Health

Summary

Mr C complained that his request for orthodontic treatment was unreasonably refused by the board. Following contact from our office, the board repeated their offer to provide Mr C with a further referral to an orthodontic consultant to assess suitability for treatment. As a result of this further action by the board, we determined that it would not be appropriate to take forward Mr C’s case at this time when he was still undergoing assessments.

Summary

Mrs C complained about the care and treatment given to her late father-in-law (Mr A) after he was admitted to a GP led unit for rehabilitation after a fall. She said that he was not properly supported or cared for which caused him to fall again and break his hip, and that there was a delay in transferring him to hospital for an operation. As well as these concerns, Mrs C also complained about communication with the family and that Mr A's wife (Mrs B)'s views were not taken into account when Mr A's discharge was being considered.

We took independent advice from a GP and from a registered nurse. We found that, while Mr A's medical care was reasonable, including his care when he fell, there were gaps in his nursing notes which were unacceptable and represented a failure in the care provided. For this reason, the first of Mrs C's complaints was upheld. The board said that they had taken steps to ensure improvement in record-keeping, and we asked them to provide us with evidence of this. We did not make any further recommendations in connection with this.

Regarding Mrs C's complaint about communication, we found that Mr A lacked capacity and could not make decisions about his own care. We found that there was no power of attorney in place to do this on his behalf. However, we noted that there were detailed discussions with the family about Mr A's discharge and that Mrs B's views on this were taken into account. We did not uphold this aspect of Mrs C's complaint.

Summary

Mrs C complained on behalf of her husband (Mr A) about the care and treatment he received from the board at Dumfries and Galloway Royal Infirmary. Mrs C complained that there was an unreasonable delay in diagnosing that Mr A was suffering from renal cancer, that there was an unreasonable delay in providing him with treatment and that staff had failed to communicate appropriately with Mr A and his family about his diagnosis and treatment.

We took independent advice from a consultant urologist who said that there was a severe failure to follow-up on a radiologist's report of a scan. The radiologist had suspected that an area of abnormality which showed in Mr A's kidney was renal cancer and had made a recommendation that the scan should be discussed at a urology multi-disciplinary team meeting (MDT). The radiologist's recommendation to discuss this at MDT was not actioned. There was also a failure to mention the scan finding in any of the correspondence on Mr A's discharge from the hospital. As a result, the suspected renal cancer was neglected until the same renal mass was found, by chance, a number of months later when Mr A had a scan to investigate a problem that was unrelated to his renal cancer. While it appeared that Mr A's tumour had not progressed when found, we found that the delay was unacceptable and that the diagnosis, management and treatment of his renal cancer was well below an expected standard. We upheld Mrs C's complaints about delays in diagnosis and treatment.

We also took independent advice from the consultant urologist, as well as a nursing adviser, about how staff communicated with Mr A and his family about his diagnosis and treatment. We did not find any reference in Mr A's medical records of medical staff having a discussion with him about his cancer diagnosis and treatment. We found that the actions taken by nursing staff had fallen short of the standard expected and needed for Mr A and his family at the time. We upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C and Mr A for:
• an unreasonable delay in diagnosing that Mr A was suffering from renal cancer;
• an unreasonable delay in providing treatment to Mr A; and
• a failure in communication.
• 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:

• A system should be in place to ensure that unexpected findings of scans are appropriately reported and acted upon in a timely manner.
• It should be ensured that radiology are summarising any significant incidental findings at the end of a scan report, as per the requirements of a previous audit, and that these findings are brought to the attention of relevant staff in a timely manner.
• Staff should be aware of the importance of communication with patients and their families. Newly appointed staff should be supported and mentored in this regard and provided with appropriate training.

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 the care and treatment provided to her mother (Mrs A) at her GP practice. Miss C was concerned that the practice were not addressing Mrs A's health problems or taking into account her fear of medical situations. Miss C had power of attorney for Mrs A and complained that the practice provided Mrs A with unreasonable treatment and that they were not keeping her informed of Mrs A's health care.

We took independent advice from a GP. We found that the practice had completed a full assessment of Mrs A and a full advanced care plan was done. Mrs A was seen on a house call, as requested, and appropriate treatment was provided. There had also been communication between the practice and other professionals regarding Mrs A's healthcare. We considered that the practice provided Mrs A with appropriate care and treatment, and therefore, did not uphold this aspect of Miss C's complaint.

In relation to Miss C's complaint about the practice failing to keep her informed, we found that at the time of Miss C's complaint, the practice held a letter confirming that Mrs A did have capacity. A subsequent assessment confirmed she lacked capacity, but the practice had not been aware of that at the time of the complaint, nor had they been aware of the power of attorney. We found that the practice acted appropriately in maintaining Mrs A's confidentiality until such time as it was brought to their attention that she no longer had capacity and Miss C had power of attorney. We did not uphold this aspect of Miss C's complaint.

Summary

Mrs C complained about the clinical and nursing care and treatment provided to her late husband (Mr A) when he was admitted to the University Hospital Ayr. We took independent advice from a consultant in emergency medicine, a consultant in acute medicine and a nursing adviser.

In relation to the clinical care and treatment provided to Mr A, having considered the available evidence and the advice provided to us we found that, overall, the medical care and treatment Mr A received was reasonable. The advice we received from the consultant in acute medicine was that Mr A's death was not preventable by the time he was admitted to hospital. We did not uphold the complaint. However, whilst the advice we received from the consultant in acute medicine was that cardiac monitoring would not have saved Mr A's life, they considered that the board should have a clear policy regarding which patients require cardiac monitoring. We made a recommendation regarding this.

Regarding the nursing care provided to Mr A, we found that there were gaps in the assessment and monitoring of Mr A and that the board wrongly focussed on anxiety being the cause of Mr A's shortness of breath. We also found that the guidance on using the Modified Early Warning Score (the monitoring of vital signs such as respiratory rate which helps alert clinicians to patients with potential for clinical deterioration or with established critical illness) was not followed, in that Mr A's Modified Early Warning Score was not repeated in line with guidance and there were gaps in the recording of his vital signs which was unreasonable. We further found that Mr A's Modified Early Warning Score should have been repeated on transfer to a new care area. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to provide a reasonable standard of nursing care and treatment to Mr A. 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:

• There should be clear a policy regarding which patients require cardiac monitoring shared between the emergency department, the critical care unit and the acute medical unit.
• A Modified Early Warning Score should be checked within the recommended time frames. In line with good practice, a Modified Early Warning Score should be checked and documented when a patient is transferred to a new care area.
• When a patient or relative raises concerns about breathlessness, a Modified Early Warning Score should be rechecked and documented.
• Relevant staff should be aware of the importance of Modified Early Warning Score in anticipating deterioration in a patient.

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

Mrs C complained that the practice had not provided her with reasonable care and treatment when she raised concerns about her skin condition. We took independent advice from a GP adviser. We found that the GPs at the practice had taken Mrs C's concerns seriously and that they had made reasonable and appropriate referrals to several specialists. We found that they had sent samples to a microbiology laboratory to be tested and that they had communicated thoroughly with the specialists regarding Mrs C's symptoms. We also found that the practice staff had communicated appropriately with Mrs C during consultations and when advising her of her diagnosis, and that the prescribed medications were appropriate. We did not uphold Mrs C's complaint.

Summary

Mr C complained about the care that his wife (Mrs A) received as a patient at both the Western General Hospital and Astley Ainslie Hospital. Mr C was unhappy that Mrs A was occasionally attended to by male nurses. Mr C also felt that Mrs A was given unreasonably high doses of medication.

We took independent advice from a nurse. The adviser explained that male nurses routinely carry out the same care as female nurses, for both female and male patients. This includes personal care such as toileting and washing. The adviser reviewed Mrs A's medical records and found that it was reasonable in the circumstances for her to be attended to, on occasion, by male nurses. The adviser also found that Mrs A was not kept sedated and was given the recommended doses of medication. We did not uphold Mr C's complaints.

Summary

Mr C complained that he was unreasonably discharged from the Royal Infirmary of Edinburgh following hip replacement surgery, as he was unable to pass urine and was constipated at the time of discharge. Mr C eventually had a catheter fitted and was advised by a consultant at the Western General Hospital that he would be put on a waiting list for transurethral resection of the prostate (a surgical procedure that involves cutting away a section of the prostate - a small gland in a man's pelvis located between the penis and bladder). Mr C complained that the board misled him about the date for his surgery and that they failed to carry out his operation within a reasonable time.

We took independent advice from a nurse. They said that it was appropriate for Mr C to be discharged from hospital, as his notes indicated that he was not experiencing any issues with passing urine or that his bowels were not working. Therefore, we did not uphold this part of the complaint. However, we noted that the board recognised they should have provided Mr C with oral laxatives on discharge and will take action to address this issue in future.

Based on the information available we did not consider that the board misled Mr C about the date for his surgery and we did not uphold this part of the complaint. However, we noted that the board had indicated that they had taken steps to try to ensure that in future, the medical team and their secretaries were kept notified of waiting times for procedures and we asked the board to provide evidence of this.

The adviser said that Mr C's surgery was completed outwith the 12 week treatment time guarantee and as the procedure was classified as 'urgent', this appeared unreasonable. The board explained the steps that they had taken to try to reduce the waiting times for patients and identify alternative providers and we asked for further evidence of this. We also found that there was poor communication between the board and Mr C regarding the delay in his surgery, advice and support available to him and in their handling of Mr C's complaint. Therefore, we upheld this part of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the unreasonable delay in providing surgery, not discussing the advice and support available to him and for the communication error in complaints handling. 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 board should inform patients as soon as possible of any inability to meet treatment targets and provide them with all the required information. This should include options available to them in the circumstances and how to provide comments/feedback or make a complaint about the delay.

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 (Mrs B) about the care and treatment provided to Mrs B's son (Mr A) at the Royal Edinburgh Hospital. Mr A had a range of complex psychiatric and physical health conditions and spent long periods of time in hospital. Mr A's health deteriorated while he was in the hospital and he was transferred to another hospital for treatment and died the following day. Ms C complained that the board failed to provide Mr A with appropriate treatment for both his mental health and his physical health. She also complained that the board failed to respond appropriately to Mr A's deteriorating physical health in the two weeks leading up to his death.

We took independent medical advice from a psychiatrist, a mental health nurse, and a consultant in general medicine. We found that Mr A received appropriate mental health treatment and that the board had followed the relevant guidelines. We did not uphold this part of the complaint.

In terms of Mr A's physical health conditions, the psychiatric adviser said that a more systematic approach to assessing/managing Mr A's risk of infection should have been taken. We also found failings in Mr A's nursing care, including a failure to adequately complete charts to monitor his weight, food and fluid intake. We upheld this part of the complaint.

On the events leading up to Mr A's death, we found that his deteriorating physical condition was not responded to adequately, on occasion, by nursing staff and that there was a delay in requesting a medical review. Based on the evidence provided, we upheld the complaint. However, the advisers said that the remedial action taken by the board in relation to this part of the complaint was reasonable and we therefore had no further recommendation to make regarding this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs B and her family for the failings in care and treatment that Mr A received in hospital. 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:

• Charts used by nursing staff to monitor patients weight, nutritional screening and food and fluid intake should be completed in full and in line with organisational expectations.
• Nursing care should be effectively and transparently planned and evaluated.

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 the medical care and treatment she received following a facial injury she sustained as a result of dental treatment. Miss C pursued a complaint about her dental treatment separately with another organisation and, when that process concluded, she decided not to pursue her complaint with us. Therefore, we closed our file on the complaint and took no further action.