Health

Summary
Mr C had a history of skin cancer and suffered from a back condition. He complained that the board failed to: make a full and accurate diagnosis of his back condition, provide him with appropriate treatments including alternative therapies, and explain the prognosis. Mr C also complained that the board failed to provide him with a report containing this information to allow him to claim appropriate benefits. In addition, Mr C complained that the board failed to ensure that there was adequate communication between different departments in the board and medical professionals from other boards on the diagnosis and treatment of his condition.

We did not uphold Mr C's complaints. After looking at the clinical records and taking advice from one of our medical advisers, we found that hospital staff did diagnose Mr C appropriately. They also made recommendations for treatment and made him aware of what his condition was and the outlook for it. Mr C had told us that he asked specific staff for a report for benefit purposes at consultations. The board said Mr C did not ask staff for such reports, and we found no mention of this in the clinical records. In addition, the board said that staff were only required to complete reports sent to them by the relevant benefits agency.

We also found evidence in Mr C's clinical records that hospital staff did communicate adequately and in reasonable time, both within the board and with relevant staff from other health boards, about the diagnosis and treatment of Mr C's condition.

Summary
Mrs C was referred for orthodontic treatment by her dentist in 2008. She was first seen by a restorative dentistry consultant in February 2009 for hygiene therapy as she had severe gum disease. She was then referred to orthodontics, and was seen in December 2009. She was referred to see a specialist about orthognathic (jaw) surgery as she wanted to undergo this form of treatment, but was not seen until January 2011.

Following this assessment, Mrs C was placed on the waiting list for surgery, and seen again in September 2011, when she was advised that her gum disease and level of oral hygiene were not sufficiently stable for surgery at that time. A treatment plan was put in place to continue to treat Mrs C's gum disease. Mrs C had also been advised previously to give up smoking, as this would affect her oral health and hygiene.

Mrs C complained to us that the board failed to provide her with treatment for her dental problems within a reasonable time. We upheld her complaint as our investigation found that her wait to see a orthognathic specialist was unreasonable. We noted that the board had implemented evening clinics to tackle the long waiting lists, and that they had experienced a shortage of qualified staff. We found, however, that the board could make further efforts to reduce waiting times within the orthodontic/orthognathic department, and we made a recommendation about this. We did not, however, find that the delay itself had adversely affected the state of Mrs C's teeth, as her oral heath and hygiene needed to be addressed before surgical treatment could begin.

Recommendation
We recommended that the board:
• implement an action plan to reduce the current waiting lists for treatment within the orthodontic/ orthognathic department.

Summary
Mrs C complained that the board's handling of her complaint was inadequate. The board dealt with her initial complaint by arranging a meeting between her and a service manager. However, this did not take place until nearly two months after she complained. Mrs C later made further complaints to the board. The board told her that they had already issued a response to her complaint. Mrs C then wrote to us. However, it was clear that the board had not responded to many of the points she had raised and we referred the complaint back to them for a response. The board took a further three months to issue a response, and their letter failed to explain the reasons for this delay.

Mrs C continued to write to the board, and the chief executive issued a further response to her, in offering a meeting with two of the board's directors. Mrs C accepted the offer and met the directors. However, at the meeting, the directors both said that they did not consider that the chief executive's letter had addressed her concerns. They said that they wished to revoke this and send her a revised letter. The chief executive then issued a full response to Mrs C. He said that it was evident that the board's response to her complaints could have been significantly improved.

We upheld Mrs C's complaint, as our investigation found that the board clearly delayed in responding, and failed to explain the reasons for these delays to her. Their earlier responses also did not address her complaints adequately or take on board all of the problems she raised.

However, we considered that the board's final letter to Mrs C was a detailed response to the complaints she had made. It was issued after the board had carried out a thorough investigation. We were pleased to see that the board identified that their earlier responses to Mrs C's complaints were not satisfactory and undertook a further investigation into the matter. The board also apologised for the length of time it had taken to complete the investigation and the distress this had caused. They also said that they were reviewing their complaints procedures to ensure that significant improvement was achieved. In view of all of this, we had no recommendations to make.

Summary
Mrs C complained that her GP practice failed to diagnose that her daughter (Miss A) had hip dysplasia (HD) as a baby. She thought that the GP who had carried out Miss A's hip examination at 6/8 weeks had not done so correctly. Mrs C said that there was a lack of detailed notes as to the precise procedures that the GP said she carried out during this examination, and that the records were not complete.

Mrs C felt that her daughter's condition should have been noticed sooner. She acknowledged that even when checks are carried out properly, the condition can be missed. However, she was also concerned that no further checks were routinely offered. (Miss A's older sister had had a further developmental check when aged between 6/9 months.) Mrs C said that because of this, Miss A had to undergo extensive surgery and rehabilitation when she was two years and nine months old. In her view Miss A's suffering could have been significantly reduced if her HD had been diagnosed earlier.

After taking advice from one of our medical advisers, we did not uphold Mrs C's complaint. Our adviser noted that there were two different accounts of what may have happened at Miss A's assessment and said that the entries in the records were of a normal standard for GP records in Scotland. He also said that the diagnosis of HD can be missed, even when the tests are performed correctly by experienced doctors. The adviser also noted that the timing of developmental assessment checks has changed from when Miss A's sister was assessed.

Based on the evidence found during our investigation, we could not support Mrs C’s view that the practice did not reasonably carry out the six to eight week examination on Miss A or make an appropriate record of that examination.

Summary
Mr C was unhappy with his former GP practice. He complained about his GP's failure to promptly given him hospital scan results, and a failure to refer him to a hospital specialist. He also complained that the practice inappropriately asked him to register with another practice, and that the practice manager failed to investigate his concerns or answer his complaints fully.

We did not uphold any of Mr C's complaints. We looked at the medical records and took advice from one of our medical advisers. Given the circumstances of this case and given that the scan took place because of a referral within the hospital and not from the practice, we did not find it unreasonable that Mr C had to ask the GP about his scan results. After Mr C did so, the GP appropriately gave advice and prepared a prescription. We also found that there was no reason for the GP to refer Mr C to the hospital, as the scan report did not indicate this (which it normally would if required).

Shortly after the consultation, the practice wrote to Mr C asking him to register with another practice nearer to his home, as he no longer lived in the practice's catchment area. Our investigation found that the practice initially appeared to have taken account of Mr C's personal circumstances and allowed him to remain on their list, despite that fact that he was living in temporary accommodation outside their established catchment area. As Mr C remained in temporary accommodation for some time, however, the practice decided that it would be more appropriate for him to register with a practice nearer to his home. We found that, in doing so, the practice acted in line with their guidance.

Finally, we found no evidence that the practice failed to investigate Mr C's concerns or answer his complaints fully. The records showed that they acted in line with their complaints procedure, and based their response on their guidelines, policies, and records of Mr C's consultations.

Summary
Ms C complained about an accident she had while being transported by the Scottish Ambulance Service (the service) to a clinic appointment. Ms C said that the driver had taken his finger from the remote-control button operating a stair-lift while Ms C was sitting on it in a wheelchair. The lift stopped suddenly and the driver fell against Ms C, who was thrown forward and to the right. She was injured by a bar at the front of the stair-lift.

Ms C said that the driver was speaking to someone else, lost concentration and took his finger off the button. The driver, however, said that he had slipped on the stairs. There was no doubt that the driver's finger came off the button but as there was no objective evidence to explain exactly how this happened, we could not uphold this complaint.

Ms C also complained that the driver then left her at the clinic reception and did not report the incident. She had to report it herself. The evidence confirmed that although the driver reported the incident to his own management, he did not report it to the clinic staff or any other hospital staff member. He apologised to Ms C and asked how she was, but did not take any action to ensure that someone attended to her. We upheld this complaint. We noted, however, that the service had provided evidence that the driver's line manager had addressed this and reminded him of his responsibilities in dealing with such incidents in the future. We, therefore, made no recommendations.

Ms C's final complaint was that the response she received from the service was inaccurate as it referred to the driver slipping on the stair and also that he had reported the incident to the clinic reception. There was no conclusive evidence to establish whether or not the driver slipped, but the service acknowledged that the driver had not reported the incident to hospital staff. We, therefore, upheld this complaint and made a recommendation.

Recommendation
We recommended that the service:
• apologise to Ms C for the failings identified.

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.