Health

Summary

Mr C complained that he was prescribed medication that caused an unpleasant side effect. He said he had not been fully informed of the possibility of experiencing this side effect.

We took independent advice from one of our medical advisers, who said that GPs are only required to mention the most common side effects. The adviser said that the patient information leaflet provided with the medication details all the other possible side effects and advises patients to report to their GP immediately if they experience any of these. The adviser also said that it was not certain that the medication Mr C complained about was what was causing the side effect. In light of the advice received we did not uphold the complaint.

Summary

Mr C suffers from cerebral palsy, has a history of bladder problems and is confined to a wheelchair. He was admitted to the Southern General Hospital with swollen feet, pain and discomfort. Mr C said that during his admission he was offered no practical nursing care at all and his friend, an elderly woman, had to help him on the ward and undress him for an examination. He said he was then left unwashed and unchanged throughout his two-day hospital stay and his visitors had to help with all his personal care needs. He said he asked nursing staff for assistance to shower the morning after his admission, but this was refused. Mr C complained about the standard of nursing care he received, saying that he was not treated with dignity and respect.

We took independent advice from our nursing adviser. We found that the evidence from the medical records indicated that Mr C had an assisted wash just once during admission, which was not reasonable. We also found that nursing staff failed to document what care had been given and had failed to personalise care for Mr C as a patient with specific disabilities. However, as the board had already taken action to address the complaint and ensure improvements, we made no recommendations.

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mrs A), who experienced a sudden and severe headache while on holiday visiting her daughter. Mrs A's daughter arranged for an ambulance to take Mrs A, who has a history of migraines, to A&E at Dr Gray's Hospital.

A junior doctor reviewed Mrs A and referred her to a senior doctor to determine whether a CT scan (a scan that uses a computer to produce an image of the body) would be necessary. The senior doctor reviewed Mrs A a few hours later, decided this was not required and discharged her, advising her to seek help if her condition worsened or did not improve. Mrs A said the doctor told her that it would be safe for her to fly home the next day, but the doctor did not recall saying this. Mrs A flew home the next day and arrived feeling very ill. A few days later she was admitted to hospital where, after further investigations, she was diagnosed with a brain aneurysm (a bulge in a blood vessel in the brain).

Mrs C complained about the care and treatment Mrs A received at A&E. She said that Mrs A was misdiagnosed and her symptoms were not taken seriously due to her history of migraines. She also complained that the doctor inappropriately advised Mrs A that it was safe to fly.

After taking independent advice on this complaint from a medical adviser, we upheld Mrs C's complaint. We found that the senior doctor had failed to properly investigate Mrs A's symptoms in line with relevant guidance and so missed the diagnosis of a brain aneurysm. In relation to whether the doctor had advised Mrs A that it was safe to fly, there was no evidence of this in the medical records and so we could not make any finding.

Recommendations

We recommended that the board:

• issue a written apology to Mrs A, acknowledging the failings our investigation identified; and
• raise the failings we found with the doctor involved for reflection and learning as part of their annual performance review.

Summary

Mr C, who is a solicitor, brought a complaint on behalf of his client (Mrs A) about the service she received after her GP referred her to a psychiatric department. Mrs A complained that the board failed to meet their targets and that her treatment did not meet any reasonable standard of care. She explained that she had requested referral to a psychologist.

During our investigation, we took independent advice from a mental health adviser. The adviser said that the Scottish Government's referral-to-treatment waiting time target of 18 weeks did not apply to mental health services. However, Mrs A had received treatment from a community psychiatric nurse (CPN) 12 working days after they received the referral. She was also seen by a consultant psychiatrist ten weeks after the GP referral. Both these appointments fell within the target times. Mrs A was also offered further appointments with a CPN and a senior charge nurse trained in cognitive behaviour therapy (CBT), but Mrs A declined these.

The adviser said that there were delays in relation to the referral for a psychology assessment to be carried out and, thereafter, in re-referring Mrs A to the local CBT service. We found that both these periods of delays were unreasonable, but we were satisfied that lower intensity psychological therapy had been progressed from the outset and higher intensity therapy was not initiated because Mrs A declined an appointment with the senior charge nurse trained in CBT.

The adviser was also satisfied that the care offered and delivered was reasonable. However, we were concerned that Mrs A had not signed the care plan that had been prepared, and which set out her presenting difficulties, the goals of the nursing care and the interventions planned, and that there was no evidence in the medical records that she had agreed the plan. We were satisfied that it was reasonable to refer Mrs A to a CPN in the first instance and that it had been explained to her that referral to a psychologist was not the only treatment option open to her.

Recommendations

We recommended that the board:

• review Mrs A's case with a view to identifying the reasons for the delay in referral for a psychology assessment and take action to prevent a recurrence; and
• in line with recovery-focused good practice and the principle of participation set out in the Mental Health Act, consider asking patients to countersign their care plans to demonstrate their understanding and agreement, and providing the patient with a copy of the care plan.
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Summary

Ms C complained to us on behalf of her client (Ms A). Ms A met with a health visitor after registering with a local GP. Ms A advised the health visitor that her child had issues with feeding and as a result, had not really been introduced to solid foods. The health visitor noted that Ms A's child was well above the range of weight and length expected for a child of that age. A number of issues relating to the family resulted in the health visitor making contact with the social work department. Ms A's child was voluntarily put into the care of the child's father following a meeting with a social worker and a paediatrician.

Ms A complained about the health visitor's actions and said that she held the health visitor predominantly responsible for the child being removed from her care. Ms A also complained about the way that the board handled her complaint. The board said that the health visitor had carried out her role appropriately and explained that a health visitor cannot be responsible for the removal of a child from its mother's care as they do not have this statutory duty.

We took independent advice from one of our advisers, who is a health visitor. Our investigation found that the health visitor's actions were reasonable on the basis of the information available to her. Some issues around record-keeping were highlighted for professional development but the adviser had no concerns about the health visitor's actions. We did, however, find that the board's handling of Ms A's complaint was unreasonable as they had not fully addressed all her concerns in their response and had not followed their complaints handling procedure.

Recommendations

We recommended that the board:

• highlight the issues regarding record-keeping to the health visitor for professional development;
• apologise for failing to follow their complaints handling procedure in this case; and
• take steps to ensure the investigation and written response to a complaint is in line with their complaints handling procedure.

Summary

Mrs C complained to us about orthopaedic treatment (treatment of conditions involving the musculoskeletal system) that she had on her foot. A surgeon at the Southern General Hospital operated on it twice. The operations were nearly two years apart, and both left her with ongoing symptoms. When her symptoms persisted, she was referred to another surgeon, and had a different operation. This was successful, and Mrs C's symptoms significantly improved. At this point she became concerned about whether the previous treatments had been appropriate, and complained to the board.

The board did not respond to Mrs C's complaint, as they considered it to be outwith their timescales. The surgeon provided a statement, however, in which he reviewed his assessments and treatments for Mrs C. He also referred to clinic appointments that were not appropriately recorded.

We took independent advice on this complaint from one of our medical advisers, a consultant orthopaedic surgeon. He reviewed Mrs C's orthopaedic treatments, and while he was critical that the first surgeon had not maintained appropriate clinical notes, he considered that the operations Mrs C had were appropriate. He said that the operation carried out by the second surgeon was a more complex and risky procedure, and that it was appropriate for alternative approaches to be tried first. He also noted that the last operation was normally only carried out by specialist foot surgeons. Having taken this advice, we decided that the treatment had been appropriate, and that it was reasonable for the first surgeon to try less complex and risky procedures before considering more complex treatment.

Recommendations

We recommended that the board:

• ensure that the doctor involved maintains appropriate clinical records in line with the standards set by the General Medical Council, bearing in mind the comments made by this office, and discusses any learning points at his next appraisal.

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.