NHS Ayrshire & Arran has apologised to the family of a cancer patient over 'failings' identified in their care. The apology follows a complaint made to the Scottish Public Services Ombudsman (SPSO) after the patient's diagnostic journey, which began with symptoms of abdominal pain and weight loss.
The patient, known only as 'A,' was later diagnosed with hepatocellular carcinoma, a type of liver cancer. However, they were not seen within the National Standard time of 14 days following suspicion of their condition. A loved one, known only as 'C,' lodged a complaint with the regulator.
Failings in diagnostic journey and hospital care
In its background report, the SPSO said: "C complained about care and treatment provided to their parent 'A.' Following symptoms of abdominal pain and weight loss, 'A' was referred to colorectal and upper gastrointestinal (GI) specialists and was subsequently diagnosed with hepatocellular carcinoma (a type of liver cancer)."
The report continued: "We took advice from a consultant gastroenterologist in relation to the medical aspects of C's complaint. We found that, following referrals for investigation of suspicion of cancer, appointments were not scheduled within the National Standards time of 14 days. Though the board acknowledged this when highlighted by our investigation, they had not identified the failing in their own complaint investigation."
The SPSO determined that while earlier appointments and diagnosis may not have changed 'A's outcome, they could have resulted in better certainty and understanding for the family, and potential improved symptom control and quality of life.
Corridor care and nursing failings
Other aspects of the patient's care were also highlighted. The report stated: "There were also a number of times when 'A' attended hospital and there were issues with waiting times in the Emergency Department, care having to be carried out in corridors due to a lack of beds, and delays in medical reviews. The board had acknowledged and apologised for these failings in their complaint response to 'C.'"
The SPSO also found a lack of specialist care pathways and input from relevant specialisms, upholding the complaint about medical care and treatment. The board's internal investigation was criticised, with the SPSO stating: "We also took advice from a nursing adviser. It was clear from the board's own investigation that there were failings in the nursing care provided to 'A.' We assessed whether the board had taken reasonable learning and improvement action after identifying these failings. While some action had been taken, overall we did not consider the board had reasonably identified and addressed the failings in nursing care, which included documentation, blood sugar monitoring, lack of nutritional planning, and lack of medication management."
The board also failed to create an action plan following their complaint investigation, and learning points were only followed up after the SPSO became involved. The complaint about nursing care was upheld.
Board's response and next steps
The SPSO noted that the board said they have since "strengthened processes" by reinforcing the requirement for action plans, improving oversight at directorate level, providing additional training for managers, and ensuring learning actions are "monitored and evidenced" before complaint responses are finalised. The SPSO has asked for evidence of this improvement action.
Dr Crawford McGuffie, Medical Director at NHS Ayrshire & Arran, said: "I am sorry that we did not meet the high standards of care that we strive for in NHS Ayrshire & Arran for this patient. The Board fully accepts the recommendations in the Scottish Public Services Ombudsman (SPSO) report. We have issued a formal apology to the family of patient 'A' and are working through the recommendations highlighted in the Scottish Public Services Ombudsman (SPSO) report."
He added: "We will ensure that we share the learning from the report within the organisation, in particular with those responsible for the operational delivery of the service and with our clinical governance teams."
