Not upheld, no recommendations

Summary

The council carried out an informal consultation exercise in respect of their schools, looking at a number of options, including possible closures and mergers. Ms C complained that the consultation included her local rural primary school. She said that there was an agreed moratorium (temporary delay) on proceeding with statutory consultations for the closure of such schools and, because of this and a recent legal case, she complained it was not appropriate for the school to be included. She also raised concerns that the council did not consult appropriately with the community and failed to highlight the potential loss of grant funding and increased transport costs when assessing the options.

We noted that the moratorium was in place while the commission for the delivery of rural education carried out a review on the closure of rural schools. However, this related specifically to progressing closures through the formal statutory consultation stage, which was not the case here. The council exercise was a review of their whole school estate and we did not consider it unreasonable that they included this school in that. Any eventual decision to proceed with closure, once the implications of the commission's report and the legal case had been considered, would still need to be taken through the statutory consultation process. Our investigation found that the council's consultation on the future of the school estate was comprehensive, and involved stakeholders such as parent councils as well as surveying the opinions of the general public. We also considered the financial information provided by officers when considering the options, but found no evidence to suggest that they misrepresented the financial case for this school. The impact of any decision on grant funding was clearly detailed in reports and they had included transport costs when assessing the overall potential cost implications.

As we found no evidence to suggest that the council's informal consultation was unreasonable, that the consultation exercise was flawed or that the financial implications for the school were misrepresented, we did not uphold Ms C's complaints.

Summary

Mr and Mrs C were unhappy that the housing association had refused to repair or replace their draughty living room windows. We found that the association had assessed the windows in question and determined that they were not in a state of immediate disrepair, and would be replaced as part of a forthcoming window replacement programme. Because of this, we did not uphold the complaint.

Summary

Ms C complained about a delay by her GPs in diagnosing that she was pregnant. She initially went to the practice to report a missed period, and was advised to take a further pregnancy test, which was negative. She attended the practice five months later saying that she had bloating and constipation. The GP thought she was constipated and prescribed a laxative. Ms C then went on holiday where she participated in various activities. She returned to the practice and it was then diagnosed that she was pregnant. The practice apologised for the missed diagnosis of pregnancy, but said that the GPs had dealt with the symptoms that she reported and had focused on the history of bloating and constipation. They also said that Ms C's complaint would be included in the appraisal folder and discussed at appraisals later in the year, where lessons learned are shared with colleagues.

We obtained independent advice on the complaint from one of our medical advisers, who considered Ms C's medical records in detail. Their advice was that the actions of the GPs were appropriate, although the diagnosis of pregnancy was missed. In such cases, as long as the clinicians involved took reasonable action based on the symptoms that were presented, we have no grounds to criticise their actions. Our adviser had no concerns about the GP's actions and prescription, and noted that the GP had told Ms C to return for re-evaluation if the symptoms did not settle.

Summary

Mr C had taken his late wife (Mrs C) to her medical practice as she had suffered from vomiting, diarrhoea and dizziness for two days, following a surgical procedure. Mrs C had a history of systemic lupus erythematosus (an inflammatory, multi-system autoimmune disease) and Mr C was concerned that due to his wife's medical history she should have been admitted to hospital. The GP who assessed Mrs C had diagnosed possible infective gastroenteritis, recommended medication and fluids and to seek a further medical review if there was no improvement. Mrs C deteriorated overnight and was admitted to hospital the next day where she continued to deteriorate and died a few days later. Mr C was concerned that his wife might have had a better chance had she been admitted earlier, and complained that the GP had not assessed her properly and had failed to arrange a hospital admission for her.

As part of our investigation, we took independent advice from one of our medical advisers. After studying Mrs C's medical records, our adviser concluded that this was a tragic case of a rapid deterioration in a person with an extremely rare condition, and she did not see any evidence in Mrs C's records to suggest that the GP could have foreseen or prevented this. We did not uphold the complaint, as our adviser said that the GP provided appropriate clinical treatment and had no concerns about their actions.

Summary

Mr C, who is a prisoner, complained because he said the prison health centre unreasonably stopped the medication used to treat his opiate addiction. The board explained to Mr C that, after giving him his tablets, he was asked to sit in another room to be observed whilst the tablets dissolved. After a short time, Mr C indicated the tablets had dissolved, although this normally took around five to ten minutes. Because of that, Mr C was searched and he was found to have a piece of cling film in his pocket which had a strong smell of lemon (with which the tablets are flavoured). As a result of this, Mr C was referred to the doctor to have his medication reviewed and it was decided to stop his prescription. He was also offered an alternative, which he accepted.

During our investigation, we took independent advice from one of our medical advisers, who said that the prison doctor's decision was reasonable, given that the health centre suspected that Mr C was not taking the medication appropriately. We also noted that the alternative was suitable. In light of this, we were satisfied the prison health centre's decision to stop Mr C's prescription was reasonable and we did not uphold the complaint.

Summary

Mr C was admitted to hospital for a hip replacement. Shortly after his operation, he said that he was in severe pain. Mr C said that he reported this to a nurse who told him that she could not divert from the anaesthetist's pain management plan until she discussed this with him when he was available later that day. The anaesthetist reviewed Mr C several hours later and prescribed a fast-acting morphine tablet. He also prescribed other pain relief, including a slow acting morphine tablet. However, Mr C complained that over the next few days, nursing staff refused a number of requests for pain relief. When his pain levels subsided several days later he decided to make no further requests for this. Mr C also complained that nursing staff failed to accurately record his reported levels of pain and the drugs administered.

We sought independent advice from our nursing adviser. The adviser said that the board's account of the drugs administered after surgery was evidenced by the medical records, although she recognised that pain was subjective and that it can be difficult in some instances to eliminate all pain. The board had also acknowledged this in their replies. We noted that the level of pain Mr C said he experienced was not reflected in the medical records. Having considered the matter carefully, we were unable to reconcile the different accounts of the level of pain experienced, and we did not uphold his complaint. We found that appropriate pain relief was administered in accordance with board policy and the level of pain recorded in Mr C's notes at the time. In addition, we noted our adviser's comments that a balance had to be struck between relieving pain and ensuring a patient was not over-sedated.

Summary

Mrs C said that a family member (Mr A) had been admitted to a community hospital for palliative care (care to prevent or relieve suffering only). She complained to us that a nurse had been very reluctant to ask the out-of-hours doctor to visit, despite Mr A's pain, and that when he did visit, the nurse did not give Mr A the medicines the doctor prescribed.

Our investigation revealed that there had been no clinical reason for the out-of-hours doctor to be contacted and that the medicines he prescribed were strong pain relievers, to be given as and when needed. (Mr A had already been prescribed middle-strength pain relievers and was taking these.) It was clear from the clinical records that there was no reason for Mr A to have the strong ones at the time and that when, a few days later, he was in particular pain, they were given. We took independent advice on the case from our nursing adviser, who said that it is established good practice for medical staff in such a situation to prescribe drugs on a 'just in case' basis, so that nursing staff can assess their patient and administer medicines when required. In conclusion, we considered that the nurse's actions had been reasonable.

Summary

Ms C complained that a hospital appointment she attended was not carried out in a reasonable manner, including that a consultant did not have access to relevant medical records from her previous care and treatment. She also complained that the consultant did not adequately communicate with her GP.

In our investigation, we considered the information provided by Ms C, along with her medical records, as well as obtaining independent advice from one of our medical advisers. We recognised that Ms C was unhappy about aspects of the appointment, but found that there was a clear difference of opinion about what happened and the manner in which the appointment was conducted, which we could not resolve on the evidence available. We found from looking at the records, and taking account of our adviser's view, that there was no evidence that the appointment was not carried out in a reasonable manner. We also found that Ms C's medical history was noted at the time of the appointment, and that the consultant's letter to her GP was reasonable.

Summary

Mrs C complained that, after a day surgery gynaecological procedure, she developed a prolapsed bladder (when the bladder bulges or protrudes onto the front wall of the vagina). She was examined by a gynaecologist who said that the prolapse was mild. She later saw another gynaecologist privately, who said that the prolapse was more significant. Mrs C said that this was an unexpected complication and had happened because the surgeon used excessive force. As a result, she said that she is now more susceptible to infections. She also said that staff knew something had gone wrong during the procedure and that they had concerns about her general health. Mrs C explained that this has been a significant, life-changing event for her, and has had an adverse impact on her quality of life. Mrs C also complained about the board's complaints handling saying they trivialised her complaint and there were inaccuracies, and that the involvement of the gynaecologist in the complaints process was of concern.

As part of our investigation of Mrs C's complaint, we took independent advice from one of our medical advisers. Their advice, which we accepted, was that there was no evidence to link Mrs C's bladder prolapse with the procedure. We also accepted the medical adviser's comments that there was no evidence showing that the surgeon failed to carry out the procedure to a reasonable standard. Although we appreciated that Mrs C had been deeply affected by her experience, we found that post-operative interventions were reasonable and in line with standard practice, and we were satisfied that there was no evidence showing that staff expected Mrs C to experience more than the usual amount of pain from the procedure. Furthermore, we noted the adviser's comments that there was no evidence in Mrs C's records of any concern about her general health condition. In terms of the way the board dealt with the complaint, we were satisfied that they treated it seriously and that any discrepancies about the severity of the prolapse in their responses were not evidence of complaints mishandling. Nor was there any evidence the investigation was compromised by the gynaecologist's role.

Summary

Ms C complained on behalf of her son (Mr A), who is a medical student. She said that the university had not reasonably investigated concerns about her son's attendance before they referred the matter to a progress committee. Ms C said that the concerns amounted to misunderstandings that arose over the evidence of her son's attendance on particular placements, and that there were procedural errors in respect of the committee. She said that her son had not been given clear reasons for the referral to the committee, that the meeting was convened at short notice, and that information available on the day of the committee meeting had not been sent to him in advance. Ms C said her son was completely unprepared for the meeting. The committee decided that Mr A should repeat a year of study.

We did not uphold Ms C's complaints. Our investigation found that the referral to the progress committee was appropriate. Mr A had received a prior warning that any further absence would result in referral, and after this had taken two days sickness absence without following the agreed notification process. We did find that the committee meeting had been convened at short notice, but also that Mr A had agreed to this and had been told that the matter under discussion would be his persistent absence. We found no evidence that Mr A was unreasonably led to believe that only his most recent absences would be under discussion, and it was appropriate in the circumstances for the committee to take account of his full absence history including periods of absence in earlier academic years. Whilst the university ultimately accepted Mr A's account of his attendance on the placements, they considered that it would be appropriate for him to repeat a year of study to gain further clinical knowledge, and to remedy issues in following instructions and fulfilling professional responsibilities.