Health

Summary

C complained about the care and treatment they had received from the board and that the board failed to communicate reasonably with them. C was diagnosed with breast cancer and felt they were not able to have a full discussion of the treatment options for their condition and that they were not being given the opportunity to make informed decisions about their care.

C sought a second opinion from a different health board and said they were offered a much fuller discussion of their treatment options, including some tests which were not offered by Tayside NHS board. C complained to the board about the differences in the treatments offered. C noted that the board appeared to be alone in not using a specific test and that their approach was outdated and not patient centred. C did not feel the board’s justification, that the test might cause anxiety amongst its patients, was in line with patient centred medicine. C also pointed to a Healthcare Improvement Scotland (HIS) report into practices within the board’s oncology (study and treatment of tumours) department. This had found areas for improvement, including communication with patients and the use of the test in question.

The board said they did not agree that the tests offered to C when they received their second opinion were necessary or required by clinical guidance. The board had accepted the findings of the HIS report, but did not agree that the test should have been offered in C’s case.

We took independent medical advice from a consultant oncologist. We found that the majority of oncologists would have offered the test in dispute, as it would have helped to guide discussions with C. In addition, the medical records did not record whether a detailed discussion was held with C about their treatment options. We found that C’s care and treatment had fallen below a reasonable standard as they were not able to have a full discussion of all the treatment options available to them and because they were not offered testing, which they could reasonably have expected to receive had they been patients of another health board in Scotland. We also found the standard of communication with C was not of a reasonable standard. We upheld both aspects of C's complaint. However, as communication with patients had been addressed by the HIS report, we did not make any recommendations in this regard.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to offer particular testing, or to discuss fully the treatment options available to them. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The board should provide patients with copies of the letters from their clinics.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mrs C complained about the care and treatment she received at Ninewells Hospital. Mrs C had previously received treatment for breast cancer and had been monitored over the years following this.

Mrs C complained that a mammogram (an x-ray test of the breasts) was not performed at a review appointment. The board said that Mrs C had already received the last of the planned annual follow-up mammograms and she did not require one when she attended for a review.

We took independent advice from a consultant breast surgeon. We found that Mrs C had received follow-up mammograms in accordance with national and local guidelines. We concluded that it was reasonable that Mrs C was not offered a mammogram at the review. We did not uphold Mrs C’s complaint.

Mrs C also complained that she was not offered an emergency appointment for breast imaging following a consultation with the Lymphoedema Service (a service managing problems with the lymphatic system, a network of vessels and glands spread throughout the body). We found that it was reasonable that Mrs C was not offered emergency breast imaging and we did not uphold this complaint.

Finally, Mrs C considered that the board’s response to her complaint contained inaccurate information. We reviewed the evidence available and we were unable to conclude that the board had provided inaccurate information. We did not uphold this complaint.

Summary

C, a prisoner, complained about the decision by the prison health care team to discontinue their prescribed pain medication. The decision to discontinue the medication was made after C failed a medication spot check. It was recorded that C did not cooperate and C was deemed to have failed the spot check.

We took independent medical advice from a GP. We were unable to reconcile the conflicting accounts provided by C and the board regarding what happened during the spot check. We were unable to conclude that the spot check was not conducted appropriately. In the context of a failed spot check, we concluded that it was reasonable that C’s medication was discontinued. We did not uphold C’s complaint; however, we made a recommendation after we identified an issue with the board’s complaint handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C that the frontline complaint response contained an inaccuracy about what they reportedly said during the spot check. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C, who had a history of breast cancer, complained that the board failed to provide them with appropriate care and treatment at the Western General Hospital for a lump on their breast. The lump was investigated but found to be of no concern. Two years later, a clinically suspicious lump was identified and investigations showed evidence of an invasive carcinoma (cancer). C raised a number of issues including why a trainee doctor was allowed to perform a biopsy on the first lump identified on their breast and whether the doctor performed the procedure correctly. C also questioned why the lump in their breast was not removed or investigated further.

We took independent advice from a consultant breast surgeon. We found that it was acceptable for the trainee doctor to perform the procedure under the supervision of the consultant surgeon, as was the case here, and that there was no evidence that the procedure was performed incorrectly. We also considered that the decision taken by the board at that time not to remove the lump or carry out further investigation was reasonable. C’s case went through the correct process and we determined that C’s treatment was reasonable. We did not uphold this part of the complaint.

C also complained that the board failed to provide them with a reasonable response to their complaint. C raised a number of issues, including that the board’s response did not address their specific concerns. We considered that the board’s response generally addressed the questions raised by C and we did not uphold this part of the complaint.

Summary

C complained about the care and treatment their parent (A) received at St John's Hospital. C considered that A did not receive reasonable medical or nursing care and treatment; in particular, that their ward placement on a ward which was only used during the winter period to provide additional medical capacity was inappropriate and resulted in A not receiving continuity of care. C raised concerns about A’s weight management and the board’s response to A’s concerns about their vision.

The board indicated that they considered that A was appropriately placed and received the same standard of care they would have on any other ward. The board acknowledged that one weekly weigh-in had been missed for A but indicated that improvements had been made in the form of more robust processes in this area of patient care.

We took independent advice from a geriatric (medicine of the elderly) and general medical adviser and a nursing adviser.

We noted that the board had missed one weekly weigh-in for A and that there had been a delay in ophthalmologist (a specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye) input. However, we concluded that overall A received reasonable care and treatment. Whilst some shortcomings were identified, A was placed in an appropriate ward that, on the whole, appropriately met their needs and they received the same care and treatment that they would have had they been on a general medical ward. Therefore, we did not uphold C’s complaints.

Summary

C complained about the care and treatment provided to their parent (A). A, who has vascular dementia and Alzheimer’s, suffered from ill health and C sought medical care and treatment from A’s practice on numerous occasions for what they suspected were urinary tract and chest infections.

A had three hospital admissions during this period and C was concerned about the care and treatment provided in particular in the time leading up to each hospital admission. C said that the GPs at the practice focused too much on A’s dementia and unreasonably failed to take C’s concerns about A’s condition seriously. As a result, C said the GPs had failed unreasonably to investigate and treat A’s deteriorating condition including a number of serious infections.

We took independent advice from an adviser who specialises in general practice. We found that GPs at the practice had taken C’s concerns seriously and assessed and treated A in a reasonable way. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received from the board for her ongoing health problems. She said that the board initially failed to appropriately diagnose and treat her health condition and then failed to provide her with appropriate care and treatment for her condition. Ms C said she was advised by the board that she had multiple sclerosis (MS) and she never had any reason to doubt the diagnosis, until ten years later she discovered she had a condition which inhibited the absorption of vitamin B12, when she found that supplementing her diet with liquid vitamin B12 resulted in her experiencing improvements in many of her symptoms.

We took independent medical advice from a consultant neurologist (a specialist in the diagnosis and treatment of disorders of the nervous system). We found that Ms C’s initial diagnosis of probable MS was appropriate. The evidence suggested that the description given to Ms C of the level of certainty of her MS was reasonable and in line with the actual status of her diagnosis at that time. We found that vitamin B12 deficiency would not be expected to have presented with the pattern of relapsing–remitting disease in Ms C’s case. We considered that there was no indication to have administered vitamin B12 injections in the early stage of Ms C’s illness, as there was no evidence that her condition related to vitamin B12 deficiency. Therefore, we did not uphold this part of the complaint.

In terms of Ms C’s subsequent treatment, Ms C raised a number of issues, including that the board did not order a further spinal MRI to compare with the spinal MRI done at the time of her diagnosis. We found that the main purpose of MRI scans in a case such as this was to secure the diagnosis, rather than to monitor progress and there was, therefore, no clear indication to repeat the scans any more regularly than was actually done. We considered that the board provided Ms C with appropriate subsequent care and treatment and did not uphold this part of the complaint.

Ms C also complained that the board failed to respond to her complaint about her diagnosis and treatment appropriately. We found that the board’s responses to Ms C’s complaint failed to address all the issues raised; the responses were issued outwith the timelines set out in the NHS Model Complaints Handling Procedure; and the board failed to keep Ms C updated on the reason for the delays and give her revised timescales for completion. We, therefore, upheld this part of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to address all the issues raised in their responses to her complaint; for issuing the responses outwith the timelines set out in the NHS Model Complaints Handling Procedure and for failing to keep her updated on the reason for the delays and give her revised timescales for completion. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The board’s responses to complaints should address all the issues raised, be issued within the timelines set out in the NHS Model Complaints Handling Procedure and keep the complainant updated on the reason for the delays and give revised timescales for completion.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C had been referred to the blood pressure clinic at the hospital by their previous GP practice, and when they did not hear from the clinic, they called their current practice to enquire about this. The practice told C that they had failed to attend an appointment at the clinic and that C was to contact the hospital in the first instance. C made enquiries with the clinic to be informed that they had indeed missed an appointment and that they should ask the GP for a further referral. C said they had not received the appointment letter.

We took independent clinical advice. We found that the practice had received notification by letter from the clinic that C had failed to attend an appointment and that should the practice deem C still required to be seen at the clinic, then they should initiate a further GP referral. We found that the practice should not have told C to contact the clinic as they were already aware that a further referral was required or that the practice could have decided to undertake more investigations locally to monitor C’s blood pressure levels. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure to communicate to C whether their blood pressure issues could have been monitored by the practice or rerefer them to the blood pressure clinic. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Staff should be mindful of the need to fully communicate to patients about whether further investigations are required before a hospital referral is deemed necessary.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C, a Patient Advice and Support Service adviser, brought the complaint on behalf of their client (B) with regard to the care and treatment provided to B’s late spouse (A). A had a compromised immune system and received regular immunoglobulin therapy (a blood-based treatment to increase the number of antibodies in the immune system). A was admitted to hospital with a high temperature and was found to have acute leukaemia. They deteriorated over several weeks and died a short time later. C complained about a number of aspects of A’s care and treatment including a change in their immunoglobulin brand; that A’s reason for admission to hospital was not clearly communicated; that A had cellulitis (a type of skin infection) in their hand; and that A being incorrectly administered a diuretic (a type of medication which increases the passing of urine) indirectly led to their death.

We took independent advice from a consultant haematologist (a specialist in diseases of the blood and bone marrow). We found that the care and treatment provided to A was reasonable. Specifically, we found that there was no indication the change in immunoglobulin brand caused A’s deterioration; there were several terms that could have been used to describe the reason for A’s admission to hospital and the board’s actions in this regard were not unreasonable; it did not appear that A had cellulitis in their hand; and the incorrect administration of a diuretic was not a cause or contributor to A’s death.

Therefore, we did not uphold C’s complaint. However, we noted some feedback for the board with regard to communication about A’s prognosis.

Summary

C underwent knee surgery, following which the hospital provided them with a sick note. At the end of that sickness period, they were told that they required two more weeks of recovery before they could return to work. When C approached the practice, they were told they should be given a sick note by the hospital. C then went back and forth between the practice and the board. C said they were told by the board’s complaints team that it was the practice’s responsibility and that if the practice refused to provide a sick note, they would be in breach of their NHS contract.

C said the process was very stressful and at one point they were without a sick note. While they were issued with one by the hospital, it was reiterated to C that this should have been the practice’s responsibility.

The practice told us they had taken advice on whether it was their responsibility to provide a sick note for C. They said that the Lanarkshire Local Medical Committee (LLMC) had told them it was the responsibility of the hospital who had operated on C. They said that the LLMC was taking the matter up with the board more generally. The practice said that they would have provided C with a sick note, but by that time, the hospital had done this.

We took independent advice from an appropriately qualified adviser. We found that records stated that C was the responsibility of the hospital until they were fully discharged. This meant that whilst C still had out-patient appointments to attend, the practice were correct to state that they were not responsible. We did not uphold C's complaint.