Health

Summary
Mr C and his family had been registered with a medical practice for several years. However, when he called for an appointment he was told that he had been removed from the list and would have to re-register. He complained to the practice about this and was told that he had been removed because correspondence sent to him had been returned unopened. We found that the practice should have checked to see if he was still at the address, but that a clerical error meant that he had instead been wrongly noted as 'no trace' on their list. We also found that they did not properly explore the reasons for this when Mr C complained and that these only became known after we investigated his concerns. Finally, following discussions with the NHS, we were able to tell Mr C that although he would have to re-register, he would be able to have a medical appointment in advance of that process. We did not uphold a complaint that the practice failed to warn him that he would be removed.

Recommendation
We recommend that the medical practice apologise to Mr C for their error.

Summary
Mr C complained about the actions of a nurse at his medical practice - for example, that she did not keep all sizes of syringe in her own room and had to keep him waiting while she collected the correct syringe from another room. He also felt that the practice's reply to his complaint did not address all his questions. Our investigation found that the nurse's actions had been reasonable. For example, she would not be expected to stock everything possible in her room and Mr C only had to wait for a few minutes. We also found that the practice had reasonably addressed Mr C's questions in their response. However, in the interests of trying to provide a practical resolution to the complaint, we did ask them for fuller information and passed that on to Mr C.
 

Summary
Mr C was admitted to the Western General Hospital for an operation to remove a testicular cyst and to undergo a vasectomy. Five months later, he was referred to another consultant and was told that during the operation the original planned surgery had not taken place. They said that the cyst had not been removed but instead he had had a hydrocele repair and vasectomy. (A hydrocele is an abnormal collection of fluid in a sac-like space such as the testicles.) Mr C complained that he was told nothing about the hydrocele problem and that he had to have a further operation to remove the cyst. Our investigation concluded that although Mr C's treatment was appropriate, the reasons for providing the alternative treatment were not adequately documented. Because of this we upheld his complaint about treatment. We also found that the board's handling of Mr C's complaint was inadequate. We did not uphold his complaint that the hydrocele procedure was performed without informed consent as the consent given included authorisation of any justified procedure found to be necessary during surgery. Our medical adviser confirmed that the procedure was justified.

Recommendations
We recommend that Lothian NHS Board:
• share the decision letter with the consultant and remind him of his responsibilities to maintain a standard of record-keeping which is in line with General Medical Council guidance;
• remind staff about the need to adhere to the timescales as set out in the NHS Complaints Procedure and to provide relevant updates; and
• apologise to Mr C for the failings identified in our decision letter.

Summary
Mrs C complained about the care provided to her by nursing staff during her stay at Raigmore Hospital. In particular she was concerned about the attitude of nursing staff and and about delays in attending to her needs. We did not find sufficient evidence to support her claims that the attitude of nursing staff was inappropriate and that they failed to attend to her needs within a reasonable time period. We noted, however, that although there was insufficient evidence to show what had happened the board had in any case apologised for any delays that Mrs C had experienced. We said that we would have considered this a reasonable outcome in the circumstances.
 

Summary
Mrs C complained about the food and about failure to provide a raised toilet seat, a blanket and sleeping pills during her three-day admission to a hospital. We concluded that the board had not acted unreasonably in respect of the food provided. In respect of the other issues, we concluded that there had been shortcomings but that what had happened was not unacceptable, particularly as the board had apologised and taken some action.
 

Summary
Mr C raised concerns that he was unreasonably discharged from the Glasgow Dental Hospital to his own dentist. He also felt that the hospital failed to adequately communicate with him and his dentist about the reasons for discharge and the treatment plan. We sought the opinion of our independent dental adviser who reviewed the relevant records and explained that the outstanding work required on Mr C was within the competence level of the average dentist and so the discharge decision was not unreasonable. However, the adviser explained that the information communicated to Mr C's dentist about the outstanding work did not include four teeth which were noted in the clinical record as requiring treatment but which were not included in the letter to Mr C's dentist about the outstanding treatment. We upheld this aspect of Mr C's complaint and made recommendations to the board.

Recommendations
We recommend that Greater Glasgow and Clyde NHS Board - Acute Services
Division:
• ensure that Glasgow Dental Hospital revisit their records and, if necessary, contact Mr C's dentist to discuss his remaining treatment plan and any amendments required; and
• ensure that Glasgow Dental Hospital remind staff of the importance of ensuring that the outstanding treatment plan as noted in the records is accurately conveyed to the dental practitioner and, if there is any difference between the treatment plan as noted in the patient's record and the treatment plan communicated to the dentist, the reasons for this are
noted on the records.

Summary
Mr C was a new patient at the practice and his medical records had not yet arrived. While the practice was waiting for them, Mr C asked for additional medication. When he did not receive this, he complained about how the practice had dealt with his request. We found that they had not in fact properly actioned it. We recommended that the practice apologise to Mr C and carry out a significant event analysis to identify the problem and prevent a recurrence.

Recommendations
We recommend that the medical practice:
• apologise to Mr C for the way they dealt with his request; and
• conduct an Significant Event Analysis of this incident.

Summary
Mr C raised concerns about a telephone consultation that he had with his GP. He was suffering from severe lower back pain. He told us that he believed that he should have had a home visit as he was admitted to hospital later that evening with Cauda Equina Syndrome (a disabling condition caused by compression of the nerves of the spine). Although our investigation found that the GP's management plan was reasonable, we found that her notes of the consultation were limited. Our medical adviser told us that in the circumstances a physical examination of Mr C was required. As this should have been carried out at his home, we upheld Mr C's complaint that the GP's telephone assessment of his condition was inadequate. We did, however, recognise that it was possible that the outcome would have been the same, even had the physical examination taken place.

Summary
Mr C complained that an employee of Grampian NHS Board passed on negative remarks about him (made by a third party) to his sister-in-law. This was in relation to the search for a care home for their relative, Mr A. The investigation revealed that the information had been relevant to the search and had not constituted any breach of confidentiality because Mr C's sister-in-law had power of attorney for Mr A. We also considered that the board had no responsibility to check whether the remarks were accurate or to give Mr C the chance to deny them.
 

Summary
Mr C attended the board's podiatry department in a health centre for an appointment to try on foot orthotics that had been modified for his foot. When he arrived the receptionist told him he had no appointment. Discussion about this matter escalated but, ultimately, his appointment was found and progressed as planned. He complained to the lead clinician that day but was dissatisfied with their response about the attitude and actions of the receptionist. He remained dissatisfied following completion of the the board's complaints procedure and raised these issues, as well as complaints handling issues, with us. We upheld the complaint that the receptionist had provided inaccurate information about Mr C's appointment but given that this was resolved, acknowledged and apologised for on the day, we did not consider any further action was necessary. We saw no objective evidence to support the complaint that the receptionist had been aggressive or abusive towards Mr C, and considered that the board's response to his complaints was reasonable.