Health

Summary

Mr C complained that the board's community health partnership (CHP) did not follow consultation guidelines for the closure of his local GP practice. Mr C also complained about the standard of numerical data that the CHP used to support the closure, and that the CHP did not provide clinical or financial reasons for the closure. We did not uphold Mr C's complaints. Our investigation found that the guidelines did not go into detail about the aspects of the consultation Mr C was unhappy with, and although Mr C disagreed with the way the consultation was carried out, we found that the CHP had followed available guidelines. These did not require the CHP to provide clinical or financial reasons to patients, and we found that the reasons for the closure had been explained to patients and local consultees. The CHP did not, however, give the proper context for figures quoted in their letters, and we drew their attention to this as communication of data must be clear, given the potentially emotive nature of proposals to close surgeries. However, the data gathered by the CHP was recorded correctly in a summary of patient consultation responses, which was provided to the CHP's management when making their decision on the closure.

Summary

Ms C was in the later stages of her first pregnancy, and was expecting twins. She went to hospital because she had vaginal bleeding. She was admitted for a consultant review and discharged home the following morning. Six days later she went into advanced labour and delivered both babies, but one of her twins died shortly after birth. Ms C complained to us about her care both before and after the birth.

Ms C's complaint had several elements, including inadequate care of a pre-eclampsia risk (a condition involving a combination of raised blood pressure and protein in the urine); inadequate care during two admissions which she said resulted in the premature birth of her twins and the death of her son; inadequate care and treatment for a post-natal haemorrhage (bleeding) and subsequent removal of products; poor record-keeping and delays in holding a clinical risk review (CRR).

Our investigation included taking independent advice from one of our medical advisers. We took account of this advice along with all the evidence provided by Ms C and the board, which included an internal report and two externally commissioned consultant reviews. Our investigation found no evidence of any failure that resulted in Ms C giving birth prematurely or any failure in care that resulted in the death of one of Ms C's twins. We also did not find any evidence of clinical failure with Ms C's post-natal care, but we did acknowledge that there were documentation failures and delays in holding the CRR.

Recommendations

We recommended that the board:

• ensure that the details of a speculum examination are fully documented to include the reasons if a cervix cannot be visualised and the rationale with regard to antenatal corticosteroids; and
• ensure the full documentation of all treatments delivered to patients is appropriately and timely recorded by those in attendance as soon as is feasibly possible, with specific reference to emergency situations.

Summary

Mrs C complained about the information and care she received from a hospital after being diagnosed with proctitis (inflammation of the lower part of the bowel). Mrs C was unhappy that she was not told about the risks of developing a more severe form of the disease, and said that the hospital had not monitored her in line with the quality care standards for the healthcare of people with inflammatory bowel disease. The board told Mrs C that they considered her care to have been appropriate and said that she had been given appropriate advice when she was referred to hospital by her GP in 2006 and 2008.

During our investigation we took independent advice from one of our medical advisers, and established that the quality care standards Mrs C referred to were not in fact put in place until 2009. We considered, however, that the results of her investigations and symptoms suggested that she was provided with appropriate care and treatment. The adviser pointed out that progression of inflammatory bowel disease cannot be predicted or, indeed, prevented and that different interventions would not have prevented Mrs C's condition from worsening. We found evidence to support that Mrs C was given advice about her condition and that an information leaflet explaining the risks had been sent to her.

Summary

Mr A had a history of contact with psychiatric services since he was a teenager and had received a range of diagnoses. Mr A's mother (Mrs C) complained that a staff member in the hospital's rehabilitation unit verbally abused him and restrained him inappropriately and, when Mrs C reported this to a senior person, it was ignored.

We did not uphold Mrs C's complaint. We looked at her account of what happened and compared it with the hospital's records, and found that there was a discrepancy in the dates of when the alleged verbal abuse and restraint took place. Because of this, it was not clear whether the board investigated the incident Mrs C referred to in her complaint. We asked our mental health adviser to review all the recorded incidents throughout Mr A's admission. We were satisfied there was only one recorded episode of physical restraint being used, which took place on a different date from the alleged incident Mrs C referred to.

We found nothing in the clinical records to suggest that the amount of force used in the recorded incident was excessive. However, we accepted what our adviser said about a lack of documented detail of the restraining techniques used. We were, however, generally satisfied that Mrs C's concerns were taken seriously and investigated promptly. The investigation which was carried out appears to have been as thorough as it could have been with the evidence available. The lack of detail in the records reflects the guidance available to staff about restraint techniques and the recording of incidents of aggression from patients. We noted that, had the incident been recorded in further detail, it might have been possible for us to comment more constructively on the appropriateness of the restraint techniques used.

Recommendations

We recommended that the board:

• considers creating a specific restraint policy, detailing the techniques that can be used and the information that should be recorded in the clinical records.

Summary

Ms C complained that the board failed to involve her in the assessment of the care needs and the care plans for her father (Mr A). Mr A was in hospital, but the board considered that he would be better placed in a care home. Ms C was unhappy with this, as she considered that Mr A should not be discharged from hospital. We found that the board had tried to involve Ms C in the assessment of her father's care needs and care plans and that they acted reasonably in relation to this. We also found that that the assessment that had been completed was comprehensive. The board had arranged for an independent consultant to review Mr A's needs and we found that this was good practice and did not uphold this complaint.

We did, however, uphold Ms C's complaints about complaints handling and being given information. The independent consultant who reviewed the case said that Mr A could be discharged from hospital as long as suitable alternative care could be identified. The board then wrote to Ms C to say that they would start the process to find Mr A suitable residential care. We considered that when they wrote to Ms C about this they should have told her that she had a right of appeal, although we noted that they had informed her of this on an earlier occasion. We also found that the board had delayed in dealing with some of Ms C's complaints.

Summary

Ms C complained that the care and treatment provided to her mother (Mrs A) was inadequate. Mrs A suffers from multiple sclerosis (MS) which is a degenerative disease affecting the nervous system. Sufferers can have various difficulties including mobility, digestive system and urinary problems.

In November 2010, Mrs A was hospitalised with a severe urinary infection which later developed into septicaemia (a serious bacterial infection). She was in several hospitals until early 2011. Ms C complained that, during her mother's time in hospital, the board failed to provide an adequate level of physiotherapy; failed to provide a reasonable level of specialist MS nursing care; failed to adequately communicate with the family, and failed to respond appropriately to Ms C's complaint.

Our investigation included taking independent advice from two medical advisers - a physician and nephrologist (kidney specialist) and a senior nurse with experience in neurological and neurosurgical nursing (treating illness or injury affecting the nervous system). We found that an appropriate level of physiotherapy and MS nursing input had been provided to Mrs A during her hospital stay.

Mrs A was, at times, very unwell and our medical advisers considered that the important thing was to address her acute symptoms of infection. When Mrs A was able to engage with the physiotherapy team, therapy was provided. Although the MS nurse only visited Mrs A once during her stay, the nursing adviser considered that there would have been no added value from further input at the time.

We found that Mrs A's MS was regularly and appropriately reviewed during her hospitalisation. However, the physician adviser felt that there was no evidence of communication between the doctors and Mrs A and her family. There were some records of communication from nursing staff but Ms C still felt that communication in general had been poor. The board had responded that next of kin are not automatically entitled to information about a patient and the patient's confidentiality had to be protected. However, our investigation found that guidance from the General Medical Council states that while patient confidentiality should be considered at all times, common sense should also prevail when a patient is very ill and unable to either give or withhold consent to share information with their family. In this case, Mrs A was at times very ill indeed and the advisers thought that staff should have used common sense in their communication with the family.

Ms C was also dissatisfied with the time taken to respond fully to her complaint and said that there were inaccuracies in the final letter from the chief executive. Our investigation confirmed that the timescales for responding to Ms C's complaint had been breached without her being kept up to date and that there were inaccuracies in the letter.

Recommendations

We recommended that the board:

• apologise for the failings in communication and complaint handling identified;
• make staff aware of and adhere to relevant guidance on communication with family/carers/loved ones; and
• make staff aware of and adhere to the guidance on complaints handling.

Summary

Mr C complained that a hospital failed to provide his late father (Mr A) with appropriate care and treatment when he developed cancer. There were several components to this complaint that included an incomplete colonoscopy (examination of the bowel with a camera on a flexible tube), discharge from the hospital when unwell, and delays with arranging a biopsy (tissue sample) and a scan. The board had acknowledged some failings before Mr C brought his complaint to us and we also looked at the action they had taken about this.

Our investigation included taking independent advice from one of our medical advisers. We took account of his advice as well as evidence from Mr C and the board. Our investigation found that the concerns Mr C raised reflected the complexity of this difficult and involved case. This included that Mr A had a number of symptoms under investigation (not linked to the cancer) when he also developed symptoms of the cancer that caused his death. Based on all the evidence, we came to the conclusion that there were no grounds to uphold the individual components of Mr C's complaints. We did find some evidence of delay between two investigative procedures, and made recommendations to address this.

On balance, however, we considered that overall Mr A received an acceptable standard of care and treatment in terms of the way that he presented to the hospital and we did not uphold the complaint.

Recommendations

We recommended that the board:

• advise of the steps taken to ensure similar delays to those experienced do not recur;
• ensure that scans are recorded in patient case notes regarding when and where they take place;
• advise on the steps taken to address multiple consultant involvement regarding ownership and co-ordination of a patient's care;
• ensure all patient case notes are filed sequentially;
• advise on the general surgery and clinical governance group (GSCCG) decision regarding the minuting of actions after a review of a complaint has taken place;
• advise on the results of the Steering Group's investigation of this case;
• advise on the setting up of the regional working group on the investigation and management of cancers with unknown primary sources; and
• advise whether the GSCCG presentation to the Integral Care and Partner Services clinical governance steering group has taken place.

Summary

Mr C and his partner sought in vitro fertilisation (IVF) treatment on the NHS. The board, however, said that because Mr C's partner's child from a previous relationship lives with them, they were not eligible for treatment. Mr C said that this decision was unreasonable because the board's policy on assisted conception discriminates against him and other men who have no biological children. He also said that the board did not deal with his complaint properly in that there were inaccuracies and delays in their responses and that they failed to address his complaint.

We explained to Mr C that it was not for us to determine whether the board's policy was discriminatory, but that we would consider whether their actions were reasonable. We found that their decision was reasonable in light of the framework for infertility services accepted by the Scottish Government and that, in taking legal advice and ensuring compliance with Scottish Government guidelines, they had acted in line with legislation and guidance.

We did find that the board delayed in responding to the complaint and that their responses should have provided a clearer explanation about the framework for infertility services from the outset. However, we made no recommendations about this, in light of the fact that the board reviewed their complaints management system earlier this year.

Summary

Mr C's elderly mother is cared for in hospital. He told us that one day when he was visiting her, the nurse in charge spoke to him in an inappropriate way. He was unhappy because when he complained to the board about the incident, he said they did not investigate or handle his complaint properly. He said that the board did not ask a witness for information and that there was an unexplained delay in passing his complaint to the board's complaints team.

We upheld his complaint about the investigation. We found that the board did the correct thing by interviewing the nurse involved, and we were satisfied that they did so as soon as they could after the complaint reached the complaints team. We could reach no conclusion about whether all the correct witnesses were interviewed, as accounts of who was there were different. We were, however, concerned that two witness statements appeared to have been taken after the date on which the board responded to Mr C's complaint, and made recommendations to address this.

We did not uphold his concerns about the complaints handling. Our investigation found that Mr C initially asked for his complaint to be handled on the ward, but later decided that he did not want to meet the member of staff who was handling it. Although there were typing errors in the board's letters and we identified a minor issue about the time it took to provide a final reply to his complaint, we noted the board's policy that staff made aware of a complaint should handle the matter locally as far as possible. We, therefore, found that the reasons for the delay in passing the complaint from the ward to the complaints team were understandable. We also noted that, as Mr C and his family had repeatedly expressed concerns about his mother's care, the board had appropriately arranged for reviews of her nursing and medical care.

Recommendations

We recommended that the board:

• remind staff to ensure that, in future, relevant witnesses to events are interviewed or asked to provide a statement as soon as possible after the event, and in any case, during the investigation of the complaint;
• provide specific guidance on obtaining witness information (in their advice to staff about operating the complaints policy); and
• review their practice for checking draft letters to be issued by the complaints team, with the aim of minimising the chance of typing errors. The board should let the Ombudsman know the steps that they put in place as a result.

Summary

Mr C complained about the board’s management of his wounds. He advised that he had to wait up to four days to have the wound dressings changed, whereas he felt they should be changed every two days. In responding to Mr C, the board indicated that, due to the nature of the skin breaks, the healing tissues should not be disturbed unless necessary.

We took independent advice from one of our clinical advisers, who said that the frequency with which dressings should be changed varies depending on factors such as clinical need, dressing type and physical conditions. Having reviewed the schedule for Mr C's dressing changes, she was content that he was having his wounds cared for in the most appropriate manner. We accepted this advice and did not uphold the complaint. However, we identified that, on occasion, the board had failed to record details of Mr C's dressing changes, and our adviser confirmed that the record keeping could have been better in this case. In responding to our enquiry, the board acknowledged this deficiency, apologised and confirmed they had raised it with the staff involved. We considered this reasonable and had no further recommendations to make.