Decision Report 201508900

Summary

Ms C complained about the care and treatment of her late great aunt (Miss A) in Aberdeen Royal Infirmary. Miss A had cancer which was noted to be progressing and a palliative care approach was taken. She died a few weeks later. Ms C raised particular concerns surrounding the decision to stop providing her great aunt with intravenous fluids (fluids delivered directly into the vein). She considered that this led to Miss A becoming dehydrated and potentially hastened her death. We took independent advice from a consultant physician. They advised that the decision to discontinue the provision of intravenous fluids was reasonable, as it was no longer clearly beneficial and had become uncomfortable for Miss A. They considered that this decision was appropriately discussed with Miss A and her family. We did not uphold this complaint. However, the adviser identified an issue, not raised as part of the complaint, surrounding the communication of a decision that Miss A would not be resuscitated in the event of cardiac or respiratory arrest. Healthcare Improvement Scotland had since inspected the hospital and identified a similar issue. They made a recommendation and we asked to board to provide confirmation that this has been implemented.

Ms C also complained about the nursing care provided to Miss A. We took independent advice from a nurse. They advised that appropriate nursing care was provided, with evidence of regular comfort checks and assistance with personal care. We, therefore, did not uphold the complaint. However, while appropriate care appeared to have been delivered, this was not formally planned in a detailed end of life care plan. We recommended that the board consider doing so in future.

Ms C complained that the board's response to her complaint was delayed and did not answer the specific questions she asked. We identified that the board did not adhere to the terms of their complaints procedure in responding to the complaint and, in particular, that they failed to address all of Ms C's specific concerns. We upheld this complaint.

Recommendations

We recommended that the board:

• inform us of the steps they have taken to implement the relevant Healthcare Improvement Scotland recommendation following their inspection of Aberdeen Royal Infirmary in August 2015;
• consider the use of an end of life care plan as outlined in the Scottish Government's guidance on 'Caring for people in the last days and hours of life';
• apologise to Ms C and her mother for failing to appropriately respond to their complaint; and
• ask complaints handling staff to reflect on the findings of this investigation and ensure future adherence to their complaints procedures, with particular focus on timescales, comprehensiveness and language.