Not upheld, no recommendations

Summary

C complained about the care and treatment that they received from the board’s neurology department. C had been reporting symptoms to the board for several years before obtaining spinal surgery abroad. After surgery, C experienced improvement in their symptoms. C complained that the board did not reasonably investigate or offer treatment for their symptoms.

We took independent advice from a neurologist and neuroradiologist (a specialist in reading medical images of the spine). We found that the board had reasonably investigated C’s symptoms and offered reasonable treatment for C’s symptoms. We found that there was no missed opportunity to identify any physical problem in C’s spine that may have caused C’s symptoms, based on MR (magnetic resonance, a type of medical imaging) images of C’s spine. Therefore, we did not uphold C’s complaint.

Summary

C complained about the care and treatment that their late parent (A) received from the board. C complained that the board failed to reasonably treat an ulcer on A’s toe or manage their related pain. C also complained that A was unreasonably transferred to a nursing home from the ward when they were too frail and unwell to leave the care of the hospital. C advised that the communication with them in relation to A’s transfer was unreasonable, both in the way the matter was discussed with them by the social worker and as the ward failed to explain that their parent was nearing the end of his life. C said that they were only made aware of this by a GP at the nursing home who explained A was receiving end of life care.

The board's response to C’s complaint confirmed that A had received treatment for their toe ulcer during their inpatient admission, with follow-up treatment planned following their discharge to the nursing home.

On the matter of A’s referral to nursing home care, the board advised that this had been discussed with C by phone. The board said that the documentation of the phone call reflected that C was in agreement with the plan, with the purpose of the referral being to arrange long term care for A. Prior to discharge, A was reviewed by a ward doctor and it was determined that they were fit for discharge based on their improving blood results following a recent chest infection and as their observations were stable. The board expressed regret that A returned to hospital 10 days later having deteriorated since leaving hospital.

We took independent advice from a consultant physician and geriatrician. We found that a plan to manage A’s toe ulcer had been put in place and that they advised that A had received pain relief as required. We considered that the plan of care made by the board was reasonable.

In reference to A’s discharge to the nursing home, we found that this had been arranged in discussion with C, noting that A was not suitable for further rehabilitation, and that their cognitive function now prevented them from living safely at home. We considered the plan of care made for A in terms of their long term care needs was reasonable and in keeping with their circumstances. Therefore, we considered that the care and treatment provided by the board to A had been reasonable. We did not uphold the complaint.

Summary

C applied for free school transport for their child (A) when A was about to begin secondary school. The council rejected this application on the grounds that A did not live within the catchment area of the secondary school they had been enrolled in. A had been enrolled at the school automatically and had not obtained a place by placing request (a request that is made when you are not in the school catchment area). C considered that A should have been provided with free school transport because A had not obtained a place at the school by placing request, and therefore the policy on privilege transport (to those who lived out of catchment) should not apply.

We found that the council's communication surrounding this issue could have been better. However, we considered that the policy on both free school transport and privilege transport had been reasonably applied. This was on the basis that regardless of how A came to be provided with a place at the school, the policy was clear regarding allocation of a transport place to those in a school catchment and those who were not. Therefore, we did not uphold C's complaint.

Summary

C complained that the council failed to obtain planning permission for the extension of a playpark. C said the development of the expanded playpark area required planning permission as it was a material change and was also a bad neighbour development.

We found that the council did not misinterpret law or policy and had proper regard for material considerations. Their decision not to take enforcement action in relation to a slide that required planning permission was also legitimate and took account of material considerations. Therefore, we did not uphold C's complaint.

However, we considered that it would have been helpful if the council's planning services had been involved at an earlier stage in the process and not only at the point that residents started raising concerns. This may have helped to identify issues in relation to the height of the slide at an earlier stage. We provided feedback to the council about this.

Summary

C complained about the care and treatment they received by the board. C was pregnant and called triage as they thought their mucus plug (a protective collection of mucus in the cervical canal) had passed and that they noticed green discharge. C was advised to stay at home and call back if they had further concerns. C went to hospital later that day and underwent an emergency caesarean section to deliver their baby (A). A appeared well following birth, but soon deteriorated. A was initially diagnosed with hypoxic ischaemic encephalopathy (a type of brain damage), and then subsequently diagnosed with quadriplegic cerebral palsy (a lifelong condition that affect movement and co-ordination).

C complained to the board about the advice provided not to attend hospital during the initial call to triage, and about the care and treatment during delivery and immediately afterwards. C believed that clinicians delayed in taking appropriate action in response to A's symptoms and considered this may have impacted their health.

In response to the complaint, the board recognised that C's recollection of the call to triage differed from the notes taken but concluded on the basis of the information available, that the assessment and advice was appropriate. The board gave a detailed account of the care and treatment provided to C and A from C's attendance at hospital, through to delivery and in the period following A's birth. The board explained the decision to proceed to an emergency caesarean section and concluded that this was appropriate and timely. The board also concluded that it was impossible to say if the outcome for A would have been different had C attended hospital earlier, and it was unlikely an earlier birth from the time of admission would have altered the outcomes. C was dissatisfied with the board's response and brought their complaints to our office.

We took independent advice from an obstetrician (specialist in pregnancy and childbirth) and from a consultant neonatologist (specialist in the medical care of newborn infants, especially ill or premature newborns). We found that the call to triage and advice given not to attend hospital was reasonable. With respect to the care and treatment during and following delivery of A, we found that whilst there was some information missing regarding the monitoring of A's heart rate, the decision making regarding the timing of proceeding to a caesarean section and the care immediately following birth was reasonable. A was given appropriate care when their health deteriorated following birth and there was no unreasonable delay in admitting them to neonatal intensive care. Therefore, we did not uphold C's complaints.

Summary

C complained about the care and treatment their spouse (A) received from the practice. A had contacted the practice on several occasions with worsening symptoms including headaches, and problems with vision and mobility. C complained that the practice unreasonably failed to undertake tests or act on results, such as when a discrepancy was found in the power of A's legs. C considered the practice unreasonably treated A for anxiety and failed to recognise there was a serious underlying reason for A's symptoms. A was ultimately found to have a brain tumour and died within a few days of receiving this diagnosis.

In responding to C's complaint, the practice provided a letter each from two of the GPs involved in A's care which explained their decision making in respect of the presenting symptoms at the time. The practice also explained they had undertaken a Significant Adverse Event Review (SAER) of A's case for learning and improvement.

We took independent advice on the complaint from a GP. We found that A had initially been treated for labyrinthitis (an inner ear infection) and urinary tract infection which was reasonable and in keeping with the symptoms reported by A at the time. We also found that after A was given a new prescription for glasses, it was appropriate to trial the glasses for improvement of the symptoms of headache and light headedness on standing. In relation to A's upper leg weakness, we found that this can occur for many reasons and, in isolation, would not suggest a more serious underlying cause. Referring to the working diagnosis of anxiety, we considered that this was not unreasonable in the circumstances.

However, the complaint presents a significant learning opportunity, highlighting the need for recognition that symptoms can deteriorate within a short time, and consideration that confused or difficult reporting of symptoms by the patient could in itself be an indicator of an underlying cause. We considered that the practice had provided a reasonable standard of care to A. Therefore, we did not uphold C's complaint but provided the practice with feedback on guidance on conducting adverse event reviews.

Summary

C, an advocacy worker, complained on behalf of A about the care and treatment they received from the board. A had been referred to the Ear, Nose and Throat (ENT) department when they noticed a growth on their neck. A was diagnosed with a positive squamous cell cancer (type of cancer that starts as a growth of cells on the skin) in their left tonsil which had spread to their neck lymph nodes. C complained about the standard of communication from the ENT department and a failure to provide appropriate treatment which they considered led to A's terminal diagnosis.

The board provided an overview of the care and treatment provided and were satisfied that appropriate care was provided. Due to the metastatic nature (spread) of A's cancer, the only treatment available was palliative. The board also noted there was regular communication with A and they were copied into letters that were sent to A's GP.

We took independent advice from a consultant ENT surgeon. We found that the clinical decision making with regards to treatment for A's cancer was appropriate and clearly set out in the records. While we recognised that A may have been under the impression that their cancer had been successfully treated, we were satisfied that the records documented detailed discussions which took place between clinical staff and A on multiple occasions regarding their diagnosis and treatment plan. We acknowledged it was possible that A may not have understood the complex and technical terminology used, however overall, we did not find that the clinical team failed to communicate with A. As such, we did not uphold C's complaints.

Summary

C complained about the care and treatment provided to their late partner (A) by the board. A had been diagnosed with anorectal cancer which had spread to their liver and was treated over several admissions to hospital. A died while receiving in-patient care. C complained that the board had failed to provide A with reasonable care and treatment while they were an in-patient. C also complained that the board had failed to communicate adequately with them.

The board did not identify any failings in A's care and treatment. However, they apologised for an aspect of their communication with C regarding A's diagnosis. C remained unhappy and asked us to investigate. C complained that clinician's had failed to take adequate action in the face of A's condition and that there had been a failure to provide adequate nursing care for A's stoma. C also complained about aspects of the board's communication regarding A's condition and death certificate.

We took independent advice from a consultant physician in acute internal medicine and a nurse. We found that the clinical and nursing care provided to A was reasonable. We found that the board's communication with A regarding their condition was also reasonable. Due to conflicting evidence we were unable to make findings about other aspects of the board's communication. Therefore, we did not uphold C's complaints but fed back to the board about keeping clear and accurate records of communication.

Summary

C complained that the council failed to undertake a proper assessment of them as a prospective adoptive parent for a foster child placed in their care (A). C also complained that the transition of A from foster care to their adoptive family was unreasonable.

The council said that it was decided that C would not be considered further as a prospective adoptive parent for A based on C's responses to enquiries made of them at the early screening stage and their circumstances at the time. C did not agree with the council's response and brought their complaint to the SPSO.

We took independent advice from a social worker. We noted that the council had acknowledged their failure to ensure sufficient visits with C had taken place. However, we found that the council's decision not to consider C further as an adoptive parent was reasonable and did not uphold this part of C's complaint.

In relation to the transition of A to their adoptive family, we found that this was reasonable and decisions were made with the best interests of A in mind. Therefore, we did not uphold this part of C's complaint.

Summary

C complained on behalf of their parent (A) about the council's investigation of incidents of anti-social behaviour from A's neighbour. C said the council failed to carry out a reasonable investigation which had an adverse effect on A's mental and physical health.

The council's initial response was very brief and simply stated that they had looked over the case notes and spoken with the staff involved. The council did not uphold C's complaint and C brought their complaint to this office. We sent the complaint back to the council and asked them to provide a more full response. The council's second response was more detailed, gave a chronology of events and summarised the action they took each time C, A (or their neighbour) reported an incident. However, it still only gave brief details of the actions taken by the council after each report and failed to evidence that this was in line with their anti-social behaviour policies.

After further enquiries the council provided evidence of the policy and procedure they followed. We found that there were a series of administrative errors on the part of the council and that council records contained inappropriate speculation about A's health and its possible impact on their complaint. Although these administrative failings undermined C's confidence in the council's actions, we found that the council did respond to the complaints of anti-social behaviour in line with their own procedures. Therefore, we did not uphold C's complaint but provided the council with feedback.