Health

Summary

Mr C complained that his dentist had failed to provide him with appropriate dental treatment. In particular Mr C felt that his dentist had taken a radiograph which was not required and that they had tried to promote the use of private dental treatment over NHS treatment.

We took independent advice from an adviser in general dentistry and found that the dentist had acted in accordance with the national guidance for taking radiographs. The radiographs indicated that there was decay present in Mr C's teeth and that the dentist had suggested appropriate treatment to be carried out. The records also contained evidence of discussions between the dentist and Mr C where it was explained what treatment was available on either NHS dental treatment or private dental treatment. There was no evidence to suggest that the dentist had promoted private dental care. Therefore, we did not uphold Mr C's complaint.

Summary

Mr C, who works for an advice and support agency, complained on behalf of his client (Mrs A) about aspects of her admission at Royal Alexandra Hospital. Mrs A was admitted to the hospital after she experienced flu-like symptoms. She was initially treated in the acute medical unit before being transferred to the acute stroke unit. Following a CT scan, a diagnosis of dural venous sinus thrombosis (a type of blood clot that affects part of the brain) was confirmed. Mrs A continued to receive care on the ward, and after she was able to move independently, she was discharged home with a follow-up consultation arranged in the neurology department.

Mrs A was unhappy about the lack of information provided to her about her condition, during her admission. She said that she was not informed that she had two clots in her brain until she attended a consultation with the neurologist three months after discharge. In response to the complaint, the board said that the stroke physician recalled discussing the diagnosis and the need for anticoagulation treatment (treatment with drugs that reduce the body's ability to form clots in the blood) with Mrs A, and also recalled Mrs A's agreement to this treatment. Mrs A was unhappy with this response and brought her complaint to us.

We took independent advice from a medical adviser with experience in stroke care. We found that the care and treatment provided to Mrs A was of a good standard. However, there was no documentation indicating that Mrs A was given an explanation of what was being done, and why, at the time of her treatment. The adviser said that it would have been good practice to record the important parts of the communication with the patient. We could not find evidence of this in the board’s record-keeping and we, therefore, were not satisfied that Mrs A was provided with appropriate information about her condition during her admission. We upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A for failing to provide her with appropriate information about her condition and any anxiety this might have caused her. 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:

• Medical staff should provide patients with the information they want or need to know in a way they can understand, and ensure this is documented.

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 visited her GP practice a number of times as she had concerns about a loss of appetite and unexplained weight loss. The practice carried out blood tests, and referred Ms C for an x-ray and an ultrasound. When these tests reported as normal, the practice referred Ms C to a gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas). Ms C complained that the practice unreasonably delayed in investigating her weight loss.

We took independent advice from a GP. We found that the practice carried out the relevant tests and referred Ms C to gastroenterology at the appropriate time. The practice acted appropriately and did not delay in investigating Ms C's weight loss. Therefore, we did not uphold this complaint.

Summary

Mr C, a prisoner, complained to the board that his prescription of pregabalin (a medication used to treat anxiety and nerve pain) was not reinstated. This medication is commonly misused in the prison environment and his prescription was stopped after he was found giving his medication to another prisoner.

We took independent advice from a GP. We found that the decision not to reinstate Mr C's medication was reasonable. Due to his history of drug misuse, the adviser considered that a prescription for pregabalin would potentially increase the risk of overdose, particularly as he was already on other medications. We found that the board had also offered Mr C reasonable alternative medication to treat his anxiety and nerve pain. Therefore, we did not uphold this complaint.

Summary

Mr C complained that the board failed to provide him with clinic appointments within a reasonable timescale. He also raised concern that the board failed to provide him with adequate notice of the cancellation and rescheduling of appointments, and he was unhappy with the board's handling of his complaint.

The board did not provide us with records and correspondence about Mr C's appointments, cancellations and rescheduled appointments. We also found that their own complaints file did not include relevant evidence, such as records of actions taken by staff in relation to Mr C's appointments and the initial handling of his complaint. The board did not explain why they offered Mr C an appointment for nine months after the originally scheduled appointment, and seven and a half months after the first rescheduled appointment that was offered (which Mr C told the board he could not attend). As we did not receive this information from the board, we had to assume that relevant records were not made at the time. We found that the board failed to follow their complaints procedure, as they did not give Mr C a written explanation for delays, updates on progress, or indicate when they expected to be able to reply. In addition, the board failed to send a response to Mr C's second complaint email, apparently due to an administrative error. We upheld all of these aspects of Mr C's complaint.

Mr C also complained that the board did not consult him about his availability for rescheduled appointments. We did not find evidence that the board were required to consult Mr C about his availability for rescheduled appointments, so we did not uphold this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to provide him with adequate notice of the cancellation and rescheduling of appointments, failing to provide rescheduled appointments to him within a reasonable timescale, failing to inform him of the cancellation of a specific appointment, and for handling his complaint unreasonably. 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:

• Relevant staff should be reminded of the process for dealing with cancelled or reduced clinics, and the necessity of keeping records.

In relation to complaints handling, we recommended:

• Staff investigating complaints should obtain the actual evidence, in addition to comments from colleagues on such evidence, and include it in their complaints file.

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

Miss C complained about care and treatment provided to her late mother (Mrs A) at Queen Elizabeth University Hospital. Miss C complained that both the nursing and medical care and treatment provided to Mrs A were unreasonable.

We took independent nursing advice. We found that, whilst a number of aspects of nursing care and treatment were reasonable, there was a failure by staff to discuss continence issues with Mrs A. We also found that nursing staff failed to complete fluid balance documentation fully and accurately, and failed to appropriately complete pressure ulcer risk assessments. We also found that there were issues with infection prevention and control. We upheld Miss C's complaint about the nursing care and treatment provided to Mrs A.

We also took independent advice from a consultant physician. We found that some aspects of medical care and treatment provided to Mrs A had been reasonable, however we determined that the frequency of dosing of morphine (a pain relief medication) was unreasonable and failed to take into account Mrs A's kidney function. We also found that there was a failure to document Mrs A's adverse reaction to tramadol (a pain relief medication) appropriately. 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 failing to provide a reasonable standard of nursing and medical care and treatment to Mrs A. The apology should meet the standards set out in the SPSO guidance on apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• When a patient has continence issues, these should be discussed with them and their continence should be assessed. They should be assisted to manage any issues in a way that protects and promotes dignity, in line with the Nursing and Midwifery Code.
• Fluid balance charts should be fully completed when required.
• Pressure ulcer risk assessments should be completed when required.
• Infection prevention and control guidance, such as the Healthcare Improvement Scotland standards for Healthcare Associated Infections, and the National Institute for Health and Care Excellence quality statement on Vascular Access Devices, should be followed.
• Kidney function should be considered when prescribing morphine.
• If a patient suffers a reaction to medication, this should be documented.

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 agency, complained on behalf of her client (Ms A). Ms C complained that Ms A did not receive a reasonable standard of psychiatric care and treatment when she was admitted to the Royal Alexandra Hospital. Ms A had been unwell and when she was admitted to hospital a psychiatrist diagnosed her as suffering from anorexia nervosa (an eating disorder) and implemented a care plan. Ms C said that Ms A did not agree to all aspects of the care plan, which she felt was very restrictive and intrusive, and that the communication with her and her family about the severity of her condition and treatment decisions was unreasonable.

We took independent advice from a psychiatry adviser. We found that, while there were no failings in relation to the psychiatric assessment and treatment provided to Ms A, the board had failed to evidence that Ms A had fully consented to her treatment, and that there were failings surrounding the extent to which she was informed of the details of her proposed care plan. We were also concerned that such a restrictive and intrusive care plan was implemented when Ms A disagreed with it, and that it was not subject to mental health legislation which would have afforded protection to Ms A. As a result, we found that Ms A was likely to have experienced distress which may have a long-term impact on her future relationships with mental health professionals. We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for failing to evidence consent to treatment. 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:

• Care plans (in particular intrusive or restrictive care plans) should be fully explained to patients and relevant consent procedures should be followed and clearly documented.
• Professionals taking decisions about detention under the Mental Health Act should be mindful of de facto detention (where a patient feels under pressure to agree to admission to hospital or to remain in hospital, often because they feel threatened by the possibility of detention, and are, therefore, not giving valid consent to their stay in hospital) and should document their reasoning for their decisions (including consideration of the mental health legislation) clearly.

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 had been on a waiting list for a knee operation for a number of months and, despite the board telling him that he would undergo the operation within 12 weeks, it took approximately five months after Mr C was first put on the waiting list for him to have the operation. Mr C said this was contrary to the treatment time guarantee (12 weeks) and did not take into account his clinical need. Mr C had told the board he was willing to travel to any hospital in the UK to undergo the operation. Mr C said that, as a result of the board's failings, his physical and mental health had deteriorated. Mr C complained to us that the board failed to provide him with a knee operation within a reasonable time and that they failed to respond to his complaint in a reasonable way.

We took independent advice from an orthopaedic adviser. We found that the board's failure to meet the treatment time guarantee or consider other healthcare providers meant that Mr C suffered pain and discomfort for number of months, with implications for his emotional health as a result. We also found it unreasonable that, at times, Mr C had to take the initiative to find out what was happening once the 12 weeks treatment time guarantee period had passed. We were not satisfied from the evidence available that the board had reasonably had regard to the legislation concerning the treatment time guarantee, and we upheld the complaint.

In relation to complaints handling, we found that the board had wrongly told Mr C that it was not NHS policy to offer surgery outwith the health board area when the guidance around the treatment time guarantee is clear that one of the things health boards must do when the guarantee is breached is consider alternative providers within and outwith Scotland and the NHS. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to provide treatment within a reasonable time. 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:

• Identify any training needs to ensure staff fully understand the legislation and guidance around the treatment time guarantee, and its application.

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 is an advocacy and support worker, complained on behalf of her client (Mr B) about the care and treatment provided to Mr B's wife (Mrs A) during her admission to the Royal Alexandra Hospital. Mrs A suffered two falls while in the hospital. Ms C complained that the standard of nursing care and treatment provided to Mrs A was unreasonable. We took independent advice from a nursing adviser. We found that, in general, the nursing care was reasonable and the action taken by nursing staff to assess and protect Mrs A against the risk of falls was reasonable. However, the advice we also received was that Mrs A should have been referred to the falls team earlier than she was and that one of the two falls had not been recorded on the computer system which is used to record clinical incidents, such as falls. This computer system is an important mechanism to record incidents so that learning and improvement can take place. On balance, we upheld Ms C's complaint about the nursing care and treatment provided to Mrs A.

Ms C also complained that the medical care and treatment provided to Mrs A was unreasonable. We took independent advice from a consultant in general medicine. We found that, in general, the medical care and treatment was reasonable. However, we also found that the assessment carried out after the first fall was inadequate and that there was no evidence in the medical records that a medical review had taken place after the second fall. In addition, we found that the communication by medical staff was poor and that they had not fully explained the prognosis for Mrs A and their concerns about her recovery. Given the failings identified we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B for failing to adequately review Mrs A after her falls, and for failing to adequately explain her prognosis to her family. 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 should receive a full medical assessment following a fall.

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 that the practice delayed in referring his late father (Mr A) for appropriate specialist investigation of his iron deficient anaemia (a condition where the blood lacks an adequate amount of healthy red blood cells). Mr C considered that an urgent colonoscopy should have been arranged, in line with cancer referral guidelines. He also raised concerns about the chosen referral pathway once a referral was eventually made, as the referral was to a vascular surgeon rather than directly for colonoscopy. Mr A was subsequently diagnosed with colorectal cancer which was not amenable to treatment and he later died. In responding to Mr C's concerns, the practice said they did not deem an earlier referral appropriate at the time in light of Mr A's other complex medical conditions.

We took independent medical advice from a GP, who advised that there were no current complex medical conditions which could have explained the significant deterioration in Mr A's red blood count. As such, they advised that cancer referral guidelines should have been followed and Mr A should have been appropriately assessed and referred for urgent investigation. We found no evidence of an appropriate examination having occurred and a referral was not made until almost nine months after iron deficient anaemia was diagnosed. We found that the referral should have been sent to a gastroenterologist or surgical doctor, rather than a vascular surgeon. In addition, the adviser highlighted that Mr A was prescribed an inappropriate dosage of iron supplements and he was not adequately monitored to assess his response to these. We concluded that there was an unreasonable failure to appropriately assess, treat and monitor Mr A's iron deficient anaemia, and an unreasonable delay in arranging appropriate specialist investigation. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the unreasonable failure to appropriately assess, treat and monitor Mr A's iron deficiency anaemia; and the unreasonable delay in arranging appropriate specialist investigation. 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:

• The GP involved in Mr A's care should refer themself to NHS Grampian's clinical support group for review of their knowledge and practice in relation to clinical assessment, prescribing and referral guidelines.

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.