Health

Summary

C was admitted to the Queen Margaret Hospital where they were detained under an Emergency Detention Certificate (EDC). C complained about the nursing care provided during their admission. They said that staff did not interact with them or show them around the ward; they did not receive adequate food; they did not have clothes or toiletries; and that staff searched their bag and removed medication.

The board said there were attempts to offer food to C, however this was sometimes refused. They said there was evidence of good nursing care provided to C and that they did attend for meals. The board confirmed C’s bag was not searched and that they do not hold a supply of clothing for patients.

We took independent advice from a mental health nurse. We found that, while some aspects of the nursing care provided to C were reasonable, there was no evidence that a nutritional screening tool was used to assess C’s nutritional state, and this should have been done within the first 24 hours of admission. We concluded the board failed to adequately assess and record C’s nutritional needs and, as such, the nursing care was below the standard expected. We upheld C's complaint.

Recommendations

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

• The board should take steps to ensure that nutritional care is in line with national standards, and in particular that all patients are subject to nutritional screening within 24 hours of admission.

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 to the practice about a consultation they had. They said that they reported symptoms of severe pain and swelling of the abdomen and that they were grey in colour and had difficulty standing up. C said the practice prescribed them with laxatives (medication to help increase bowel movements). C continued to deteriorate and days later was admitted to hospital as an emergency, where it was found they had perforated diverticular (diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older) disease. C said they had to undergo emergency surgery and were an inpatient for a month. C felt that the practice should have diagnosed their serious condition and arranged an urgent hospital admission.

We took independent advice from a medical practitioner. We found that the GP involved had carried out an appropriate examination based on C’s presenting symptoms and that a diagnosis of constipation was reasonable. There was no clinical indication that C’s health was going to suddenly deteriorate with severe diverticular disease and that they would require a hospital admission. We did not uphold the complaint.

Summary

C complained about the care and treatment their ex-partner (A) received from the board during a hospital admission. A was taken to hospital after self-harming. They had also written a suicide note, which was taken to hospital with them. After being assessed by psychiatric clinicians, it was decided that A did not require hospital admission for psychiatric observation or detoxification. It was also concluded that A showed no evidence of a specific plan or intent to carry out suicide and did not present with a mental illness. A was discharged that day but completed suicide the following day.

C complained to us about the general care and treatment provided to A and the fact that they were discharged home. In addition to this, C complained that they were not informed that A had been admitted to and discharged from hospital, given that they were still A’s next of kin.

We took advice on this complaint from an appropriately qualified adviser with a background as a consultant psychiatrist. We found that staff carried out an appropriately detailed assessment of A and made decisions that were in line with relevant guidance, based on the information available to them at the time. The board had previously acknowledged that the suicide note had not been reviewed by the clinicians who attended A and we agreed that this was a shortcoming. However, despite the outcome, we were satisfied that the board had provided a reasonable and appropriate level of care and treatment to A overall. Therefore, we did not uphold this aspect of the complaint.

In respect of whether C should have been notified of A’s admission and discharge, we concluded that the board’s actions were reasonable. Although C was listed as A’s next of kin, A was living with their father at the time. It was reasonable for the hospital to conclude that A’s father was the most appropriate point of contact at that time. Therefore, it was reasonable for the hospital to discuss matters with A’s father rather than with C. With this in mind, we did not uphold this aspect of the complaint.

Summary

C, an advocacy worker, complained to us on behalf of their client (B) about the care and treatment the board provided to B's spouse (A). During our investigation, we took independent advice from an adviser in respiratory and internal medicine.

In 2011, A's GP referred them to the board, after an x-ray showed irregularities in their lungs. For around two years, A was followed up at the respiratory medicine clinic with chest x-rays. Medical staff concluded the lung irregularities were unlikely to be cancerous and A was discharged. Around that time, A was diagnosed with rheumatoid arthritis (a long-term condition that causes pain, swelling and stiffness in the joints). In late 2017, A was diagnosed with small cell lung cancer at Ninewells Hospital that had already spread to their liver. A died shortly afterwards.

C complained that between 2011 and 2013, the board failed to diagnose A with lung cancer. We found A was given appropriate follow-up with chest x-rays and it was reasonable the lung irregularities were not considered to be cancerous. We did not uphold this complaint.

C complained that between 2013 and 2017, A was experiencing symptoms of lung cancer that were wrongly attributed to rheumatoid arthritis. We found that it was reasonable A was diagnosed with rheumatoid arthritis. We found A had not reported cancer related symptoms at their rheumatology reviews. We also found that as small cell lung cancer is very aggressive, the symptoms would usually develop over months and not years. We did not uphold this complaint.

C also complained that A's discharge letter from Ninewells Hospital was unreasonable, as it contained incorrect information about A's condition. The board acknowledged there was an error in the discharge letter. We found the discharge letter was unreasonable due to the error and we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to B for the failings in the board's complaints handling. 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' discharge letters should contain accurate information about their condition and the outcome of investigations.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the Model Complaints Handling Procedure (MCHP). The MCHP and guidance can be found here: https://www.spso.org.uk/the-model-complaints-handling-procedures.

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 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.