Not upheld, no recommendations

Summary

Mr C, a housing association tenant, had told the association that he was concerned about the quality of the chimney sweeping undertaken by a contractor on the association's behalf. As a result, a technical inspector from the association accompanied the contractors when Mr C's chimneys were swept.

Mr C complained that this sweep of his chimneys was not carried out to a reasonable safety standard, and that a further test related to his chimneys carried out on the same day had not been undertaken properly. The association investigated Mr C's complaints. They advised that the technical inspector had no concerns about the way the contractors had carried out their tasks but, in recognition of Mr C's concerns, agreed that his sweeps would in future be undertaken top down, weather conditions permitting.

Mr C remained dissatisfied and raised his concerns with us. We decided that we could not consider Mr C's specific complaint to us about the test undertaken at his property, as he had not yet made that properly to the association. On the other matter, we did not uphold his complaint. Our investigation found that the association had taken reasonable steps to ensure that the works carried out on their behalf were of a reasonable safety standard, given the view of the technical inspector and the relevant accreditations of the contractor.

Summary

Mr and Mrs C complained that the housing association failed to include a leaflet of conditions when providing an application form for permission to erect a garden shed. Mr and Mrs C completed the form, then went ahead and bought a shed. However, their application was refused as the proposed shed was larger than the permitted size. After complaining to the association about the lack of information about the conditions, Mr and Mrs C complained to us. They also complained that the association failed to investigate Mr C's allegations that other tenants already had oversized sheds.

Our investigation found that it was not possible to say for sure whether a copy of the conditions leaflet was enclosed with the application form. However, Mr C's support worker had been told that a shed should not be built until permission to do so was given. The form that Mr C completed also explained this and asked him, in signing it, to say that he had read and understood the conditions. We also noted that Mr and Mrs C chose to buy the shed before they had the necessary permission. We found it entirely reasonable that the association applied their own policies in terms of the permitted size of garden sheds.

We were satisfied that Mr and Mrs C were told that they should not construct a shed until permission was granted. As a result of this, and as we did not find any evidence that showed that Mr C had reported other tenants with sheds above the permitted size to the housing association, we did not uphold Mr and Mrs C's complaints.

Summary

Mr C suffered a hand injury while he was in prison. He was treated in hospital the day he was injured, when an x-ray showed he had a metacarpal fracture (an injury to one of the small bones in the hand). The hand was strapped up, and he was seen again around a week later, when another x-ray showed the position of the fracture to be acceptable. The doctor noted that Mr C's hand should remain in strapping until the next review appointment. The next month, Mr C complained to the board that his treatment had been inappropriate. He was concerned that strapping rather than a cast was used, and said that he remained in a great deal of pain. He said that his hand was swollen and becoming deformed, with the bone sticking out. Mr C had further appointments over the next three months, and after a CT scan was taken, a hamate fracture (an injury to a small bone on the outside of the wrist) was identified in addition to the metacarpal fracture. He underwent steroid injections for pain management, and was considering surgery.

After taking independent medical advice, we did not uphold Mr C's complaint, as we found that the management of his injury had been appropriate. We found that the use of strapping to allow him to continue to move his hand, rather than a plaster cast, was appropriate for this type of injury. We also found that the hamate fracture could not be detected easily from the initial x-rays due to its position. We found that the shape of Mr C's hand was not due to the bone sticking out, but rather due to the formation of callus (thickened skin) as the injury healed. We also found that surgery at an earlier stage would not have been appropriate because time had to be allowed for healing before surgery could be carried out. We did not uphold the complaint, although we did note some minor issues in relation to the board's response to Mr C's complaint, which we drew to their attention.

Summary

Mr C visited a dentist several times in the summer of 2011 where he had seven teeth removed and two fillings. Around three months later, Mr C was admitted to hospital suffering from fever and was subsequently diagnosed with sub-acute bacterial endocarditis (a chronic bacterial infection of the valves of the heart) and underwent surgery.

Mr C complained that the dentist failed to prescribe him antibiotics despite Mr C having told him that he felt feverish after the first three teeth were extracted. Mr C said that a hospital doctor had commented that patients undergoing any form of invasive dental treatment should be administered antibiotics.

We noted that the dentist treated Mr C for infected sockets in June 2011 by washing them out with an antiseptic solution and packing them with a dressing. This form of treatment is in line with guidance issued by the Faculty of General Dental Practice. National guidance issued by the National Institute of Clinical Excellence recommended that antibiotics were only to be given routinely to a small minority of patients undergoing dental treatment who have a certain heart defect. As Mr C had no previous medical history, such as a heart condition, that would require administering antibiotics before or after the tooth extractions, we considered that the dentist acted appropriately and in line with the national guidelines.

Mr C's dental records showed that he was given antibiotics in July 2011 but there was no reason given as to why these were prescribed. The dentist later explained that they were given because infection of the sockets had persisted, which we considered reasonable.

Mr C's hospital records showed that the endocarditis was caused by Strep Viridans (a bacteria found in the mouth and throat of most people). The bacteria can enter the bloodstream following a dental extraction but is usually killed by the body's immune system in a healthy person. It is normally only a problem for those with a compromised immune system or pre-existing heart defect, neither of which Mr C had at this time. We considered that it was highly likely that Mr C was infected by the bacteria following the dental extractions and that, for unknown reasons, his immune system was unable to respond to the bacteria, resulting in his endocarditis. However, this did not mean that the dental extraction was carried out incorrectly, nor that he should have been given antibiotics.

Summary

At a consultation with her GP, Mrs C said she had swollen ankles. Her GP advised her to stop taking her medication for high blood pressure, which she did. Mrs C was admitted to hospital with chest pain two months after the consultation with her GP and died several hours later. Over time, Mrs C's husband (Mr C) became concerned about a possible link between the medication being stopped and his wife's death.

Mr C complained that the GP's advice was not properly considered or reasonable. He also complained that the practice did not take reasonable steps to monitor his wife's health following their advice that she should stop taking the medication prescribed for high blood pressure.

We found, from looking at the evidence and taking advice from one of our medical advisers, that ankle swelling was a common side effect of the blood pressure medication Mrs C had been taking and, given Mrs C's symptoms, the advice to stop taking blood pressure medication was reasonable. We also found that blood tests were organised after the consultation with the GP, but that there was no clear instruction for a follow-up check of blood pressure. However, blood pressure was monitored at other appointments with staff at the practice, and was within normal limits. It was not entirely clear from the records that this was part of a systematic plan of care that followed from the decision to discontinue the medication. Therefore, we asked the practice to reflect on follow-up arrangements made for patients when medications are discontinued, and to record specific plans for follow-up within the records. However, overall, we found that there was evidence that the practice took reasonable steps to monitor Mrs C's health and we did not uphold Mr C's complaints.

Summary

Mr A's dentist gave him a filling in autumn 2011. This was a very large restoration and Mr A was treated for minor pain over the next few weeks. In early 2012 he returned to the practice with further pain associated with the tooth. The practice told him that the dentist who treated him had left, and had in fact practiced there under his own NHS contract. They offered treatment but told Mr A that they would charge for this. Mr A recalled that his previous dentist had told him that any follow-up treatment required on the tooth would be free of charge, and declined the offer of paid treatment. He returned to the practice the next month and again said that he would only consent to treatment if it was provided free of charge. He refused to sign forms consenting to paid treatment or a medical history form.

Mr A complained about this to the practice, who explained their position and advised that they had taken steps to remove him from their treatment list on the basis that Mr A had lost confidence in them.

Ms C, who is an advice worker, wrote to the local health board on Mr A's behalf and this was passed to the practice for a response. The practice repeated the information they had given Mr A about his treatment and his removal from their practice list. They also offered him the cost of the treatment he had experienced problems with, but noted this was not the full amount he had paid at that time, as that had included treatment for another matter.

Mr A remained dissatisfied and Ms C complained to us on his behalf. We did not, however, uphold the complaint as we decided that there was no evidence of service failure. This was because the practice were correct in saying that the responsibility for treatment lay with the dentist who provided it and not themselves, now that he had left the practice.

Summary

Ms C's mother (Mrs A) was admitted to a hospital accident and emergency department (A&E). In the resuscitation room three gold necklaces were removed from Mrs A, along with other jewellery which was handed to her family immediately. Mrs A was then transferred to another ward, where she passed away. On collecting Mrs A's personal belongings, her family discovered that the necklaces were missing. The A&E department was searched, with the family present, and other departments were contacted but the necklaces were not found.

Mrs A's family complained to the hospital about the loss of the necklaces. In their response, the board accepted that the necklaces had been lost there and noted that the usual procedure of sealing belongings in a bag and giving them to the patient or next of kin had not happened on this occasion, advised that the importance of documenting and caring for patients' belongings had been reiterated to staff and that new labels and a belongings register had been provided in the A&E department. The board expressed their regret at the distress that had been caused and offered their sincere apologies to the family.

Ms C was dissatisfied with this response and complained to us. We decided that the board's response had been reasonable, and did not uphold that complaint. She had made other complaints relating to the loss of the necklaces and the board's investigation, but we could not consider these as they had not yet completed the board's complaints procedures.

Summary

Mrs C complained that the board's rheumatology service (which deals with conditions affecting the musculoskeletal system, including joints, bones and muscles) unreasonably failed to offer an appointment to her mother (Mrs A). Mrs A had slipped at home the previous week, was unable to put weight on her leg, and was in pain and discomfort. Mrs A's GP had diagnosed a 'flare-up' of arthritis. Mrs C phoned the rheumatology service, where her mother had been a long-standing patient, in the hope that they would see her at the regular weekly clinic. Mrs C said that her request was unreasonably refused and that she was told that this was because the service was short staffed and clinics had been cancelled in the unexpected absence of two key members of staff.

The board said that this was not why the request was refused. They said that the specialist rheumatology nurse who spoke to Mrs C refused the request because she did not think that Mrs A's symptoms were consistent with a 'flare-up' of arthritis. The nurse advised Mrs C to take her mother to the accident and emergency department (A&E), or revisit her GP. The board said that, in spite of the lower than usual staffing levels, had Mrs A required a review because of her arthritis, then she would have been offered an appointment at a nurse-led clinic. Five days later Mrs A was admitted to A&E and was discovered to have a fracture.

Although we understood Mrs C's concerns about this, we did not uphold the complaint. This was because it was not possible during our investigation to reconcile the two very different accounts of the same phone call. There was no supportable evidence to suggest that the rheumatology service had unreasonably refused to see Mrs A on the basis of capacity alone, and there were in fact sound clinical reasons for Mrs A to be referred to A&E either directly, or via her GP.

Summary

Mrs C complained about the treatment that her late husband (Mr C) received after he was admitted to hospital with an infected ulcer on his toe. Mrs C also complained that staff did not adequately monitor how much pain her husband was experiencing and did not make adequate arrangements when he was discharged from hospital on three separate occasions, including arranging transport home.

Mr C developed ulcers and ischemia (insufficient blood flow) to his foot and underwent surgery to improve the blood flow through the artery below his knee. He was discharged shortly afterwards but a few weeks later his toe became necrotic (the tissue in the toe died because of a lack of blood and oxygen). Mr C was admitted to hospital again and the decision was taken to observe and wait for auto amputation (for the toe to fall off spontaneously). When the condition of his toe worsened, Mr C had emergency surgery, resulting in some toes being amputated. However, he died a few weeks later. Mrs C said there was an unreasonable delay in fully investigating and treating her husband's toe, which meant he had to have more radical surgery. Mrs C believed that her husband would still be alive if an operation been carried out sooner and had he not been discharged several times.

After taking independent advice from one of our medical advisers, we did not uphold Mrs C's complaints. We found that Mr C received appropriate treatment from a podiatrist (a clinician who diagnoses and treats abnormalities of the lower limb) and that there was no undue delay in referring him to a vascular specialist (a clinician who treats disorders of the circulatory system). The treatment provided by vascular surgeons was also timely and appropriate.

Whilst we identified that on one occasion there was an error with Mr C's pain relief medication, our adviser said that overall his pain was monitored adequately and appropriate pain relief prescribed. Finally, we found that the hospital acted reasonably in not providing Mr C with transport home after he was discharged, as he did not meet the relevant criteria.

Summary

Mr C was discharged from hospital after having major surgery to remove tumours from his stomach area. When the district nurse attended she noted that the wound, which was substantial, had reopened. She called the medical practice to request an ambulance. The GP was visiting patients at the time and could not be located. Mr C's wife said that if the GP could not be located within five minutes she would call the ambulance, which she did. By this time the GP was on his way to Mr C's house but, when he was advised that an ambulance had been called, he returned to the surgery. Mr C complained that the practice did not immediately call for an ambulance.

We took independent advice from one of our medical advisers, who explained that it was reasonable for the GP to wish to assess Mr C before deciding whether an ambulance was necessary. He commented that in this case it was probably necessary, but that it might not have been necessary to call an emergency ambulance. He also pointed out that the district nurse would know that she could call an ambulance directly by phoning 999 if this was required.

As our investigation found that the practice acted reasonably, and as we noted that the ambulance would not have arrived any more quickly had the GP reviewed Mr C first, we did not uphold this complaint.