Health

Summary
Mr C was unhappy with his GP practice. He told us that he left his medication on a bus by mistake. The next day he telephoned the practice, arranged for another prescription and went to collect it. Mr C told us that the prescription was wrong as it was for a medicine that he had not requested. He said that he returned to the reception to ask for the prescription to be looked at again and to complain about what had happened. Mr C said he was treated inappropriately by the GP at that point. He complained to the practice and as he remained dissatisfied with their response, he brought his complaint to us.

Mr C decided to withdraw his complaint before we completed our investigation.

Summary
Mr C made a complaint alleging that a GP refused to issue a long-term medical certificate; failed to examine and assess his condition and made an inappropriate note in Mr C's medical records. He complained that none of the GPs at the practice have fully examined him or assessed his condition including his level of pain and ability to sit, stand or walk for any length of time.

Mr C has been unwell for some time, firstly with low mood and latterly with back and leg pain. The Department for Work and Pensions (DWP) assessed him as being fit for work as far as his low mood was concerned. Two months later Mr C asked a GP to issue him with a sickness certificate covering a period of four months. The GP declined but did continue to issue certificates for shorter periods.

After taking advice from one of our medical advisers, we did not uphold any of Mr C's complaints. On the issue of the certificate, we found the GP had considered that Mr C's condition would be better managed with regular reviews and so his clinical opinion was that it would be inappropriate to issue a long-term certificate. We found that this complied with guidance from the DWP which says that in the first six months of an illness, certificates can only be issued for a maximum period of three months at any one time (and that this should be the exception rather than the rule). Our adviser agreed with the GP that it was clinically appropriate to monitor Mr C's condition regularly.

Examination of Mr C's clinical records confirmed that Mr C had attended the practice on a regular basis and the records contained evidence of examinations, investigations, referrals to specialists, reviews of medication and trials of therapy.  Our medical adviser confirmed that the records indicated that the GPs had taken appropriate action to review, treat and monitor Mr C's condition.

One of the GPs had put a temporary 'pop-up' note on the practice's computerised records to remind staff that if a telephone request was made for an extension to Mr C's medical certificate for low mood, it was not to be issued. The note was not part of Mr C's actual medical records. Mr C claimed that the note prevented any of the GPs from issuing him with a medical certificate. When we examined Mr C's electronic medical records, we found that the note did not form a part of these, and we found it reasonable that the note was made. Our adviser commented that such notes are normal and considered to be good practice. We found no evidence that this prevented the GPs from issuing medical certificates to Mr C.

Summary
Ms C's daughter (Miss A) was referred to hospital complaining of difficulty swallowing. She also had abdominal pain and tenderness. An endoscopy (an examination using a camera on a thin tube) was carried out but the endoscopist did not report any significant abnormalities. Miss A was seen by an ear nose and throat surgeon about two months later. He arranged for her to be admitted to another hospital where further examinations and tests were carried out. Miss A was found to have a large cancerous tumour in her throat. She was discharged from hospital with a plan to provide chemotherapy and radiotherapy. Before her scheduled treatment date, however, her condition deteriorated and she was admitted to hospital. Miss A received two courses of chemotherapy, but died shortly after her second treatment.

Ms C complained that her daughter's tumour was not diagnosed by the endoscopist. She felt that, had it been, Miss A could have commenced treatment sooner, and her prognosis might have been better. Ms C also raised concerns about the monitoring of Miss A's condition, communication with the family and mistakes made by the board in their minutes of a meeting with the family to discuss their complaints.

After taking the advice of two of our medical advisers, we did not uphold most of Ms C's complaints. We accepted that the endoscopy was not designed to examine the area of Miss A's mouth where the tumour was visible. Whilst we felt that some view of the mouth should have been taken, this would in fact have been to check for obstructions rather than a diagnostic examination.

We also found that Miss A had restricted movement of her neck and jaw and that this, combined with the process of swallowing the endoscope, would have restricted the available view. Although we were satisfied with the endoscopist's actions we were, however, concerned to note that she had said that she would not examine a patient's mouth prior to the procedure. We asked the board draw her attention to our comments about the importance of non-diagnostic oral examinations.

We were also satisfied that investigations into Miss A's condition were appropriately progressed after the endoscopy. One of our advisers noted that the tumour was so advanced that, even had it been found on the day of the endoscopy, Miss A's prognosis would not have been any different. We found the board's monitoring of Miss A's condition, and their communication with Miss A and her family while she was in hospital, to be appropriate. We did not find evidence of specific details being provided to the family when the hospital decided to discontinue treatment. However, we felt that it was not necessarily appropriate for staff to do so and were satisfied that the family had the opportunity to ask questions of the staff on duty.

The board's minutes of their meeting with Ms C stated that Miss A had been present, rather than her sister. We upheld Ms C's complaint about this and about the general accuracy of the minutes, recognising the impact that this administrative mistake would have had at a time of such distress.

Recommendations
We recommended that the board:
• draw our adviser's comments regarding non-diagnostic oral examinations to the endoscopist's attention; and
• apologise to Ms C in writing for their mistake in the meeting minutes.

Summary
Mrs C complained that the board refused to provide her with batteries for her privately purchased hearing aid and was unhappy with the way they dealt with her complaint. (They had previously supplied batteries for her old hearing aid, which was also privately purchased.)

Our investigation found that, when Mrs C replaced her hearing aid, the battery required was a different size. The board told her that they could no longer supply batteries because they only provide batteries that fit NHS hearing aids, which only use the same size of battery as Mrs C's previous hearing aid. We considered this to be reasonable and did not uphold this complaint.

Mrs C also complained that her complaint was not properly handled. She said that someone she had previously complained about was involved in providing information for the board's response, and the responses to her complaint were delayed and contradictory. We found that it was appropriate for the person concerned to have been involved in the complaint response, as the complaint was about policy for which the individual had responsibility. We did, however, uphold the complaint about delay as we agreed that responses were delayed and contained contradictory information, and made a recommendation to the board about this.

Recommendation
We recommended that the board:
• apologise to Mrs C for the failings identified.

Summary
Ms C complained to the Ombudsman about the length of time that her late mother (Mrs A) had been prescribed medication (Mogadon/Nitrazepam). Ms C had read literature which mentioned that Nitrazepam should not be prescribed for more than nine months. She wondered whether the medication could have been the cause of Mrs A's obsessional episodes and led on to her suffering from dementia and Alzheimer's disease.

Our investigation found that medical opinion had changed over the years and that currently it would not be best practice to prescribe Nitrazepam for a prolonged period. However, withdrawal of the medication is quite complex and requires the risks to be balanced against the benefits. In Mrs A's case our medical adviser said that long term prescription of the medication was appropriate.

Summary
Mr C had a number of health problems. When he fell and hurt himself in hospital, a support worker complained on his behalf that the board provided him with inadequate care. As a result of the fall, Mr C hurt his knee, and had mobility problems. Mr C had found it difficult to adopt a comfortable resting position in bed. He said he told nursing staff that he considered himself to be in danger of falling but they did not assist him and were to blame for his fall. Nursing staff said they were concerned that Mr C's position in bed was precarious, so they assisted him to a safer and more comfortable position and advised him not to try to stand up.

We did not uphold this complaint. There was no evidence to support either Mr C's account or the nursing staff's account of this, and so we could not determine exactly what was said. From looking at the records and taking advice from our nursing adviser, we found that the nursing notes did not record staff concerns about Mr C's position in bed, although the adviser noted this may not have been possible on a busy ward. The notes also did not record Mr C's apparent failure to comply with advice from nursing staff. This information was recorded in statements from nursing staff in response to Mr C's complaint. While we accepted our adviser's view about a busy ward, we drew the board's attention to our view that we would normally expect staff concerns to be noted in the records at the time. However, an appropriate risk assessment was carried out and a care plan was in place to look after Mr C, and our adviser concluded there was not enough evidence to suggest that the care provided to Mr C was inadequate.

Summary
Mr C complained that the board failed to provide his daughter (Ms A) with continuous intensive support and treatment for her mental health issues. Mr C said that Ms A had a complicated medical history and had been left with psychological problems that include severe anxiety and obsessive/compulsive behaviour (OCD) and emetophobia (fear of sickness or vomiting) that has a negative impact on all aspects of her daily living. She cannot work or live alone and, two years on, has made little or no progress under the care of local mental health teams at the board despite her trying to work with the partnership team. Mr C felt that Ms A was not given adequate support, or funding for specialist help that he believes she needs at a national unit in London. When Mr C brought his complaint to us he said that the board had not adequately addressed his complaint, appeared disinterested and lacked concern about the situation.

After taking advice from one of our medical advisers, we did not uphold Mr C's complaint. Our adviser considered the management of OCD, and the core interventions and treatment in the National Institute of Health and Clinical Excellence guidelines. He concluded that Ms A was given a suitably intensive service in that she had been offered appropriate interventions. He said that the records showed that Ms A had a number of clear clinical plans of care and had received multi-disciplinary input from a variety of clinicians and services. The adviser also considered there were no unreasonable delays in the provision of treatment. We decided that there was no evidence to support Mr C's view that Ms A had not received a suitably intensive service from the board.

The adviser also said that the general rule that applies both in Scotland and England is that Ms A would only be referred to external services if and when available options within local services were exhausted. We decided that there were justifiable reasons why the board did not refer Ms A to the national unit, as she was at the early stage of her care and treatment when the request was made and the services offered by the board were not exhausted.

We found that Ms A's overall care and level of input from clinicians and services were appropriate.

Summary
Mrs C had fertility treatment which began in 2008. She had a successful pregnancy in 2009 and in 2011 was invited back for further treatment. On attending the appointment, she was advised there had been an administrative error, and she should not have been invited for further treatment as she had already had a child. Mrs C complained that she was never told that this would be the case. The board considered whether to make an exception to the criteria for treatment in Mrs C's case, but decided there was no basis to deviate from them.

The board explained that, under their policy, couples were entitled to a maximum of two cycles of treatment. Mrs C had become pregnant during the first cycle. She had frozen embryos remaining from that cycle, which were implanted in 2010 but did not result in a further pregnancy. The board said this was the stage at which the first cycle of treatment ended, and Mrs C was not entitled to a second cycle of NHS treatment as she had already had a child as a result of the first.

We found that the correspondence sent to Mrs C about the criteria for treatment had not been clear. On that basis we upheld her complaint. We made no recommendations as we found that, as a result of Mrs C's case, the board had undertaken a range of measures to prevent a similar error happening again. These included reviewing the correspondence sent to patients, developing a new consent form and ensuring that review meetings took all previous treatment outcomes for patients into account.

Summary
Miss C complained about how the board handled her complaint. Our investigation established that there had been some delay by the board in replying but that their complaint file showed that they had been actively working on the complaint the whole time. They had also replied very promptly to two further complaint letters from Miss C on the same subject. Other aspects of their complaints handling were good. For example, it was clear they had investigated thoroughly. Although we would not condone delay, we did not consider, in the circumstances of this case, that there were sufficient grounds to uphold the complaint.

Summary
After a road traffic accident, Ms C attended the accident and emergency department of a hospital. She received care and treatment for her injuries in the accident and emergency department. Within 24 hours she was admitted to a ward for further treatment, then transferred to an orthopaedic ward before being discharged. She continued to be seen by an orthopaedic consultant as an out-patient.

Ms C complained about the care and treatment she received from the board for her injuries arising from the accident and said that she was not kept informed about her condition. She also complained about the board's actions in relation to requests from her insurers and a UK government department for information about her injuries and disability.

We found no evidence to show that the board's care and treatment of Ms C was unreasonable or that they failed to keep her informed about her condition. We also found no evidence that the board responded unreasonably to requests for information about her injuries and disability.