SPSO Individual Decisions

Miss C complained about care provided by her GP practice. She attended the practice a number of times over a period of six months with various symptoms which were ascribed to depression and treated as such. When Miss C began displaying slurred speech, her GP urgently referred her to hospital where she was diagnosed with a brain tumour. We sought independent advice from a medical adviser. Their view was that Miss C's symptoms were reasonably ascribed to other causes and it was not until the symptom of slurred speech occurred that it became clear there might be another cause for Miss C's condition. The adviser said the GP then took appropriate action by urgently referring Miss C. For this reason we did not uphold this complaint. We did however uphold the complaint about post-operative care as the practice had acknowledged that their normal practice is to contact patients once they have been discharged from hospital and this did not happen in this case. The practice said they intended to carry out an Enhanced Significant Adverse Event (ESAE), and we made a recommendation in relation to this.

Mr C complained about the clinical treatment and nursing care received by his mother (Mrs A) at University Hospital Crosshouse, in particular that the board had not prevented Mrs A from catching hospital acquired pneumonia (HAP). Mrs A died while in hospital. During our investigation we took independent advice from two advisers, a consultant in respiratory medicine and a nursing adviser. The consultant in respiratory medicine noted that the clinical care given to Mrs A was reasonable. They said that given the nature and severity of Mrs A's condition, she was vulnerable to catching HAP and that the medical team caring for her took all necessary measures to prevent infection. The adviser also noted that although '1A Pneumonia' was recorded on Mrs A's death certificate, the certificate should have referred to HAP. We therefore made a recommendation to address this. The nursing adviser noted that there was no evidence of failings and that the nursing care and treatment provided to Mrs A was reasonable. We therefore did not uphold Mr C's complaints. In their response to Mr C's complaints to them, the board accepted that some of the communication with Mr C and his family had caused confusion and misunderstanding. They apologised for this and took action to address this. The board also apologised that they had failed to offer spiritual support to Mrs A. We therefore made recommendations to address these issues.

Mr and Mrs C complained to us about the treatment they received at an out-of-hours centre where they took their baby on the advice of NHS 24 as he was not feeding well and was blue around his lips. There was a wait to see a GP and the baby went pale and struggled to breathe. The baby was seen urgently by a GP who examined him through his clothing and told Mr and Mrs C to take the baby to the A&E department at Crosshouse Hospital in their car. On arrival at the hospital, the baby stopped breathing and had to be resuscitated. The baby remained in hospital for three days. Mr and Mrs C felt that the GP should have given their baby oxygen and arranged for an ambulance transfer to hospital. We took independent advice from an adviser in general practice medicine and concluded that the GP had carried out an inadequate examination of the baby as they did not remove the baby's clothing. In addition, we noted that the GP had maintained that they did not administer oxygen to the baby as it would have delayed the referral to hospital. We found that as oxygen was available at the out-of-hours centre, the GP should have administered it to the baby. We also found that it was inappropriate to have asked Mr and Mrs C to have transported their baby to hospital without clinical support. We upheld the complaint.

Mr C complained that the board had failed to provide compression stockings for his varicose vein surgery at University Hospital Ayr. Mr C said he was unusually large and already received custom-made support stockings from the hospital. On the day of his surgery, however, the stockings he required needed to provide a greater degree of compression than his day-to-day pair. None had been ordered by Mr C's doctor and none of the standard sizes fitted him. As a result, Mr C's surgery was delayed. Mr C said he felt this was unacceptable and that staff had failed to recognise the serious inconvenience this had caused him. We took independent advice from a consultant vascular surgeon and consultant physician. They found that it was unreasonable for the board to have not ensured the correct size of stocking was available. We therefore upheld this aspect of Mr C's complaint. Mr C said that staff had made fun of his unusual size, which he considered unprofessional. We were unable to investigate this aspect of Mr C's complaint as it was not possible to confirm what had been said. Mr C also complained that he had not been provided with an appropriate level of information about the planned surgical procedure and that he had subsequently found out there were possible serious side effects. Mr C said he would not have consented to the procedure had he been aware of these. We found, however, that the decision not to proceed with surgery due to the correct size of stockings not being available was appropriate given Mr C's medical history. With regard to the information provided to Mr C about his surgical options, the advisers found that this was adequate and set out clearly the possible risks of surgery. We therefore did not uphold this aspect of Mr C's complaint.

Mr C complained that he was not prescribed medication to treat high blood pressure and that during a home visit a GP did not diagnose a deep vein thrombosis (DVT) in his leg. Mr C had a knee replacement operation in December 2014 and requested a home visit in January 2015 as he was suffering from pain and swelling in his leg. A GP attended and examined Mr C's leg but did not find any obvious signs of DVT. A week later, Mr C had a post-operative check on his leg and the DVT was discovered and he was admitted to hospital for treatment. Our investigation included taking independent advice from a medical adviser who was of the view that the examination carried out by the GP was appropriate and that there were no recorded signs that would have suggested DVT. The adviser stated that DVTs can develop over time and that the signs are difficult to identify in the early stages. We did not uphold this aspect of the complaint. Following his treatment for the DVT Mr C was referred to the anti-coagulation clinic to monitor his blood, and he was prescribed Warfarin (an anti-coagulation medication) to reduce the risk of further clots for six months. During this time Mr C stopped taking the medication to treat his high blood pressure. When he was advised by the clinic to stop taking the Warfarin, Mr C requested a prescription for his blood pressure medication from the GP which he stated was not provided for seven days. The records showed that the prescription was issued on the day it was requested and we did not uphold this aspect of the complaint. Related reading View Decision Report 201508030 as a PDF (11.36 KB) Updated: March 13, 2018

Mr C was injured in an accident in the prison workshop. He cut his arm and suffered bruising to his elbow. This was treated in the prison health centre by a nurse, who cleaned and dressed the cut. Later that day Mr C raised concerns about his tetanus immunity and that evening he received a tetanus injection. Mr C complained to us that he should have received testing and treatment for blood borne viruses and that the treatment he was given immediately after the accident was inadequate. He also complained about two separate incidents where he believed he had been given incorrect medication by nursing staff. Mr C also complained that the board had not handled his complaints reasonably. After taking independent advice from a nurse and a GP on the care and treatment Mr C received following the accident, we did not uphold these aspects of his complaint. The advice we received was that Mr C's nursing care was reasonable and that he was appropriately tested for blood borne viruses. Although Mr C did receive a tetanus injection after raising concerns, we have made a recommendation that nursing staff be reminded to ask patients about their tetanus status when patients have suffered cuts. After taking independent advice from a nursing adviser, we upheld Mr C's complaint about the administration of medication. We found that the board had acknowledged that Mr C was offered the wrong type of medicine on one occasion. The adviser considered this error to be unreasonable. The board advised Mr C they had taken steps to address this and we have made a recommendation in relation to this. We found no evidence that the board acted unreasonably with regard to the complaints handling process, therefore we did not uphold Mr C's complaint in relation to this.

Miss C complained to us following two admissions to University Hospital Crosshouse with severe abdominal pain and persistent vomiting. She was transferred between several different wards, and was due to have a scan of her abdomen. However, she discharged herself prior to this scan taking place. She was re-admitted five days later for an investigative procedure, but chose to be discharged the following day. She complained that the care and treatment was inadequate, and that she was not given the treatment she needed to resolve her symptoms. She also complained that there was a delay in giving her a scan and she was left in pain by poor practices in relation to the insertion of a cannula and a catheter. She said staff were dismissive of her pain and did not identify her as being at risk of falls. She also said hygiene standards were poor, and medical staff failed to diagnose and treat her appropriately. We obtained independent nursing and gastroenterology advice. The nursing adviser noted concerns Miss C raised in relation to her care, and also the feedback from the board, which had acknowledged some failings. The adviser considered that it was reasonable that Miss C was not assessed for her falls risk, but noted that she should have been given access to a buzzer. The adviser also acknowledged apparent problems with Miss C's cannula site and catheter, though they did not find any evidence of problems in relation to hygiene. The gastroenterology adviser did not identify any concerns with Miss C's treatment. The adviser noted that there was no evidence to indicate Miss C had Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system), as she thought she did. We considered the evidence available, and were satisfied that there were failings in relation to Miss C's nursing care, but not in relation to her clinical treatment. We also considered the evidence in relation to her moves between wards, and were satisfied that

Mrs C complained about the care and treatment she received from the board at University Hospital Crosshouse following her inner labial reduction surgery (reduction of the two flaps of skin on either side of the vaginal opening). Her concerns included that the board failed to provide her with a reasonable standard of care when she reported problems after the procedure and that the entire area of tissue from the inner labia had been removed during subsequent corrective surgery without reasonable discussion or explanation. We obtained independent medical advice on the case from a consultant gynaecologist. They said that at the first sign of post-operative problems, Mrs C should have been seen as a matter of priority and the surgeon who carried out the operation should not have refused to see her. The adviser said that the surgeon suggesting that Mrs C's GP contact the plastic surgery service was not appropriate and caused further delay in Mrs C's treatment. We therefore upheld this part of the complaint. However, we noted that the adviser said that they did not feel that the outcome would have been materially different if the subsequent corrective surgery had taken place sooner. We also noted that the board had taken appropriate remedial action as a result of Mrs C's complaint. In terms of the corrective surgery, the adviser said that almost the entire area of the inner labia was removed without consent or proper explanation. We therefore upheld this part of Mrs C's complaint. Although we noted that the board had taken reasonable remedial action in relation to their consent process, we made two recommendations.

Mr C was admitted to University Hospital Crosshouse with a suspected infection following shoulder surgery a few days earlier. He complained that he received poor care in relation to the infection that developed in his wound, which required treatment under three separate general anaesthetics. Mr C was dissatisfied with the nursing care in terms of the lack of access to a bathroom and a shower, as well as the way in which his medicines were administered. He also complained about the board's delay in responding to his complaint. We took independent advice from medical and nursing advisers on the care and treatment Mr C received. We were critical of a lack of evidence showing that Mr C's wound had been examined by three different doctors who had reviewed him on the day of admission to hospital. We made a recommendation to address this failing. However, we considered the assessments and treatment carried out thereafter were reasonable. In terms of the nursing care, we found that there was good reason (because of infection control and the facilities in the high dependency unit) for Mr C not having specific access to a bathroom and shower. We did not uphold Mr C's complaints about his medical and nursing care, although we did identify shortcomings in the prescribing of his medication and made two recommendations to the board about this. There was also an unreasonable delay of four months in the board responding to his complaint and we made a further recommendation to address the matter.

Miss C's baby was not lying properly, but was in the breech position (legs downward). After unsuccessful attempts to turn the baby, she was booked in for a caesarean section (an operation to deliver a baby which involves cutting the front of the abdomen and womb). However, several days before the planned caesarean, Miss C began experiencing labour pains and called Ayrshire Maternity Unit. She was asked to come in and was reviewed, then sent back home. Two days later she called again and was asked to come in. Miss C was then admitted and monitored on the ward. She was reviewed by a doctor on several occasions, but told she was not in active labour and a caesarean was planned for the following morning. However, Miss C continued to experience symptoms and a consultant reviewed her and found she was in active labour. Miss C was sent immediately to the labour suite, where her baby was born a few minutes later. Miss C complained about the advice she was given on the phone and the management of the birth, in particular that staff did not recognise that she was in labour and arrange an emergency caesarean. Staff from the board met with Miss C to discuss her complaint. They explained that when she was examined by the first doctor her cervix was closed, which meant that she was not in active labour. They also explained that, because Miss C's baby was under 39 weeks, the doctor wanted to prescribe steroids and allow time for these to work before conducting a caesarean (to decrease the risk of breathing problems for the baby). After taking independent obstetric and midwifery advice, we did not uphold Miss C's complaint. We found that Miss C experienced rapid labour, which could not have been predicted by staff, and the care and treatment was reasonable in light of the circumstances known to staff at the time. Related reading View Decision Report 201508111 as a PDF (11.51 KB) Updated: March 13, 2018

Mr C contacted NHS24 to tell them that he had taken an overdose of paracetamol. He was advised to go to the local A&E department as soon as possible for blood tests and treatment. He agreed to do so. He called back some time later advising that he no longer intended to go to A&E. As a result, NHS24 asked a doctor from the board's GP out-of-hours service to call him. The doctor called and discussed the potential impact of the overdose and highlighted how important it was to attend A&E but Mr C still refused to attend. Following the call, the doctor discussed Mr C's call with the specialist mental health team and they suggested that the doctor call for an ambulance to attend Mr C's home. Mr C complained to our office as he was unhappy that the doctor failed to take appropriate steps to ensure he was safe following the call. We considered Mr C's concerns and reviewed the board's records. We also sought independent advice from an adviser who is a GP. Having done so, we were satisfied that the doctor did provide appropriate advice to Mr C and, by calling an ambulance, the doctor had taken appropriate steps to ensure his safety. As a result, we did not uphold the complaint. Related reading View Decision Report 201508258 as a PDF (11.18 KB) Updated: March 13, 2018

Mr C complained about his wife (Mrs A)'s neurological consultation which they both attended, the correspondence following this consultation, and the way the board handled his complaints. Mr C said that the way the consultation at Crosshouse Hospital had been conducted failed to meet Mrs A's specific needs and requirements arising from the fact that she was autistic and had dyslexia, Asperger's syndrome and anxiety. Mrs A was subsequently diagnosed with a disc protrusion (a common form of spinal disc deterioration that causes neck and back pain) by another consultant and Mr C said that the failure to meet Mrs A's needs meant that the first consultant missed the diagnosis. We took independent advice from a medical adviser and an equalities adviser. We found that it was not reasonable to expect the first consultant to have diagnosed a disc protrusion and the findings from a later investigation were not evidence that the diagnostic process had been hindered. In relation to the equalities aspect of the complaint, however, it was not clear that the consultation booking process and the consultation procedure would meet the needs of people with disabilities generally. While we found that the consultant was aware Mrs A had specific needs and requirements and had made adjustments in line with their understanding of them, the current process (whereby information about the consultation was normally read by the consultant just before the patient was seen) did not enable the board to plan ahead and make reasonable adjustments once a patient's needs were known. It was also not clear if staff had received appropriate training about making reasonable adjustments. We therefore upheld the complaint in light of the evidence in relation to the equalities aspect of the consultation booking process and consultation procedure. With regard to the other aspects of Mr C's complaint, we found that the subsequent correspondence about the consultation was reasonable and that the board han

Mrs C suffers from fibromyalgia (a long term condition that causes pain all over the body). Over the course of several years, she received a number of treatments including acupuncture and attended the pain management clinic at Crosshouse Hospital. Unfortunately, none of the treatments resulted in good control of Mrs C's pain and, in early 2014, a decision was made to discontinue her acupuncture course and to discharge her. It was suggested that she attend a pain management programme but Mrs C disagreed and complained to the board. We took independent advice from a consultant in anaesthesia and pain specialist and we found that Mrs C had received all the standard pain management approaches for fibromyalgia but that her treatment had not been successful. We learned that this was not uncommon. Mrs C had also had a second opinion but it was agreed that there was little that could be done for her that would likely make a significant lasting difference and that it would be futile to continue. While it was evident that Mrs C suffers considerable pain and it was hugely disappointing that medication or other intervention would not help her, there was no evidence to suggest that this was the consequence of any action or inaction on the part of the board. For this reason, we did not uphold the complaint. Related reading View Decision Report 201508291 as a PDF (11.26 KB) Updated: March 13, 2018

Mr and Mrs C complained about the care and treatment provided to their daughter (Ms A) at Ayr Hospital. Ms A had a complex medical history and had required several operations over the course of her life. Ms A suffered repeated urine infections and underwent an operation for this in the hospital. During the operation, Ms A breathed in fluid from her stomach. She was admitted into the intensive care unit (ICU) and placed on a ventilator. Ms A deteriorated over the weekend and did not recover, and she died shortly afterwards in the ICU. Mr and Mrs C complained Ms A's care was inconsistent and that there was an inadequate level of medical staffing over the weekend. Mr and Mrs C said they had been given contradictory accounts of Ms A's condition and it had been a shock when they were informed treatment was to be withdrawn from her. They believed this should have been discussed with them and that the way the staff broke the news to them was inappropriate. They also complained that, after she died, Ms A was left connected to drips and monitors, which they felt was inappropriate. The board met with Mr and Mrs C following their complaint. They did not discuss Ms A's care and treatment but they apologised if staff had increased the family's distress through their language or actions. We took independent advice from a consultant in intensive care medicine and a senior nurse. The advice we received was that the care and treatment was reasonable. The medical records showed an appropriate level of medical review, along with the correct treatment for Ms A's condition. We found that communication with Mr and Mrs C was appropriate. It was, however, unreasonable for the family to have been left with Ms A after she died, without any attempts by staff to ascertain their wishes. We found this had added significantly to the family's distress. Although the care and treatment was reasonable, the board had accepted there were failings in communication with the family. We foun

Mr C complained about the care and treatment that his late wife (Mrs A) had received at University Hospital Crosshouse across a number of admissions. Mr C was concerned that staff were overly focussed on Mrs A's existing conditions and did not pay enough attention to new symptoms that were unconnected to these. Mrs A passed away after she became very unwell with a bleeding duodenal ulcer (an ulcer in part of the bowel, just after the stomach) following a number of admissions to the hospital across four months. After taking independent advice on this case from a consultant geriatrician, we upheld Mr C's complaint. We found that while many aspects of Mrs A's care had been good, there was a failure to carry out appropriate investigations to determine the cause of her anaemia after this was revealed by blood tests during one of her admissions. We received advice that this meant a potential opportunity to diagnose the ulcer earlier was missed and that this could have led to specific treatment to reduce the risk of this bleeding. We made a number of recommendations to address the issues we identified.

Ms C complained about the care and treatment she received from University Hospital Crosshouse for what she believed was suspected appendicitis. She said she made frequent visits to the A&E department at the hospital and was also admitted to the hospital, but her condition was not reasonably assessed and treated. She said her condition then deteriorated and spread to her bowel and she had to have part of her large and small bowel removed. Ms C also complained that her complaint about her treatment was not reasonably responded to by the board. We took independent advice from two advisers, one a consultant in emergency medicine and the other a consultant colorectal surgeon (who specialises in conditions relating to or affecting the colon and rectum). The emergency medicine adviser said that the treatment Ms C received in the A&E department at the hospital was reasonable. The colorectal surgical adviser said they did not think that there was an unreasonable failure by the board to diagnose Ms C's appendicitis sooner, as the initial clinical signs would not have been very obvious for acute appendicitis. They also said there was a delayed diagnosis of acute appendicitis, but explained that the diagnosis of this is sometimes challenging even to an experienced surgeon and it would have been difficult to know and impossible to determine at what precise moment Ms C actually had acute appendicitis. We therefore did not uphold Ms C's complaint that her condition was not reasonably assessed and treated, but we did make a recommendation based on the advice we received about how the board should have shared the learning points from Ms C's complaints. In terms of the complaints handling, Ms C indicated in her complaint to the board that she was concerned about the care and treatment she received from the board and her GP. The board did not appear to take any action to assist in progressing Ms C's complaint about her GP, either by contacting Ms C's GP practice or by advising

Mrs C complained about care and treatment provided to her late father at University Hospital Crosshouse, and about the board's handling of her complaint. During our investigation the board sent a letter to Mrs C that acknowledged and apologised for their failings, and set out an action plan to remedy the failings. We discussed the letter with Mrs C and, as she was satisfied that the board had resolved her complaints, we agreed to close the file on her complaint. In closing the file, we wrote to the board to express our concerns about the time they took to deal with Mrs C's complaint. While we did not make a formal recommendation, we asked them to provide us with evidence relating to their action plan, which they did. Related reading View Decision Report 201500526 as a PDF (10.92 KB) Updated: March 13, 2018

Ms C complained about the treatment her father (Mr A) received from the practice over a five month period in 2013. Mr A had been diagnosed with bladder cancer in 2012 and attended the practice on a number of occasions complaining of back pain. Ms C did not feel that his condition was taken seriously or that adequate treatment was provided by the practice. We sought independent medical advice on this case. Whilst we generally found that the practice provided good treatment in line with national guidance during the period in question, we found that the GPs could have been more proactive in arranging specialist investigations when Mr A's pain failed to reduce. Our investigation also highlighted significant concerns about the management of Mr A's pain some months later on the day he died. We were critical of the practice for failing to react to the urgency of the situation when family members contacted them, and for failing to have important palliative care drugs available to alleviate Mr A's pain.

Mr C complained that the board failed to take reasonable steps to diagnose and treat his elbow pain after he raised concern at Ayrshire Central Hospital in August 2013. He was unhappy with the time taken to carry out nerve conduction tests at the end of December 2013, which indicated that he had cubital tunnel syndrome (nerve compression). He was not given the results until six weeks later and was then referred for specialist surgical review. Mr C felt that, had his diagnosis been reached sooner and surgery carried out promptly, additional nerve damage would not have occurred. We took independent advice from two advisers: a physiotherapist and an orthopaedic consultant (a specialist in conditions involving the musculoskeletal system). We noted that the board apologised to Mr C for a delay in Mr C receiving his results and they took reasonable action to carry out a review and make improvements in this respect. However, we identified that when Mr C first presented with his elbow pain, the physiotherapist did not take into account the possibility of nerve compression. In addition, whilst a different physiotherapist noted motor deficit two weeks later, they did not arrange immediate referral to a specialist in accordance with the board's musculoskeletal guidance. Instead, they raised concern in an email to an orthopaedic doctor but did not mention all the relevant symptoms. We also found records indicating that there had been earlier discussion about referring Mr C for nerve conduction tests at the beginning of September 2013 but this was not organised until four weeks later. Whilst we concluded that staff acted unreasonably in not referring Mr C for specialist review from the outset and arranging the tests sooner, there was insufficient evidence to demonstrate that he sustained additional nerve damage.

Ms C complained about the care and treatment her late father (Mr A) received from the board's out-of-hours service shortly before his death. Mr A had been diagnosed with bladder cancer and was receiving palliative care. On the day Mr A died he was in severe pain in the early hours of the morning and Ms C's mother (Mrs A) contacted NHS 24. Mr A was seen by a doctor from the out-of-hours service and was given morphine for the pain. He remained in pain and another out-of-hours doctor was asked to attend but they felt they would not be able to attend before their shift ended, so asked that Mr A's GP attend instead. Mr A was told the GP would attend at 08:00 however the GP was not contacted until 08:05 and did not attend until 08:45. Mr A died in the early afternoon. Ms C complained that the actions of the out-of-hours doctors prolonged Mr A's severe pain during the final hours of his life. We took independent advice on Ms C's complaint from a GP adviser. We found that the first out-of-hours doctor attended in good time but provided a dosage of morphine that was too low to improve Mr A's pain and did not take into account the medication he had already been taking which had little effect. We found there was a similar failure to look into Mr A's recent history by the second out-of-hours doctor as there was no evidence of this second doctor speaking to either Mr or Mrs A to assess Mr A's condition at that time nor of them making their decision with reference to the earlier out-of-hours attendance. We were critical that the decision to refer Mr A to his GP practice was taken without taking into account his needs. The second call to the out-of-hours doctor was given a one hour priority, but passing the call on to Mr A's GP practice (which had not yet opened at the time of the call being passed on) meant it was not possible for the one hour timescale to be met. We noted that the board's out-of-hours policy recognised situations like this and provided scope for the

Mrs C's GP referred her urgently to University Hospital Crosshouse in April 2014 as it was suspected that she had breast cancer. However, after examination and ultrasound, her tests were found to be normal. She was told that everything was satisfactory but, because of a family history of breast cancer, she would be referred to the genetics department for risk assessment. Mrs C said that she was never contacted by the genetics department and because of her results, she said she was unconcerned. In November 2014, Mrs C was re-referred to hospital. She had a breast lump and breast cancer was confirmed. Mrs C complained that her illness should have been diagnosed earlier. She said that because it was not, her cancer had grown and she required to have a double mastectomy. She said that insufficient investigation was made in April 2014. She complained to the board who said that as no abnormality had been found initially, at either the scan or on examination, there had been no clinical indication to refer her for a mammogram and there was no abnormality to biopsy. We took independent advice from a consultant breast surgeon and we found that, in view of her presenting symptoms, Mrs C had been treated reasonably and appropriately. She had been examined and assessed in terms of best clinical practice. Nevertheless, despite this, it was likely that her breast cancer had been missed the first time. There was nothing the board could have done to have prevented her delayed diagnosis. For this reason, the complaint was not upheld. However, it had been intended to see Mrs C in the genetics department for a risk assessment but it appeared that a letter inviting her to provide information about her family may not have been sent. Accordingly, the board were asked to apologise although, even if the letter had been sent, Mrs C's outcome would have been unchanged.

Mrs C complained about the gastroenterology care she received from the board. Mrs C was attending an out-patient clinic at University Hospital Ayr and had previously undergone surgery to remove her gallbladder. She continued to experience various problems with her digestion along with skin problems, particularly on her hands. Mrs C complained that there had been too many consultants involved in her care and that there had been a lack of continuity in her care. Mrs C also complained that the board had not coordinated her care appropriately and that they unreasonably failed to reach a diagnosis of her condition. During our investigation, we took independent advice from a consultant gastroenterologist. We found that the board had acknowledged there were a number of gastroenterologists involved in Mrs C's care due to retirement and sick leave and they had apologised for this. However, the advice we received was that for patients with chronic conditions like Mrs C, the use of short term locum consultants should be avoided. We found that this had affected the continuity of Mrs C's care and resulted in a potentially avoidable referral to another NHS board. We upheld Mrs C's complaints regarding the number of consultants involved and the lack of continuity in her gastroenterology care. The adviser considered that there was evidence of good coordination of Mrs C's care with referrals to other specialties being followed up promptly by a single consultant and consequently we did not uphold that element of her complaint. We also did not uphold Mrs C's complaint about a lack of definitive diagnosis. The advice we received was that the board had carried out numerous investigations to try to determine the cause of Mrs C's continuing symptoms and that reasonable steps were taken in attempts to reach a definitive diagnosis. The adviser highlighted two blood tests that could be carried out for completeness but overall, the board's action on diagnosis was considered to be r

Mrs C complained about the care and treatment provided by the practice. Mrs C raised concerns that the practice did not provide a reasonable standard of care when she presented with symptoms of bowel discomfort and diarrhoea over a period of several months. In particular, she was concerned the practice failed to diagnose her colonic cancer at an early stage. Mrs C also raised concerns about timeliness of blood tests, the antibiotics prescribed, and her concerns that the practice was dismissive of her symptoms. She also complained the practice unreasonably failed to provide a letter of referral she asked for in order to arrange a private scan. The practice said that Mrs C's treatment had been reasonable. In particular, they noted that Mrs C had attended a colonoscopy (an examination of the bowel with a camera on a flexible tube) two months prior to the period in question, which had shown no signs of cancer, but provided an alternative explanation, which was consistent with her symptoms. The practice said that the GP in question understood Mrs C had requested a scan, and had arranged appropriate investigations. After receiving independent advice from a GP, we did not uphold Mrs C's complaint. We found that the practice had acted reasonably in the circumstances, based on the result of the colonoscopy, the alternative diagnosis, and the nature of the symptoms Mrs C experienced. We also considered that the practice provided appropriate care and treatment in relation to blood tests, prescription of antibiotics, and was responsive to her symptoms. We also considered the actions of the practice in relation to the scan were reasonable in the circumstances. During the course of our investigation, we noted aspects of the practice's complaints procedure did not comply with the Scottish Government's 'Can I help you?' guidance, so although we did not uphold the complaint, we made a recommendation about this.

Ms C raised a number of concerns about the care and treatment her father (Mr A) received at Biggart Hospital. Mr A had been transferred from another hospital for rehabilitation after he suffered a fracture to his right upper arm after a fall. We took independent advice on the case from a medical adviser and a nursing adviser. The medical adviser considered that while communication between ward staff and the fracture clinic fell below a reasonable level, the board had acknowledged this and apologised. The medical adviser said the length of Mr A's stay at the hospital was reasonable, based on the injury he had suffered and his particular circumstances. The medical adviser considered the initial assessment of Mr A's chest fell below a reasonable standard because, although in their complaints response the board stated that this was to treat a chest infection, Mr A's medical records did not record why he was prescribed antibiotics and how this treatment would be reviewed. The medical adviser and the nursing adviser both considered that further investigation and assessment should have been made when swelling to Mr A's leg was identified by nursing staff. The advisers also said that Mr A had not been provided with a reasonable amount of physiotherapy treatment and there was a lack of provision of physiotherapy for Mr A on weekends and bank holidays. They also considered the amount of occupational therapy provided to Mr A was below a reasonable level. Although the board had apologised to Ms C that the level of support fell short of her expectations, the medical adviser was critical of the board's failure to acknowledge that a lack of staff time and workload commitments had impacted on the service Mr A received.

Mr C complained about the care and treatment he received at Ayr Hospital's A&E department after injuring his foot several years ago. Mr C said that no fracture was detected at the time, however, when he was reviewed a short time later a fracture was found. Mr C sustained a similar injury a year later and said that a doctor had told him he would not have needed surgery had his foot been put in plaster at the time of the original injury. We were unable to complete our investigation into Mr C's complaint and reach a decision because he did not respond to our efforts to contact him. Related reading View Decision Report 201501697 as a PDF (10.88 KB) Updated: March 13, 2018