Health

Summary

Mr C complained that his pain medication had been stopped and said that he suffered significant pain as a result.

We took independent advice from a GP. We found that the decision to stop Mr C's pain medication was reasonable and he was reasonably followed up with, and offered appropriate alternatives, for his pain. Therefore, we did not uphold Mr C's complaint.

Summary

Miss C was referred by her GP to a health board in Scotland for gender reassignment. However, although she was assessed as being eligible and referred to the board's gender identity clinic, she is still waiting for some treatment including surgery. Miss C said that the delay in treatment has had an adverse effect on her mental health, which has been exacerbated by the failure to keep her informed about the delays in a reasonable way.

We considered the relevant Scottish Government protocol, which requires health boards to ensure their gender reassignment service is provided in an effective way and within a reasonable time. We also considered the evidence from Miss C's clinical records about her contact with the clinic. We found that the board do not yet have a functioning gender reassignment pathway. We recognised the continuing difficulties the board experienced in providing some aspects of their gender reassignment service and noted the steps they had taken to re-establish this and address the remaining gaps identified. Even so, the board are still not in a position to provide a full gender reassignment service, which has a far-reaching impact on transgender patients.

In relation to communication, we found that the standard of communication between staff and Miss C and her family was unreasonable and noted it was likely the impact of delays on transgender patients would be compounded by any communication failings. In addition to staff failing to respond at all to communication, there was a failure to be open and transparent about the difficulties the board had in providing a gender reassignment service. We upheld the complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the failings identified in this investigation and acknowledge the impact that this has had on her. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Carry out an equality impact assessment when all the relevant services are established and provide a copy to this office.
• Finalise an action/improvement plan of the board's activities underway to establish a functioning gender reassignment pathway and provide a copy to this office.
• Review the current arrangements for communication and implement any changes identified to ensure the board meets the requirements of the protocol and the needs of transgender patients.
• Review the psychological support offered to patients accessing the board's gender reassignment service to ensure it is adequate in light of the potential impact delays and gaps in the service will have on patients.

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 about the way NHS 24 managed a number of phone calls which he made to them reporting that he felt that he had something stuck in his throat. Mr C said that NHS 24 staff had initially referred him to the out-of-hours service where he spoke to a GP and was given advice to drink fizzy drinks. Mr C then contacted NHS 24 again as the problem had not resolved and subsequently an ambulance was despatched to take him to hospital. Mr C felt that NHS 24 staff failed to take his concerns seriously.

We took independent professional advice from an experienced nurse. We found that NHS 24 staff had recorded Mr C's symptoms appropriately and that his breathing was not compromised and initially made a referral that Mr C should be assessed by an out-of-hours service GP. When Mr C made further contact as his condition had not resolved, he stated that he felt he was choking and therefore arrangements were made for an ambulance to attend. We found that it was appropriate for NHS 24 staff to have referred Mr C to the other organisations in view of his symptoms reported during the telephone calls. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to him by the hospital when he had been admitted for a biopsy (a tissue sample taken for testing) and insertion of chest drain (a flexible plastic tube is inserted through the chest wall and into the affected area to drain it of fluid). He complained that pain relief had been inappropriate and caused urinary blockage; that there had been a failure to make a referral to his local hospital for urinary issues; and that his relatives had been informed there was a crash in his blood pressure, but that this was then denied.

We took independent advice from a surgeon. We found that the referral to Mr C's local urinary team was made appropriately and there was no evidence that Mr C had a blood pressure crash. However, we found that there were failures in Mr C's care and treatment in relation to the management of his pain; his pain was not assessed regularly and in line with the pain assessment chart, and the pain relief that was given was not adequate for Mr C's needs and was not in line with the British National Formulary on prescribing. We also found that management and monitoring of Mr C's urinary output and retention was unreasonable. We therefore upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failures in relation to the management of his pain, and management and monitoring of his urinary output and urinary retention. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets .

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

• Medication given for pain relief should be adequate for the patient's needs and in line with the British National Formulary on prescribing.
• Pain levels should be assessed in line with the general pain assessment chart.
• Urinary output should be monitored closely after surgery and staff should be alert to the possibility of urinary retention.

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's complained about the care and treatment provided by the board to her husband (Mr A) over several of years, in a number of respects. Mrs C said that this had an adverse effect on the care provided to Mr A and, as a result, his mental health had suffered.

We took independent advice from an adviser who specialises in psychiatry. We found that the standard of care and provision of treatment was reasonable in all respects and we did not uphold this aspect of the complaint.

Mrs C was also concerned about the way the board had handled her complaint. We found that the board's complaint response reflected the findings of their investigation and was reasonable. Therefore, we did not uphold this aspect of Mrs C's complaint.

Summary

Ms C complained on behalf of her late uncle (Mr A) about the care and treatment he received from his GP practice. Ms C complained that the practice failed to treat Mr A as an urgent patient, even though he was experiencing symptoms that could have been caused by a stroke.

We took independent medical advice from a GP. We found that when Mr A contacted the practice, he did not provide information that suggested it was an emergency and it was reasonable that the GP arranged to see him later that week. However, the next day, Mr A's wife (Ms B) contacted the practice with concerns about Mr A's condition worsening and she spoke to another GP. Ms B asked for Mr A to be seen earlier but this was refused. We found that during this phone call, the GP failed to carry out an appropriate assessment of Mr A's condition, did not communicate reasonably, and inappropriately failed to see Mr A urgently, even though the symptoms Ms B described could have been caused by a stroke. We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A's family for the failings identified in the care and treatment he received. The apology should meet the standards set out in the SPSO guidelines on apology available at: www.spso.org.uk/information-leaflets .

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

• When a patient (or their representative) contacts a GP with concerns, the GP should take an adequate medical history and carry out an appropriate assessment of the patient's condition, in a manner that is in line with the General Medical Council guidance on good medical practice.

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 to us on behalf of his late father (Mr A) who was diagnosed with and subsequently died as a result of septic arthritis (a serious type of joint infection). Mr C complained that the practice failed to provide reasonable care and treatment in relation to Mr A's shoulder pain, including providing phone consultations rather than face-to-face assessments and that the practice did not refer Mr A for x-ray or to orthopaedics (specialism that deals with diseases and injuries of the musculoskeletal system). Mr C considered that this had caused delays with Mr A being diagnosed with joint sepsis.

We found that the practice's consultations and care and treatment that Mr A received were reasonable, including referring Mr A to physiotherapy. Therefore, we did not uphold this complaint.

Summary

Miss C complained about the care and treatment she received from Ninewells Hospital in relation to the birth of her child. Miss C highlighted that her child has brain related problems. Miss C also complained about the time it took for the board to respond to her complaint.

Following the birth of Miss C's child, the board conducted a Local Adverse Event Review (LAER) to detail the root causes and key learning from an adverse event. The LAER found that the root cause was that Miss C had hyponatremia (low sodium concentration in the blood - a rare complication in low-risk labouring women). The LAER identified a number of concerns in terms of the administration of intravenous (IV) fluids on the midwifery unit, timing of blood tests, confusion surrounding the need to transfer Miss C due to her behaviours and significantly altered conscious state, and the obstetric (pregnancy and childbirth) team not being informed of the transfer and associated concerns. As a result, the board took action to address these issues to ensure learning and improvements.

We took independent advice from a consultant obstetrician and a midwife. We noted that Miss C was a low-risk patient at the beginning of her labour in the midwifery unit. We found that the progress of the first stage of Miss C's labour was unreasonable and she was given excessive fluids orally and by IV infusion which was not recorded on a fluid balance chart or reviewed by medical staff prior to IV fluids being given, after which she became unresponsive.

We also found that, despite not having any sedating analgesia (pain relief), the deterioration in Miss C's condition was not recognised and assistance was not requested. There was an unreasonable delay in transferring her to the labour ward, with unfamiliar staff being involved in the transfer and key information not communicated effectively to the new team. However, we were unable to say what effect earlier detection and treatment would have had on the outcome for her child.

After Miss C's transfer to the labour ward, the medical staff recognised her poor condition promptly and delivered her child. Had Miss C been transferred when the delay in the first stage of labour was diagnosed, it was likely that blood tests would have been taken leading to an earlier diagnosis of the problem. We found that there was a delay in obtaining and acting on the blood results which we considered unreasonable, although this delay would not have affected Miss C's child's outcome. In view of these findings, we upheld this aspect of the complaint. The board has already taken some action in respect of their findings on this case. However, we made further recommendations to ensure learning.

In terms of the board's handling of Miss C's complaint, we found that there was evidence that the complaints department made attempts to arrange a meeting to discuss Miss C's concerns with her and provide the complaint response within good time. However, it appears that there was a delay in clinical staff responding to these attempts. While the update response sent to Miss C was factually correct, in the absence of any evidence from the board justifying the delay, we found that the time taken to deal with the complaint was unreasonable. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for failing to recognise her deterioration and for the delay in dealing with her complaint. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets .

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

• All relevant staff should be fully appraised and aware of key information.
• All relevant staff should be able to recognise and manage a deteriorating patient.
• Clinical staff should respond to the board's complaint investigations in a timely manner.
• Patients should be appropriately transferred to obstetric care.
• Communication of blood test results should be recorded in a structured and consistent way.
• All staff taking blood tests should take responsibility to obtain the results or communicate with the next shift about any outstanding results.

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, an MSP, complained on behalf of his constituents Ms B and Ms A (Ms B's daughter) about the service provided by a community mental health team (CMHT). Ms A was a young adult with Asperger's Syndrome (a form of autism, in which people may find difficulty in social relationships and in communicating) and she received treatment for obsessive compulsive disorder (OCD, a common mental health condition where a person has obsessive thoughts and compulsive behaviours) and depression.

During our investigation of Mr C's complaint, we considered the evidence provided by Mr C and the board. We also received independent advice from a consultant psychiatrist.

Mr C raised concern that the CMHT did not provide Ms A with reasonable mental health care and treatment. We considered that the doctors involved in Ms A's care appropriately took into account her Asperger's Syndrome and we found that the treatment provided for Ms A's OCD and depression was reasonable. We did not uphold this complaint.

Mr C complained that the CMHT failed to provide Ms B with reasonable advice and information to support her as a carer for Ms A. We found that Ms B and Ms A were given details of support organisations and Ms B was offered a carer's assessment. However, we did not find sufficient evidence that general information about management of conditions was provided to Ms B. On balance, we upheld this complaint.

Finally, we considered whether the board provided a reasonable response to Mr C's complaint. We found that the board had accurately identified and responded to many of the complaints raised. However, we noted that the board did not address all the points that Ms B raised separately. We were unable to conclude that the board provided a full response to the points Ms B raised in line with the requirements of the NHS Scotland Complaints Handling Procedure. On balance, we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms B for failing to provide general information about management of conditions and treatments, and not responding to a number of points raised in her complaint. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets .

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

• Family members supporting the care of a patient should receive general information about management of conditions and treatments, whilst maintaining a patient's right to confidentiality.

In relation to complaints handling, we recommended:

• Under the NHS Scotland Complaints Handling Procedure an investigation should establish all the facts relevant to the points made in the complaint and to give the person making the complaint a full, objective and proportionate response that represents the final position.

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 she had not been provided with appropriate treatment at a dental hopsital. Mrs C said that she had been suffering from severe pain for an extended period, due to a poorly fitting denture.

We took independent advice from a dental advisor. We found that Mrs C had been reviewed appropriately and when she had expressed concerns, her care and treatment had been assessed by a number of different specialists. Mrs C had been treated reasonably and appropriately.

Mrs C also complained that a referral to a specialist at a different health board had been cancelled by Tayside NHS board. Mrs C felt this was also unreasonable. We found that Mrs C had not met the criteria for a referral to a different board, as her treatment could reasonably be provided locally.

We also found that Mrs C's complaint was handled by the board in line with their complaints handling process and whilst we recognised that she did not agree with the outcome, this did not constitute evidence of maladministration on the part of the board.

We did not uphold Mrs C's complaints.