Health

Summary

Mr C developed a lump on his ear and his GP referred him to Hairmyres Hospital for investigations. Mr C was seen at the dermatology clinic at the hospital six weeks after his GP referral. He was diagnosed with squamous cell carcinoma of the ear (a type of cancer in the skin's cells). Mr C was routinely referred to the hospital's plastic surgery department for treatment and he was offered a plastic surgery appointment around two months later. In the meantime, Mr C contacted the dermatology clinic, as the lump on his ear was increasing in size daily. Mr C's referral to the plastic surgery department was upgraded to urgent and he was offered an appointment a week later. When Mr C attended that appointment, he confirmed that he had already arranged private surgery to treat his squamous cell carcinoma, as he felt the treatment time at the hospital had been too long. Mr C complained to us about delays in diagnosing and treating his squamous cell carcinoma.

We took independent advice from a consultant dermatologist. We found that there was no unreasonable delay in the hospital diagnosing Mr C's squamous cell carcinoma. However, we found that squamous cell carcinoma on the ear is considered a high-risk site, as it has the potential to spread around the body. Therefore, we considered that Mr C should have been urgently referred to the plastic surgery department after his diagnosis. We found that it was unclear whether Mr C would have been treated within the 18 week referral to treatment standard, which applies to 90 percent of all routine surgeries in Scotland. We considered that this standard may not have been met, given how complex the surgery would be and how long Mr C's clinical journey had already taken. We recognised that it is not a 100 percent standard, but given the level of risk of having squamous cell carcinoma on the ear, we considered that Mr C should have been treated within that timescale. For this reason, we upheld Mr C's complaint. However, we did not recommend that Mr C's private treatment costs be refunded. This is because we noted that he had arranged private surgery before he received a date for surgery from the hospital. Although we had concerns that the hospital may not have met the 18 week standard, we were unable to say with certainty they would not have done so, and so we did not consider it to be reasonable to recommend that the board reimburse Mr C's private treatment costs.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for referring him to plastic surgery as a routine referral when his squamous cell carcinoma was on a high-risk site. 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:

• Patients with squamous cell carcinoma should receive the appropriate treatment, from the correct clinician(s), at the appropriate time, taking into account the relevant clinical guidance.

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 on behalf of his neighbour (Mr A) about the care and treatment provided to Mr A for kidney stones at Raigmore Hospital. Mr A had a number of surgical procedures over the course of a year to remove his kidney stones, however none of these were successful and Mr A was referred to a different health board for further treatment.

We took independent advice from a consultant urologist. We found that both the medical and surgical management of Mr A's kidney stones had been reasonable, despite the procedures failing to be successful. Therefore, we did not uphold this aspect of Mr C's complaint. However, we did find that the referral to the other health board was not appropriately recorded in Mr A's medical records and we made a recommendation regarding this.

Mr C also complained about the board's communication with Mr A. He said that it had not been explained to Mr A what the treatment plans were, and that the surgeon failed to visit him after his most recent surgical procedure to explain the next steps. We found that, although communication throughout much of the time Mr A was receiving treatment was reasonable, it was not reasonable that the surgeon failed to make plans for post-operative discussions. We also found that there was a failure to make a note of a phone call the surgeon had with Mr A. Additionally, we found that the board's complaint response was poor as it failed to sufficiently cover the points complained about. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the failure to communicate with him reasonably. 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:

• Referrals to other health care providers should form a part of a patient's record.
• In similar situations, surgeons should proactively make arrangements to meet with patients post-operatively in order to discuss the operation and further management plans. Where this is not possible this should be raised with the patient in advance and an agreement on how to do this should be reached.
• Phone consultations which are part of clinical care should be recorded in writing in the patient's medical records.

In relation to complaints handling, we recommended:

• Complaint responses should fully address all issues raised by the initial complaint.

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 unreasonably removed her from the patient list. Mrs C had been expecting to receive a call from the receptionist about whether her adult son could have an appointment with a GP to discuss blood test results. Mrs C had earlier tried to speak to a GP by phone to see about an appointment for her son but was told that the GP would not speak to her. Mrs C left her contact details and asked that the practice return her call with details of an appointment time. Mrs C then received a phone call from the practice manager who said that the decision had been taken to remove her from the patient list. Mrs C could think of no reason why she had been removed from the patient list.

We took into account the contractual regulations and relevant guidance regarding the removal of patients from the practice list. This sets out that, other than in cases involving violence or aggression, a patient whose behaviour is giving cause for concern should be given a written warning informing them that they will be removed from the practice list if they do not alter their behaviour. The warning should last for 12 months. While the practice did provide us with two examples of why they had concerns about Mrs C's actions, staff did not formally bring them to Mrs C's attention in line with the regulations and guidance and therefore she was unaware of the practice's concerns. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for unreasonably removing her from the practice list. The apology should comply with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• Staff should be aware of and comply with the guidance and regulations where there are concerns about patient behaviour.

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 raised concerns about the way hospital nursing staff arranged a care package with the council for her late father (Mr A) upon his discharge from Glasgow Royal Infirmary. Mr A's discharge from hospital was delayed as Ms C was told that the care providers were closed over the holidays. After being discharged no carers arrived to assist Mr A. Ms C contacted the hospital but was told nothing could be done as it was the weekend and there was no out-of-hours service. Ms C complained that the board failed to ensure that a package of care was in place for Mr A on his discharge from hospital and that she was not provided with an out-of-hours emergency phone number for the care provider.

We considered that there was a failure to reasonably ensure that the council was contacted to put a package of care in place. We found that there was contradictory information regarding how the package of care had been arranged and who within the nursing staff had arranged it with the council. It was not possible to determine with any certainty who arranged this and what was arranged. We upheld this aspect of the complaint.

We also found that nursing staff were not aware of the fact that an out-of-hours number was available and could be called at the weekend and on public holidays. We found that it was possible that Mr A could have been provided with a package of care over the holidays or at the weekend if the out-of-hours service had been contacted by the nursing staff or if Ms C had been provided with the number. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to ensure that a care package was arranged with the council for Mr A's discharge from hospital.
• Apologise to Ms C for not calling the out-of-hours phone number for packages of care and for not providing Ms C with this number. The apology should meet the standards set out in the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.

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

• All nursing staff should be aware of the requirement to record who contacted the council to arrange a package of care; the name of the person this was arranged with; the date the care package would start and any discussion regarding the care the patient would require at home.
• All nursing staff should be aware of the out-of-hours contact phone number for packages of care for public holidays and weekends. Staff should contact this number where appropriate to do so. The number should be provided to families where appropriate to do so.

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 late father (Mr A) at the Glasgow Royal Infirmary. Miss C also complained about communication between the hospital staff and Mr A and his family.

Mr A was seen by the ear, nose and throat department due to having an ongoing hoarse voice and was subsequently referred to the respiratory department. Mr A was started on medication to treat tuberculosis (a bacterial infection mainly affecting the lungs). Mr A was later admitted to hospital due to shortness of breath and it was found he did not have tuberculosis, but lymphoma (a type of cancer). Miss C complained that the board did not consider other possible diagnoses and this resulted in a delay in reaching the correct diagnosis of lymphoma. Miss C also had concerns that the consultants involved in her father's care did not fully take into account his inability to eat properly and the effect this may have had on his existing diabetes.

We took independent advice from a consultant respiratory physician. We found that it was reasonable and appropriate to consider tuberculosis as the most likely diagnosis, and that this was in line with national guidance. The advice we received is that the consultants were open to alternative diagnoses, and that they reasonably took into account the effect of his illness on his diabetic control. Therefore, we did not uphold this aspect of Miss C's complaint.

Miss C complained about communication between the hospital staff and Mr A and his family. We noted that the board had acknowledged and apologised that communication was not of a good standard, and they had discussed this with the relevant staff to determine how this matter could be improved. We upheld this complaint, but found that the board had appropriately taken action on this matter and therefore did not make any further recommendations.

Summary

Mr C complained about the prison healthcare team's decision to withdraw his suboxone medication (medication used to treat opiate addictions). He also complained that it took an unreasonable amount of time for him to be reviewed by a GP when his prescription was discontinued.

We took independent advice from a medical adviser. Mr C was found to be concealing his medication and so it was stopped. The advice we received was that this decision was reasonable as it was in line with the medication contract that Mr C had signed. We did not uphold this aspect of Mr C's complaint.

Regarding the time taken for Mr C to be reviewed by a GP, we found that Mr C's records were reviewed by a GP within three days and that he subsequently received an appointment. The advice we received was that this wait was not unreasonable. We did not uphold this part of Mr C's complaint.

Summary

Mr C, who is an advocacy and support worker, complained on behalf of his client (Ms B) about the clinical treatment provided to Ms B's son (Mr A). Mr A had been attending the practice over a number of months with recurrent symptoms, and Ms B felt that further investigations should have been carried out to determine the cause of Mr A's symptoms.

We took independent advice from a general practitioner. We found that Mr A had been appropriately assessed, examined and investigated by the practice. We also found that appropriate referrals were made for further investigations in light of Ms B's concerns. We found that the care and treatment provided was in line with the General Medical Council Good Medical Practice guidance. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the practice had unreasonably refused to provide Mr A with a medical appointment. We found that there had been no indication for an urgent appointment when Ms B had contacted the practice and that appropriate and adequate advice had been provided by the practice to Ms B based on Mr A's past clinical record, past attendances and persistently normal investigations. We did not uphold this aspect of Mr C's complaint.

Summary

Mrs C complained to us about the care and treatment she received at her GP practice. She considered that the practice delayed in diagnosing the severity of circulation problems in her leg and she questioned the treatment she had received. Mrs C felt that she should have been referred to the hospital's vascular department sooner. She believed that if she had been provided with appropriate clinical treatment and referred to vascular surgeons earlier then she may not have had to have her lower leg amputated.

We took independent advice from a GP adviser. We found that the assessment and treatment provided to Mrs C by the practice doctors was reasonable and appropriate and was in accordance with national guidelines. We found that there was no unreasonable delay by the practice in making the referral to the vascular department and that the referral did not require to be urgent because, at the time Mrs C was assessed, there was nothing to suggest critical ischaemia (an advanced state of peripheral artery disease and a threat to a limb). In addition, the referral had appropriately requested further investigation and clearly stated that Mrs C's doctor suspected vascular disease and asked that a doppler scan (a non-invasive test that can be used to estimate the patient's blood flow through blood vessels by bouncing high-frequency sound waves off of circulating red blood cells) be arranged. We also considered that there was no evidence to support the view that an earlier referral by the practice could have avoided the loss of Mrs C's lower leg.

Taking account of the evidence available, and the advice we received, we did not uphold Mrs C's complaints.

Summary

Mr C, who was diagnosed with gastric lymphoma (a cancer originating in the stomach), complained that there had been an unreasonable delay by the practice in referring him for a specialist opinion. We took independent advice from a general practitioner. We found that there was no undue delay in referring Mr C for a specialist opinion given the information the practice had on which to base their decision. We also found that the practice had been diligent in their review of Mr C's case and that the action taken by the practice was reasonable. We did not uphold Mr C's complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A). Mr A had been on a waiting list for a prostate operation for severe incontinence for a number of months and, despite several letters from the board saying that he would undergo the operation within weeks, he was still waiting when Ms C made the complaint to us, approximately nine months after Mr A was first put on the waiting list. Ms C said this was contrary to the treatment time guarantee (12 weeks) and did not take into account Mr A's clinical need. She also noted that Mr A was willing to travel to any hospital in the UK to undergo the operation. Ms C told us that Mr A's operation had been cancelled on three occasions at the very last minute and said that, as a result of the board's failings, his physical and mental health had deteriorated.

We took independent advice from an adviser who specialises in urology. We found that the board's failure to meet the treatment time guarantee or consider other healthcare providers meant that Mr A suffered severe lower urinary tract symptoms unnecessarily for an unreasonable number of months, with significant implications for his physical and emotional health as a result. In relation to communication, we also found it unreasonable that, at times, Mr A 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.

Recommendations

What we asked the organisation to do in this case:

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

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

• Review their process and patient letters to ensure that they comply with the treatment time guidance, including considering alternative providers and communication with patients.
• Reflect on this case in relation to whether opportunities to reassess Mr A's clinical priority were missed and report back to us on the findings.

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.