Health

Summary

Mrs C complained to us about the care and treatment of her son (Mr A) at the Royal Edinburgh Hospital. Mr A was admitted to hospital under a short-term detention certificate when he was having an acute reaction to stress. He was discharged nine days later, but had ongoing contact with psychiatric services. He was readmitted to hospital the following month, and was an in-patient for a month. After he was discharged he continued to be in the care of psychiatric services, and engaged to varying levels with community based staff. Around ten weeks after his discharge Mr A committed suicide.

Mrs C complained that her son's care was not sufficiently coordinated between professionals and teams. She was also concerned that her son had been discharged without a care plan in place and with no support, and said that staff were unwilling to provide her with enough information for her to be able to support her son.

We took independent advice from two of our advisers - a psychiatric nurse and a psychiatrist. The advisers reviewed Mr A's care and treatment and said that Mr A's care had been appropriately coordinated. They said that information about a patient's care and treatment could not always be shared with all family members, but that information was passed on appropriately during Mr A's care. Mr A was given appropriate medication, but at times he had been reluctant to take this. The advisers also explained that, while the medication prescribed may have slowed Mr A down, it would not have lowered his mood. In relation to Mr A's discharge, the advisers said that the discharge process was properly planned and cohesive. On the basis of this advice, we did not uphold the complaint about Mr A's care and treatment.

Mrs C also complained that she had not received a full response to her complaints within a reasonable timescale. She had chased the board for responses, and felt that her concerns were not addressed honestly. She also met with board staff in an effort to get answers. It was nearly two years from when Mrs C first wrote to the board when they finally told her she could contact us. The NHS complaints procedures says that complainants should be told that they can approach us after 40 business days, even if the board have not provided a final response to the complaint by then. We upheld this complaint, as the timescales were not in line with the NHS complaints procedures. We also found that the responses lacked the detail that Mrs C was expecting and did not address all her concerns, which was not in line with good complaints handling.

Recommendations

We recommended that the board:

• apologise to Mrs C for their failure to address her complaints in a timely and appropriate manner.

Summary

Ms C, who is an independent advocate, complained on behalf of her client (Miss A) that the medical practice did not respect Miss A's wish to use an advocacy service. She also complained that the quality of communication from the practice was poor, and that they unreasonably removed Miss A from their patient list.

We took independent advice from a medical adviser and a mental health adviser. The mental health adviser said that Miss A had a right to use an advocacy service and that the evidence showed that, although the practice had tried to engage with Ms C, they had not properly understood the role of the advocacy service and had not respected Miss A's wishes. The medical adviser said that the standard of correspondence fell below a reasonable standard. Letters from the practice were emotive and unprofessional and the practice failed to maintain a professional level of distance. The mental health adviser said that in his view they had not taken enough account of Miss A's mental health issues. We, therefore, upheld the complaints about the practice's engagement with the advocacy service and that the standard of their communication was below that which Miss A had a right to expect. We also found that they failed to direct correspondence to Ms C, despite Miss A's clearly stated wish that this should happen.

We took the view, however, that the practice's decision to remove Miss A from their patient list was reasonable, noting that they had complied with the terms of the standard general medical service contract, by giving written warning to Miss A that they intended to take this action unless she provided them with an emergency contact phone number. We did not find this unreasonable, and did not uphold the complaint as we found that they acted in accordance with national guidelines.

Recommendations

We recommended that the practice:

• provide evidence that all staff have been reminded of the role of independent advocates;
• remind all staff of the need to use appropriate language when communicating in writing with patients;
• review their complaints handling procedure to ensure that complaint correspondence is clearly identified and that it signposts complainants to SPSO at the appropriate stage; and
• apologise for the failings that our investigation identified.

Summary

Ms C complained to us that when she attended A&E at the Royal Infirmary of Edinburgh with sciatica (back and leg pain caused by irritation or compression of the sciatic nerve) she was not provided with appropriate care and treatment and had to take a taxi home at her own expense.

We took independent advice from one of our medical advisers, who looked at Ms C's medical records. We found evidence that Ms C had been properly assessed and that she was given pain relief, with appropriate advice to seek further medical assistance should her condition deteriorate. Our adviser said that there was no clinical reason to admit Ms C to hospital at that time. There was nothing showing that Ms C had raised concerns with staff about getting home from hospital and we took the view that the board's response about being unable to refund her taxi fare was reasonable.

Summary

Mr C complained that he waited too long to see a prison dentist after a crown fell out. He said that he had twice asked to see the dentist and had explained that he was suffering some pain. In response to Mr C's complaint, the board said that they did not consider his dental problem to be an emergency and that his needs would be met by a routine appointment, for which he was placed on a waiting list. Mr C then complained to us as he was concerned the root would be beyond repair if he waited any longer for an appointment. Although he then received treatment, Mr C continued to pursue his complaint with us as he felt he had waited too long for treatment and did not want this to happen again.

We took independent advice on this case from a dental adviser. Although Mr C had asked for an emergency appointment, our adviser considered that he had been appropriately categorised as needing routine dental care even though he had some pain. We found this to be in accordance with guidance to which the board referred when treating prisoners. However, we upheld his complaint as we found that it was four weeks before the crown was re-cemented. We considered this wait to be unreasonably long, and not in accordance with the seven day timescale set out in the guidance for treating routine patients. We also found that there was no documented information to show that Mr C was given advice about pain management while waiting for his appointment. We noted that the Scottish Government will shortly be publishing national guidance for a robust framework for oral health improvement and dental services in Scottish prisons, and made our recommendations in the light of this.

Recommendations

We recommended that the board:

• apologise to Mr C for the unreasonable delay in being seen by the dentist and for the lack of pain relief advice; and
• consider developing a policy for dental care within the prison when the Scottish Government's national guidance is published.

Summary

Mrs C had a hip replacement a few years ago which initially seemed to be successful. In early 2013, Mrs C attended her medical practice with pain in her thigh that was preventing her from bending to put her shoes on or driving. She was prescribed painkillers for a possible muscle or ligament injury and advised to rest. Mrs C's pain continued and she was sent for an x-ray which was reported as normal by a radiologist (a specialist in x-rays). The pain got no better and Mrs C was referred to a specialist. Some months after initially attending the practice, Mrs C contacted them to ask for a referral to a private hospital. Later that month, the practice arranged crutches for Mrs C as she was struggling to walk, and she was seen by the private consultant a few days later. He considered that the x-ray showed a possible issue and made suggestions for further investigations at an NHS hospital. These were carried out the following month and showed that Mrs C's replacement hip had become loose, causing the thigh bone to fracture. Mrs C complained that the practice failed to diagnose the cause of the pain in her thigh.

We took independent advice from one of our medical advisers, who is a GP. The adviser reviewed Mrs C's medical records and said that although the x-ray was normal, the fact that she continued to suffer from pain and visited the practice on several occasions should have prompted them to carry out further

x-rays, particularly when she had to be given crutches to walk. We, therefore, upheld her complaint.

Recommendations

We recommended that the practice:

• ensure that GPs familiarise themselves with the diagnosis and management of hip fracture, paying particular reference to the need to reassess patients who may clinically present with a fracture but have a negative x-ray;
• carry out a significant event meeting to discuss this clinical incident and any lessons that can be learned; and
• apologise to Mrs C for failing to take reasonable steps to diagnose the cause of her pain.

Summary

Mrs C, who is an advice worker, complained to us on behalf of her client (Mrs A), about the care and treatment of Mrs A's late husband (Mr A). A GP from the medical practice had examined Mr A earlier in the day and prescribed antibiotic tablets and a throat spray. Mrs C complained that the GP then failed to reattend Mr and Mrs A's home to visit Mr A when he began having breathing difficulties. Mr A died later that day.

We took independent advice on this case from one of our medical advisers. Our adviser explained that the GP recorded a thorough history and examination in keeping with an upper respiratory infection. She said that the GP examined Mr A's chest and noted that it was clear. With regards to Mrs A's specific concern about the GP's failure to reattend, the adviser reviewed the notes relating to a phone call and was satisfied that it did not contain anything to suggest an increasing severity of Mr A's condition. Based on the advice received, we were satisfied that the GP's care and treatment was reasonable.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr C) following his diagnosis and treatment for cancer in 2010. Mr C was diagnosed with cancer of the oesophagus (gullet), and in November 2010 had chemotherapy (treatment with toxic drugs to kill or reduce cancer cells) and surgery. He attended regular follow-up appointments, firstly with the surgeon who treated him, and then with a nurse specialist from the surgeon's team. During these appointments Mr C reported that he was suffering nausea and 'gagging' when eating and that although he had a reduced appetite, he was forcing himself to eat to try to regain his health. In the late summer of 2012 he became increasingly unwell and his GP referred him back to the surgeon.

The surgeon reviewed Mr C and ordered a computerised tomography scan (CT scan - which uses a computer to produce an image of the body), which took place in early October. As Mr A continued to deteriorate, he was admitted to Raigmore Hospital a few days later. When the scan was reviewed Mr C was diagnosed with a recurrence of his cancer, which was inoperable. He died later that month after being transferred to a hospice.

During our investigation we took independent advice from a medical adviser who is a cancer specialist with experience of oesophageal cancers. Mrs C told us that she was concerned that no CT scan was carried out after surgery to confirm that all the cancer had been removed, and that regular CT scanning was not part of the follow-up programme. The adviser said that there is no scan or test that can definitely say that all cancer has been removed and, similarly, national guidance on the management of oesophageal cancers did not recommend regular CT scanning as no benefit has been found in this. The board's local follow-up protocol mirrored that guidance. The adviser also said that Mr C's ongoing symptoms were common in patients who have had oesophageal cancers, and can take a year or more to settle down. The adviser noted that the symptoms were recorded and monitored and that relevant advice, for example from a dietician, had been given. We were satisfied that Mr C was appropriately followed up and that, when he became unwell, the board took appropriate and timely action to investigate this.

Summary

Mr C complained that a prison health centre unreasonably stopped medication that he had previously been prescribed.

We took independent advice from one of our medical advisers, who reviewed Mr C's medical records. These noted that he said he was tired and having difficulty in waking up, and that the health centre told him that it was not sensible to continue taking the medication (a sleeping tablet). Our adviser said that this medication is only intended for short-term use. In light of the advice we received, we considered that the health centre doctor provided a reasonable standard of care and that the decision to stop Mr C's medication was appropriate in the circumstances.

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mr A) who was not satisfied with the care and treatment provided to his late wife (Mrs A) at the Beatson Oncology Centre. Mrs A was diagnosed with local and secondary breast cancer in 2003 and was treated first with chemotherapy (a treatment where medicine is used to kill cancerous cells) although this had little effect. She was then treated successfully with hormonal therapy. In 2006 a new tumour developed and an alternative hormonal treatment was prescribed. Scans in 2007 showed no progression in the secondary cancer but the tumour had increased slightly. The tumour continued to grow slowly and in 2009 Mrs A's hormonal treatment was changed again, the tumour was surgically removed and she was treated with radiotherapy (a treatment using high-energy radiation). Two years later, scans revealed that the cancer had spread to her liver and she started a course of chemotherapy. Mrs A continued to feel unwell and was eventually admitted to the centre suffering from confusion, breathlessness and swollen legs. Staff tried to find the cause of Mrs A's symptoms but she died about two months later.

Our investigation included taking independent advice from three of our advisers - a consultant oncologist (cancer specialist); a palliative care consultant (end of life care specialist); and a senior nurse. We found that the care and treatment provided to Mrs A had been reasonable, appropriate and timely. When her cancer initially failed to respond to chemotherapy the treatment was changed, and this controlled the progression of the disease in the early stages. When a further tumour was found in 2006, appropriate treatment and follow-up was undertaken. Again, when the cancer was found to have spread, appropriate treatment was started to try to address this, although it was unsuccessful. Overall, the advisers were satisfied that the medical and nursing care provided to Mrs A were reasonable.

There were some problems with communication between staff and Mr A and his family, in particular towards the end of Mrs A's life when the family said that she had been put on an informal end of life care pathway similar to the Liverpool Care Pathway (a protocol used to guide staff caring for patients who are nearing the end of their life, by treating symptoms and trying to ensure patients remain comfortable and die with dignity). The advisers, however, found no evidence in the medical records that Mrs A was put on an end of life care pathway, and were satisfied that the care she received towards the end of her life was appropriate, and took account of her needs and symptoms.

Summary

Mr C requires regular blood sampling due to the medication that he is prescribed. At one appointment there was difficulty obtaining a blood sample and Mr C was in pain. He attended his GP who referred him to a neurologist who diagnosed nerve damage, possibly caused by the attempt to take blood. Mr C complained that the board had not provided him with a reasonable standard of care and that they had not properly responded to his complaint.

We took independent medical advice on this complaint from our nursing adviser. Our investigation found that the board had apologised for the distress caused and had made arrangements for Mr C to have future blood samples taken by another team. We considered these actions to be reasonable and did not uphold the complaint. However, we did not consider the time taken by the board to respond to Mr C's complaint to be reasonable, so we upheld this aspect of his complaint and recommended that the board apologise to Mr C for the delay.

Recommendations

We recommended that the board:

• apologise to Mr C for the time taken to respond to his complaint.