SPSO Individual Decisions

C complained that the Scottish Prison Service (SPS) failed to take reasonable steps to ensure that they had prompt access to medical attention. C stopped taking prescribed medication after experiencing side effects and submitted a request to be seen by a nurse. C was not seen by a nurse during the following two-week period despite their symptoms worsening. C was then informed that they would be seen by a nurse that day but this did not happen. C raised this with prison staff who advised a call had been placed to NHS 24 instead, given healthcare staff were no longer available. C was later informed the call had been ended due to the expected wait time. In response to C's complaint, the SPS said that the correct procedure had been followed by staff in attempting to call NHS 24. However, it was recognised alternative arrangements could have been made to facilitate the call. We found that it was unclear whether C’s request for medical attention was communicated properly by SPS to healthcare staff. Whilst a reasonable attempt was made to contact NHS 24, and the SPS acknowledged the call could have been facilitated despite the wait time, the SPS did not explain what action had been taken to remedy matters. While there appeared to have been a protocol in place for such situations, it was not clear that prison staff were aware of this. C also complained that the SPS failed to handle their complaint reasonably. We found that the SPS’ handling of the complaint was poor because not all of the issues raised by C were responded to and they did not communicate what remedial action was taken. The SPS also failed to provide accurate information in response to our initial enquiries. Therefore, we upheld C's complaint.

C complained about the care and treatment provided to A by the Scottish Ambulance Service (SAS). A had a pacemaker fitted and developed a severe headache and rash. A phoned NHS 24 as they were finding it difficult to breathe. Paramedics attended A at home but A was not admitted to hospital. A phoned NHS 24 again the following day and when paramedics attended, they sought telephone advice from a consultant at the local hospital. The consultant advised that A should take paracetamol and see the GP the following morning. A phoned the GP the next day and was told to go to the COVID-19 hub where A collapsed and was taken to hospital by ambulance. A was admitted to hospital and died the following day from sepsis (blood infection). C complained about the decision not to take A to hospital and is concerned that the paramedics failed to recognise the signs of sepsis and to take the appropriate action. We took independent advice from a registered paramedic. We found that in hindsight it was unreasonable that SAS did not recognise the seriousness of A’s condition, including applying any weighting to past medical history, in particular recent surgery and the fact that the presence of infection could have been the result of sepsis. However, we found that many of the clinical signs and symptoms observed in A would have been present in a patient experiencing COVID-19. Based on the conditions and guidelines SAS were operating to at the time we found that it was reasonable that the paramedics’ working diagnosis was COVID-19. Whilst we considered it was reasonable that A was not taken to hospital, we were critical that there is no evidence that A was informed of the risks and benefits of the option of staying at home, going to hospital or of any alternative options available. We also found that it was unreasonable that key information was not passed to the consultant during a call and that record keeping was unreasonable. Furthermore, we found that it was unreasonable th

C complained about the care and treatment provided to their late parent (A) by the board's out of hours (OOH) service. A was experiencing worsening symptoms of disorientation, fatigue and abdominal pain. C telephoned NHS 24 and received a call back from an OOH GP who arranged for an ambulance to attend A's home. Paramedics examined A and called the OOH service who agreed that an OOH GP would carry out a home visit to A. Paramedics left the house and the OOH GP attended shortly afterwards. Upon examination, A was found to have a mild fever and fast heart rate, with all other observations recorded as normal. The OOH GP prescribed antibiotics. A died a few days later. We took independent advice from a GP. We found that it was an appropriate course of action to request a paramedic assessment upon receiving C's initial call to the OOH service. We also found that given the observations of the paramedics and the OOH GP, it was appropriate to treat and manage A at home and to take into consideration that A's own GP practice would be open some four hours later. Therefore, we did not uphold C's complaint but did provide feedback to the board in relation to the GP's record-keeping. Related reading View Decision Report 202205600 as a PDF (24.42 KB) Updated: August 16, 2023

C complained about the care and treatment provided to their late parent (A). A felt unwell whilst residing in a care home. They were coughing up blood associated with green phlegm and had chest and abdominal pain. Staff at the care home contacted NHS 24 and were advised that a home visit would be conducted. However, the GP subsequently carried out a telephone consultation due to concerns around the transmission of COVID-19. They diagnosed A with a chest infection. A second GP visited 48 hours later and suspected A had pulmonary embolism (a blocked blood vessel in the lungs) and deep vein thrombosis (a blood clot in a vein). A was admitted to hospital where this was confirmed. A died a few months later and C said that pulmonary embolism was described as a contributing factor on their death certificate. C was concerned that the GP did not conduct a home visit and subsequently failed to correctly diagnose A's condition and instead focused on the transmission of COVID-19 and associated risks. C believes that if a home visit had been conducted, A would have been correctly diagnosed 48 hours earlier and could have received treatment. The board responded and identified some issues in the medical history and documentation taken. C remained dissatisfied with the board's response and brought their complaint to us. We took independent advice from a GP. We found that it was reasonable that no home visit was offered in the context of COVID-19. However, the medical history and particularly the documentation taken by the GP was unreasonable. In particular, there was no documentation to support the consideration of respiratory rate/breathlessness, leg pain/swelling and pulmonary embolism. In view of these failings, we upheld C's complaint that the board failed to provide A with reasonable care and treatment. The board had already apologised for the failings and had highlighted them to relevant staff as a learning point. However, we  provided some further feedback to the board. Rela

C complained about the care and treatment provided to their adult child (A) by the board. A had an extensive history of epilepsy and was diagnosed with ictal asystole (a rare but potentially devastating complication of epileptic seizures). A was referred by the board's neurology service (specialists in disorders of the nervous system) to the cardiology service due to ongoing seizures with loss of consciousness which could not be controlled with medication. A was fitted with a pacemaker but later developed severe headaches and a rash. A was advised to stop taking recently prescribed tablets and that the rash was likely caused by the ointment used when the pacemaker was fitted. A few days later, A was finding it difficult to breathe and called NHS 24. Paramedics attended A at home but A was not admitted to hospital. A phoned NHS 24 again the following day and when paramedics attended, they took advice from an emergency medical consultant at the hospital who advised that A should take paracetamol and see the GP the following morning. A was advised by the GP to attend the COVID-19 hub where A collapsed and was taken to hospital. A was admitted to hospital and died the following day from sepsis (a life-threatening reaction to an infection). C complained that the board's cardiology service failed to provide reasonable care and treatment to A. We took independent advice from a consultant cardiologist. We found that there was a failure to provide a clear timeframe on the day of the pacemaker implantation and a failure to take reasonable action when A developed a rash following the procedure. We also found that the board failed to identify the asystole earlier but had already acknowledged this in their complaint response to C. Given these failings, we upheld this part of C's complaint. C complained that an emergency medical consultant unreasonably told the paramedic that A should take paracetamol and see the GP the following morning. We took independent advice from a consult

C's spouse (A) became unwell with severe lower abdominal pain and vomiting. C phoned for an ambulance and was told by the Scottish Ambulance Service (SAS) that A's symptoms did not warrant an emergency attendance and transferred the call to NHS 24. A's condition worsened over the next couple of days and A was taken to hospital, where they were found to have a perforated bowel (hole in the bowel) and kidney failure. A was given palliative care and died in hospital shortly afterwards. C complained about the SAS decision not to dispatch an ambulance to A and considered that the call out system failed to save A's life. We took independent advice from a paramedic. We found that the telephone assessment conducted was reasonable and that appropriate questions were asked. From the responses provided, it was reasonably determined that there were no immediately life threatening symptoms that required dispatch of an emergency ambulance at that time. On this occasion, it was reasonable to transfer the call to NHS 24 for secondary triage to allow a more in depth line of questioning to be carried out to try to understand more about presentation of A's complaint. We, therefore, did not uphold the complaint. Related reading View Decision Report 202006236 as a PDF (24.35 KB) Updated: August 24, 2022

C's late partner (A) tested positive for COVID-19. A's condition worsened over time and C called 111 as they were concerned A's breathing was becoming laboured. C had to wait around 20 minutes before the call was answered. Once connected, the call lasted around 30 minutes. The call handler contacted the Scottish Ambulance Service (SAS) and said that they were 'looking to arrange an immediate response for a patient'. A's condition deteriorated further and C made a 999 call around ten minutes after ending the call to 111, as assistance had not yet arrived. However, by the time paramedics arrived, A had stopped breathing and could not be resuscitated. C complained about the length of time it took for an ambulance to arrive. They complained that paramedics did not arrive in personal protective equipment (PPE), and considered that they wasted time getting dressed outside when it was an emergency call. C also queried whether a defibrillator (an electronic device that applies an electric shock to restore the rhythm of a fibrillating heart) had been used as they could not hear any shock being administered. We took independent advice from a paramedic. With regard to the initial call from NHS 24, we found that this had been dealt with appropriately. The call taker had assigned the request for an ambulance the correct level of priority, in terms of the SAS coding system in place at the time. Therefore, we did not uphold this aspect of the complaint. However, we noted weaknesses in the NHS 24-SAS service interaction and suggested that SAS review the process and consider making improvements if necessary. We found that the response to the 999 call was reasonable, proportionate and timely. We noted that it would not have been appropriate to provide shock to A, given their clinical condition. We also accepted SAS' explanation as to why crew required to put on PPE when they arrived at the scene, which was necessary for infection control. We did not uphold this complai

C’s late partner (A) tested positive for COVID-19. A week after testing positive, A called 111 as they were still feeling very ill. They explained that they had had a fever for a few days and were having difficulty regulating their temperature. A was advised by a nurse practitioner to remain hydrated, continue taking paracetamol, and to continue to self-isolate until they had no fever for 48 hours. They were also advised to call back if they had any further concerns about their symptoms. C called 111 again a few days later as they were concerned A’s breathing was becoming laboured. C had to wait around 20 minutes before the call was answered. During the call, the call handler repeatedly asked to speak to A to take information directly from them, even though C kept answering for A as A was confused. The call lasted around 30 minutes. The call handler contacted Scottish Ambulance Service and requested an ambulance on an emergency basis, but by the time paramedics arrived A had stopped breathing and could not be resuscitated. C complained about the clinical assessments of A’s condition on both instances. We took advice from an advanced nurse practitioner with experience of assessing patients with similar presentations. We found the assessment on the first instance to be reasonable, and we therefore did not uphold this complaint. We considered it unreasonable for the second call to have lasted 30 minutes before an ambulance was called. We noted that the call handler was following the protocol correctly, but were of the view that if the protocol took 30 minutes to establish that an emergency response was required, it was not fit for purpose. We considered that rigid following of the protocol led to a delay in obtaining medical attention for A. Therefore, we upheld this complaint.

C complained that the board failed to appropriately triage their relative (A) when A self-presented to the Medical Assessment Unit (MAU) at Western General Hospital feeling unwell. A spoke with the receptionist who took details of their symptoms and, having discussed A's symptoms with clinical staff, the receptionist advised A that they should contact NHS 24. A left the hospital and contacted NHS 24 who advised A to take paracetamol for the pain. A was taken to another hospital in the early hours of the next day and had an emergency operation for a ruptured appendix. In response to the complaint, the board explained that the receptionist acted in line with their normal processes. C was not satisfied with the response provided and brought the complaint to our office. We found that the board were unable to evidence that A was reviewed by a triage nurse or doctor in person as per their protocol. Given there was no evidence that the appropriate protocol was followed, we upheld the complaint. In addition, having reviewed the handling of C's original complaint, we concluded that the board failed to appropriately investigate and respond to C's complaint.

C complained about the treatment the board provided to their spouse (A). After falling unwell, C had contacted NHS 24 on A's behalf as they were concerned that A's symptoms may have been due to a cardiac (heart and its blood vessels) issue. A then spoke to a medical professional from NHS 24 who signposted them towards Borders Emergency Care Service (BECS), an out-of-hours service, which they attended. When A attended BECS, they were examined by a trainee advance nurse practitioner (ANP). After examining A and taking a history from them, the trainee ANP's view was that A's symptoms were due to a muscular strain rather than being cardiac in nature. A was discharged on this basis but died four days later as a result of coronary artery atheroma (fatty deposits that build up on the walls of arteries around the heart). C complained that A's death was preventable and that they were not examined appropriately when they attended BECS. We took independent advice from a nurse. We found that the examination of A, and the trainee ANP's decision-making, were reasonable given the information provided to them. In addition to this, it was appropriate for a trainee ANP to examine A and reach conclusions on their treatment. We concluded that A received appropriate treatment when they attended BECS. Therefore, we did not uphold this complaint. Related reading View Decision Report 201907297 as a PDF (24.41 KB) Updated: October 21, 2020

Mr C complained about the treatment which he had received at A&E of Caithness General Hospital. He had initially contacted NHS 24 and arrangements were made for him to be taken to hospital. Caithness Hospital does not have an ear, nose and throat (ENT) department and Mr C said that he expected to be transferred to another hospital to see the specialists there, but instead he was discharged home. Mr C's GP made a subsequent referral to ENT at Raigmore Hospital. Mr C felt it had inappropriately been downgraded and that he was not provided with appropriate treatment for his reported symptoms. We took independent advice from an A&E consultant and from an ENT consultant. We found that Mr C had been appropriately assessed and treated at A&E on his initial attendance, and when he was subsequently referred to the ENT department, his symptoms were appropriately assessed and reasonable investigations were carried out in an effort to reach a diagnosis. We did not uphold the complaint. Related reading View Decision Report 201903644 as a PDF (24.19 KB) Updated: July 22, 2020

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. Related reading View Decision Report 201904120 as a PDF (24.27 KB) Updated: March 18, 2020

Mr C complained about the advice he received from NHS 24 staff when he called for assistance for a dental problem. He spoke to a dental nurse initially who advised that he should take painkillers and contact his dentist when the practice opened later that morning and ask for an urgent appointment. Mr C was unhappy with this advice and asked to speak to another dental nurse and again remained dissatisfied with the advice given. The telephone calls to NHS 24 became challenging and staff terminated a call as Mr C was deemed to have been offensive. We took independent advice from a dentist. We found that the advice that Mr C should attend his own dentist later that morning was appropriate. It was also appropriate that he was given advice to take painkillers and that there was no medical need for an emergency appointment. We also found that Mr C's behaviour during the calls was challenging for all concerned and that it was not unreasonable for the staff to have terminated the call when it was clear that nothing further would be achieved. We did not uphold the complaint. Related reading View Decision Report 201805151 as a PDF (23.81 KB) Updated: March 20, 2019

Ms C complained that NHS 24 failed to provide her with an appropriate assessment of her condition and advice during a telephone call. We took independent advice from a GP. We found that the questions asked by NHS 24 to assess Ms C's condition were reasonable and that there was no clinical indication for Ms C to be advised to attend A&E. We also noted that Ms  C was advised to see a pharmacist. We found that, ideally, Ms C should have been referred directly to the out-of-hours service, but it was not unreasonable or unsafe for Ms C to be advised to see a pharmacist. We did not uphold Ms C's complaint. Related reading View Decision Report 201803603 as a PDF (23.59 KB) Updated: March 20, 2019

Mr C complained that NHS 24 failed to handle his call appropriately. Mr C initially phoned 999 to request an ambulance for his wife (Mrs A). However, it was deemed that an ambulance was not required and Mr C was referred to NHS 24 for a further assessment of Mrs A's symptoms to be carried out. Mr C complained to NHS 24 about the call handler's line of questioning and their refusal to send an ambulance. NHS 24 acknowledged the call could have been handled better. Mr  C was unhappy with this response and brought his complaint to us. We took independent advice from a nursing adviser who reviewed the case records and the audio recording of the call. We found that the call handler should have been more flexible in their questioning and they could have been more empathetic and understanding of Mr C's frustration. We upheld the complaint and asked NHS 24 to provide an update on the learning and improvement they had already identified. Related reading View Decision Report 201803695 as a PDF (23.78 KB) Updated: January 23, 2019

Ms C complained that NHS 24 failed to provide appropriate assistance when she called them to raise concerns that her mother (Mrs A) had been discharged from hospital too early following a suicide attempt. She said that she had not received any advice or assistance and complained that she had only been able to speak to a call handler and not a clinician. We took independent advice from a practitioner experienced in out-of-hours services. We found that NHS 24's handling of the call had been reasonable. The call handler contacted Mrs A, who had told them that she had been seen by psychiatry that day and had psychiatric follow-up arranged. The call handler also spoke to a senior nurse. We found that the advice provided to Ms C had been appropriate and it had been reasonable to advise her to contact Mrs A's GP practice at that time. We did not uphold the complaint. Ms C also complained about NHS 24's handling of her complaint. We found that this had been reasonable and did not uphold this aspect of the complaint. Related reading View Decision Report 201706372 as a PDF (23.81 KB) Updated: December 19, 2018

Mr C complained about the out-of-hours care provided to his mother (Mrs A) by the partnership. Mrs A was started on antibiotics for cellulitis (a bacterial infection of the skin and tissues beneath the skin) but the following day Mr C rang NHS 24 as he remained concerned about her symptoms. An out-of-hours doctor visited Mrs A at home to further assess her condition. A few hours after the home visit, Mr C rang NHS 24 again raising concerns about a deterioration in Mrs A's condition and an ambulance was arranged. Mrs A was admitted to intensive care with sepsis. Mr C complained that the out-of-hours doctor failed to recognise the potential seriousness of Mrs A's symptoms and failed to arrange hospital admission. We took independent medical advice from a general practitioner. We found that the doctor carried out an appropriate examination and assessed Mrs A as being clinically stable. We were satisfied that the doctor took reasonable account of the family's concerns. We found that the doctor did not overlook any significant signs or symptoms, and noted in particular that Mrs A's presenting symptoms did not meet the high-risk criteria for urgent emergency care. We also noted that the doctor provided appropriate advice to attend A&E if Mrs A's condition worsened. We considered that the out-of-hours care provided by the partnership was reasonable and did not uphold Mr C's complaint. Related reading View Decision Report 201708602 as a PDF (11.27 KB) Updated: December 2, 2018

Mr C complained about the way NHS 24 had handled a phone call from him when he reported that he had been experiencing headaches for over three weeks and was told that he was suffering from migraines. Mr C subsequently went on to develop vertebral artery dissection (a tear to the inner lining of an artery in the neck which supplies blood to the brain and can cause a blood clot) three weeks later. Mr C believed that the call to NHS 24 was not managed appropriately and that he was unreasonably only advised to rest and increase his fluid intake. We took independent advice from a practitioner experienced in out-of-hours services. We found that NHS 24 had treated Mr C's concerns seriously and they had conducted a clinical investigation report. Mr C had contacted NHS 24 during the hours when GP surgeries are open and, during such periods, the remit of NHS 24 is to provide advice and to direct patients to contact their GP. We were satisfied that, in view of Mr C's reported symptoms at that time, there was no requirement for him to attend hospital or arrange an emergency ambulance and that it was appropriate to direct him to his GP surgery. We did not uphold the complaint. Related reading View Decision Report 201707513 as a PDF (11.2 KB) Updated: December 2, 2018

Mr C complained on behalf of his wife (Mrs A) that the ambulance service unreasonably failed to dispatch an ambulance following an emergency call and that they did not handle his complaint reasonably. Mrs A had been diagnosed with a tumour at the rear of her brain and was waiting for an operation. Mr C said that Mrs A was told to call the emergency services if she experienced certain symptoms. When Mrs A subsequently experienced these symptoms, Mr C called the emergency services and spoke to a call handler who referred Mrs A to NHS 24. Mr C was unhappy that the ambulance service failed to dispatch an ambulance following the emergency call. We took independent advice from a consultant in emergency medicine. We found that the information reported during the emergency call did not confirm that Mrs A had an immediately life-threatening condition, which would have required the dispatch of an ambulance as an emergency. The adviser noted that the decision to refer the call to NHS 24 in order to get a more detailed assessment of the situation by a clinically trained person was reasonable. We found that the decisions taken by the ambulance service were reasonable and therefore, we did not uphold this aspect of Mr C's complaint. In relation to complaints handling, we found that the ambulance service had performed a detailed audit of the emergency call and that the member of staff involved had appropriately reflected on the call. We were satisfied that the complaint investigation carried out was reasonable and that the response to Mr C addressed the points he had raised. We did not uphold this aspect of Mr C's complaint. Related reading View Decision Report 201705035 as a PDF (11.32 KB) Updated: December 2, 2018

Mr C complained about a consultation that his brother (Mr A) had with an out-of-hours service doctor. Mr A was referred to the on-call doctor by NHS 24 when he called to report pain in his chest and both arms. Mr A was examined by the on-call doctor who considered that muscular pain was the likely cause. Mr A returned home, however, later that evening he was taken to the emergency department by Mr C and was ultimately diagnosed with a heart attack. Mr C complained to the board about the consultation with the on-call doctor as he considered that Mr A's condition should have been identified sooner. Mr C was also concerned that the board's response to his complaint was unreasonable. We took independent advice from a GP experienced in out-of-hours care. We found that Mr A did not have the typical presentation of a heart attack and consequently, this could not have been foreseen by the on-call doctor. We found that arriving at what later turned out to be an incorrect diagnosis did not mean that the on-call doctor was at fault and we found that there was evidence that they had adequately and appropriately assessed Mr A. We did not uphold this aspect of Mr C's complaint. Regarding Mr C's complaint about the board's response to his concerns, we found that there was a minor inaccuracy in the response and that there was a lack of evidence that Mr C had been kept properly updated when the timescale for responding to his complaint passed. We upheld this aspect of Mr C's complaint.

Mr C complained about the care and treatment his wife (Mrs A) received at Dunbar Hospital. Mr C and Mrs A had just moved to the area and had not yet registered with a local GP practice when Mrs A became unwell with flu-like symptoms. NHS 24 advised her to attend Dunbar Hospital, where she was diagnosed with a respiratory infection and prescribed antibiotics. Mrs A had two further attendances and phone contact with the hospital, before registering with a local GP. The GP diagnosed pneumonia, prescribed a new course of antibiotics and subsequently arranged an emergency admission to a different hospital for treatment. Mr C complained that the doctor who initially assessed Mrs A at Dunbar Hospital failed to diagnose her pneumonia. He also complained that Mrs A was assessed by nursing staff on her subsequent attendances at the hospital and not a doctor, despite his understanding that the plan was for further medical review. In addition, he complained that the nurse Mrs A spoke to when she phoned Dunbar Hospital did not make appropriate arrangements for her to be seen by a doctor and simply advised her to register with a local GP. We took independent advice from both a GP and a nurse. Both advisers considered that the respective assessments of Mrs A were reasonable and they considered it appropriate for her to have been advised to register with a local GP. They noted that the out-of-hours service at Dunbar Hospital is for emergency care when GP surgeries are closed. They also noted that routine follow-up and the arrangements of tests is usually carried out by the GP. The GP adviser considered that Mrs A's initial diagnosis and treatment were appropriate and noted that the treatment would have been the same if pneumonia had been suspected initially. We did not uphold this aspect of the complaint. Mr C also raised concerns that the board's response to his complaint contained a number of inaccurate and misleading statements. In particular, he considered that it i

Ms C complained about her contact with NHS 24 when she phoned them about her late mother (Mrs A). Specifically, Ms C said that NHS 24 unreasonably delayed in answering her call and in assessing Mrs A's condition. Ms C also said that NHS 24 failed to take appropriate action in response to Mrs A's symptoms, as they did not immediately call an ambulance for Mrs A, even though she had a history of sepsis. During our investigation we took independent advice from an out-of-hours practitioner. We found that there was no unreasonable delay in answering Ms C's call, or in assessing Mrs A's condition. We found that sepsis cannot be diagnosed over the phone. We considered that NHS 24 took appropriate clinical action in response to Mrs A's symptoms, by arranging an urgent out-of-hours GP visit. We did not uphold Ms C's complaint. Related reading View Decision Report 201609114 as a PDF (10.98 KB) Updated: March 13, 2018

Ms C complained about the care provided to her father-in-law (Mr A) during a call to NHS 24. Mr A reported that he had been suffering with a cold and cough for five days with symptoms including dizziness, pain in the chest area and a fever. He had also been sick and, while he could drink water, he had not taken his medications. The NHS 24 call handler took details from Mr A and passed these on to a pharmacist. The pharmacist recommended that he buy a medicine to help suppress his cough and allow him to take his other medication. Mr A was also advised on what to do should his condition worsen. Mr A had further contact with the out-of-hours services the following day. He was later admitted to hospital and died as a result of sepsis (blood infection). Ms C complained about Mr A's first call with NHS 24 as she felt that he had not received appropriate advice or care. We took independent advice from a practitioner experienced in out-of-hours services. The advice we received was that the care and treatment recommended were reasonable on the basis of the information that was available to the call handler and the pharmacist. The adviser considered that appropriate safety advice had been provided by NHS 24 on what to do if Mr A's condition should worsen. No failings were identified in the way that Mr A was managed by NHS 24 and therefore we did not uphold Ms C's complaint. Related reading View Decision Report 201603357 as a PDF (11.27 KB) Updated: March 13, 2018

Mrs C complained to us about the treatment she received when she attended the emergency dental clinic at Wishaw General Hospital. Mrs C was experiencing pain from a left molar tooth and was scheduled to have root canal treatment carried out by her own dentist. Mrs C contacted NHS 24 and explained the problems she was experiencing and they made her an appointment at the clinic the following day. When she attended the clinic she said the dentist read the NHS 24 referral note, asked her a few questions, numbed her mouth, removed a nerve in a tooth, and put in place a temporary filling. When Mrs C returned home, the anaesthetic began to wear off and she looked in her mouth to discover the dentist had treated the wrong tooth and not the one which was scheduled to have root canal treatment. As a result she had to attend another NHS facility for emergency treatment on the correct tooth. We took independent advice from an adviser in general dentistry and concluded that the dentist had taken note of Mrs C's dental history and the information contained in the NHS 24 referral, and had conducted an appropriate examination of her mouth. We found that the dentist had identified a tooth which was causing pain and that appropriate treatment was provided. We felt it was reasonable for the dentist to have treated the tooth which he had identified as causing a problem. While the tooth which was treated was not the one scheduled for root canal treatment, there was nothing to indicate that the tooth was incorrectly treated. We did not uphold the complaint. Related reading View Decision Report 201700753 as a PDF (11.3 KB) Updated: March 13, 2018

Ms C complained to us about the way NHS 24 handled calls she made to them on two separate occasions. We took independent medical advice and found that when Ms C made her first call to NHS 24 to report symptoms she was experiencing, they failed to deal with her call in line with the appropriate protocol. The protocol said that staff should speak to a doctor as soon as possible. However, in Ms C's case, staff said that they would arrange for a nurse to call Ms C back within a three-hour timescale. Though Ms C was called by a nurse within that timescale, we found that it was likely that this delayed Ms C's admission to hospital. Although we upheld this aspect of Ms C's complaint, we were satisfied that NHS 24 has apologised for this and shared the learning from Ms C's complaint with staff. Ms C also complained about the handling of two calls she made to NHS 24 almost a year later regarding symptoms she was experiencing. Staff initially said that someone would call her back within two hours. However, Ms C had to call them again, as she had not been called back within two hours and her symptoms had deteriorated. She was then referred to an out-of-hours service to be assessed by a GP. NHS 24 had accepted that the handling of the calls was not of the standard they expect from staff and that some of Ms C's symptoms should have been explored further. We therefore upheld this aspect of Ms C's complaint. The board had apologised to Ms C for this and had taken action to prevent similar problems occurring. In view of the action already taken by NHS 24, we did not make recommendations. Related reading View Decision Report 201507493 as a PDF (11.34 KB) Updated: March 13, 2018