Health

Summary

C complained about the treatment they received from the practice. C had a pre-existing diagnosis of Chronic Fatigue Syndrome (CFS). C attended the practice about back pain they were experiencing. They were referred to neurology (specialists concerned with the diagnosis and treatment of disorders of the nervous system), urology (specialists in the male and female urinary tract, and the male reproductive organs), rheumatology (specialists that deals with rheumatism, arthritis, and other disorders of the joints, muscles, and ligaments) and orthopaedics (specialists in the treatment of diseases and injuries of the musculoskeletal system) on a routine basis. The neurological service performed two MRI scans which identified a lesion (a region in an organ or tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumour). C was advised by specialists to come back in six months for a review. At around this time, C was advised that, despite referrals to orthopaedics, they would not be offered an appointment as they had passed the referral to the pain clinic. The practice followed this up with the service, requesting further MRI scans.

On several occasions, C consulted with the practice regarding severe pain and worsening symptoms. C was later seen by neurosurgeons, who confirmed that the lesion was the cause of the pain and C underwent surgery. The lesion was cancerous, and C underwent therapy to treat it.

C said that the practice showed a lack of understanding of the pain and symptoms that they presented with and failed to prioritise investigations which would have resulted in a timelier diagnosis. C considered that there was an assumption that the pain had an underlying psychological element.

We took independent advice from an appropriately qualified adviser. We found that GPs were responsive to C's requests for further investigations and appropriate referrals were made. There was no significant delay in any referrals being sent. The practice had appropriate discussions with C regarding pain relief, the addictive qualities of medication and sought advice from specialists about managing pain. We found that the care and treatment provided by the practice was reasonable. We did not uphold the complaint.

Summary

C complained that when the Driver & Vehicle Licensing Agency (DVLA) contacted the practice about C's fitness to drive, the practice incorrectly advised the DVLA that they had attended detoxification for alcohol in the past 12 months.

We took independent advice from a GP. We found that the treatment C had received from the practice was not to treat alcohol withdrawal and would not be classed as a detoxification programme. We found that there was no evidence that C had attended a detoxification programme in the past 12 months. Therefore, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failing identified. 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 practice should ensure their knowledge of detoxification programmes is up to date - who delivers them and what a programme entails. Also the practice should ensure the information held by the DVLA in relation to this issue provides details of the treatment given to C.

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 on behalf of their partner (A). A had been suffering from debilitating shoulder problems over an extended period. A had been referred from their own NHS Board to Greater Glasgow and Clyde NHS Board for specialist surgery. Although surgery was carried out, it did not relieve A's symptoms. A underwent further surgery and received a second opinion from Greater Glasgow and Clyde NHS Board, as well as undergoing neurological tests and assessment at the pain clinic. During this period A moved house, which meant a different NHS Board became responsible for A's care.

C felt that Greater Glasgow and Clyde NHS Board had failed to properly consider A's symptoms and that they were unwilling or reluctant to investigate or perform further surgery on A. C had a lengthy correspondence with the board, during which they made several formal complaints.

Whilst this correspondence was ongoing, the board suggested that A should be referred to a specialist in England. C and A were told this referral was to be made, but they were not told what the process would be. A referral of this nature required A's own health board's agreement, but this was not provided. C made a number of attempts to contact Greater Glasgow and Clyde NHS Board to discover whether the referral was going ahead. When they did not receive a response, C took A to have further surgery on A's shoulder privately.

C said they had been forced to do this by the board's failure to provide A with adequate care and treatment and their decision to block the referral to England. C said the board should reimburse them for the expenses they had incurred and provide guarantees A would receive the treatment they would need in future. The board had declined to pay for the cost of private medical treatment, because their view was that A had chosen to take this course of action independently.

We received independent medical advice. We found that the board had provided A with reasonable care and treatment. The investigations that had been carried out were appropriate for the symptoms reported and these investigations, and the provision of a second opinion, had been carried out within a reasonable timescale. We did not uphold this aspect of C's complaint.

In relation to the referral to England, we found that the board had not made the decision to cancel A's referral to England. This decision had been made by A's own health board. Therefore, we did not uphold this aspect of C's complaint.

The board had, however, failed to acknowledge or respond to C's questions about the referral, or to respond to questions from their MSP. They had also unreasonably prevented C from accessing the complaints process. The board had told C they would be able to liaise with a named contact about A's treatment. Despite it being clear that the named contact was not responding to C and that C was not receiving answers to their questions, the board failed to take action to address this but also failed to allow C to raise a new complaint. We considered the boards communication with C to be unreasonable and upheld this aspect of their complaint. However, we noted that this did not justify reimbursing C for the cost of private treatment in England.

Recommendations

What we asked the organisation to do in this case:

• Clarify for C and A which board had responsibility for the decision not to proceed with the out of board referral, explain what the process followed was and clarify who remained responsible for A's ongoing care and treatment.

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

• The board should ensure they have a clear procedure for staff to follow, when out of board referrals are made, including communicating the outcome to the patient.

In relation to complaints handling, we recommended:

• The board should review their procedures to ensure that when communication with a patient or their representative breaks down, complaints staff are able to escalate the matter appropriately.

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 that the care she received from the board when she attended A&E at Queen Elizabeth University Hospital and a surgical hot clinic (the hot clinic provides assessment and management of patients referred by A&E that need further investigations and assessment but that do not require to be admitted) the following day was unreasonable. We took independent advice from a consultant in emergency medicine. We found that while the majority of the care and treatment Ms C received in A&E was reasonable, the wait for triage and the wait for pain relief was unreasonable and there was no evidence of pain scores being recorded in Ms C's notes. With regard to Ms C's attendance at the hot clinic, there was an issue with her appointment, and the way the hot clinic operated did not appear to have been communicated to Ms C in advance to manage her expectations. As a result, we upheld this aspect of Ms C's complaint.

Ms C further complained that there was an undue delay in the board providing her with an endoscopy (a medical procedure where a tube-like instrument is put into the body to look inside). We found that Ms C had to wait 15 weeks for an endoscopy which was outwith the 6 week national standard waiting time and as a result, we upheld this aspect of the complaint.

Ms C also complained that the board's handling of her complaint was unreasonable. We found that the board's handling of Ms C's complaint was not in line with the NHS Complaints Handling Procedure and as a result, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the unreasonable care and treatment, the unreasonable delay in receiving her endoscopy and the unreasonable handling of her complaint. 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 triaged timeously, in line with relevant guidelines. Pain scores should be recorded regularly and acted upon timeously in line with relevant guidelines.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the NHS Scotland Model Complaints Handling Procedure.

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 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.