Health

Summary

Mr C had concerns that action was not being taken to prevent patients, visitors and staff from smoking at entrances to buildings at Monklands Hospital. He tried to report the matter via the contact number displayed on the 'no smoking' signs but no such number existed. When Mr C spoke to staff about the matter they seemed resigned to the fact that smoking outside the premises was an ongoing problem that happened all the time. He complained to the board but their response did not address all the issues he raised, and he brought the matter to us. We upheld his complaint, as we found that the board's response lacked detail and did not address a number of Mr C’s questions.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings which have been identified as a result of our investigation; and
• review their original response and provide Mr C with a further response which addresses the specific concerns which were raised.

Summary

Mrs C was unhappy with a phone consultation she had with an out-of-hours GP. Specifically, Mrs C complained that the GP failed to visit her at home or arrange a visit by another GP, and that the GP terminated the phone consultation and gave an inaccurate account of the phone consultation. In addition, Mrs C complained about the board's handling of her complaint.

We looked at Mrs C's medical records, and took independent advice from one of our medical advisers. We concluded that the service Mrs C received was below a standard that could have been reasonably expected. We found that the GP should have agreed an outcome of the consultation with Mrs C and communicated this to her; in particular, that Mrs C should have been referred for a home visit as she felt unable to travel to the local hospital. In terms of how the board dealt with Mrs C's complaint, we found that their initial responses were in line with their process, and that it was reasonable of them to offer an opportunity to meet with staff to discuss the complaint. However, a delay in concluding the complaint was unreasonable, and it was only after Mrs C had prompted the board that a promised update was provided. We upheld these aspects of Mrs C's complaint. However, given the actions already taken by the board to resolve these matters, we did not make any recommendations.

In relation to Mrs C's complaints about what happened during the phone consultation, we found that there was no audio recording of the call. Where there are differing accounts of what was said or what happened in a particular situation, it can be difficult to prove what actually happened. In such cases, we primarily base our findings on written records. As there was no audio recording in this case, there was no way to determine what was said, or how the call was ended. Even then, it would have been difficult to ascertain exactly what caused the call to end. We could not resolve these aspects of Mrs C's complaint given the differing accounts. However, that did not mean we believed one account over another. Given there was insufficient evidence to allow us to reach a finding, we did not uphold these aspects of Mrs C's complaint.

Summary

Ms C, who is an advice worker, complained on behalf of her client (Ms A) about the actions of a health visitor in relation to a burn to Ms A's child's arm. The burn was treated at the time by the child's grandmother, who is a healthcare professional. Some weeks later, the child's GP noticed the burn during a routine visit, and asked the health visitor to visit Ms A. During the visit, Ms A explained that the burn had been caused by an accident with a pair of hair straighteners: she had left the hair straighteners on, thinking they were out of reach of the child, but the child had pulled on the cord, causing the straighteners to fall onto the child's arm. The health visitor was not satisfied with this description and, after consulting with the child's GP, the child protection adviser and the duty social worker, she submitted a Notification of Concern to social work.

Ms C complained that the health visitor acted inappropriately by insisting that social work take action, despite being advised by the child protection adviser and the duty social worker that the child was not at risk. Ms C raised concerns that the health visitor failed to assess the situation appropriately and did not obtain additional information from the previous health visitor or the child's medical practice; that the description of the burn given to social work by the health visitor was inaccurate; and that the health visitor acted unreasonably by failing to inform Ms A before making the referral.

We investigated Ms C's complaint and took independent nursing advice from one of our advisers. We found that the health visitor had followed the appropriate procedures in making the referral to social work, including by appropriately discussing her concerns with the child's GP, the child protection adviser and the duty social worker. Although the health visitor did not follow the advice provided by the duty social worker that a referral was not necessary, we accepted that the decision whether to make the referral was a matter for the health visitor's professional judgment, and we were not critical of this. We also found that the description of the burn which the health visitor gave social work was reasonable in the circumstances. However, we found that the health visitor failed to comply with the relevant policy by not discussing her decision to share information with social work with Ms A, before making the referral. On balance, we upheld Ms C's complaint.

Recommendations

We recommended that the board:

• issue a written apology to Ms A for the failings our investigation found;
• review their guidance on child protection referrals, including both internal and national guidance, to ensure that there are clear and consistent steps for healthcare professionals to follow when considering a child protection concern; and
• raise the findings of our investigation with the health visitor for reflection.

Summary

Mrs C complained on behalf of her late mother (Mrs A) about the care and treatment Mrs A received at Monklands Hospital. She had fractured her neck and was admitted to hospital for conservative management (medical treatment avoiding radical therapeutic measures or operations).

Mrs A had a history of chronic obstructive pulmonary disease (a type of lung disease) and was treated for a chest infection whilst in hospital. She was also found to have fractured ribs. Mrs A's chest condition deteriorated and an x-ray revealed a haemothorax (blood in the cavity surrounding the lung). A chest drain was inserted to drain the fluid, and she was transferred to the High Dependency Unit for several days then transferred back to the ward when her condition stabilised. However, a few days later she suffered a rapid deterioration and died.

We took independent advice on this case from one of our medical advisers who found that the decision to transfer Mrs A back to the ward was reasonable given that her breathing rate, oxygen levels, blood pressure, and heart rate were all stable and met the board's transfer criteria in this respect. We also took independent advice from our nursing adviser, and noted that the board had acknowledged that there was delay in a drip being reconnected due to the cannula (intravenous tube) becoming dislodged and that a dose of antibiotics was missed. They provided refresher training for the ward staff, and a member of the nursing staff had apologised to the family. We found this reasonable and our nursing adviser considered that this was not a significant failing that affected the overall outcome for Mrs A.

Although we noted that the board had arranged for staff to have refresher training in relation to chest drains, neither of our advisers identified any evidence of failings with the management of the chest drain. In relation to Mrs C's concerns about staffing on the ward, we found that some of the shifts had lower numbers than planned, but that bank staff and overtime were used to address this, which was reasonable. On balance, we concluded that the medical and nursing care was reasonable.

Summary

Mrs C complained about the treatment she had received from her GP when she reported a lump in her breast. Mrs C attended the medical practice twice before being referred to the breast clinic where she was later diagnosed with breast cancer.

Mrs C said that she should have been referred to the breast clinic sooner and was concerned about the GP's attitude. Mrs C also said that when she was referred, the referral should have been classed as urgent rather than routine.

During our investigation we asked for independent advice from one of our GP advisers. Our adviser found that the GP had conducted a thorough examination of Mrs C and gave her appropriate advice regarding monitoring the lump. The adviser said that it was hard to judge the attitude of the GP through the medical notes, however, based on the record of Mrs C's condition at the time of the referral, and relevant National Institute for Health and Care Excellence (NICE) guidance, a routine referral was appropriate. We did not uphold Mrs C's complaints.

Summary

Ms C, who is an advocate, complained to us on behalf of her client (Mr A) that the board's response to his complaint was inadequate.

Mr A had complained to the board about the conduct of a nurse. The board investigated Mr A's complaint and, in their written response, acknowledged that his experience was distressing and they apologised. The board explained to Mr A that their investigation had been conducted in line with their Management of Employee Conduct Policy, and that they were unable to share any actions arising from the investigation due to the confidentiality of employee matters. In a further letter to Mr A, the board confirmed that he would not be notified of the outcome of any internal board process.

We concluded that it was reasonable in the circumstances that the board did not tell Mr A whether his complaint was or was not upheld. This was because the standard complaints procedure, under which Mr A submitted his complaint to the board, was superseded by the Management of Employee Conduct Policy due to the nature of the allegations made in Mr A's complaint. This was why the board decided they could not tell Mr A whether his complaint about the nurse had or had not been upheld, as to have done so would breach employee confidentiality. Although we thought that they could have explained the sequence of events more clearly, we considered that the board's response to Mr A's complaint provided relevant information that they were able to share with him in the circumstances, and we did not uphold the complaint.

Summary

Ms C had been living abroad but returned to Scotland, although she still had connections overseas. She was experiencing difficult personal circumstances and she was referred for psychiatric review. She received mental health care but complained that her treatment was inadequate and that the board failed to provide appropriate support. In particular, Ms C complained that after a referral to psychological services, it took too long for her to be seen; that although she was frequently suicidal, she was not admitted to hospital; and that there was a general failure to respond to her needs which contributed to her acute mental distress. She said as a consequence, this led to her child being taken into care.

We took independent advice from one of our advisers who specialises in mental health. We found that Ms C's initial assessment and plan were appropriate and a psychiatric review took place on schedule. At times of crisis, there was a good response with reasonable follow-up arrangements being put in place. However, although it was not considered that Ms C required compulsory treatment, her management was complicated by her continuing treatment overseas and her travel between the two countries and, at various times, she declined psychiatric appointments.

However, we found there was an extended delay before Ms C was seen by psychological services and so we upheld her complaint about this. The board had already apologised to Ms C for the delay, so we did not make a recommendation about this, but we did make two other recommendations.

Recommendations

We recommended that the board:

• confirm to us the actions they have taken to resolve the delay identified; and
• confirm to us that they are satisfied that they can meet reasonable waiting times for psychological services.

Summary

Mr C complained to us about the care and treatment he had received from a dentist. He had attended the dentist for emergency treatment, who had extracted a badly broken tooth. Mr C was given an antibiotic and advised to return to the surgery for a more detailed examination to be carried out to assess what other dental treatment was required.

Mr C returned to the dentist two days later and complained of pain and swelling. He said that he had been unable to eat. It was noted that a small swelling was present at the border of the lower jaw and there was pus discharging from the area where the tooth had been extracted. The dentist diagnosed a dry socket (an infected wound at the site of an extraction) and Mr C was prescribed another antibiotic and an antiseptic mouthwash. A dressing was not applied, as this was too uncomfortable for him.

Mr C attended his GP on the following day, as he was still in some pain. He was then admitted to hospital later that day with a submandibular (inside the lower jaw) abscess, which was spreading into the tissue spaces. This was leading to extensive swelling, which was threatening his breathing. He was also suffering from a fever. Mr C was admitted in order that the hospital could drain the infected fluid from the abscess.

There was nothing to indicate the presence of the abscess when Mr C had the tooth extracted on his first visit to the dentist. However, when Mr C attended again two days later, the dentist noted unusual symptoms, including a spreading infection, that did not fit the normal pattern. The development of an abscess of the type Mr C experienced following dental extraction is a very rare occurrence. After taking independent advice from our dental adviser, we found that that the dentist should have arranged an urgent referral to the local maxillofacial surgery department (the specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) when Mr C had returned complaining of pain and swelling, but had failed to do so. In view of this, we found that the dentist did not provide reasonable care and treatment on that occasion and upheld the complaint.

Recommendations

We recommended that the dentist:

• issue a written apology to Mr C for the failings identified.

Summary

Mr A was admitted to the Royal Northern Infirmary for rehabilitation. He was suffering from lung cancer as well as recuperating from a stroke and a broken arm. He had a stoma bag (a surgically made pouch on the outside of the body) as a result of an earlier ileostomy (a surgical procedure on the small intestine). It was hoped that he would be able to recover some of his mobility whilst in hospital, but Mr A became unwell after a few days and was transferred to another hospital, where he later died as a result of a blocked bowel. His daughter (Ms C) complained to us about the care and treatment her father received at the Royal Northern Infirmary towards the end of his life.

We took independent advice on Mr A's care from our nursing adviser. We found that as a result of Ms C's complaint, a significant event review was carried out which included several recommendations and actions to be taken. While we found that there were issues about the lack of end of life care and poor communication with Ms C and the rest of the family, we found that the pain assessment, nursing and stoma care Mr A received was reasonable. We, therefore, did not uphold Ms C's complaint about her father's care and treatment.

Ms C also complained that the board failed to deal with her complaint according to their policies and procedures. As we found that there were considerable delays in responding, we upheld this complaint.

Summary

Mr C complained that the board had failed to provide his partner (Mr A) with appropriate and timely treatment for a needlestick injury (when the skin is accidentally pierced by a needle), when he attended the A&E department at the Southern General Hospital. He said that Mr A had to wait for two and a half hours to see a doctor and that other people who arrived after him were seen before him. Mr C complained that they refused to give Mr A post exposure prophylaxis (PEP - short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure), despite the fact that the needle had been discarded close to the home of an HIV positive drug user. He also said that Mr A was not offered a polymerase chain reaction (PCR) test (a test that can be used to identify HIV) which can be done around ten days after the exposure.

After obtaining independent advice from our medical adviser, we found that the care and treatment provided to Mr A had been reasonable, appropriate and in keeping with standard care. Patients with a community-acquired needlestick injury are not treated as a priority when they attend A&E. It was not unreasonable that some patients with other conditions who arrived after Mr A were assessed before him. The board had acted in line with their guidelines in relation to providing PEP and it was not given because any benefit would have been outweighed by the risk of side effects. It was also appropriate that a PCR test was not used, as another test was available. In view of all of this, we did not uphold the complaint.