Not upheld, no recommendations

Summary

C complained on behalf of their partner (A) about the care and treatment provided to A by the board when they presented to the obstetric triage department 25 weeks’ gestation with pain and abdominal tightening. A was assessed as having Braxton Hicks (when the womb contracts and relaxes during pregnancy, also known as ‘false labour’) given advice on what to do if their condition worsened, and discharged. Four weeks’ later A suffered preterm prelabour rupture of the membranes (PPROM) and their child was delivered prematurely.

C complained about the care and treatment provided to A as they considered the assessment at 25 weeks’ gestation was a missed opportunity for further investigation or follow-up.

The board’s complaint investigation identified that according to local guidelines, A should have been reviewed by a more senior doctor. However, they were of the view that it was unlikely that this would have led to a different outcome.

We took independent advice from a medical adviser. We found that while there were some areas for potential improvement, overall the care and treatment provided to A was reasonable. We therefore did not uphold C's complaint, though we did provide feedback to the board according to the adviser’s comments.

Summary

C complained about the council’s decsion to build a prison facility next to their and others’ property. C’s complaint covers the council’s planning and environmental health services.

Regarding the planning process, C considered the council had failed to safeguard neighbouring residents when granting planning permission. C said the council did not consider the proximity of the houses to the prison and the soil type present on the site. They also felt that a Noise Impact Assessment should be carried out. C said this resulted in damage to property, issues with noise and vibration, and the loss of house value.

We took independent advice from a planning adviser. We concluded that the council had carried out their planning obligations, in line with relevant legislation, guidance and policies. We recognised that C disagreed with the council’s position but concluded that the council handled the planning applications reasonably. Therefore, we did not uphold this part of C’s complaint.

In respect of the environmental health service, C said that the council failed to safeguard them during the construction of the new facility. They explained that they experienced noise and vibration issues. C said these vibrations caused visible damage to their property.

We found that the council’s environmental health service acted reasonably in response to concerns raised by C. It was for the council to decide whether the threshold was met for noise and vibration from the construction site to be considered a statutory nuisance. We were satisfied that the council had provided reasonable explanations for why this threshold was not met. Therefore, we did not uphold this part of C’s complaint.

Summary

C complained about the care and treatment they received from the board when they attended the hospital with pain and a tight feeling in their leg. C raised concerns that the board failed to: reasonably assess them on admission to hospital, and undertake the correct scans; provide them with timely information about their test results; reasonably identify an arterial clot and diagnose their condition; and provide them with reasonable treatment following admission to hospital.

We took independent advice from a consultant in acute medicine. We found that a detailed clinical assessment of C’s right leg and foot was carried out on their admission to hospital, and that it was reasonable that the clinicians did not identify an arterial clot at that time. We found that the possible diagnoses that were considered at the time were correct, and the diagnosis of plantar fasciitis was a reasonable conclusion to have reached. We also found that the correct scan had been carried out to exclude deep vein thrombosis (DVT, a blood clot in a vein) as a cause of C’s symptoms, and that the care and attention C received from medical staff was reasonable.

Therefore, we did not uphold C’s complaint.

Summary

C complained about the standard of medical care and treatment provided by the board to their late sibling (A) during a long admission to hospital. A’s medical history was complex as they suffered from a number of life threatening conditions during their hospital admission and they were under the care of a number of specialities. It was not until after A died, when the post mortem was performed, that A’s cancer was identified.

C said that the various clinicians should have identified A’s cancer, and that communication was not reasonable. C also said clinicians did not manage A’s pain well which was unreasonable and very distressing for the family.

We took independent advice from specialists in urology (urinary system and male reproductive organs), cardiology (heart), radiology (imaging) and end of life care. We found that treatment decisions were reasonable, and that the board managed A’s pain in a reasonable way. We also found that it was reasonable for clinicians not to have diagnosed A with cancer. Therefore, we did not uphold C’s complaints.

However, there were aspects of communication that the board should consider improving and we provided this as feedback.

Summary

C complained on behalf of their late partner (A) who died from a stroke caused by a blood clot. A was admitted to hospital with seizures after collapsing at home and sustaining a head injury. A couple of days later A was identified to have had a stroke, and they died the next day. C complained that an MRI scan was not carried out in order to verify the cause of A’s seizures (a blood clot), in a timely manner to enable acute stroke interventions.

We took independent advice from a consultant in intensive care medicine and a consultant stroke physician. We found that receiving a CT head scan when A first presented was appropriate. A working diagnosis of seizure was reasonable at that time. We found that it was reasonable that time critical acute stroke interventions were not indicated, and therefore an MRI was not indicated. A repeat CT scan did not show any significant changes from the initial scan. We noted that an MRI scan at this point would have been unlikely to have altered A’s immediate management.

C was concerned that placing A in a medically induced coma masked the progression of the stroke, however, we found that this action was in keeping with guidelines. We considered that the clinical management of A was reasonable. Therefore, we did not uphold C’s complaint.

Summary

C complained in relation to their late child (A) and the actions of the social work services. A suffered from significant and life-limiting health conditions. During the final months of A’s life, a number of healthcare and education professionals raised concerns about C’s approach to A’s medical needs and care. Social workers made contact with C and initiated a child protection investigation, which ultimately did not establish child protection issues.

C complained that contact that they received from the partnership, both via the phone and in person, was harassing and unreasonable. C considered that the partnership failed to recognise that the reports of other agencies were inaccurate, and harassing in nature, and had displayed bias by ignoring C’s views in this regard.

We took independent advice from an experienced social worker. We found that it was evident that healthcare professionals had been concerned about A and had notified social workers of these concerns. In making enquiries and initiating a child protection investigation, social work services had followed the process set out in the National Guidance for Child Protection and in doing so had acted appropriately. While we recognise the difficult circumstances involved, I did not uphold C’s complaint.

Summary

C is a kidney transplant patient who was suffering from COVID-19 when they were admitted to hospital. C’s COVID-19 worsened and C developed blood clots in their lungs. C was treated with anti-coagulant medication. However, over time C developed a haematoma (a collection of blood) in their right arm and a large haematoma which caused permanent damage to nerves in C’s left thigh. C complained that staff had not been proactive enough in monitoring the effects of the anti-coagulant medication or in managing the blood clots and haematomas. C also complained that a referral to a neurologist should have taken place at the time and would have improved their long term prognosis.

The board explained that the effect of the anti-coagulant was not usually measured, but could be useful in patients with kidney disease. They had therefore monitored as required. Medication was changed due to concerns that the blood clots were getting worse and then stopped in light of the bleed into C’s thigh. A neurology referral was not made, as following discussion with surgical and radiological experts it was determined that supportive therapy was the most suitable management strategy for C’s case.

We took advice from a consultant haematologist and consultant neurologist. We found that C had both blood clots and significant bleeding. Both can be life-threatening, and treating one may make the other worse. We found that the monitoring and management of the anti-coagulant medication and the management of the haematomas and blood clots was reasonable and that it was reasonable not to refer to neurology and not to have considered femoral neuropathy. Therefore, we did not uphold the complaint.

Summary

C complained that the advice and treatment provided by the board following their positive COVID-19 test was unreasonable. C was a kidney transplant patient who tested positive for COVID-19 in early 2022. C said that they had contacted the renal unit who referred them on to the Covid Pathway (a central unit offering treatment advice and antiviral medication for high-risk patients). C received antiviral medication from a Covid Pathway nurse but was not referred to a renal clinician or advised to stop the immunosuppressant medication they were taking.

C later contacted the renal unit with concerns about diarrhoea. C was advised to stop the immunosuppressant over the weekend and was given advice on what to do if their condition worsened. C felt that they were given wrong advice about their medication and that their disease progression was more severe because of this.

The board advised that they had no record of C’s contact with the renal unit about COVID-19. Their first record was 11 days later, when they spoke to a renal nurse with concerns about diarrhoea.

We took independent advice from a pharmacist and a consultant nephrologist (specialist in the diagnosis, treatment, and management of kidney conditions). We found that if C had indeed phoned the renal unit initially, C should have been escalated to a clinician for medication advice. We were also critical that the nurse at the Covid Pathway had not sought advice from or referred C to the renal unit.

However, we noted that the immunosuppression medication was new and the situation was fluid at the time. We noted that improvements were made within two weeks, during which, guidance was published to ensure robust advice and treatment for COVID-19 positive, immunosuppressed patients and contact details for specialist clinical units were provided to the Covid Pathway. We also considered that the COVID-19 pandemic had since largely subsided.

We considered that the advice and treatment that C received was reasonable as we could not definitively say that C had initially contacted the renal unit, the situation was new and fluid, and improvements to the process had been appropriately and quickly made. Therefore, we did not uphold C's complaint.

Summary

C complained that the board failed to provide them with reasonable care and treatment in relation to their breast cancer care. C raised concerns that that the board failed to carry out necessary scans and failed to offer neoadjuvant chemotherapy (treatment given before the primary course of treatment to reduce the size of the tumour). C also complained about the waiting times in relation to surgeries and the mastectomy report; and that the board failed to adhere to the relevant local and national guidelines.

We took independent advice from a consultant breast surgeon. We found that the care and treatment provided to C was reasonable. In particular, we found that C did not meet the requirements to receive neoadjuvant chemotherapy prior to surgery and, accordingly, it was not unreasonable that the board did not perform further scans. We found that the waiting times were reasonable. We also found that the board’s medical team had followed relevant local and national guidelines and C had been provided with reasonable care and treatment based on the information available to the clinicians at the time. Therefore, we did not uphold C’s complaint.

In relation to complaint handling, we found that C was provided with updates on the progress of their investigation and the reason for the delay. However, C was not given a revised timescale for completion so we provided feedback to the board on this point.

Summary

C had a number of concerns about their child (A)’s behaviour, development, and educational attainment. A was referred to Child and Adolescent Mental Health Services (CAMHS) in the board. An assessment was carried out, the result of which was that A was not diagnosed with a neurodevelopmental condition.

C complained that the board had unreasonably discharged A from the CAMHS service after having determined that they did not have attention deficit hyperactivity disorder (ADHD), without sufficient consideration being given to other potential diagnoses, and that the board failed to provide reasonable support following the lack of a diagnosis.

We took independent advice from a psychologist specialising in CAMHS. We found that the while the board had ruled out ADHD, their assessment had also considered other neurodevelopmental conditions such as autism spectrum disorder (ASD) and intellectual disability (ID), as well as a broader consideration of A’s circumstances and early life experiences. It was evident that A did not meet the criteria for ongoing treatment via CAMHS and that that the board had carried out a sufficiently thorough and comprehensive assessment prior to discharging A. We also found that appropriate thought and consideration had been given to ensuring that A and C were engaged with the relevant agencies with respect to ongoing support being available, in particular through A’s schooling.

For these reasons, we found that the care and treatment provided to C and A had been reasonable and we did not uphold C’s complaints.