Health

Summary

Mrs C complained to us on behalf of her late son (Mr A). Mr A was admitted to University Hospital Monklands for surgery to treat perianal abscesses (a collection of pus or infected fluid near the anus). Mr A was discharged home and received visits from district nurses to check his surgical wounds. Mr A began to feel unwell and he died a few days after his discharge home.

Mrs C complained that Mr A did not receive reasonable care and treatment in the hospital and that district nurses failed to recognise Mr A was seriously unwell.

We took independent advice from a colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus) and a nurse. We found that the care and treatment Mr A received in the hospital was reasonable and there was no indication Mr A should not be discharged home. We found no evidence that district nurses were aware that Mr A was feeling unwell. Therefore, we did not uphold the complaint.

Summary

Mrs C complained about the treatment which she received at A&E of Raigmore Hospital following a fall where she bumped her head and suffered hearing problems. The staff believed the hearing loss would be temporary and discharged her home. However, Mrs C's hearing loss continued over a number of months and she attended her GP on a number of occasions. A referral was made to the ear, nose and throat department (ENT) where a hearing aid was fitted. Mrs C believed that she should have been referred to ENT specialists at the time of the A&E attendance.

We took independent advice from a consultant in emergency medicine. We found that staff at A&E carried out appropriate investigations at the time of Mrs C's attendance and that it was reasonable to suspect the hearing loss would be temporary. There was no clinical indication for an immediate referral to ENT and advice was given to attend her GP should the symptoms not resolve. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her child (Child A) received from a practice managed by the health board. Child A had initially attended the practice for treatment of tonsillitis. However, they continued to be unwell and Mrs C took them back to the practice a number of times over the subsequent months.

Mrs C complained that, despite raising concerns about Child A's symptoms with the GPs, her suspicion that Child A may have glandular fever was not properly investigated. Based on Child A's presentation, the practice concluded that they were suffering from post-viral symptoms. However, Mrs C stated that this was never communicated to her. Mrs C complained that the practice did not provide reasonable care and treatment to Child A in respect of their presenting symptoms.

We took independent advice from a GP. We found that the clinical decision-making and management in respect of Child A's presenting symptoms was reasonable. From the review of the consultation notes, it was likely that post-viral symptoms were discussed with Mrs C. However, we concluded that it was not possible to categorically confirm this from the medical records kept by the practice. While we did not consider this to mean that the practice failed to provide reasonable care and treatment to Child A, we did provide feedback about the fact that Mrs C was not left with a clear understanding of the diagnosis that had been made. However, on the basis of reasonable care and treatment being provided to Child A, we did not uphold this complaint.

Summary

Mr C complained about the treatment which he had received at A&E of Caithness General Hospital. He had initially contacted NHS 24 and arrangements were made for him to be taken to hospital. Caithness Hospital does not have an ear, nose and throat (ENT) department and Mr C said that he expected to be transferred to another hospital to see the specialists there, but instead he was discharged home. Mr C's GP made a subsequent referral to ENT at Raigmore Hospital. Mr C felt it had inappropriately been downgraded and that he was not provided with appropriate treatment for his reported symptoms.

We took independent advice from an A&E consultant and from an ENT consultant. We found that Mr C had been appropriately assessed and treated at A&E on his initial attendance, and when he was subsequently referred to the ENT department, his symptoms were appropriately assessed and reasonable investigations were carried out in an effort to reach a diagnosis. We did not uphold the complaint.

Summary

C complained about their detention under an emergency detention order under the Mental Health (Care and Treatment) (Scotland) Act 2003. C stated that the detention was unnecessary and that the board failed to inform them about it. C also complained that there was a failure to offer support and signposting to advocacy services.

We took independent advice from a consultant psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness). We found that the detention was appropriate from both a clinical and legal perspective under the Mental Health (Care and Treatment) (Scotland) Act 2003. We found that it was considered to be in C's best interests to detain them because of legitimate concerns about their mental health. The documentation was signed by a medical practitioner with full General Medical Council (GMC) registration and with the consent of a mental health officer, in accordance with the requirements of the act. We did not uphold this aspect of C's complaint.

We also found that C was informed of their detention within a reasonable period of time. We noted that prioritisation was given to addressing C's mental and physical health. The clinical team sought the views of C's relatives to inform their ongoing clinical management of C. Under the circumstances, this was an appropriate and reasonable action which then resulted in C's detention being revoked early. We did not uphold this aspect of the complaints.

Summary

Ms C complained on behalf of her child (Child A) that the care and treatment Child A received from the board was unreasonable. Ms C complained that there was an unreasonable delay in diagnosing Child A's hip dysplasia (when the hip socket doesn't fully cover the ball portion of the upper thighbone) and dislocated hip.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that it was unreasonable that Child A's legs and hips were not examined during a consultation. We considered that had Child A's hips and legs been examined and concerns noted, this should have prompted further investigations to be arranged, such as x-rays, and there was a high likelihood of an x-ray at this time indicating hip dysplasia. Therefore, we upheld this aspect of Ms C's complaint.

Ms C also complained that the board's handling of her complaint was unreasonable. We found that there were delays in the board's response to Ms C's complaint and the board did not provide proactive updates about the status of Ms C's complaint. We found that the board's handling of the complaint was not in line with the NHS Model Complaints Handling Procedure (MCHP) and, therefore, upheld this aspect of Ms C's complaint.

We noted that the board had already taken action to improve their complaints handling. We made no further recommendations but did provide feedback on this point.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failings identified in the care and treatment provided to Child A and for the failures identified 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 should be fully examined when presenting at an orthopaedic clinic and further investigations organised as appropriate.

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

Mr C complained about the board's actions regarding his access to overnight accommodation at a facility provided by them, whilst Mr C was attending New Craig Psychiatric Hospital for treatment. Mr C said that the board unreasonably failed to provide him with overnight accommodation when he attended the hospital. He said that when he questioned this, he was initially advised that the accommodation was fully booked, but was subsequently informed that he would not be provided with accommodation as there had also been complaints about his behaviour there on a previous occasion. Mr C also complained that the board failed to investigate the complaints made about his conduct at the accommodation appropriately.

We found that the board had failed to make a written record of the complaints made about Mr C during a previous stay at the accommodation; did not notify Mr C about the complaints; failed to give Mr C an opportunity to respond to the complaints; and failed to make a written record of their assessment of the situation and their decision to no longer offer Mr C accommodation. As the board decided to act based on the complaints they received about Mr C, we considered that the board should have carried out some form of investigation. Therefore, we upheld these aspects of Mr C's complaint.

Mr C also said that the board failed to respond appropriately to his concerns and complaint about their handling of the complaints. We found that when MSPs first contacted the board on Mr C's behalf, the board failed to classify this as a first stage complaint under the NHS Model Complaints Handing Procedure (MCHP) and that the board failed to look into matters for Mr C and respond to him, as agreed in an email to him. We found that it was unreasonable for the member of staff to investigate Mr C's complaint to the board, when they were the subject (in part) of the complaint. We also found that the board failed to address all of the issues raised in Mr C's complaint to them and failed to demonstrate that each element had been fully investigated, in accordance with the NHS MCHP. Therefore, 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 deal appropriately with the accommodation complaints and the complaints made by him and MSPs about this. 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:

• Complaints about residents at the residential accommodation should be appropriately investigated and recorded by the board's staff.

In relation to complaints handling, we recommended:

• Complaints from patients should be appropriately recognised, investigated and responded to in accordance with the NHS MCHP and the SPSO guidance on MCHPs.

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 a left total hip replacement for progressive osteoarthritis (chronic breakdown of cartilage in the joints leading to pain, stiffness and swelling). Following the surgery, it was identified C suffered nerve damage which resulted in a foot drop/sciatic nerve palsy (loss of movement and or lack of sensation) and a limp. C complained that the board failed to provide the appropriate aftercare to address these issues.

The board confirmed they provided the appropriate aftercare in the form of an ankle foot orthosis (a brace) and physiotherapy. The board noted C's initial problems had resolved and there were other factors that contributed to C's ongoing issues.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that C's foot drop was managed appropriately by the provision of the orthosis and several physiotherapy sessions. We also concluded that the board's opinion that there were other factors which were the cause of C's ongoing problems was reasonable. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late sister (Ms A) by practice. Ms A had attended the practice on a number of occasions over many months. She had symptoms of low energy and mood, fatigue, and lack of motivation. The practice diagnosed a depressive illness and prescribed antidepressant medication. Ms A continued to deteriorate and was admitted to hospital where it was found that she had had a tumour at the base of her skull and she later died. Mrs C said that the practice should have considered alternative diagnoses rather than depression.

We took independent advice from a GP. We found that it was reasonable for the practice to continue along the route of a depressive illness in view of Ms A's reported symptoms, and it was only when red flag symptoms were reported that it was appropriate to refer Ms A to hospital. Therefore, we did not uphold the complaint.

Summary

Mrs C, an advocate, complained on behalf of her client (Mrs B) about the decision to discharge Mrs B's late husband (Mr A) from Royal Alexandra Hospital. Mr A had been diagnosed with a chest infection and bowel obstruction. When Mr A arrived home following discharge, he collapsed and had to be readmitted. The board confirmed that all appropriate assessments had been carried out prior to Mr A's discharge and his observations from the morning of his discharge were found to be in the normal range.

We took independent advice from a consultant surgeon. We noted that Mr A underwent regular observations and that he was assessed as ready for discharge by a consultant, physiotherapist and occupational therapist. There was no evidence to suggest a significant deterioration in Mr A's condition in the run up to his discharge. We did not uphold the complaint.