Health

Summary

Ms C complained to us about the care and treatment she received from her GP practice. She said that staff at the practice had not listened to her and had not provided reasonable care and treatment for her adhesions, diarrhoea and Myalgic Encephalomyelitis (ME; a long-term illness with a wide range of symptoms including extreme tiredness). She also said that the practice seemed fixated by her having depression and that she needed bereavement counselling or antidepressants without understanding her situation.

We took independent advice from a GP. We found that there was no evidence that staff had not listened to Ms C and that they had provided reasonable care and treatment in relation to her adhesions, diarrhoea and ME. It was also reasonable for the practice to offer Ms C bereavement counselling along with other treatment in relation to this. We considered that the care and treatment provided to Ms C was reasonable and we did not uphold the complaint.

Summary

Mr A fell at home and a 999 call was made to the Scottish Ambulance Service (SAS) to attend. The call was prioritised as an emergency response where an ambulance would be dispatched as soon as one became available. An ambulance arrived with Mr A approximately four hours after the initial call. Mr A was later diagnosed with a broken hip.

During Mr A's rehabilitation in hospital, there were concerns that he had sepsis. Staff at the hospital called for an ambulance and requested an emergency response to transfer Mr A to another hospital for treatment. The ambulance arrived over two hours after the initial request.

Mr A's daughter (Mrs C) complained that the time taken for an ambulance to attend on both occasions was unreasonable and that Mr A's condition, on both occasions, should have resulted in an emergency response.

We took independent advice from an appropriately qualified adviser. We found that on each occasion the delay in an ambulance attending was not attributable to failings on the part of SAS assessing and prioritising the requests for an ambulance, or not appropriately allocating its resources. The delays were a result of a lack of availability of resources at the times in question and ambulances attending to higher priority calls. Whilst there was a significant delay in the ambulance attending to Mr A on each occasion, this was not attributable to failings on the part of SAS handling the calls. We did not uphold the complaint.

Summary

C complained that the Scottish Ambulance Service (SAS) failed to respond reasonably to the request for an emergency ambulance service for their child (A). C expressed concern about the overall time taken for A to be taken to hospital; which was approximately two hours from the original call being made requesting an emergency ambulance, to A arriving at hospital and being reviewed by a doctor. C also complained about how SAS responded to their complaint about that matter.

SAS upheld C's complaint on the basis of a longer wait than would have been expected for this category of call and offered an apology for that wait. They explained that this was a very busy time for the service but confirmed that a call audit had concluded that the call was handled very well and was of high compliance with their dispatch system.

We took independent advice from a paramedic. We found that there were concerns with SAS's response for an emergency ambulance, including:

The delay in elevating the response level which relied on the subjective opinion of a non-clinical call handler.

The lack of clinical advisor input into the call which could have negated the limitations of the system and possibly changed the level of acuity, and as such the response time and time taken for A to reach hospital.

The decision of the original ambulance crew to wait on the second responding crew to transport A.

Therefore, we upheld the complaint that SAS failed to respond reasonably to the request for an emergency ambulance to attend to A.

In relation to complaint handling, we found that SAS's response to C's complaint was appropriate. We also noted that their apology was in line with SPSO guidance. Therefore, we considered that SAS reasonably responded to C's complaint and we did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to respond reasonably to the request for an emergency ambulance to attend to A. 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:

• Clinical advisors should be able to assess a patient's condition in line with current guidance - which provides that a clinical advisor's first point of contact should be at 45 minutes from the time of call within the yellow patient cohort. If a decision is made for this not to happen, the reasons for that decision should be clearly recorded.
• Patients should be transported by ambulance using the appropriate harness.

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

Ms C complained about the decision of staff at the Royal Hospital for Sick Children to assess that two referral letters from her child's (Child A) GP should be graded as routine rather than urgent. Child A had ankyloglossia (tongue-tie); this occurs where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual which affected their ability to feed. As the board had added Child A to the routine waiting list, Ms C paid for the procedure to be completed on a private basis, and Child A immediately improved their feeding ability. Ms C believed that the GP referral letters should have been graded as urgent which would have allowed the procedure to be carried out sooner.

We took independent advice from a consultant paediatrician (consultant specialising in the medical care of children). We found that as Child A was able to feed using a bottle and was gaining weight, there was no need to classify the referral letters as urgent; this was in line with board policy. We did not uphold the complaint.

Summary

Ms C complained about the medical care and treatment provided to her father (Mr A) when he was an in-patient at the Royal Infirmary of Edinburgh. Ms C had concerns about the medical reviews, the decision to withdraw treatment/fluids, the monitoring of Mr A's condition, whether Mr A had an infection, the decision to reinstate active treatment, and communication with Mr A's family.

We took independent advice from a consultant in geriatrics (a doctor who specialises in medicine of the elderly) and general medicine. We found that the care and treatment provided to Mr A was reasonable and decisions were made sensitively to balance the wishes of Mr A's family and to reduce distress for Mr A. We did not uphold this complaint.

Summary

Mrs C complained about the care and treatment her late brother (Mr A) received from the practice. Mr A attended two consultations at the practice as he had experienced shortness of breath on exertion for the previous few weeks. The GP arranged for a chest x-ray and blood tests to be carried out. These tests did not highlight any concerns but Mr A confirmed that his breathing difficulties were ongoing. The GP felt his breathing difficulties could have been caused by angina (chest pain caused by reduced blood flow to the heart muscles) and increased his medication for this with the intention to refer Mr A for more specialist assessment if his symptoms persisted. Mr A died suddenly one week after his second consultation. Following a post-mortem, it was confirmed that the primary cause of death was a pulmonary embolism (a blockage in one of the pulmonary arteries in the lungs, caused by a blood clot). Mrs C complained to the practice and queried why the GP did not look at Mr A's medical history, as this included details of a previous blood clot. In addition to this, Mrs C queried why no further investigation was carried out after the second consultation when Mr A's x-ray results were confirmed as clear. In their response to Mrs C's complaint, the practice concluded that the GP's clinical assessment and decision-making, based on the information at the time, was considered and reasonable. Mrs C was unhappy with this response and brought her complaint to us.

We took independent advice from a GP. We found that the care and treatment the practice provided to Mr A was reasonable. We were satisfied that appropriate consideration was given to Mr A's medical history in respect of blood clots when assessing his breathing difficulties. We also concluded that the practice's actions, after Mr A's x-ray results were known, were reasonable and appropriate. We were satisfied that the records indicated the practice had a firm treatment plan in place for Mr A and had clearly detailed the reasons for this approach. Therefore, we did not uphold Mrs C's complaints.

Summary

Ms C complained about the care and treatment she received at the Royal Infirmary of Edinburgh. Ms C complained that she was unreasonably prescribed a drug, uniphyllin, in order to treat her asthma.

We took independent advice from a consultant in respiratory and general internal medicine. We found that it was reasonable to prescribe uniphyllin for Ms C's asthma and long-term breathing difficulties. Therefore, we did not uphold this aspect of the complaint.

Ms C experienced a tonic-clonic seizure (type of seizure that involves both stiffening and twitching or jerking of a person's muscles) whilst taking the drug and said that she was not advised that this was a possible side effect. We considered that it would have been reasonable for Ms C to have been provided with information so that she could be involved in decisions made about her care and the possible side effects of medication. We upheld this aspect of Ms C's complaint.

Ms C also complained that she was given an increased dose of the drug without the effect of this being monitored. We found that the symptoms Ms C was experiencing were not necessarily a sign that the dose she was given was too high. An increase was also reasonable for maximum therapeutic effect. We did not uphold this aspect of Ms C's complaint.

Finally, Ms C complained that there was an unreasonable delay in advising her to stop taking the drug after she had a seizure. We considered that it would have been reasonable for Ms C to have been advised in A&E to stop taking the drug when she was admitted after her seizure. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to advise her of the possible side effects of the drug and for failing to advise her when she attended A&E with a seizure that she should stop taking the drug because she was at risk of further seizures. 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:

• To ensure General Medical Council good practice is followed when considering treatments to ensure patients are aware of significant side effects.

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 underwent specialist reconstructive surgery. After the surgery, C experienced urinary incontinence. C said that they had believed the surgery would be of a routine nature and complained that they had not been not provided with adequate information about it; in particular, that a possible side effect was incontinence.

We took independent advice from a urology adviser (a doctor who specialises in the male and female urinary tract, and the male reproductive organs). We found that the board failed to provide adequate information to C about the planned procedure prior to obtaining their consent and, therefore, we upheld this complaint.

C also complained about the delay in the surgery being carried out. The board accepted that there was a delay in C accessing treatment and explained that the delay reflected the waiting list issues the department had at the time. We found that there was an unreasonable delay in C's planned procedure being carried out. We upheld this complaint.

C complained that the board failed to provide them with reasonable care and treatment. C had concerns about how the board managed their place on the waiting list for the planned procedure and about the aftercare provided. The board acknowledged that there was a breakdown in communication which resulted in C having to arrange aftercare themselves. However, they said that their waiting list was managed appropriately. We found that there was nothing to suggest that C's place on the board's waiting list was managed inappropriately. However, we upheld the complaint on the basis of the breakdown in communication which resulted in C arranging aftercare treatment themselves.

Finally, C complained that the board failed to handle their complaint reasonably. The board acknowledged that there had been a delay in responding to C's complaint and that they had not communicated about the delay with C. We found that the board did not respond to C's complaint within expected timescales or communicate with C about that delay. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the identified failures. 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 consent process should follow national guidelines. Consent should be taken, where possible, prior to the day of surgery. As part of the consent process, there should be a clear discussion of the risks and benefits (of having the surgery and not having the surgery) and of any alternative treatment options; and those discussions should be clearly documented.
• Patients should get appropriate follow-up appointments.

In relation to complaints handling, we recommended:

• Staff should handle complaints in line with the Model Complaints Handling Procedure, which includes responding to complaints within timescales and where this is not possible, advising complainants of this and providing revised timescales.

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

Ms C complained about the dental assessment she received from a consultant in restorative dentistry at the board and the consultant's report of their findings. Ms C said that the consultant failed to consider her health/dental health issues and the views of her own dentist appropriately. She complained that the consultant unreasonably concluded that she did not qualify for specialist treatment at the board. Ms C felt that the consultant should have agreed for her to have dental implants.

We took independent advice from a dentist. We found that Ms C's dentist felt that her natural dentition should be removed to make way for dentures and that they referred Ms C to the board for a second opinion. We found that dental implants were not available on the NHS, other than in exceptional circumstances, which Ms C did not meet those criteria. We noted that the two alternative treatment options identified for Ms C by the board consultant would most appropriately be carried out by her own dentist rather than a specialist at the board. We also found that Ms C's health and dental phobia issues would usually be managed by a patient's dentist and would not be the remit of a restorative consultant. However, we noted that if these proved to be too complex, then a patient should be referred to the Public Dental Service, where dentists are better versed in treating patients with medical, behavioural or phobia issues

We concluded that the board provided Ms C with appropriate care and treatment and, therefore, did not uphold the complaint.

Summary

Mr C has autistic spectrum disorder (a developmental disability that affects how a person communicates with, and relates to, other people). After attending an advice clinic, Mr C was assessed by a psychologist. He was then referred to a community mental health service to see if they could help him with social skills and managing anxiety. The community mental health service did not consider they could meet Mr C's specific needs; and they explained that he might be able to access support from a charity instead.

Mr C complained that after his psychology assessment, he was not referred for care and treatment suitable to his needs. We took independent advice from a psychologist. We found that Mr C was appropriately assessed and referred for help with social skills. We found that the community mental health service gave the referral careful consideration. We also found it was reasonable that they refused it, as the charity was better equipped to meet Mr C's needs. We did not uphold this aspect of the complaint.

Mr C also complained that the board failed to handle his complaint in a reasonable manner. We found that the board did not communicate clearly with Mr C about his complaint, in particular in relation to the scope of their investigation. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to handle his complaint in a reasonable manner. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• The board should communicate with complainants in a way that is clear and easy to understand.

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.