Health

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.

Summary

C attended the practice to collect prescriptions and had a brief discussion with a member of staff. Subsequently, C received a letter from the practice informing them their registration with the practice had been terminated due to inappropriate behaviour. C considered the practice’s actions to be unreasonable.

We found that the practice failed to follow the relevant process prior to removing C’s registration. The practice did not give a prior warning or keep reasonable records of the actions they took. We also found that the practice did not provide an accurate response to C’s complaint. As such, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to investigate C’s complaint appropriately, failing to issue an accurate response letter and for unreasonably removing C from the list of patients. The apologies 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 attended A&E at Wishaw General Hospital complaining of chest tightness, sweating, nausea and palpitations (a noticeably rapid, strong, or irregular heartbeat due to agitation, exertion, or illness). C felt that their concerns were not fully listened to and concerns about side effects of medication were not taken into account.

We took independent advice from a consultant in emergency medicine. We found that the assessment C received was of a reasonable standard for a patient presenting with chest pain and appropriate investigations were carried out. We did not uphold this aspect of the complaint.

C also complained about the response they received to their complaints. We found that while some of the board's actions were reasonable (a resolution was sought; C spoke with the consultant about their concerns; C was offered to add their account to the medical record), overall the board's complaint handling was unreasonable. We found that the board had not responded to all of the points that C raised as complaints, and the board acknowledged this failing in a later complaint response. We also found that the board should have been clearer when advising C of which stage of the complaints process they were at and should have managed C's expectations about the next steps if a resolution could not be reached. Therefore, we upheld this aspect of the complaint.

C also complained about the board's application of their Unacceptable Actions Policy (UAP). We found that the board had acted in line with process. While they had warned C that they had a UAP and why they considered C's actions were unreasonable, they did not formally restrict C's contact with them through the UAP. We did not uphold this complaint.

Recommendations

In relation to complaints handling, we recommended:

• The board should ensure that complaints communications are clear.

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 they received from their GP practice when they presented with problems with their sight and a headache. Whilst in the waiting room, C became more unwell. Following an examination, an emergency ambulance was called and C was taken to hospital where they were later diagnosed with a stroke. C complained that more immediate action should have been taken when they initially contacted and then attended the practice. The practice did not identify significant failings during their complaint investigation, but noted that some aspects could have been handled better.

We took independent advice from a GP. We found that the practice’s initial handling of C’s call to the practice was reasonable, and it was appropriate that C was signposted to contact an optician. Furthermore, we found that, once C attended the practice, the care provided was reasonable and consistent with clinical guidance on assessment, history taking and examination. We did not uphold C’s complaint.

Summary

C complained about the care and treatment provided to their parent (A). A was diagnosed with cancer and was admitted to hospital. As the hospital team struggled to control A’s pain, A was transferred to hospice care, where they later died. C complained about the care and treatment offered to A at the hospice and asserted that it was not reasonable. C’s position was that as a result of that unreasonable care and treatment, A experienced chronic pain and died prematurely. C stated that they believed that staff involved in A’s care failed to act in line with guidelines and ignored medical guidance.

The board found no evidence to support C’s assertions that A was not provided with reasonable care and treatment. The board said that a multi-disciplinary, patient-centred approach was taken to A’s care and many clinicians contributed to A’s pain management strategy.

We took independent advice from a medical adviser. We did not find any failings in A’s care and treatment and did not consider that it was unreasonable. Therefore, we did not uphold this complaint.

Summary

C complained about the care and treatment provided to them by the board when they presented with abdominal pain. C complained that they were repeatedly unnecessarily catheterised, their symptoms and clinical context were ignored, and they were misdiagnosed as having a bladder tumour instead of an ovarian tumour.

We took independent advice from a nurse, a radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans), a urologist (a doctor who specialises in the male and female urinary tract, and the male reproductive organs), and a sonographer (a healthcare professional who performs diagnostic medical sonography, or diagnostic ultrasound). We found that both nursing and urology care and treatment provided to C was reasonable. However, we found that an ultrasound scan incorrectly interpreted a mass as being a bladder tumour, when in fact the mass represented a large ovarian tumour. Though this was a misinterpretation of the scan, we found that given the clinical information available at the time, this misinterpretation was not unreasonable. We did not uphold this aspect of C’s complaint.

C also complained about the board's handling of their complaint. We found that there were significant complaint handling failings, including failure to advise C in a timely manner which aspect of the complaint they would investigate; failure to update C in a timely manner throughout the investigation; incorrect information being contained in the complaint response and no apology being given for this. We therefore upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the unreasonable handling of their complaint. 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:

• Staff should be aware of the scope of a complaints investigation and the relevant standards and processes that apply. Staff should be able to appropriately obtain and evaluate the evidence obtained and use this to give reasons for decisions reached; and complaints should be handled in line with the model complaint handling procedure. SPSO have issued a guidance tool to support investigations staff. This can be accessed here: www.spso.org.uk/how-we-offer-support-and-guidance. The model complaints handling procedure and guidance can be found here: 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

Ms C, who works for an advocacy and support agency, complained on behalf of a family about the care and treatment that their relative (Mr A) received from the board. Mr A was admitted to Raigmore Hospital with endocarditis (an infection of the inner lining of the heart). He was discharged home for out-patient parenteral antibiotic therapy (where antibiotics are given to a patient in their own home). Mr A's condition worsened and he died a few weeks later. Ms C complained about Mr A's medical care and treatment, and that he was not medically fit to be discharged home.

We took independent advice from a cardiologist (specialists in the heart and blood vessels) and from a nurse. We found that Mr A's condition was diagnosed in a timely manner and he was given appropriate treatment. We also found that it was reasonable that Mr A was discharged home, as there was an appropriate plan to continue his treatment at home.

Ms C complained about the communication with Mr A's family. We found that the medical and nursing records showed evidence of appropriate communication with Mr A's family.

Ms C further complained that Mr A was discharged home without appropriate care planning and an appropriate care package. We found that there was appropriate multi-disciplinary care planning for Mr A's discharge home.

Ms C also complained about the board's complaints handling; in particular, that there was a delay in their response and its tone lacked empathy. We considered that as it was a complex complaint, it was reasonable that the investigation took longer than usual and regular updates were provided. We did not consider the tone was inappropriate.

We did not uphold Ms C’s complaints.