Health

Summary

Ms C complained about the care and treatment provided to her by the board at Queen Elizabeth University Hospital when she was admitted with cellulitis (a bacterial skin infection) and with sepsis (blood infection). She complained about nursing and medical care in A&E and the acute receiving unit (ARU).

We took independent medical advice from a senior nurse, a consultant in emergency medicine, and a consultant in acute medicine. In relation to nursing and medical care in the A&E, we found that this was reasonable and we did not uphold these aspects of Ms C's complaint. However, we identified failings in the monitoring of Ms C's condition by nursing staff in the ARU. We upheld this aspect of Ms C's complaint, however, we noted that the board had previously acknowledged this and had taken action to address these failings.

In relation to medical treatment in the ARU, we found that the fluids prescribed to Ms C were unreasonable as they were not a recommended fluid for patients with sepsis, and they were not provided at a fast enough rate. We also noted that there was a failure to recheck Ms C's national early warning score (NEWS - an aggregate of weighted physiological parameters that gives an indication of how unwell a patient is, or if they are deteriorating) prior to transferring her to another ward. We therefore upheld this aspect of Ms C's complaint.

Ms C also complained about the board's handling of her complaint. We found that the board did not respond to the complaint within the required timescale and for this reason we upheld this aspect of Ms C's complaint. However, as the board had apologised and learnt from this matter already, we did not make any further recommendations.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to prescribe intravenous fluids reasonably based on the relevant guidance; and the failure to recheck her NEWS score prior to transferring her to another ward. 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:

• Intravenous fluids should be prescribed in line with relevant guidance.
• NEWS scores should be rechecked appropriately prior to transfer.

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 complained about the care and treatment they received from the practice after attending with concerns relating to swelling of the parotid gland (a salivary gland that lies immediately in front of the ear). C attended the practice several times and was eventually diagnosed with cancer. C later learned that it was terminal. C said that the practice had failed to treat their symptoms appropriately and that it took too long to refer them to the ear, nose and throat (ENT) department.

We took independent advice from a GP. We found that the practice had provided reasonable care and treatment to C, that they treated their symptoms appropriately and made appropriate and timely referrals to ENT. Therefore, we did not uphold C's complaint.

Summary

Miss C complained that the board did not provide her with reasonable care and treatment during her admission to Royal Cornhill Hospital. She also complained that the board's staff did not communicate reasonably with her during this admission.

Miss C said that she was not given clear information about her condition or possible treatment and that her treatment plan was decided upon before she was assessed. Miss C said that she was prescribed an unreasonable amount of medication and that there was an unreasonable delay before she was seen by the dietician. She also felt that there was a lack of structured therapeutic activity and she was often left for many hours without contact from members of staff. Miss C said that decisions about her discharge and the arrangements put in place were unreasonable.

We took independent advice from a consultant psychiatrist. We found that an appropriate management plan for Miss C's care and treatment was put in place which included a care and recovery plan. The evidence showed that the aims of Miss C's admission and the plan of treatment were discussed with her and that the treatment plan was reasonable. There were also timely referrals to the dietician and the medication Miss C was prescribed was in keeping with national guidance. We also found that the approach taken in relation to the management and the arrangements for Miss C's discharge were reasonable, as was communication between staff and Miss C. We did ask the board to provide feedback with regards to an incident during which Miss C was restrained. The evidence showed that staff recorded after the incident that a particular type of restraint was not appropriate for Miss C given her personal circumstances. The board also provided us with further information about their more recent restraint policy and practices which we found to be reasonable.

We did not uphold Miss C's complaints.

Summary

C complained about the care their parent (A) received at Forth Valley Royal Hospital and Falkirk Community Hospital.

We took independent advice from a nursing adviser. We did not identify any failings regarding the care provided to A at Forth Valley Royal Hospital and so did not uphold this aspect of the complaint. However, regarding the care provided to A at Falkirk Community Hospital we found that:

A was unreasonably transferred to a four-bedded room rather than a single room;

there was an unreasonable delay in A having their dietary/fluid requirements assessed by nursing staff following their admission to Falkirk Community Hospital; and

A was not given prescribed medication while awaiting discharge from hospital.

We upheld this aspect of the complaint.

C also complained about the board's handling of their complaint. We found that the board did not consider whether C had authorised their sibling to raise a complaint on C's behalf. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for transferring A to a four-bedded room at Falkirk Community Hospital rather than a single room; the delay in assessing A's dietary/fluid requirements on their admission to Falkirk Community Hospital; not giving A their prescribed medication while they were awaiting discharge from hospital; and not confirming whether C had authorised their sibling to make a complaint on their behalf about the out-of-hours GP. 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:

• Patients receiving palliative/end of life care should be transferred to a single room. In the event that this is not possible, where appropriate, they and/or their family/carer should be consulted prior to the transfer going ahead.
• Patients should receive prescribed medications while awaiting discharge from hospital.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the board's complaints handling procedure including consideration being given to checking whether individuals have authorised a person to make a complaint on their behalf, particularly where multiple complaints are received from members of the same family.

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's parent (A), who has a diagnosis of Alzheimer's disease (the most common type of dementia), was a patient in Falkirk Community Hospital. On discharge, A was moved to a nursing home, as they required greater care. C questioned the board's care of A while they were a patient in the hospital; in particular about the prolonged use of Risperidone (an antipsychotic drug). C was also unhappy about the delay in issuing a discharge letter and the fact that it was sent to the nursing home. C complained that the letter contained incorrect information.

The board's view was that A had been prescribed Risperidone before they were admitted to hospital and that as they remained agitated and confused at times, in the absence of any clinical indication that they were experiencing side effects, there was no reason to alter the dose that had already been prescribed. Furthermore, they said that the medication was regularly monitored. The board agreed that there had been a delay in issuing a discharge letter and apologised that the letter contained incorrect information.

We took independent advice from an appropriately qualified adviser. We found that Risperidone had been prescribed reasonably and appropriately to A and that its use had been regularly monitored. We did not uphold this aspect of the complaint. However, we found that with regard to the discharge letter, the level of care given to A (with regard to delay and release of sensitive information) fell below the standard they could have expected. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the delay and failing to discuss/obtain consent for the sensitive content of a discharge letter prior to releasing it to the care home.The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/informationleaflets

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

• Discharge letters should be issued in a timely way. Sensitive information included in a discharge letter should be discussed with and consent obtained from the patient/guardian prior to its inclusion.

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 complained about two matters. The first related to whether or not the treatment plan prepared by a dentist employed by the dental practice was clinically necessary. We did not uphold this complaint on the basis that images taken of the teeth and an x-ray showed that the work set out in the treatment plan was required to the teeth as there was decay, part of a filling was missing and part of a tooth was missing. The clinical notes also referred to this.

The second related to a failure to provide C with evidence that the work was clinically necessary when asked to do so. We did not uphold this complaint on the basis that the clinical notes and the images were sent to C by the dental practice. The dentist, who had left the practice subsequently, wrote to C to provide them with information about why the treatment was necessary.

Whilst we did not uphold this complaint we did recognise that communication when dealing with the complaint could have been better and a more coordinated approach between the dentist and the dental practice would have resulted in better complaint handling. We noted the dental practice had already apologised for this and made an offer to C as a good will gesture.

Summary

Mrs C complained that the care her child (Child A) received from the board during their admission for bacterial meningitis (an infection of the protective membranes that surround the brain and spinal cord) was unreasonable. Mrs C said that Child A was not given the full dose of antibiotics and that the day after discharge they had to be re-admitted as the infection had not been cleared. Mrs C also complained that Child A was given an MRI scan using the feed and wrap technique (use of feeding and swaddling to induce natural sleep in infants), which did not work, rather than performing the test under general anaesthetic.

We took independent advice from a consultant paediatrician (a medical practitioner specialising in children and their diseases). We found that, on review of the medical notes, Child A received the stated course of antibiotics, there were no concerns over the timing of the doses, and it was reasonable for Child A to have been discharged initially. We also found that it was reasonable for Child A to have their MRI using the feed and wrap technique in the first instance. As a result, we did not uphold this aspect of the complaint.

Mrs C also complained that the handling of her complaint was unreasonable. We were satisfied that the board had followed the NHS Complaints Handling Procedure and as a result, did not uphold this aspect of the complaint.

Summary

C complained about the care and treatment provided to their late partner (A). C said that there was an unreasonable delay in diagnosing that A was suffering from cancer. We took independent advice from a consultant in acute medicine (a doctor who specialises in the immediate and early management of adult patients with a wide range of medical conditions who present in hospital as emergencies) and a consultant in respiratory medicine (a doctor who specialises in treating and managing patients with conditions affecting their lungs). We found that the care and treatment A received was reasonable and that there was no delay in diagnosing that they had cancer. As such, we did not uphold the complaint.

C also complained that the medical care and treatment provided to A after diagnosis was unreasonable. We took independent advice from a consultant in respiratory medicine. We found that the care and treatment given to A was reasonable; that all appropriate investigations and tests were carried out and that these were performed rapidly. We also noted that A's main consultant was actively involved and spoke at length to the family, as did the clinical nurse specialist. Finally, we found that there were frequent discussions where A and the family were updated on their condition. Therefore, we did not uphold the complaint.

In addition, C complained that the nursing care and treatment provided to A after the diagnosis of cancer was unreasonable. We took independent advice from a nursing adviser. We found that, while the majority of the nursing care and treatment given to A was reasonable and in line with the Nursing Midwifery Council Code, the board had accepted that the condition that C had found A in when they had attended the ward on one occasion was unreasonable and that they had taken action as a result. On balance, we upheld the complaint but made no recommendations.

Finally, C complained that A was unreasonably discharged from Forth Valley Royal Hospital. We took independent advice from a consultant in respiratory medicine and from a nursing adviser. We found no evidence that A had been unreasonably discharged and as such we did not uphold the complaint.

Summary

C complained on behalf of the child (A) about the care and treatment received by the board. A was referred to neurology (the branch of medicine concerned with the diagnosis and treatment of disorders of the nervous system) after reporting that they were experiencing upper body jerks and involuntary twitching. A review was undertaken by a private healthcare provider on behalf of the board as part of a neurology waiting list initiative. The neurologist agreed that an MRI scan and an EEG (electroencephalogram - a test used to evaluate the electrical activity in the brain) would be carried out. Some years later, A was admitted to hospital after a seizure. It was noted that the earlier EEG referral was not progressed. Another EEG was arranged and following that, A was diagnosed with epilepsy (a condition that affects the brain and causes frequent seizures).

C said that they considered the failure to carry out the EEG meant there was a delay in diagnosing A's epilepsy. The board said it was the neurologist's intention to have the scan carried out. An apology was given for the lack of follow-up in A's case.

The evidence available confirmed that the neurologist appropriately considered the possibility that A was suffering from myoclonic epilepsy (brief shock-like jerks of a muscle or group of muscles), and intended to order appropriate investigations. However, there was no evidence available to confirm that the request for the EEG was actioned or followed up. The relevant paperwork was not available to reflect back on what may have happened.

We took independent advice from an appropriately qualified adviser. We found that an EEG should have been carried out in A's case. The relevant guidance indicates the significance of arranging an EEG in cases of suspected myoclonic epilepsy.

We upheld the complaint but did not recommend any further action because the board had already apologised for not actioning the EEG. In addition, the board also told us they no longer used the services of the provider.

Summary

C complained about the care and treatment provided to their child (A). A was treated with intravenous immunoglobin (antibodies) because it was suspected they had an immune-related movement disorder. The focus of C's complaint was about the decision to stop this treatment as they considered it was of benefit to A.

During our investigation we noted that the decision to start and stop this treatment was made by a doctor under a different health board. The treatment plan was commenced at the other board and moved to Fife NHS board because it was more convenient for A and their family to attend. We were therefore unable to comment on whether or not it was reasonable to stop this treatment, as the decision was not made by the board subject to the complaint. In relation to the treatment carried out at Fife NHS board, we found that the infusions of immunoglobin were administered by the board in accordance with the plan that was put in place by clinicians under the other board. We did not uphold this complaint.

We provided feedback to the board in relation to their complaints handling. As this complaint focussed on the decisions made about treatment, it would have been helpful to C and this office if this had been clarified at an early stage so that the correct focus of the investigation (a different board) could have been identified earlier.