.

Mr C then wrote to us to complain that some of his consultations with the practice had not been recorded accurately. In view of this, we decided to reopen the case to investigate his complaint that his medical records were inaccurate. We obtained a full historical print out of Mr C's computer record from the practice and considered this along with the information he provided to us. However, there was no evidence that the practice had altered or deleted any of the records of the consultations that he had referred to. Our adviser also considered that the GPs had acted reasonably in summarising the consultations in the computer records. In view of all of this, we did not uphold this complaint.

Summary

Ms C attended A&E at Borders General Hospital in September 2013 with a painful knee following a fall. She was treated conservatively (a non-surgical approach) and underwent physiotherapy. Ms C fell a further two times and in April 2014, she was referred to a hospital in another board area for specialist advice. The specialist there diagnosed her with an injury to one of her ligaments and performed reconstructive surgery.

Ms C complained that healthcare professionals failed unreasonably to diagnose her condition until she was referred to the specialist. She said this meant she did not receive appropriate treatment within a reasonable time and that corrective surgery should have been undertaken a year earlier. As a result of the board's failures, she told us she had periods of immobility, and financial and social difficulties, all of which had a negative emotional impact on her.

After taking independent advice from our medical adviser, we found that the clinical picture was complex and, in the circumstances, the initial assessment was reasonable. We also found that it was reasonable to manage the injury conservatively and that she was referred to a specialist within a reasonable time.

Summary

Mrs C complained that after her late husband (Mr C) was admitted to Crosshouse Hospital for surgery in October 2013, the care and treatment he was shown were inadequate. In particular, she said that he was discharged too early and with inappropriate follow-up. Later, after he had been admitted again (in January 2014) for further planned surgery to create a stoma (a surgically made pouch outside the body), he was not provided with timely or appropriate treatment. She said that it was as a consequence of these failures in his care that Mr C died.

We took independent medical advice from a consultant general and colorectal (bowel) surgeon and found that on the day of his discharge in October 2013, Mr C was reported as well and that his discharge was reasonable. We also found that arrangements were made to see Mr C again in six weeks' time, which was common practice for follow-up in similar circumstances. Afterwards, when Mr C was admitted again for the creation of a stoma, it was found that part of his small bowel was sticking to a surgical connection which had been formed during his operation the previous year. As soon as this was released there was a leak of faeces which caused a serious infection which required an operation the next day. There had been no evidence of a leak until it became apparent. Despite appropriate and timely treatment, Mr C did not recover from the infection, and he died in March 2014. We did not uphold Mrs C's complaint.

Summary

Mr C complained about the care and treatment provided to his late brother, Mr A (who had a significant mental health condition), when he was admitted to University Hospital Ayr with internal bleeding. Following treatment, Mr A was transferred to East Ayrshire Community Hospital with a view to discharging him home a few days later. However, when Mr A's support workers came to the hospital to take him home, they raised concerns about his condition and he was readmitted to University Hospital Ayr. Mr A had further internal bleeding and several weeks later a scan showed that he had had a stroke. He was later discharged to a nursing home, where he became severely disabled and in need of constant attention before his death some six months later.

Mr C complained that if it were not for Mr A's support workers querying his discharge, he would have been sent home and died. Mr C also believed that the result of the stroke would not have been as serious if Mr A had received adequate care and treatment sooner. Mr C was also unhappy with communication from a stroke consultant about the possibility of stem cell treatment, and the board's response to the complaint, saying it was not an accurate reflection of what happened.

We took independent advice from one of our medical advisers after which we upheld Mr C's complaint. Our investigation found that Mr A was clinically unstable when he was transferred to the community hospital, that healthcare professionals failed to check a blood test before the transfer, and that the stroke consultant's discussion with Mr C unreasonably raised his hopes for curative treatment. However, we found that healthcare professionals had diagnosed Mr A's stroke within a reasonable time. In relation to Mr C's complaint about the board's response to his complaint, we found shortcomings in the board's response and made a recommendation to the board about this.

Recommendations

We recommended that the board:

• inform us of how they intend to ensure the safety of transfers to community hospitals, particularly for vulnerable adults with severe mental health problems such as Mr A;
• provide a copy of the latest audit of the appropriateness of admissions to the community hospital;
• feedback the failings identified in relation to checking a blood test and communication about stem cell treatment to the relevant healthcare professionals;
• bring the failures identified to the attention of relevant complaints staff; and
• apologise to Mr C for the failings this investigation identified.

Summary

Mrs A had been treated in the community for a urinary tract infection, confusion and dehydration, but the treatment did not address her condition and she went into Ayr Hospital for further treatment. Mrs A's daughter (Miss C) then complained on her mother's behalf about nursing care, prescribing of antibiotics (a range of drugs used to fight bacterial infection) and complaints handling.

During their complaints procedure, the board had already acknowledged some failings in the nursing care, and our investigation, which included taking independent advice from our nursing adviser, confirmed these failings. On balance, we upheld this complaint, although our nursing adviser explained that some of the nursing care and treatment was appropriate.

On one occasion during Mrs A's admission she required to be prescribed intravenous (directly into the vein) antibiotics and a medical review had been requested. There was a delay of four hours before a doctor attended to review her, and a further delay of seven hours before the antibiotics could be given as that doctor did not write up a prescription. We took independent advice from our medical adviser, who reviewed the evidence and was critical of these delays.

Miss C also complained that the board had not made a timely response to her complaint. Our investigation found that, while they did not respond within the 20 working days recommended in the NHS complaints handling procedure, there was no evidence of any avoidable delays and Miss C was kept informed. Although some of the communication with Miss C took place at her instigation, overall we found that the handling of her complaints was reasonable.

Recommendations

We recommended that the board:

• take action to ensure that all staff involved in this complaint are reminded of the need for effective communication with patients, relatives and carers;
• review their discharge procedures and documentation to ensure that relevant information is passed on to those involved in a patient's ongoing care; and
• issue a written apology for the additional failings identified during this investigation.

Summary

Mr C complained to the practice that he was concerned that his daughter (Miss A) had been inappropriately prescribed medication for bladder problems. He felt that this was not clinically indicated and was for convenience only, and that Miss A was at risk of side effects from the medication. The practice believed that the medication was appropriate for the symptoms Miss A presented with.

We took independent advice from one of our medical advisers, an experienced GP. Our adviser was satisfied from the medical records that, given Miss A's reported symptoms of urinary frequency and medical history, the medication was appropriate. We found that the practice's actions in prescribing the medication was appropriate and we did not uphold Mr C's complaint.

Summary

Mr C complained to the board that a decision had been taken inappropriately to reduce the number of gluten-free foods available on prescription for his mother (Mrs A) who suffers from a coeliac condition. Previously Mrs A was prescribed 18 units and this had been reduced to 14 units. The board maintained that Mrs A had been appropriately assessed in accordance with national guidelines and in view of her medical condition. We took independent advice from one of our medical advisers, and found that the dietitian had carried out a thorough assessment and that the prescribing of 14 units was appropriate.

Summary

Miss A is profoundly deaf and uses British Sign Language (BSL). Ms C, an advocate, complained on her behalf that the board did not arrange a BSL interpreter for her. We found that Miss A was left in Ninewells Hospital without an interpreter for nearly three days, which was unacceptable. The board had initially tried to get an interpreter, but it was then left to Miss A's family to do so. When they could not, the board arranged for an interpreter to attend. There were also problems in ensuring that interpreters were there at the same time as doctors.

The board agreed it is their responsibility, not that of the patient's family, to try to secure an interpreter. In responding to our enquiries, they told us that staff had been made aware of the complaint and knew the process for booking interpreter services. They had added phone numbers for five interpreters to staff guidance. Ward staff had been reminded to escalate to senior staff if they experienced difficulties securing an interpreter out-of-hours. The board also apologised for not providing an interpreter to support Miss A. After Ms C complained to us, they entered into a legal agreement with the Equality and Human Rights Commission and committed to trying to ensure that every patient with additional communication requirements receives the same level of services as those without such requirements. In view of this, although we upheld the complaint, we did not make any recommendations.

Ms C also complained that wards did not display a poster advertising BSL interpreter services. The board told us that all wards are required to display this, but could not confirm that it was displayed in the wards Miss A was in when in hospital. Because of this, on balance we upheld this complaint. However, we did not make recommendations, as the board now carry out a weekly audit of posters, ensuring that they are displayed in every clinical area.