SPSO Individual Decisions

C complained about the treatment provided to their late parent (A) by their GP practice. A had prostate cancer for a number of years which later spread to their liver. C complained that the practice failed to reasonably monitor A's blood sugar levels (HbA1c) after prescribing medication. We took independent advice from a GP. We found that the decision to commence medication for A's raised HbA1c was reasonable and appeared to be made with the input of a specialist medical consultant. However, there was no record to indicate that the practice discussed the risks of hypoglycaemia (low blood sugar) with A or took steps to allow A to monitor their blood sugar levels. We considered that the responsibility of monitoring any risks from the medication fell to the practice. Therefore, we upheld this aspect of C's complaint. C complained that the practice failed to reasonably respond to A's reduced haemoglobin (Hb) levels. We found that, while the actions taken after the blood test results reported two weeks prior to A's death were reasonable, there was an opportunity prior to that to act on A's falling Hb levels. We noted that given the trend of A's falling Hb levels and their overall clinical picture, there was a fair to good chance that A's condition would deteriorate prior to a scheduled admission for a blood transfusion. We considered that the decision not to admit A prior to the scheduled admission, was a doctor-led decision rather than one made in conjunction with A and their family's wishes. As such, we upheld this aspect of C's complaint. Finally, C complained that the practice failed to reasonably manage A's pain and comfort. We found that the pain management was reasonable and that the practice provided a high standard of palliative care. The medications administered, the timing of them and the increases in dosage were in keeping with the recommended standards of care, and in keeping with A's needs. Therefore, we did not uphold this aspect of C's compla

C complained on behalf of their spouse (A). A was urgently referred to a consultant obstetrician and gynaecologist (specialist in pregnancy, childbirth and the female reproductive system) at Forth Valley NHS Board. Following further investigations, A's case was discussed at a multidisciplinary team meeting (MDT) which included specialists from health boards in the west of Scotland. A different health board took the lead in determining A's treatment plan. A was diagnosed with probable ovarian cancer and was treated with chemotherapy and surgery. C complained about a delay in starting A's treatment, about the decision not to offer chemotherapy first and about how the board responded to their contacts during this time. We took independent advice from a consultant gynaecological oncologist (cancer specialist). Scottish Government guidance, NHS Scotland performance against Local Delivery Plan standards, says 95% of those referred urgently with a suspicion of cancer to begin treatment within 62 days of receipt of referral. From A's urgent referral to the start of treatment was 63 days, one day more than the guidance. As Forth Valley NHS Board was responsible for meeting this target but did not meet it, we upheld this complaint. We found that while some clinicians would have treated with chemotherapy first, it was also completely acceptable practice, and indeed encouraged by relevant clinical guidelines, to provide surgery first. We accepted this advice and did not uphold this complaint. We considered the communication between C, A and the board. We found that while not every contact was responded to as quickly as the board said it would, and some communication was passed on without acknowledgement, the board did respond to the substantive questions C and A raised. We did not uphold this complaint.

C complained about the medical and nursing care that their late parent (A) received at Forth Valley Royal Hospital. Regarding A's medical care and treatment, we took independent advice from a general and colorectal (bowel) surgeon. We found that reasonable action was taken to assess A's cardiac murmur (unusual sounds made by turbulent blood in or near the heart). However, following the exclusion of malignancy or an acute surgical issue, it would have been reasonable to involve a more specialised team involved in the care of the aged. It was reasonable that the board made a referral to the Aging and Health department in the circumstances. However, we found that it was unreasonable that this specialist review did not take place (which may have provided a different perspective on A's symptoms). We noted that the board had already acknowledged and apologised for this failure and had described that the board took reasonable action to address this. We upheld this aspect of C's complaint and requested evidence of the action the board had taken. Regarding A's nursing care, we took independent advice from a nursing adviser. We found that the assessment and control of A's pain was reasonable and that there was evidence that A's pain level was regularly assessed and that a review of their nursing notes did not indicate that A was in pain for most of their in-patient stay. However, we also found that it was unreasonable that A's fluid intake and output were not monitored using a food balance monitoring chart given their overall condition, cognitive issues, feeling of nausea, low blood pressure, swollen legs and that they had been receiving IV fluids. Therefore, we upheld this aspect of C's complaint.

C has Crohn's disease (a condition where parts of the digestive system become inflamed) and had received various treatments, including two previous surgical procedures to remove lengths of small bowel. C attended Forth Valley Royal Hospital with abdominal pain. A CT scan showed inflammation of the ileum (a portion of the small intestine) at the site of the joint that had been created by the previous bowel resection (partial surgical removal of an organ). The decision was made to operate as an elective procedure (surgery that is scheduled in advance because it does not involve a medical emergency). The operating surgeon considered the length of small bowel identified on previous imaging was not causing an obstruction, and decided not to remove it. C continued to experience difficulties following the surgery, including a number of further hospital admissions. C complained that the care and treatment they received from the board was unreasonable. We took independent advice from a general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that, while the level of investigations carried out were reasonable, a midline incision (a vertical cut made in the abdomen to allow access for a medical procedure) should have been performed in C's case. We noted that if a midline incision was employed, then it is likely that the resection would have been carried out as planned. We were also critical of the level of documentation provided by the board. As a result, we upheld this element of the complaint. C further complained that the communication they received from the board was unreasonable. We found that there was no evidence to show that appropriate explanations were given to C following the surgery, and no evidence to demonstrate the board's clinicians effectively communicated with C about their condition. As a result, we upheld this element of the complaint.

C complained to us on behalf of their late parent (A). A was admitted to Forth Valley Royal Hospital after falling at home. A few days into their admission, A was diagnosed with pneumonia (a chest infection) and then later developed sepsis (a severe complication of infection). A's condition deteriorated and they died. C complained about A's medical treatment; in particular, that there was a delay in recognising and treating A's sepsis. We took independent advice from a geriatric (medicine of the elderly) adviser. We found that A's medical care and treatment was reasonable. We did not uphold this complaint. C also complained about A's nursing care. C said that A was not given enough help with personal care and that their conversations with nursing staff had not been recorded adequately. We took independent advice from an acute nursing adviser. We found that the standard and frequency of the communication recorded appeared reasonable. However, we found that there was a lack of evidence of regular and appropriate care rounding to meet A's personal care needs. We upheld this complaint.

C complained to us about the care and treatment provided to their late parent (A). A was admitted to Forth Valley Royal Hospital. A few weeks later, A was transferred to Stirling Community Hospital. A developed pneumonia (a chest infection) and was transferred back to Forth Valley Royal Hospital a few days later. A's condition deteriorated and they died. C complained about A's medical treatment; in particular, that there was a delay in responding to A's chest infection. We took independent advice from a geriatric (medicine of the elderly) adviser. We found that when A's condition worsened at Stirling Community Hospital, A should have been urgently reviewed by medical staff in case A had sepsis (a severe complication of infection). We found that when A's condition worsened significantly at Forth Valley Royal Hospital, A was not given prompt and appropriate antibiotic treatment for possible sepsis. We found that A was not reviewed by medical staff within reasonable timeframes. We also found that anticipatory care planning had not taken place with A and their family, given it was likely A had been nearing the end of their life before they had developed pneumonia. We upheld this complaint. C also complained about A's nursing care at Forth Valley Royal Hospital; in particular, that A was not given appropriate falls care, and, that A was not given enough help with personal care. We took independent advice from an acute nursing adviser. We found that nursing staff should have formed and recorded a specific plan to address A's risk of falls at night/overnight, as that was when A was at highest risk of falling. We also found that there was a lack of evidence of regular and appropriate care rounding to meet A's personal care needs. We upheld this complaint.

C complained about a psychiatric consultation at Falkirk Community Hospital. They complained that they did not receive adequate support from the psychiatrist and that the psychiatrist made inappropriate comments regarding the impact of suicide on others and the best way to complete suicide. We took independent advice from a consultant psychiatrist. It was not possible to confirm from the notes the way the psychiatrist communicated with C or exactly what was discussed surrounding suicide. The board explained that it was the psychiatrist's normal practice to discuss the impact of suicide on others but refuted that C was advised of the best way to take their own life. We considered that the psychiatrist carried out a reasonable assessment and proposed an appropriate management plan. We did not uphold this complaint. C also complained that a board run GP practice refused to continue their prescription for gabapentin (an anticonvulsant medication primarily used to treat partial seizures and neuropathic pain) until C had been seen by the psychiatrist. This medication had been prescribed overseas and C noted that it was for restless leg syndrome (RLS) and not a psychological condition. The board explained that gabapentin is a controlled drug in the UK which can only be prescribed in specific circumstances and with specialist input. They noted it is unlicensed for RLS. We took independent advice from a GP, who noted that gabapentin can be prescribed 'off-label' to treat RLS and they saw no reason for changing this if C had been taking it with good effect and was established on a reasonable dose. However, if the practice had concerns and wished to change this, it should have been gradually reduced and not stopped suddenly. We concluded that it was unreasonable to have refused to prescribe C gabapentin pending a psychiatric review. We upheld this complaint.

C's adult child (A) had anxiety and a functional neurological illness (a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts). One morning A was found to be anxious and unwell. A's other parent (B) thought that it appeared different to A's previous episodes and called the GP who visited A at home. The GP believed that A should be admitted to hospital and called 999. An ambulance crew attended the scene. There was some discussion between the GP and the hospital about which department A should be admitted to; the Mental Health Unit or the Clinical Assessment Unit. The ambulance crew transported A to hospital where A was quickly assessed and taken to the Intensive Care Unit. A died later that day. C complained that the GP had not properly assessed A, they had not taken blood pressure readings or their temperature. C said that the GP assessed A through the prism of mental health and had not properly considered whether there could be another cause to their presentation, which was different from previous ones. We took independent advice from a GP. We found that it was appropriate for the GP to consider A's prior medical history when assessing their condition. We found that the GP correctly identified that assessment at hospital was needed, recognising the seriousness of A's condition. On the basis of information available to the GP at the time, their assessment and conclusions were reasonable. Therefore, we did not uphold the complaint. Related reading View Decision Report 201907500 as a PDF (24.53 KB) Updated: March 24, 2021

C developed severe left arm pain and 'pins and needles' in the fingers of their left hand. Around a year later, C began to experience the same problems with their right side. Their GP was concerned their symptoms were bilateral and they urgently referred C to the board's neurosurgery service (specialists in surgery on the nervous system, especially the brain and spinal cord). C complained that the board failed to respond to their GP referral in a reasonable manner. In particular, that the board unreasonably downgraded the urgency of the referral. During our investigation, we took independent advice from a specialist in orthopaedic medicine (the treatment of diseases and injuries of the musculoskeletal system). We found that C did not have any red flags or signs of a serious underlying condition so they did not require to be seen urgently. We also found that C's referral was appropriately redirected to orthopaedics. However, we noted that there was an unreasonable delay (over five weeks) in telling C's GP that their referral had been vetted and redirected. In light of this delay, we upheld the complaint. We also found that the board did not adequately respond to C's complaint.

C complained to the board about the circumstances whereby their late parent (A) was a patient at Forth Valley Royal Hospital. A had been admitted after suffering a stroke (a serious medical condition that happens when the blood supply to part of the brain is cut off). A also had delirium and a background of dementia. Whilst an in-patient, A suffered a fall. Staff were aware that A had to be supervised and to be accompanied at all times when they were out of bed. However, despite being under close observation, a contracted nurse allowed A to remain in the toilet unsupervised and they sustained a fall which resulted in a severe head injury and subsequently A’s death. C believes that A should not have been left unattended and that, had that been the case, the fall may have been prevented. We took independent advice from an appropriately qualified adviser. We found that staff at the hospital had carried out a comprehensive falls risk assessment in regards to A and that A was not to be left unsupervised. It was felt that A had no awareness regarding the use of the call bell system (a button or cord found in hospitals that patients can use to alert hospital staff of their need for help). However, a nurse had stepped out of the toilet to afford A some privacy and A attempted to rise from the toilet unaided and suffered a fall. Although the record-keeping regarding the falls risk was completed to a good standard, there was a breakdown in communication between permanent staff and the contracted nurse about the specific level of observation required for A. We upheld the complaint.

C raised numerous concerns and complaints about repeated errors with the issuing of Movelat (pain relieving gel). C maintained the gel should be issued to them weekly but when submitting requests to receive the gel, they experienced difficulties. C received mixed responses as to why the gel was not issued. Some of the replies issued indicated the gel should be issued monthly. Other replies acknowledged that the gel should be issued weekly and explanations were offered for the error. The evidence available confirmed that the gel was to be prescribed weekly to C. Despite this, C had to continually raise concerns in relation to ongoing errors with the prescribing frequency of the medication. It took some time before preventative steps were taken, by way of a note that was added to C's record confirming that the frequency of the prescription for the gel should not be changed. We accepted that any delay in issuing the gel will not have had serious consequence for C, and we recognised the actions taken to minimise errors with the prescribing frequency of the gel. However, we found the administrative handling of the matter was poor. C had to unnecessarily submit repeated feedback and complaints only to receive mixed replies and for the problem with the prescribing frequency to continue longer than it needed to. As such, we upheld this aspect of the complaint. C also complained about the decision taken by the healthcare team to discontinue a prescription for Difflam spray (an anti-inflammatory spray used to treat many painful conditions of the mouth or throat). It was explained to C that the throat spray was a short-term treatment for symptomatic relief of painful conditions of the mouth. It was noted that C had been taking the spray for several months, but there was no record to confirm the reason for that. C was reviewed by the dentist, who found no evidence of ulcers. The dentist had initially agreed to reinstate the spray but it was discontinued following a

C, an advice and support worker, complained on behalf of their client (A) in relation to the care and treatment provided to A by the board. A attended Forth Valley Royal Hospital as they had suffered a myocardial infarction (heart attack - when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle) the previous week. A presented to the hospital complaining of pain and swelling affecting their wrist. A was examined and treated for this. A said that the board failed to provide reasonable care and treatment to them as they were not treated appropriately and questioned whether alternative treatments could have been offered. A also said that it took several visits to A&E to be treated appropriately and that they were not referred to a specialist following that first visit. We took independent advice from an appropriately qualified adviser with expertise in emergency medicine. We did not observe any concerns with the care and treatment that A received and concluded that assessment, treatment and advice given were reasonable. Therefore, we did not uphold C's complaint. Related reading View Decision Report 201902016 as a PDF (24.29 KB) Updated: January 20, 2021

C complained about the care and treatment provided to their late parent (A) who died from an aggressive and complicated form of cancer. C considered that there was a lack of urgency in the board’s actions and there was no clear plan for A’s treatment. The board confirmed that they carried out a number of investigations and referred A’s case to the National Sarcoma Team in order to seek their view. Further tests were requested and a referral was made to the Acute Pain Service. The board said that while no definitive diagnosis was reached, there had been a plan to pursue radiotherapy; however, A’s condition quickly deteriorated and they died. We took independent advice from a consultant gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines). We found that the treatment plan of A’s condition was reasonable and we did not consider there was a lack of urgency. However, we concluded that, at the point when significant changes were observed in a scan compared to a scan performed some months prior, the board should have held a local multi-disciplinary team (MDT) discussion and/or referred to a cancer of unknown primary (CUP) (where the place cancer began is not known) MDT to discuss A’s case. This may have resulted in a more faster and possibly would have led clinicians to concentrate more on pain relief. On balance, we upheld the complaint.

C, an advocate, complained on behalf of their client (A). A was given a diagnoses and later the board provided A with a second opinion. During the consultation the board say A became angry and behaved in a threatening way. The board said they would be happy to offer treatment to A, but this would be dependent on A following a set of recommendations. A said that during the second opinion consultation they were being called a liar, and while they raised their voice, they were not threatening. A told us that they had tried to meet the board’s recommendations, but that the board would not accept that they complied with the recommendations made. We took independent advice from a consultant psychiatrist (a doctor who specialises in the diagnosis, treatment and prevention of mental ill health conditions). We found that the board’s response to A’s behaviour was reasonable and in line with NHS policy. We did not uphold this aspect of the complaint. The recommendations the board made to A were reasonable. Due to A’s diagnosis, treatment would be most successful if A was able to make some changes to their behaviour. We did not uphold this aspect of the complaint. Related reading View Decision Report 201906783 as a PDF (24.24 KB) Updated: December 16, 2020

C brought a complaint to us about the care and treatment given to their late child (A). A was admitted to the Neo-Natal Unit at Forth Valley Royal Hospital due to prematurity and respiratory (the branch of medicine that deals with conditions affecting the lungs) distress and was a few weeks later admitted to the Children’s Ward. A was later diagnosed with cardiac (heart and its blood vessels) conditions. A underwent open heart surgery at the Royal Hospital for Children but later died. C complained that the care and treatment provided to A was unreasonable because there were missed opportunities to diagnose A’s cardiac condition and that, had it been diagnosed earlier, there would have been a positive outcome. We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in the female reproductive system, pregnancy and childbirth) and from a consultant in respiratory medicine. We found that overall the care and treatment was reasonable. In particular, there was no evidence that would suggest A’s heart condition had been missed in the neonatal period. We also found that, based on the available evidence, it was not possible to say conclusively that there had been an unreasonable delay in diagnosing A’s cardiac condition from a paediatric perspective. We did not uphold the complaint. Related reading View Decision Report 201902071 as a PDF (24.4 KB) Updated: December 16, 2020

C complained about the care provided to their parent (A) after A suffered an unwitnessed fall. C said that A had deteriorated continuously from this point, whilst the board said that A had not shown any significant signs of distress until later, when they began to deteriorate significantly. A was transferred to Forth Valley Royal Hospital, where they were found to have fractured ribs and a pneumothorax (collapsed lung). C did not believe that A was examined quickly enough after their fall and considered it unreasonable that the examination had failed to identify the serious injuries A had sustained. We took independent medical advice. We found that A’s care and treatment fell below a reasonable standard. There was an excessive delay in providing A with a medical examination and there was inadequate investigation of A’s subsequent symptoms. In addition, A’s mental deterioration and existing diagnosis of dementia were not taken into consideration in the assessment of their condition or in the communication with their family. We upheld both of C’s complaints on the basis that A’s care and treatment was not of a reasonable standard. As the board had concluded staff had followed the board’s procedures after A’s fall, we found that these procedures were not adequate and required review.

C complained about the care and treatment they received regarding a fractured collarbone. C was scheduled to have surgery but on the day of the surgery a decision was made to cancel on the basis that C’s collarbone had healed. C complained about the decision to cancel the surgery and that a decision was not made to proceed with surgery at an earlier date. We took independent advice from an orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that it was reasonable for the board to allow for six months of conservative (non-operative) management and to cancel the surgery following an x-ray which showed the fracture had joined together. However, we found that it was unreasonable not to mention or discuss operative intervention and its associated risks at earlier clinic appointments. This is because patients should be informed of all treatment options including that of no treatment in accordance with the General Medical Council’s guidance on consent. We also found that it was unreasonable for one of the clinic letters to state that the x-rays showed hypertrophic (healing tissue has formed but the bone fractures have not joined) non-union. We noted that the x-rays actually showed a delayed union (when a fracture takes longer than usual to heal) because approximately four months had passed since C’s injury at that point. We also found that the decision to proceed with surgical intervention was unreasonable given that the x-rays showed delayed union, rather than hypertrophic non-union and there was no evidence that the clinician had discussed C’s case with the consultant. In light of the above, we upheld C’s complaint.

C complained on behalf of their family member (A). A had several admissions to hospital with complaints of abdominal and back pain. They underwent a laparoscopic cholecystectomy (removal of the gallbladder) but their symptoms did not improve. Following an MRI scan, a spinal infection was suspected and antibiotics were commenced, which resulted in a C.diff (a bacterium that can cause symptoms ranging from diarrhoea to life-threatening inflammation of the colon) infection. This type of infection most commonly affects people who have been treated with antibiotics. Further scans were then carried out which showed suspicious lesions on A's lung, and they were diagnosed with cancer. C was concerned that, despite the tests and investigations arranged during A's time in hospital, it took around six months before cancer was diagnosed. In addition, C was unhappy with the board's handling of their complaints. We took independent advice from an appropriately qualified adviser. We found that there were frequent and detailed reviews of A's care, and appropriate management plans were made and carried out. A's cancer could only reasonably have been expected in the last admission, and although there was an initial incorrect diagnosis of infection, this was a reasonable one to make at the time, and it was then corrected once A's symptoms changed and they failed to respond to the initial treatment. We did not uphold this aspect of the complaint. In looking at the board's handling of C's complaint, the complexity of the issues that were raised meant that the level of investigation required impacted on the timescales. The responses issued to C demonstrated that the complaints were taken seriously by the board and the matters were investigated thoroughly. Overall, it was a lengthy process, with some significant delays, which was acknowledged by the board who apologised to C. We upheld the complaint but did not make any further recommendations. Related reading View Decision Re

C complained about the care their parent (A) received at Forth Valley Royal Hospital and Falkirk Community Hospital. We took independent advice from a nursing adviser. We did not identify any failings regarding the care provided to A at Forth Valley Royal Hospital and so did not uphold this aspect of the complaint. However, regarding the care provided to A at Falkirk Community Hospital we found that: A was unreasonably transferred to a four-bedded room rather than a single room; there was an unreasonable delay in A having their dietary/fluid requirements assessed by nursing staff following their admission to Falkirk Community Hospital; and A was not given prescribed medication while awaiting discharge from hospital. We upheld this aspect of the complaint. C also complained about the board's handling of their complaint. We found that the board did not consider whether C had authorised their sibling to raise a complaint on C's behalf. We upheld this aspect of the complaint.

C's parent (A), who has a diagnosis of Alzheimer's disease (the most common type of dementia), was a patient in Falkirk Community Hospital. On discharge, A was moved to a nursing home, as they required greater care. C questioned the board's care of A while they were a patient in the hospital; in particular about the prolonged use of Risperidone (an antipsychotic drug). C was also unhappy about the delay in issuing a discharge letter and the fact that it was sent to the nursing home. C complained that the letter contained incorrect information. The board's view was that A had been prescribed Risperidone before they were admitted to hospital and that as they remained agitated and confused at times, in the absence of any clinical indication that they were experiencing side effects, there was no reason to alter the dose that had already been prescribed. Furthermore, they said that the medication was regularly monitored. The board agreed that there had been a delay in issuing a discharge letter and apologised that the letter contained incorrect information. We took independent advice from an appropriately qualified adviser. We found that Risperidone had been prescribed reasonably and appropriately to A and that its use had been regularly monitored. We did not uphold this aspect of the complaint. However, we found that with regard to the discharge letter, the level of care given to A (with regard to delay and release of sensitive information) fell below the standard they could have expected. Therefore, we upheld this aspect of the complaint.

C complained about the care and treatment provided to their late partner (A). C said that there was an unreasonable delay in diagnosing that A was suffering from cancer. We took independent advice from a consultant in acute medicine (a doctor who specialises in the immediate and early management of adult patients with a wide range of medical conditions who present in hospital as emergencies) and a consultant in respiratory medicine (a doctor who specialises in treating and managing patients with conditions affecting their lungs). We found that the care and treatment A received was reasonable and that there was no delay in diagnosing that they had cancer. As such, we did not uphold the complaint. C also complained that the medical care and treatment provided to A after diagnosis was unreasonable. We took independent advice from a consultant in respiratory medicine. We found that the care and treatment given to A was reasonable; that all appropriate investigations and tests were carried out and that these were performed rapidly. We also noted that A's main consultant was actively involved and spoke at length to the family, as did the clinical nurse specialist. Finally, we found that there were frequent discussions where A and the family were updated on their condition. Therefore, we did not uphold the complaint. In addition, C complained that the nursing care and treatment provided to A after the diagnosis of cancer was unreasonable. We took independent advice from a nursing adviser. We found that, while the majority of the nursing care and treatment given to A was reasonable and in line with the Nursing Midwifery Council Code, the board had accepted that the condition that C had found A in when they had attended the ward on one occasion was unreasonable and that they had taken action as a result. On balance, we upheld the complaint but made no recommendations. Finally, C complained that A was unreasonably discharged from Forth Valley Royal Hospital. We t

Mrs C complained that the care her child (Child A) received from the board during their admission for bacterial meningitis (an infection of the protective membranes that surround the brain and spinal cord) was unreasonable. Mrs C said that Child A was not given the full dose of antibiotics and that the day after discharge they had to be re-admitted as the infection had not been cleared. Mrs C also complained that Child A was given an MRI scan using the feed and wrap technique (use of feeding and swaddling to induce natural sleep in infants), which did not work, rather than performing the test under general anaesthetic. We took independent advice from a consultant paediatrician (a medical practitioner specialising in children and their diseases). We found that, on review of the medical notes, Child A received the stated course of antibiotics, there were no concerns over the timing of the doses, and it was reasonable for Child A to have been discharged initially. We also found that it was reasonable for Child A to have their MRI using the feed and wrap technique in the first instance. As a result, we did not uphold this aspect of the complaint. Mrs C also complained that the handling of her complaint was unreasonable. We were satisfied that the board had followed the NHS Complaints Handling Procedure and as a result, did not uphold this aspect of the complaint. Related reading View Decision Report 201809858 as a PDF (24.37 KB) Updated: September 23, 2020

C complained about two matters. The first related to whether or not the treatment plan prepared by a dentist employed by the dental practice was clinically necessary. We did not uphold this complaint on the basis that images taken of the teeth and an x-ray showed that the work set out in the treatment plan was required to the teeth as there was decay, part of a filling was missing and part of a tooth was missing. The clinical notes also referred to this. The second related to a failure to provide C with evidence that the work was clinically necessary when asked to do so. We did not uphold this complaint on the basis that the clinical notes and the images were sent to C by the dental practice. The dentist, who had left the practice subsequently, wrote to C to provide them with information about why the treatment was necessary. Whilst we did not uphold this complaint we did recognise that communication when dealing with the complaint could have been better and a more coordinated approach between the dentist and the dental practice would have resulted in better complaint handling. We noted the dental practice had already apologised for this and made an offer to C as a good will gesture. Related reading View Decision Report 201902176 as a PDF (24.26 KB) Updated: September 23, 2020

C complained about the care and treatment provided to them by the board. C presented to hospital with abdominal pain and bleeding and was told that they were either experiencing a miscarriage or an ectopic pregnancy (a pregnancy in which the foetus develops outside the uterus, typically in a fallopian tube). C was told to return for a scan in several days. C complained that the board did not offer a scan at the time of presentation, keep them in for observation or discuss treatment options. C felt that, as a result of the delay in scanning, their condition deteriorated and they had fewer treatment options when they attended another hospital several days later. We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in the female reproductive system, pregnancy and childbirth). We found that it was reasonable that C was not given a scan on presentation as this was outwith scanning hours; and that it was reasonable that they were not kept in for observation or to discuss treatment options. However, we found that C should have been offered a scan within 24 hours of presenting at the hospital, or failing this, as soon as scanning services were available, as opposed to being given the next routine scan appointment. On this basis, we upheld the complaint.

C complained about the care and treatment provided by the board’s Children and Adolescent Mental Health Service (CAMHS) in respect of their child (A). After a number of referrals, A attended an initial appointment with CAMHS. This was due to A’s challenging behaviour. The outcome of this assessment was that A would be further assessed before a conclusion was reached on how to progress. Between this initial assessment and the point C made their complaint, CAMHS engaged with C and A in a variety of ways. A left the family home and moved in with their grandparent. C felt that CAMHS did not provide the help that they and A needed during this time. In C's view, they had been involved with CAMHS for years but nothing productive had been done. Overall, C felt CAMHS failed to provide appropriate care and treatment for A. We took independent advice from a consultant child and adolescent psychiatrist. We found that overall care and treatment provided by CAMHS was reasonable and in line with relevant guidance for this area. We concluded that the actions taken by CAMHS was reasonable and based on an appropriate consideration of the evidence and A’s presentation. We identified that there were some areas where greater clarity in relation to specialist terms may have been helpful and that there was uncertainty around whether the contents of a risk assessment should have been shared with C. However, we did not consider this to mean that the overall care and treatment provided to A was unreasonable. We did not uphold C’s complaint. Related reading View Decision Report 201901698 as a PDF (24.5 KB) Updated: August 19, 2020