Not upheld, no recommendations

Summary
Mrs C was unhappy because the housing association who own the property where she lives were installing new kitchens as part of a refurbishment programme, but were refusing to do so in her property because she had installed a range cooker which was not a standard sized appliance.

The association had also told her that they would not continue to maintain the existing kitchen that had been installed 15 years earlier, as they would not be able to source replacements parts. She was particularly unhappy as she said that other tenants in the area with range cookers had had new kitchens installed.

We found that the association had notified all tenants that as part of the forthcoming kitchen replacement programme, the minimum requirements were to ensure space for standard sized appliances. We found that Mrs C had removed a cupboard and part of a worktop to install her cooker and had not obtained permission to do so, which was in fact in breach of her tenancy agreement.

The association acknowledged that in an earlier phase of the kitchen replacement programme their designer had met with tenants and developed individual layouts but said that this had led to difficulties with new incoming tenants. As a result, the association had decided that in all future phases, only standard appliances would be accommodated in the new kitchen layouts.

We found that the association had acted reasonably in this matter and we did not uphold the complaint.

Summary
Mr C had a history of skin cancer and suffered from a back condition. He complained that the board failed to: make a full and accurate diagnosis of his back condition, provide him with appropriate treatments including alternative therapies, and explain the prognosis. Mr C also complained that the board failed to provide him with a report containing this information to allow him to claim appropriate benefits. In addition, Mr C complained that the board failed to ensure that there was adequate communication between different departments in the board and medical professionals from other boards on the diagnosis and treatment of his condition.

We did not uphold Mr C's complaints. After looking at the clinical records and taking advice from one of our medical advisers, we found that hospital staff did diagnose Mr C appropriately. They also made recommendations for treatment and made him aware of what his condition was and the outlook for it. Mr C had told us that he asked specific staff for a report for benefit purposes at consultations. The board said Mr C did not ask staff for such reports, and we found no mention of this in the clinical records. In addition, the board said that staff were only required to complete reports sent to them by the relevant benefits agency.

We also found evidence in Mr C's clinical records that hospital staff did communicate adequately and in reasonable time, both within the board and with relevant staff from other health boards, about the diagnosis and treatment of Mr C's condition.

Summary
Mrs C complained that her GP practice failed to diagnose that her daughter (Miss A) had hip dysplasia (HD) as a baby. She thought that the GP who had carried out Miss A's hip examination at 6/8 weeks had not done so correctly. Mrs C said that there was a lack of detailed notes as to the precise procedures that the GP said she carried out during this examination, and that the records were not complete.

Mrs C felt that her daughter's condition should have been noticed sooner. She acknowledged that even when checks are carried out properly, the condition can be missed. However, she was also concerned that no further checks were routinely offered. (Miss A's older sister had had a further developmental check when aged between 6/9 months.) Mrs C said that because of this, Miss A had to undergo extensive surgery and rehabilitation when she was two years and nine months old. In her view Miss A's suffering could have been significantly reduced if her HD had been diagnosed earlier.

After taking advice from one of our medical advisers, we did not uphold Mrs C's complaint. Our adviser noted that there were two different accounts of what may have happened at Miss A's assessment and said that the entries in the records were of a normal standard for GP records in Scotland. He also said that the diagnosis of HD can be missed, even when the tests are performed correctly by experienced doctors. The adviser also noted that the timing of developmental assessment checks has changed from when Miss A's sister was assessed.

Based on the evidence found during our investigation, we could not support Mrs C’s view that the practice did not reasonably carry out the six to eight week examination on Miss A or make an appropriate record of that examination.

Summary
Mr C was unhappy with his former GP practice. He complained about his GP's failure to promptly given him hospital scan results, and a failure to refer him to a hospital specialist. He also complained that the practice inappropriately asked him to register with another practice, and that the practice manager failed to investigate his concerns or answer his complaints fully.

We did not uphold any of Mr C's complaints. We looked at the medical records and took advice from one of our medical advisers. Given the circumstances of this case and given that the scan took place because of a referral within the hospital and not from the practice, we did not find it unreasonable that Mr C had to ask the GP about his scan results. After Mr C did so, the GP appropriately gave advice and prepared a prescription. We also found that there was no reason for the GP to refer Mr C to the hospital, as the scan report did not indicate this (which it normally would if required).

Shortly after the consultation, the practice wrote to Mr C asking him to register with another practice nearer to his home, as he no longer lived in the practice's catchment area. Our investigation found that the practice initially appeared to have taken account of Mr C's personal circumstances and allowed him to remain on their list, despite that fact that he was living in temporary accommodation outside their established catchment area. As Mr C remained in temporary accommodation for some time, however, the practice decided that it would be more appropriate for him to register with a practice nearer to his home. We found that, in doing so, the practice acted in line with their guidance.

Finally, we found no evidence that the practice failed to investigate Mr C's concerns or answer his complaints fully. The records showed that they acted in line with their complaints procedure, and based their response on their guidelines, policies, and records of Mr C's consultations.

Summary
Mr C made a complaint alleging that a GP refused to issue a long-term medical certificate; failed to examine and assess his condition and made an inappropriate note in Mr C's medical records. He complained that none of the GPs at the practice have fully examined him or assessed his condition including his level of pain and ability to sit, stand or walk for any length of time.

Mr C has been unwell for some time, firstly with low mood and latterly with back and leg pain. The Department for Work and Pensions (DWP) assessed him as being fit for work as far as his low mood was concerned. Two months later Mr C asked a GP to issue him with a sickness certificate covering a period of four months. The GP declined but did continue to issue certificates for shorter periods.

After taking advice from one of our medical advisers, we did not uphold any of Mr C's complaints. On the issue of the certificate, we found the GP had considered that Mr C's condition would be better managed with regular reviews and so his clinical opinion was that it would be inappropriate to issue a long-term certificate. We found that this complied with guidance from the DWP which says that in the first six months of an illness, certificates can only be issued for a maximum period of three months at any one time (and that this should be the exception rather than the rule). Our adviser agreed with the GP that it was clinically appropriate to monitor Mr C's condition regularly.

Examination of Mr C's clinical records confirmed that Mr C had attended the practice on a regular basis and the records contained evidence of examinations, investigations, referrals to specialists, reviews of medication and trials of therapy.  Our medical adviser confirmed that the records indicated that the GPs had taken appropriate action to review, treat and monitor Mr C's condition.

One of the GPs had put a temporary 'pop-up' note on the practice's computerised records to remind staff that if a telephone request was made for an extension to Mr C's medical certificate for low mood, it was not to be issued. The note was not part of Mr C's actual medical records. Mr C claimed that the note prevented any of the GPs from issuing him with a medical certificate. When we examined Mr C's electronic medical records, we found that the note did not form a part of these, and we found it reasonable that the note was made. Our adviser commented that such notes are normal and considered to be good practice. We found no evidence that this prevented the GPs from issuing medical certificates to Mr C.

Summary
Ms C complained to the Ombudsman about the length of time that her late mother (Mrs A) had been prescribed medication (Mogadon/Nitrazepam). Ms C had read literature which mentioned that Nitrazepam should not be prescribed for more than nine months. She wondered whether the medication could have been the cause of Mrs A's obsessional episodes and led on to her suffering from dementia and Alzheimer's disease.

Our investigation found that medical opinion had changed over the years and that currently it would not be best practice to prescribe Nitrazepam for a prolonged period. However, withdrawal of the medication is quite complex and requires the risks to be balanced against the benefits. In Mrs A's case our medical adviser said that long term prescription of the medication was appropriate.

Summary
Mr C had a number of health problems. When he fell and hurt himself in hospital, a support worker complained on his behalf that the board provided him with inadequate care. As a result of the fall, Mr C hurt his knee, and had mobility problems. Mr C had found it difficult to adopt a comfortable resting position in bed. He said he told nursing staff that he considered himself to be in danger of falling but they did not assist him and were to blame for his fall. Nursing staff said they were concerned that Mr C's position in bed was precarious, so they assisted him to a safer and more comfortable position and advised him not to try to stand up.

We did not uphold this complaint. There was no evidence to support either Mr C's account or the nursing staff's account of this, and so we could not determine exactly what was said. From looking at the records and taking advice from our nursing adviser, we found that the nursing notes did not record staff concerns about Mr C's position in bed, although the adviser noted this may not have been possible on a busy ward. The notes also did not record Mr C's apparent failure to comply with advice from nursing staff. This information was recorded in statements from nursing staff in response to Mr C's complaint. While we accepted our adviser's view about a busy ward, we drew the board's attention to our view that we would normally expect staff concerns to be noted in the records at the time. However, an appropriate risk assessment was carried out and a care plan was in place to look after Mr C, and our adviser concluded there was not enough evidence to suggest that the care provided to Mr C was inadequate.

Summary
Mr C complained that the board failed to provide his daughter (Ms A) with continuous intensive support and treatment for her mental health issues. Mr C said that Ms A had a complicated medical history and had been left with psychological problems that include severe anxiety and obsessive/compulsive behaviour (OCD) and emetophobia (fear of sickness or vomiting) that has a negative impact on all aspects of her daily living. She cannot work or live alone and, two years on, has made little or no progress under the care of local mental health teams at the board despite her trying to work with the partnership team. Mr C felt that Ms A was not given adequate support, or funding for specialist help that he believes she needs at a national unit in London. When Mr C brought his complaint to us he said that the board had not adequately addressed his complaint, appeared disinterested and lacked concern about the situation.

After taking advice from one of our medical advisers, we did not uphold Mr C's complaint. Our adviser considered the management of OCD, and the core interventions and treatment in the National Institute of Health and Clinical Excellence guidelines. He concluded that Ms A was given a suitably intensive service in that she had been offered appropriate interventions. He said that the records showed that Ms A had a number of clear clinical plans of care and had received multi-disciplinary input from a variety of clinicians and services. The adviser also considered there were no unreasonable delays in the provision of treatment. We decided that there was no evidence to support Mr C's view that Ms A had not received a suitably intensive service from the board.

The adviser also said that the general rule that applies both in Scotland and England is that Ms A would only be referred to external services if and when available options within local services were exhausted. We decided that there were justifiable reasons why the board did not refer Ms A to the national unit, as she was at the early stage of her care and treatment when the request was made and the services offered by the board were not exhausted.

We found that Ms A's overall care and level of input from clinicians and services were appropriate.

Summary
Miss C complained about how the board handled her complaint. Our investigation established that there had been some delay by the board in replying but that their complaint file showed that they had been actively working on the complaint the whole time. They had also replied very promptly to two further complaint letters from Miss C on the same subject. Other aspects of their complaints handling were good. For example, it was clear they had investigated thoroughly. Although we would not condone delay, we did not consider, in the circumstances of this case, that there were sufficient grounds to uphold the complaint.

Summary
After a road traffic accident, Ms C attended the accident and emergency department of a hospital. She received care and treatment for her injuries in the accident and emergency department. Within 24 hours she was admitted to a ward for further treatment, then transferred to an orthopaedic ward before being discharged. She continued to be seen by an orthopaedic consultant as an out-patient.

Ms C complained about the care and treatment she received from the board for her injuries arising from the accident and said that she was not kept informed about her condition. She also complained about the board's actions in relation to requests from her insurers and a UK government department for information about her injuries and disability.

We found no evidence to show that the board's care and treatment of Ms C was unreasonable or that they failed to keep her informed about her condition. We also found no evidence that the board responded unreasonably to requests for information about her injuries and disability.