Health

Summary

Mr A was in hospital for four months, and his daughter (Ms C) was unhappy about aspects of his nursing care during that time. Mr A was prescribed a low dose of madopar (a drug used to treat Parkinson's disease), which was increased two weeks later. The medical records show that his behaviour became increasingly problematic, and Ms C said that Mr A became very aggressive while taking the drug.

About two months later, Mr A was transferred to another ward contrary to the wishes of Ms C. Ms C said that nursing staff sat at a table during visiting time and failed to attend to her father's needs or communicate with the family. Mr A had three falls and Ms C said staff failed to explain why this happened or how he had a cut on his head, and that there was an unreasonable delay in swabbing the cut. Ms C was also concerned about the management of Mr A's skin condition.

After taking independent advice from our nursing adviser, we found that aspects of the nursing care provided to Mr A fell below a reasonable standard, and we upheld Ms C's complaint. However, the board had acknowledged the shortcomings in relation to communication and nursing staff availability during visiting time and had taken action on this. The adviser reviewed evidence from the board's audits and quality improvement plan and was of the view that they took sufficient action to address these shortcomings. We, therefore, did not find it necessary to make any recommendations.

In relation to Mr A’s transfer from one ward to another, the adviser said that the decision was reasonable. The ward staff took the family's views into account, but there was a clear rationale for moving Mr A to a more appropriate setting. In relation to medication, we found that the prescription of madopar was reasonable.

Summary

Mr C was admitted to a mental health ward in hospital after taking an overdose. A few days after his admission, he was transferred to another mental health ward. Several days later, Mr C was assaulted by another patient. He was examined by medical staff who concluded that he had not suffered a significant head injury but noted that he was upset and distressed by what happened. Mr C suffered from a headache on several occasions in the weeks following the assault and was again examined. Medical staff again concluded that he did not have a significant head injury. A CT scan (a special scan using a computer to produce an image of the body) was carried out shortly after Mr C's discharge and showed nothing abnormal. Mr C said he expressed his concerns about his safety when he was transferred, and received assurances from staff that he would be safe. He complained that he was inappropriately placed in a ward where he was vulnerable to an unprovoked attack and that the after-care provided to him following the assault was inadequate.

Our investigation found that, while there were failures to update Mr C's risk assessment at certain points, there was nothing to suggest that the assessment would have changed or that Mr C was at particular risk of assault from others whilst in hospital. The independent advice from our medical adviser was that it would, however, be helpful if the board's guidelines were more specific in relation to key times when risk assessments should be completed. We found that the transfer was reasonable as was Mr C's care and treatment after the assault. We did not uphold Mr C's complaints, but made recommendations because we had identified failures in relation to record-keeping and risk assessment.

Recommendations

We recommended that the board:

• review its guidelines on risk assessment in light of our adviser's comments; and
• bring the failures in record-keeping to the attention of relevant staff.

Summary

Mrs C's late mother (Mrs A) was admitted to hospital following a stroke. She was transferred to another ward a few days later. The day after her transfer to the ward, Mrs C told a nurse that her mother had a headache and needed pain relief. Mrs C said that the nurse was very defensive and extremely rude when she tried to discuss her concerns about her mother's pain relief. A scan was carried out, which did not show any physical cause for Mrs A's headache, and a psychiatrist later diagnosed a chronic tension headache.

Mrs C complained about the nurse's attitude and that Mrs A's pain relief was not reasonably managed after her stroke. After taking independent advice from one of our medical advisers, we found that Mrs A was given appropriate pain relief within a reasonable time, as only certain types of pain relief are normally provided after a stroke, to avoid affecting the patient's brain function. We found no evidence that the nurse had behaved inappropriately or in an unreasonable manner towards Mrs C.

Summary

Mr C complained that the board failed to take reasonable steps to fund travel and accommodation costs for his mother (Mrs A) following his father's emergency transfer to a hospital on the mainland. Mrs A wished to accompany her husband but there was no room in the ambulance, and so she made arrangements to travel to the mainland herself. Mrs A's GP had signed a post-dated escort authorisation form for her. Because of this she submitted an expenses claim, expecting the board to pay her costs, but they refused to do so.

Our investigation found that the board's policy says that they will only fund costs when someone is required to escort a patient who needs their support when travelling. This does not apply where the patient has travelled by ambulance, nor where family members to travel to be with someone who had been taken to hospital, and so the GP had incorrectly signed the form. Because of this, we did not uphold Mr C's complaint. In responding to our enquiries, the board also explained that they intended to highlight the requirements of the patient travel policy to all GPs in their area to ensure that the correct information is provided to families in future.

Recommendations

We recommended that the board:

• provide the Ombudsman with evidence that they have reminded GPs in their area about correct use of the patient travel policy.

Summary

Mr C, who had heart problems, was to undergo elective (non-urgent) surgery in the hospital to improve the blood flow to his heart to relieve the symptoms of angina (chest pain) he was suffering. His wife (Mrs C) complained that his planned transfer from another hospital for this procedure was cancelled five times. Mr C was eventually transferred, but died late the following evening. Mrs C also complained that the hospital's response to her complaint glossed over the reasons for one of her husband's discharges from hospital and was not consistent with the response from the other hospital.

Our investigation, which included taking independent advice from a medical adviser who is a consultant cardiologist (heart specialist), found that the reasons for the multiple cancellations of Mr C's transfer were all medically based. The adviser was of the view that each of the cancellations was reasonable, based on Mr C's clinical condition at the time. The adviser said that the procedure was designed to relieve chest pain. However, because of Mr C's other serious medical conditions, even if the procedure been carried out during his first admission to hospital it would have been unlikely to have changed the eventual outcome or to have prolonged his life. This is because Mr C's eventual condition would not have been cured, altered or improved by the procedure.

Our investigation also found that the reasons for Mr C's discharge were clear and had been made clear at the time. He was discharged so that another medical condition could be addressed to try to ensure that he was fit enough to undergo the surgical procedure, and we took the view that this was reasonable. Similarly, we found that there was no contradiction in the information provided in the complaint responses. Although we appreciated that this had been a very difficult time for Mrs C and her husband, we were satisfied that the overall care and treatment provided was reasonable.

Summary

Mr C complained about the care and treatment provided to him by the medical practice. We started our investigation, but Mr C died before it was completed. As we had no contact details for Mr C's next of kin or executor/executrix, we were unable to take this complaint further, and closed our file.

Summary

Mr C complained about the care and treatment provided to him by the medical practice. We started our investigation, but Mr C died before it was completed. As we had no contact details for Mr C's next of kin or executor/executrix, we were unable to take this complaint further, and closed our file.

Summary

Mr C complained to us about advice given to him by the board's out-of-hours service. We started our investigation, but Mr C died before it was completed. As we had no contact details for Mr C's next of kin or executor/executrix we were unable to take this complaint further and closed our file.

Summary
Mr C, who is a prisoner, complained about the prison health centre's complaints handling. Mr C had submitted a formal complaint about the health care and treatment he had received. However, the health centre responded to the complaint under the feedback procedure, not the complaints procedure. The board said that this was in accordance with the approach for all informal complaints, which should be dealt with by local response. They said that any further complaints or feedback forms would be dealt with through the formal complaints procedure. They also commented that, where possible, complaints are addressed at the point of contact, unless the complainant wished to pursue their complaint through the formal complaints procedure.
 

We considered that as Mr C had submitted a formal complaint, it should have dealt with as such. We were concerned that the board were using the feedback procedure as an additional level to the NHS complaints procedure. This is restricting, and over-complicates prisoners' access to the NHS complaints procedure. It is clear that Scottish Government guidance does not require NHS users to complete the feedback procedure before accessing the complaints procedure. This should also apply to people receiving NHS care and treatment whilst in prison.

Mr C went on to make a further formal complaint to the health centre. However, he said that they returned the complaint form to him, and explained that it was not answered, along with several others, due to the fact that they met him to see if the issues could be dealt with. They said that during the meeting, Mr C withdrew the complaint after agreeing that the problems were resolved. However, we found no records to support this in the evidence we received from the board.

Mr C then submitted a further complaint to the health centre, but did not receive a response. The health centre should have sent this complaint to the board for response. Mr C contacted the board, who advised that they had not received it from the health centre. The board could provide no explanation as to why this complaint and the previous complaint were not submitted to them in line with their complaints procedure. In view of these failings, we upheld Mr C's complaint.

Recommendations
We recommended that the board:

• consider our findings and review the handling of prison healthcare complaints to ensure that they are being dealt with in line with the good practice outlined in the Scottish Government Guidance 'Can I help you?'; and
• issue a written apology for the failings identified.

Summary
Ms C is an advocate for the sister of the late Mr A. Ms C complained that the care and treatment that two medical practices provided to Mr A was unreasonable.

Mr A had attended the first practice until March 2010, when he changed his registration to the second practice. At the time of the events complained about, the practices were independent of each other. The second practice has since taken over management of the first practice.

Mr A began to attend his GP at the first practice in July 2009, reporting recurring bouts of diarrhoea. Blood tests suggested that he had an infection of helicobacter pylori (a bacteria commonly found in the stomachs of middle-aged people which has been linked to ulcers and some stomach cancers). Mr A was treated with three different types of antibiotics and was advised to eat a bland diet. He continued to report symptoms of altered bowel habit, and then weight loss, as his food and drink options became more limited.

Mr A was eventually referred to hospital in February 2010, and was diagnosed the following month with Mantle Cell Lymphoma (MCL - a cancer of the white blood cells). He was treated by both his local NHS board and the specialist team at another board. In June 2011, he was told that his test results were clear.

In August 2011, however, Mr A's symptoms returned and he again visited a GP, this time at the second practice. Tests initially suggested that the MCL had returned. However, after a liver biopsy (where a sample of tissue is taken for examination in the laboratory), Mr A was told that he had a second type of cancer, incurable small cell lung cancer. This had already spread to his liver. Mr A died some three weeks later.

As part of our investigation, we took independent advice from a medical adviser. We found that in July 2009 the North East Scotland Cancer Co-ordinating and Advisory Group had issued guidance for GPs on the action to take and when to take it, when patients reported symptoms suspicious of cancer. A symptom that should have triggered an urgent referral to a specialist colorectal surgeon (a specialist in disorders of the stomach and bowel) was where a patient reported altered bowel habit for more than six weeks. Mr A had reported his symptoms for some seven months before he was referred. Even then, he was given only a routine referral to a general surgeon, rather than the urgent specialist referral described in the guidance. We upheld Ms C's complaint and made recommendations to address these failings.

Recommendations
We recommended that the practice:

• apologise for the failings identified;
• review a sample of clinical records from all GPs at both practices to assess the standard of record-keeping in line with General Medical Council guidance, and if deficiencies are found these are to be discussed at the GP(s) annual appraisal(s) and if necessary appropriate training to be undertaken; and
• ensure that all GPs in both practices are aware of and take cognisance of the local guidance on urgent referral of symptoms suspicious of cancer.