Health

Summary

Mrs C, who lives on one of the Scottish islands, complained that the board failed to repay her full transport and accommodation costs when she escorted her mother to a mainland hospital for in-patient treatment. Mrs C had intended to stay for four nights, then take her mother home but, as her mother was not well enough to leave hospital on the expected date, Mrs C had to return home alone. She was unhappy that, in these circumstances, the board had not paid her full costs.

The board's patient transport policy says that they can only reimburse costs associated with escorting a patient to and from hospital. Mrs C had chosen to stay over, and the board explained that as her mother was not discharged when expected, there was only one approved journey for which an escort was required. They also explained that they can only reimburse accommodation costs when the escort stays and escorts the patient home (provided that the total cost of the stay does not exceed the cost of a second return fare to collect the patient). If the patient is not discharged when expected, accommodation costs cannot be reimbursed, but the board will pay for a second return journey to escort the patient home. We also found that the guidance says that authorised escorts are expected to return home at the earliest opportunity or to stay at their own expense. We noted that the patient travel team had advised Mrs C of the available options before the outward journey. On her return they had said that they would be happy to book a second flight for her to collect her mother, or alternatively if she organised her own flight for this, they would pay her overnight accommodation claim.

We did not uphold the complaint as we found that the board had acted in accordance with their procedures. We noted that although they were of the view that they had provided accurate information before Mrs C travelled, the board had also asked the patient travel team to review the guidance issued to patients and GPs, to ensure that it is as clear as possible for the future.

Summary

Mrs C is 88 years old and has a number of health issues, including osteoarthritis (the most common form of arthritis that affects the joints). After she attended hospital for investigation of a breathing problem, she complained that service staff treated her unreasonably when assisting her to and from their patient transport vehicle. Mrs C also complained that there was an delay in the vehicle arriving to take her home from hospital, and that the service’s handling of her complaint was unreasonable.

As there was no independent evidence of what occurred when Mrs C arrived at the hospital, or when she was returned home, we could not say for certain what happened. However, we noted that the service upheld her complaint about patient transport crew walking her to and from their vehicle when they should have used a wheelchair, and that the methods they used to assist her caused her pain. They also acknowledged that Mrs C was left waiting for a considerable time for transport home from the hospital, and we found that the records in fact showed that she had to wait for almost two and a half hours from when the service logged her as ready for transport. In relation to complaints handling, we saw evidence that the service had taken Mrs C’s complaint seriously, but had accepted that there were delays in their investigation. We upheld all Mrs C's complaints, but as the service had already taken action by apologising, speaking to the staff involved, and amending their records to show the correct type of transport she needs in future, we made only one recommendation.

Recommendations

We recommended that the service:

• ensure there is no unnecessary delay in crews providing statements in response to complaints.

Summary

Mrs C complained about the care and treatment that a hospital provided to her brother (Mr A) after he was admitted with increasing confusion and suspected pneumonia. Mrs C, who was her brother's welfare guardian, was concerned that he was not given enough fluids and food; he was discharged prematurely and was readmitted a few hours later; there was a failure to diagnose his fractured leg; changes were made to his medication; and about poor communication.

After taking independent advice from three of our medical advisers (a nurse, a consultant physician and a consultant psychiatrist), we found that nursing staff did not fully take into account Mr A's specific needs. He had a long standing mental illness and, despite knowing that there was a problem with him eating and drinking, there was no specific information on how to manage this. We found that Mr A's fluid intake was not properly monitored and there was a lack of consideration given to blood test results that indicated possible signs of dehydration.

We did not consider that Mr A's discharge was unreasonable, because dehydration is difficult to diagnose. Hospital staff had taken steps to speak with Mr A's community psychiatric nurse (CPN) to establish his usual behaviour, and it was agreed that the CPN would visit him at home later that day to see if he needed psychiatric review. In addition, when it was known that his blood test results were abnormal, he was readmitted to hospital. Although we could not be certain when Mr A fractured his leg, he was promptly reviewed and diagnosed after bruising and swelling were identified.

We were also of the view that it was appropriate to stop some of Mr A's medication (which had a sedating effect) because this could make his pneumonia worse. However, we considered that medical staff could have explained this to the family when Mr A was first admitted to hospital. In addition, although we found that the hospital obtained appropriate information from Mr A's GP, we thought that nursing staff could have sought advice sooner from the CPN about Mr A's eating and drinking.

Recommendations

We recommended that the board:

• review fluid intake and output monitoring for patients with communication difficulties who have suspected or actual dehydration, and audit their documentation of patients from the ward Mr A was in;
• ensure that the educational and training needs of nursing staff in the ward have been met in terms of holistically managing patients with mental illness;
• draw to the attention of relevant staff involved in Mr A's care the importance of ensuring that relatives, particularly those with welfare guardianship, are fully informed of the reasons for any changes in treatment in a timely manner and that the content of discussions are sufficiently documented; and
• apologise to Mrs C and Mr A for the failings we identified.

Summary

Mrs A lives in a care home and needs 24 hour nursing care as she has numerous medical conditions. Her son (Mr C) considered that her medical and nursing needs met the criteria for continuing care funding (funding provided by the NHS for specialist clinical or nursing treatment) set out in the Scottish Government's guidance document (CEL6). The board assessed Mrs A's needs, but did not consider that she met the criteria for continuing care funding. Mr C appealed this, but funding was again refused. He complained to us about the board's assessment of his mother's eligibility. He did not believe the assessment process had been followed correctly or that he and the professionals who directly care for his mother were sufficiently involved in it.

We found that, in terms of the assessment of Mrs A's clinical and nursing needs, the board took an appropriately multi-disciplinary approach, using a single assessor to gather information and comments from various professionals involved in Mrs A's care. We did not uphold the complaint, as we were satisfied that the board had suitable tools in place to properly assess Mrs A's eligibility for continuing care funding and that the assessor was able to reach a clear, reasoned and evidence-based conclusion. The overall assessment was appropriate and well-documented.

That said, we considered the board failed to properly involve Mr C and the care home in the initial assessment and made recommendations relating to this. We were also critical of their communication and explanations of the assessment process and the purpose of a meeting that Mr C attended. However, we noted that these issues were largely resolved at the appeal stage.

Recommendations

We recommended that the board:

• apologise to Mr C and Mrs A for failing to properly include them in the initial assessment; and
• consider adding a section to their decision-making tool, which records the views of relatives, carers and other stakeholders, such as care home staff.

Summary

Mr C hurt his head when his vehicle overturned. He said that when he arrived at hospital he walked in without a wheelchair or a neck brace. He was examined by a doctor, who instructed a nurse to dress Mr C's head wound and advised him to take painkillers. After this, Mr C attended two GP appointments, but went to hospital again about two weeks later feeling faint and woozy. He said he was left unattended for an hour until seen by a doctor, who did not examine him and advised him to buy painkillers from a shop. A few days later, Mr C saw a consultant who told him that there was nothing wrong and to continue with the painkillers. Mr C complained to us that the board failed to provide a neck collar, and did not properly clean the wound and investigate his injury. Finally, he said that they did not take him seriously when he attended hospital several weeks later.

We took independent advice on this case from one of our medical advisers, who specialises in emergency medicine. The adviser said that there were failings in the care and treatment provided immediately after Mr C's accident. When he was taken to the emergency department, he was not immobilised as he should have been. Given the nature of his injury, it was possible that he might have had a neck fracture, which should have been ruled out through careful examination before he was mobilised. A more thorough investigation might also have highlighted the need for an x-ray. However, there was evidence in the medical records that his wound was treated appropriately. Furthermore, after Mr C's initial attendance at hospital, the adviser said that management of the injury and subsequent symptoms was reasonable. We accepted that advice, but upheld the complaint as we were concerned about the management of his injury immediately after the accident.

Recommendations

We recommended that the board:

• ensure that the failures identified are raised as part of the annual appraisal process of relevant staff; and
• apologise to Mr C for the failures identified during our investigation.

Summary

Mrs C, who has power of attorney for her father (Mr A), complained that she had not been involved in assessments to establish whether he met the criteria for NHS continuing care funding (funding provided by the NHS for specialist clinical or nursing treatment).

We found that, although the assessment is essentially a clinical one, the input of the patient or carers is crucial in the overall process. When Mrs C told the staff about her concerns they assumed this to be an appeal request on their decision, and they instructed an independent clinician to assess Mr A. We found that, from a clinical perspective, the staff acted in an appropriate manner. However, national guidance is quite clear that the views of the patient or their carers are an important part of the process and so we upheld the complaint. We were pleased to note that the board are now involving Mrs C in discussions about Mr A's care and treatment.

Recommendations

We recommended that the board:

• formally apologise to Mrs C for the failings identified in our investigation; and
• remind staff who deal with NHS continuing healthcare applications of the requirement to involve patients and their carers in the process.

Summary

Mr C complained that the board had not provided him with written confirmation of his blood test results. When he attended hospital, he had undergone a test for deep vein thrombosis (DVT), but the copy of his results that he had obtained did not mention this. After he contacted the board to complain, they sent him a further copy of his test results but again there was no indication that the test for DVT had been performed.

During our investigation, we established that there are two methods of reporting test results, one of which contains fuller information than the other. Unfortunately, Mr C had not been provided with the full version. The board asked that we apologise to Mr C on their behalf, and told us that they had reminded staff of their responsibilities in this respect. We also provided Mr C with a full copy of the test results.

Summary

After Mr C fell downstairs, he was admitted to a local hospital, where a scan did not show any fractures. However, the next morning he had no feeling in his legs and he was transferred to a second hospital, where a consultant interpreted a further emergency scan as showing only degenerative changes in his spine. Mr C was later referred elsewhere, where he was finally diagnosed with an undisplaced fracture (a break in the bone, where the two parts of the bone are still aligned) of his spine. He now has to use a wheelchair.

His wife (Mrs C) complained about Mr C's care and treatment at the second hospital. She was concerned that he had not been handled and moved appropriately and that this could have affected the outcome for him. She was unhappy that his undisplaced fracture had not been diagnosed and that he was not kept lying down and in a neck brace.

To investigate the complaint, we considered all the relevant documentation, including the complaints correspondence and Mr C's medical records. We also obtained independent advice from two of our medical advisers, a consultant neurosurgeon and a consultant diagnostic and interventional neuroradiologist. The advice received confirmed that the board missed an undisplaced fracture of a vertebra (a bone of the spine) which should have been detected when interpreting the scan in the second hospital. The adviser commented that, despite this, Mr C had been managed as if he had had a spinal injury. The adviser said, however, that the damage to Mr C's spine had already occurred before he was admitted to the second hospital and that the treatment would not have affected Mr C's outcome. We upheld Mrs C's complaint, but as the board had already admitted that there were failures in the way they cared for and treated Mr C, and had taken action to address this, we did not find it necessary to make any recommendations.

Summary

Mrs C complained about the care and treatment provided to her late daughter (Miss A) by two GPs at the practice. Miss A was 14 months old when she became ill with a fever, vomiting and diarrhoea. Mrs C treated her with Calpol (an over-the-counter children's medication, used to treat aches, pains and fever) and tepid baths when her temperature was high. The following day Miss A's condition had not improved so Mrs C contacted the practice, and Miss A was seen twice that day by two different GPs. A viral infection was diagnosed and Mrs C was told to continue the treatment and to introduce ibuprofen (an over-the-counter anti-inflammatory medication). Mrs C asked if her daughter should be admitted to hospital but the GPs did not think there was evidence of a condition that warranted admission at that time. Early the next morning, however, Miss A collapsed. She was taken to hospital by emergency ambulance, but could not be revived. Mrs C also complained that after Miss A's death, one of the GPs involved did not contact the family to discuss the events and despite Mrs C seeing the GP in the local area on occasion, the GP did not speak to her.

Our investigation included taking independent advice from one of our medical advisers, who said that Miss A's symptoms indicated a viral infection, and that this was confirmed by the observations and examinations by the two GPs. Having studied Miss A's clinical records, the adviser said that the care, treatment and advice provided by the two GPs was reasonable. The post-mortem report on Miss A had confirmed the presence of a viral infection, and also a bacterial infection. Our adviser explained that this can occur when a patient’s system has been weakened by a viral infection, that it was not something that the GPs could have foreseen, and there was no evidence of it when they saw Miss A. Such infections can progress very quickly and cause organ failure and death in a short time. A consultant paediatrician, who reviewed the case and the post mortem report for the board, had said that even had Miss A been admitted to hospital, the outcome would be unlikely to have been any different, and our adviser agreed with this view.

On the matter of communication, one of the GPs involved said in response to the complaint that he had personally wished to speak to Mrs C and the family after Miss A died, but that the partners in the practice took a joint decision that the other GP involved (who was the practice's senior partner) should visit the family. This visit took place five days after Miss A's death. Having considered this, we took the view that the practice did communicate in a reasonable way with Mrs C at that time.

Summary

Miss C suffers from an anxiety disorder, and had been prescribed diazepam (a medicine which helps to control feelings of anxiety) for a number of years. When she requested a repeat prescription, Miss C was told to call the practice. Miss C said she was then told in a phone conversation with her GP that her prescription for diazepam would be stopped after a period of reduction and that, in future, she would have to attend an appointment at the practice before a repeat prescription would be issued. Miss C told us that her prescription had not previously been monitored, and had been increased over the previous years. Miss C considered that it was wrong to stop the medication. She was dissatisfied with the explanation provided by her GP and also the manner in which he responded to the complaint, which she considered to be inappropriate and unsympathetic.

We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the practice had not failed in their care of Miss C in relation to prescribing medication. However, in relation to the complaints handling, we found that although the GP provided reasonable explanations, the tone of his letters was unnecessarily sharp and at times insensitive, and his response could and should have been more considerate and empathetic.

Recommendations

We recommended that the practice:

• ensure that they and the GP reflect on the handling of this complaint to ensure that in future complaints are handled in an appropriate manner; and
• apologise to Miss C for the failures identified by this investigation.