Not upheld, no recommendations

Summary

C complained that the council had failed to provide reasonable support to meet their child's (A) educational and emotional needs at school. We noted that the council's procedures regarding their Staged Intervention Framework do not set out specifically what steps will be taken when concerns about a child's learning are reported or what stage of intervention should be applied. The procedures set out the type of support that may be provided. We considered that it would be a discretionary matter for the council regarding the stage of intervention required and the support to provide. We noted that the support that A received appeared to be consistent with the council's procedures.

We did not find evidence of an administrative or procedural failings regarding the support provided to A. In light of this, we did not uphold C's complaint.

Summary

C, an advocacy worker, complained on behalf of their client (A) about the community mental health services provided to A by the partnership. C complained that the consultant's assessment of A was unreasonable as they only met once during a 45-minute consultation. C also complained that the partnership's decision to withdraw their community psychiatric nurse (CPN) support was unreasonable as they had been finding this support to be beneficial.

The partnership confirmed that they were satisfied that the assessment of A's condition was made by a suitably qualified person and they had adequate information available to them in order to reach their conclusions. They explained that the decision to withdraw CPN support was due to A's poor engagement with the supports offered to them.

We took independent advice from a consultant psychiatrist (a doctor specialising in the diagnosis, treatment and prevention of mental ill health conditions). We concluded that the person who assessed A was appropriately qualified to reach their conclusions and the assessment contained sufficient information to support their clinical diagnosis. We also found that the reasons for withdrawn CPN support were reasonable as there was evidence that A was not engaging well with the service. As such, we did not uphold the complaints.

Summary

C submitted a complaint on behalf of their sibling (A). A was treated by the partnership over a period of approximately 18 months under two separate admissions to hospital. C complained about the treatment provided during that time through a number of complaint submissions.

We took independent advice from an appropriately qualified adviser about the complaints.

C complained that the partnership failed to provide reasonable treatment to A. We found that the medication prescribed for A was reasonable, adhered to relevant guidance and was reasonably monitored to ensure treatment benefits were balanced with possible side effects. Therefore, we did not uphold this complaint.

C complained that the partnership failed to provide reasonable care to A. We found that while there was a failing in terms of A's contact with their child, overall the care provided to A by the partnership was reasonable. Therefore, we did not uphold this complaint.

C complained that the partnership failed to use a reasonable level of restraint on A. We found that the use of physical restraint was appropriate and reasonable, was used in accordance with partnership's policies and in accordance with legislation. The adviser considered physical restraint was utilised for the minimum period of time necessary and there were no prolonged periods of restraint. As such, we did not uphold this complaint.

C complained that the partnership unreasonably discharged A after their first admission. We found that the actions taken prior to A's first discharge were reasonable, with the discharge itself well planned and reasonable. They were of the view that risk were identified and the rationale given for discharge balanced the risks with the benefits to A. We considered that the actions taken to mitigate those risks were reasonable. As such, we did not uphold the complaint.

C complained that the partnership unreasonably discharged A after their second admission. We found the partnership's rationale behind discharging was reasonable. We found that communication prior to discharge was also reasonable. Risks were mitigated through supports put in place in the community and A's clinical presentation and the decision to discharge was appropriate, reasonable and made with A's best interest in mind. As such, we did not uphold the complaint.

C complained that the partnership failed to reasonably communicate with A's named carer while A was under the partnership's care. We found, based on the records available, that there was evidence of involvement by A's family and their named carer into the management, treatment, progress and discharge. We considered the medical record evidenced reasonable, regular communication with A's named carer and their wider family, which was in line with expected practice. Therefore, we did not uphold the complaint.

Summary

C held power of attorney (POA) powers for A and complained about the partnership's assessment of the financial contribution they required A to pay towards care at home costs. A received a direct payment from the partnership which helped to pay for a care at home service. A also paid for additional care with personal funds to increase the care received to 24/7. C complained that the financial assessment undertaken was not in accordance with the relevant charging policy and that the partnership failed to take account of the fact that A was paying for a significant amount of their care to ensure they had 24/7 care. The partnership confirmed that they were satisfied that the financial assessments were properly undertaken and the charges applied were in accordance with their charging policy.

C felt that the additional costs A had, by purchasing additional care, should have been taken into account. The relevant guidance only requires the local authority to consider, using their powers to waive charges, if the supported person has difficulty in meeting the approved cost. We found that the partnership had applied the relevant charging appropriately and had explained the rationale for how the financial contribution charged complied with their charging policy. We, therefore, did not uphold the complaint.

Summary

C provides care to their child (A) who is an adult living in their own tenancy. A has a learning disability, is registered blind, has some hearing loss and has epilepsy. A receives care in their property under Self Directed Support (SDS).

C provides care for A when other carers are not present. This is done around C's full-time work. C receives six weeks of respite provision. C has requested an increase in A's support as they are struggling to provide the extra care A needs in their tenancy.

The partnership proposed that A share their two bedroom home with another service user so they could 'pool' their care packages. Alternatively, A could move to a different tenancy with support already in place. C, who holds welfare power of attorney for A, has declined these options, saying A is more settled and confident living alone in their own tenancy.

We took independent advice from a social work adviser. The partnership are obliged to follow the Self Directed Support Act 2013. We found that the parternship had followed that legislation and considered both A's needs and C's needs as a carer. That the available options (sharing accommodation or entering residential care) are not ones C wishes to pursue, does not mean they are unreasonable options in and of themselves. We did not uphold this complaint.

Summary

C complained to us about two matters relating to the partnership. Firstly, they were concerned about an occupational therapy assessment carried out to identify appropriate adaptations for a new property they were being offered, as they did not consider the adaptations made met their needs as a disabled person. Secondly, they were also concerned about a decision made to remove direct payments for support that they had been receiving, as they disputed the partnership's view that these had been improperly managed.

We took independent advice from an occupational therapy adviser, who confirmed that the adaptations made to the new property were appropriate, based on the needs assessments completed. We also found that the records of audits carried out into C's management of the direct payments reasonably evidenced the improper management alleged by the partnership. We considered that the partnership had managed both matters appropriately and did not uphold C's complaints.

Summary

C complained to us that the partnership had unreasonably decided that the overnight support for their relative (A) could be provided by technology in A's home. This had previously been provided by a carer.

We took independent advice from a social work adviser. We found that the partnership had reasonably assessed A's needs; had reasonably addressed the concerns raised by the family; and had reasonably decided to replace the overnight sleepover support with enhanced telecare. We did not find evidence that the partnership had failed to pay adequate attention to human rights considerations. In particular, we were satisfied that they had appropriately considered A's needs and outcomes along with the views of A's family, previous respite carers and appropriate professionals. We did not uphold the complaint.

Summary

C complained on behalf of their client (B) in relation to the care and treatment provided to B's partner (A) whilst A was a patient at Western Isles Hospital.

C complained that the board failed to provide A with reasonable care and treatment whilst A was a patient in the hospital. In particular, C is concerned that venous thromboembolism (referring to blood clots in the veins) testing (VTE) was not carried out and that there was a delay in coagulation screening (screening laboratory tests which allows an initial broad categorization of haemostatic problems). C considered that if reasonable care and treatment had been provided, A may not have died. C also believed that the board did not reasonably respond to their complaint about this matter.

The board noted that whilst a VTE assessment was not performed, and there was a delay in coagulation screening, this would not have altered A's clinical management or have changed the outcome, as A was extremely ill. The board stated that they considered they had reasonably responded to C's complaint.

We took independent advice from an appropriately qualified adviser who determined that although the overall care and treatment offered to A was reasonable, there was learning for the board.

We found that the board had failed to conduct a VTE assessment and had failed to administer a prophylactic dose of heparin on the evening of A's admission which was unreasonable. However, even if a VTE assessment had been carried out, and a prophylactic dose of heparin given, it would not have altered the clinical outcome in this case. We also found that the board's reason for a delay in coagulation screening was reasonable. We, therefore, did not uphold this complaint. Furthermore, we found that the board had reasonably responded to C's complaint. We identified learning for the board which was provided by way of feedback.

Summary

C complained that the Scottish Ambulance Service made the decision that their headache was due to a less serious cause (rather than the serious diagnosis that was later identified), which did not require urgent assessment at A&E. C was also concerned that they were taken to the out-of-hours GP rather than to A&E.

We found that the there was no evidence in the records that the ambulance crew made any decisions about the cause of C's headache. The records indicate that the crew considered the symptoms C was experiencing required hospital assessment.

The records also indicated that a handover was given to a nurse within A&E at the hospital and that the nurse was advised that C had a two day history of headaches. It appeared that the decision to transfer C to the out-of-hours service was made by staff within the A&E department, rather than by the ambulance crew.

We did not uphold C's complaint.

Summary

C complained about the actions of Scottish Ambulance Service (SAS) staff when they attended to their adult child (A) following an epileptic seizure (bursts of electrical activity in the brain that temporarily affect how it works and can cause a wide range of symptoms). A was moved onto a chair to be taken out of the house to an ambulance. When A arrived at hospital they were found to have broken vertebrae (individual bones that interlock with each other to form the spinal column). C complained about the manner in which staff had transferred A and about their clinical assessment of A.

SAS said that staff carried out a risk assessment on how to get A to the ambulance; the moving and handling skills applied were based on the clinical assessment of A and access difficulties at the scene.

We took independent advice from a paramedic. We found that the history assessment and energy involved with A's mechanism of injury made it extremely unlikely to cause a significant spinal injury. Given the age and medical history obtained, there were no risk factors which would lead the paramedic to suspect spinal injury. This, coupled with the restricted space within which they were working, made the use of a carry chair a reasonable means of transferring the patient. Therefore, we did not uphold this complaint.

In relation to the clinical assessment, we found that while A complained of back pain, this was not considered to be a spinal injury. We considered the assessment and management were reasonable for a patient suffering a 'seizure now stopped'. We noted that the paramedic used the finding of motor, sensation and circulation of lower limbs in their risk assessment to help rule out/in spinal injury. Given the history and assessment findings, we considered the care provided was reasonable. As such, we did not uphold this complaint.

We noted there had been complaints handling issues, but SAS had taken appropriate steps to address this and had apologised to C.