Health

Summary

Mr C complained to the practice about the lack of care provided to his late partner (Ms A). Ms A had attended the practice on numerous occasions over a four  month period reporting continuing neck pain. The practice had diagnosed that Ms A was suffering from Polymyalgia Rheumatica (inflammation of the muscles in the neck, shoulder or hip) and prescribed painkillers. Ms A subsequently attended hospital due to the pain and a x-ray revealed she had neck fractures caused by lung cancer spreading through her body. Mr C felt there had been a delay in carrying out investigations which would have identified the cancer at an earlier time.

We took independent advice from a GP adviser. We found that, based on Ms A's presenting symptoms, it was not unreasonable that the practice followed a working diagnosis of Polymyalgia Rheumatica. They prescribed appropriate medication which was changed to an alternative when it did not alleviate the symptoms. There were no red flag signs which would have indicated the possibility of cancer or symptoms which warranted either a hospital admission or an urgent hospital referral for a specialist opinion from a respiratory clinician. We found that Ms A's cancer presented in an unusual manner and that the cancer could not have reasonably been diagnosed earlier. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to him at one of the board's addiction clinics. In particular, he felt that he did not receive appropriate support in order to help him withdraw from his diazepam medication (medication to help anxiety or withdrawal symptoms) in a safe and controlled manner. He said that he had been discharged back to the community mental health team without any assistance to reduce his medication.

We took independent advice from a psychiatrist. We found that Mr C's consultant psychiatrist had referred him to the addiction unit for advice and support to assist in his withdrawal from diazepam. The referral to the addiction team was on a time limited basis, with further care and treatment to be provided by the community mental health team. The addiction team made appropriate slight amendments to the dosage of Mr C's medication. We also found that Mr C received appropriate advice on psychological support services which were available in the community. We found that it was also appropriate that a long term treatment plan to enable Mr C to reduce his diazepam dosage was managed by the community mental health team as Mr C had a number of other health issues which would have been outwith the scope of the addiction unit. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late brother (Mr  A) by the board. Mrs C was concerned that failings in Mr A's care and treatment led to his death. The cause of Mr A's death was pulmonary embolism (a blood clot in the lungs).

Mrs C complained that the board did not give Mr A an appropriate consultation or examination when he attended the out-of-hours service and was seen by a doctor and a nurse. We took independent advice from a GP adviser and from a nurse. We found that the board held no records of Mr A's consultation with the doctor or the nurse, and we considered this to be unreasonable. In response to our investigation, the board acknowledged that they did not hold adequate records. They said that a reminder had been issued to out-of-hours staff about good record-keeping standards, and that audits of reports had since been carried out. We asked to see evidence of this. We upheld this aspect of Mrs C's complaint.

Following Mr A's attendance at the out-of-hours service, he attended A&E at Monklands Hospital. Mrs C complained that appropriate investigations were not carried out. We took independent advice from a consultant in emergency medicine. We found that the majority of the investigations carried out in A&E were reasonable. We also found that the history and examinations undertaken would not reasonably have led doctors to suspect a pulmonary embolism. However, we found that there was a failure to investigate an abnormality on Mr  A's electrocardiogram (ECG - a test which records the electrical activity of the heart). This abnormality would indicate the possibility of an acute coronary sydrome (when the heart is not getting enough blood), which should have been excluded through further investigations. We noted that, even if these further investigations had been carried out, it is not possible to conclude that Mr A's pulmonary embolism would have been identified. We upheld this aspect of Mrs  C's complaint.

We also found that the board's own complaints investigation did not identify or address the failings in care provided to Mr A, and so we made a recommendation in relation to this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C and her family for the failure to record the consultation with the doctor and the assessment carried out by the nurse at the out-of-hours service and the failure to investigate the abnormality on Mr A's ECG in A&E. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Abnormalities on patient ECG's carried out in A&E should be properly investigated.

In relation to complaints handling, we recommended:

• The board's complaints handling system should ensure that failings (and good practice) are identified, and enable learning from complaints to inform service development and improvement.

Summary

Mr C, a solicitor, complained on behalf of his client (Ms B) regarding the way the board managed her daughter's (Ms A) transition from paediatric services to adult services. In particular, Ms B was concerned about the co-ordination of Ms A's care and her ability to access services when she needed to.

We took independent advice from a consultant paediatrician. While we found evidence of good practice in relation to a number of areas of transition care, we found little evidence of co-ordinated planning to support transition. In particular, we considered that a healthcare professional responsible for managing and co-ordinating transition should have been identified, as indicated by the board's transition guidance. We further noted that the board's guidance did not appear to have been reviewed in line with the planned timescales for review. We found that the board had appropriately met with Ms A's family and listened to their concerns, however, there was also evidence that the board and Ms A's GP had differing views on who was leading clinically. On balance, we upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A and Ms B for the lack of coordination and support from a lead healthcare professional during the transition from paediatric services to adult services. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Clinical teams within paediatric and adult services should have structured discussion to contribute to the planning of patients' transitions and this should be documented.
• There should be guidance in place detailing a clear pathway for transition from children's to adult services for practitioners to use to guide transition management.
• Patients with complex health needs, their family members and carers should be properly informed about who is responsible for coordinating their care at difference stages of transition.

Summary

Miss C complained about the care and treatment provided to her late father (Mr  A) during admissions in Monklands Hospital and Coathill Hospital.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and a nurse with expertise in pressure ulcer prevention.

Miss C raised concern that Mr A, who had diabetes, was discharged from Monklands Hospital with a large pressure ulcer on his left foot. In response to Miss C's complaint, the board acknowledged that there was little documentation of the care provided for Mr A's feet and they apologised for this. We found no evidence that medical staff reviewed Mr A's feet during this admission and considered that this was unreasonable in the circumstances. We also found a number of failings in the way nursing staff assessed, documented and managed Mr A's feet during the admission. We noted that there was a delay in referral to the podiatry team (the area of medicine which deals with the feet and ankles) and no evidence that Mr A was physically reviewed by podiatry. Finally, we were critical about the lack of information and equipment given to Mr A and his family before discharge and that the board did not ensure that arrangements for ongoing care were in place. We upheld this aspect of Miss C's complaint.

During a subsequent admission in Coathill Hospital, Mr A was found to have fallen. Initially, no injuries were noted by either nursing or medical staff. When Mr A was reviewed by an occupational therapist the day following the fall, pain was noted yet this was not escalated to the medical team. The board apologised to Miss C for this failing. Two days following the fall, nursing staff found Mr A to be in pain and an x-ray was arranged. This identified that Mr A had a broken hip and he received treatment the following day. We found that the initial medical review did not appear to have included an examination to specifically assess if Mr A had suffered any injuries as a result of his fall. We also considered that there was an unreasonable delay in arranging an x-ray and diagnosing Mr A's hip fracture. Therefore, we upheld this aspect of Miss C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the failings in nursing and medical care, failing to provide sufficient equipment and information prior to discharge, failing to ensure that arrangements for ongoing care were in place and the unreasonable delay in diagnosing Mr A's hip fracture. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Where a patient has a combination of poor blood supply, diabetes, and wounds on the feet, a medical examination should be carried out prior to discharge.
• All patients with diabetes who have existing foot damage or develop foot damage should be referred to podiatry as soon as the damage is discovered. Patients at risk of developing pressure damage to their feet should be assessed and fitted with protective footwear. Nursing staff should complete a wound assessment chart for every wound a patient has. Patients at risk of developing pressure damage or who have existing pressure damage should have a plan of care in place for interventions at least every two hours. Staff must be able to diagnose and grade pressure damage and accurately report their findings. Where a patient requires specialist assessment by a podiatrist a review should be carried out within a reasonable time.
• Patients and their families/carers should be provided with verbal and written information on pressure ulcer risk, details of a patient's pressure damage and how to manage this whilst preventing further damage, details of follow- up arrangements for wound dressing, a supply of wound dressings and pressure relieving footwear.
• Where a patient has fallen whilst in hospital, a medical examination for injury should be performed promptly.

Summary

Mr C complained on behalf of his mother (Mrs A) regarding cataract surgery (surgery which involves replacing the cloudy lens inside the eye with an artificial one) she received at Hairmyres Hospital. Mr C stated that the board failed to give his mother the appropriate priority for surgery and failed to provide surgery within a reasonable period of time.

We took independent advice from a consultant ophthalmologist (a specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye). We found that the categorisation of non-priority was reasonable according to nationwide practice. However, when Mr C notified the board that Mrs A's condition had deteriorated whilst she was on the waiting list for surgery, no further review of her condition was offered. This meant that there was no opportunity to assess if Mrs A required to move up the waiting list. Therefore, we upheld this aspect of Mr C's complaint.

In relation to the surgery waiting time, we found that Mrs A was referred for an out-patient appointment outside the NHS target times. We noted that Mrs A could not be referred for surgery elsewhere in order to cut down on her waiting time due to her condition and the density of her cataract. However, Mrs A was given surgery 22 weeks after being listed for surgery which was outside the NHS treatment guarantee time of 12 weeks. We upheld this aspect of Mr C's complaint. However, we acknowledged that the board had apologised for this delay which reflects the current situation nationwide due to the demand on the NHS for eye surgery.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C and Mrs A for the failure to re-assess Mrs A whilst she was on the waiting list to establish if her priority for surgery had changed. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

• Where the patient, relative or GP notifies the board of rapid deterioration, steps should be taken to re-assess the patient to establish if their prioritisation for surgery has changed.

Summary

Mr C complained about the care and treatment his late father (Mr A) received during his two admission to Wishaw General Hospital. Mr A was diagnosed with bowel cancer and Mr C complained that the board failed to provide Mr A with appropriate medical and nursing care and treatment.

We took independent advice from a consultant in acute medicine, a consultant in colorectal surgery (a specialist in disorders of the rectum, anus and colon) and a nurse. In respect of Mr A's first admission, we considered that Mr A's underlying issues were all reasonably investigated, treated and resolved. In respect of Mr  A's second admission, we found that all appropriate investigations were carried out and that, overall, Mr A received appropriate medical treatment. However, we noted that there was an unreasonable delay before Mr A was seen by the speech and language therapy service (SALT) given that there was concerns regarding his ability to swallow. Therefore, we upheld this aspect of Mr  C's complaint.

In relation to the nursing care, we found that there was no evidence to indicate any failings in nursing care and that the nursing records were of a reasonable standard. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the board failed to communicate appropriately with Mr  A's family regarding his condition at a meeting. In particular, that only two family members were allowed to attend the meeting when there were twice as many hospital staff in attendance and that he was not allowed to record the meeting. We considered it was unreasonable that Mr C had been restricted to two family members while double the number of hospital staff attended the meeting. Mr C also appeared to have been open with hospital staff that he wanted to record the meeting and the reason for this. Therefore, we considered it would have been reasonable to have allowed him to record the meeting. We upheld this aspect of Mr C's complaint. We also noted that that these issues could have been avoided if the board had a policy that ensured both parties were aware of the ground rules for such meetings in advance. We made a recommendation to the board in light of this finding.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the unreasonable delay by hospital staff in referring Mr A to SALT, for restricting the number of family members who were permitted to attend the meeting and not allowing the meeting to be recorded. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

• Patients with impaired ability to swallow should receive an appropriate and timely referral to SALT.
• Both staff and patients and/or their families should be clear about what to expect in advance of a meeting.

Summary

Mrs C complained about the treatment she received from a podiatrist (a medical professional who specialises in the feet and ankles) when she attended a consultation to remove some hardened skin around her toe. Mrs C believed that the podiatrist had removed too much skin as her toe became painful and she was subsequently diagnosed with an infection.

We took independent advice from a podiatrist. We found no evidence from the clinical records that there was a problem for the podiatrist when treating Mrs C's toe. We noted that they gave Mrs C appropriate advice on changing the type of footwear she wore as this would have contributed to her foot problems. We also found that Mrs C had other health conditions which may have contributed to her being susceptible to skin infections. We did not uphold the complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mrs B) about the care and treatment provided to Mrs B's late husband (Mr A) at Belford Hospital. Mr A was admitted to hospital on a number of occasions over a short period of time for breathlessness and chest pain. Ms C complained about the clinical care and nursing treatment provided to Mr A, the board's communication with Mrs B about her husband's deterioration, and the post-mortem care (care after death) provided to Mr A.

We took independent advice from a consultant physician and from a nursing adviser. We found that there were a number of failings with regards to the clinical treatment provided to Mr A, and we upheld this aspect of the complaint. However, we found that the nursing care had been reasonable and so we did not uphold this part of the complaint.

Regarding communication, we found that there was a failure to discuss Mr A's deterioration with Mrs B in a timely manner, and so we upheld this part of the complaint.

We found that the post-mortem care provided to Mr A was reasonable, and we did not uphold this aspect of the complaint. However, we found that the board had not addressed Ms C's concerns around post-mortem care in their original complaint repsonse. We, therefore, made a recommendation regarding this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs B for the failure to provide Mr A with reasonable clinical treatment, and for the failure to communicate reasonably with her about Mr  A's deterioration. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Patient care should be in line with the Scottish Intercollegiate Guidelines Network guideline 139: Care of the Deteriorating Patient, and Healthcare Improvement Scotland guidance on Structured Response to the Deteriorating Patient.

In relation to complaints handling, we recommended:

• All issues raised in complaints letters should be addressed.

Summary

Mrs C complained about the treatment which her late husband (Mr A) received during attendances at the out-of-hours service at the Vale of Leven Hospital. Mr  A had attended on three occasions over a period of 15 months with chest pains and numbness, where staff repeatedly told him he had a trapped nerve and prescribed painkillers. Mr A subsequently died of a heart attack a month following the last hospital attendance. Mrs C felt that the board had not carried out sufficient examinations to have ruled out the possibility of Mr A having heart disease.

We took independent advice from a GP adviser. We found that the GPs who saw Mr A had carried out appropriate assessments and obtained a reasonable history based on his reported symptoms. It was reasonable that the GPs had each arrived at a working diagnosis of musculoskeletal symptoms as a result of a trapped nerve. There also was no clinical evidence that Mr A required to be referred to a hospital specialism, such as cardiology (the area of medicine which deals with the heart and circulatory system). We did not uphold the complaint.