Not upheld, no recommendations

Summary

C complained that the social work service unreasonably failed to carry out an appropriate assessment of their grandchild (A)'s parents. They also complained about the level of support provided to the parents. In particular, C complained that there was too much focus on the past behaviours of the parents, and that social work had unreasonably planned for A to be adopted prior to their birth. C also said a social worker showing bias towards the parents, and that social work had interfered with a housing transfer application.

We took independent advice from a social worker. We found that the assessment of the parents undertaken by social work had been reasonable, noting that the relevant guidance required for the past behaviours of parents to be considered as part of a wider comprehensive assessment to determine future risks to a child. We also found the plan to move A to the adoption register had occurred over a period of time, and we did not find evidence to support C's view that it had been planned prior to A's birth. We considered the overall level of support provided to the parents had been reasonable, including in relation to the housing transfer application. In relation to C's complaint about the social worker, we did not find evidence to support that a full investigation of this point had taken place, and we provided feedback to the council on this matter. Overall, we considered that the assessment and support provided to the parents by social work had been reasonable. We did not uphold C's complaints.

Summary

C complained about the care and treatment provided by the practice. C was diagnosed with polycystic ovary syndrome (PCOS, a condition that affects the function of the ovaries) a number of years ago and had previously had an ovarian cyst removed. Over the following years, C experienced a number of symptoms, including abdominal pain which the practice attributed to irritable bowel syndrome (IBS, a common condition that affects the digestive system). C complained that the practice did not explore a potential link to their PCOS. C attended A&E with severe pain. It was identified that C had a large ovarian cyst which required surgery. C complained that the practice's failure to diagnose the cyst exacerbated their symptoms and led to prolonged pain and discomfort. C also complained about poor postoperative care by the practice.

The practice confirmed they were satisfied that their treatment of C's symptoms was appropriate in the circumstances and explained that the NHS does not offer routine surveillance scans for patients with PCOS or to patients who have a history of cysts.

We took independent advice from a GP. We found that prior to C's attendance at A&E, there was no significant evidence of a cyst and in the absence of any other clinical indication it was reasonable to attribute C's symptoms to IBS. With regard to C's concern about the postoperative care provided, we noted that the practice diagnosed an incisional hernia and referred C to the Surgical Admissions Unit where an ultrasound was carried out but failed to show anything. A subsequent CT scan identified three hernias. We concluded that the GP's presumed diagnosis of a hernia was reasonable and therefore C was appropriately referred to the Surgical Admissions Unit. Overall, we were satisfied that the care and treatment provided to C was reasonable and we did not uphold C's complaints.

Summary

C complained about the care and treatment provided to their spouse (A) by the out-of-hours (OOH) service. A had a headache, temperature and dizziness and collapsed twice. The OOH GP spoke with A and A's family and prescribed painkillers for their headache. A later started hallucinating and the OOH service sent an advanced nurse practitioner who diagnosed A with a urine infection. A was later taken to hospital where they died from organ failure a few weeks later.

We took independent advice from a GP. We found that it was reasonable for the GP have carried out a telephone consultation instead of a home visit and that the telephone assessment conducted appears to have been reasonable. We also considered that it was reasonable for the OOH GP to have obtained a medical history from A and A's family and that given the symptoms described and the results of the urine test, the diagnosis of a urine infection was reasonable, as was treatment with antibiotics rather than admission to hospital. We also found it reasonable that a Significant Adverse Event Review was not considered given that there were no direct issues raised with the OOH service at the time of events.

We did not uphold C's complaint but provided feedback to the board that the notes of the telephone consultation were inadequate given that reasonable record keeping is an integral part of patient care.

Summary

C complained about the council’s Community Care Assessment (CCA) of their young adult child's (A) care and support needs. The CCA recommended that A continue to work with Social Work to meet the family’s desired outcome of A working towards independent living and becoming less reliant on their parents. C complained that the CCA did not take into account all of the information that they had submitted for consideration. In particular, they were concerned that the CCA failed to take account of the family’s home situation and allow for periods of respite for both A and their parents.

The council concluded that the CCA had taken account of, and referred to, all relevant information, including from other relevant council departments and outside organisations. The council were also of the view that the CCA had taken into consideration A’s outcomes, including time that would be neither spent by A at home nor with their parents.

We took independent advice from a social work adviser. We found that the council’s decisions following the CCA regarding respite for A were reasonable, and that they reasonably took account of the family’s home situation.

We found that the CCA was completed following the principles of the relevant legislation and reached a reasonable conclusion. We found nothing to suggest that the council failed to take account of relevant information, or minimised any potential risks to A or others. We did not uphold C’s complaint.

Summary

C complained on behalf of their relative (A) who is an elderly adult with profound learning difficulties and other support needs. C complained regarding the Partnership's assessment of A’s care and support package. The assessment resulted in A’s budget being reduced. The Partnership confirmed that they considered the budget was sufficient to meet A’s identified care needs. They explained that since A’s last assessment, the council had introduced an eligibility criteria and that the recent assessment was undertaken in accordance with the new criteria.

C complained that the Partnership failed to demonstrate how the budget met A’s needs and that the Partnership failed to produce a final support plan.

We took independent advice from a social worker. We found that the assessment was carried out to a high standard and while C and the Partnership were not able to reach an agreement and finalise the support plan, we did not consider the Partnership had failed to demonstrate how the budget proposed would meet A’s needs. We did not consider the Partnership contributed in a significant way to the failure to produce a final support plan and that they made reasonable attempts to work with C and A's guardian in order to produce the final support plan. As such, we did not uphold the complaints.

Summary

C complained about the standard of medical care and treatment provided to their spouse (A). A was diagnosed with, and treated for, advanced breast cancer. A’s condition deteriorated and they later died. C complained that clinicians failed to, amongst other things, act upon A's worsening symptoms or their concerns that their cancer may be spreading. C also raised concerns about the end of life care A had received from the board.

The board, in responding to C’s concerns, did not consider that there had been a failure to act on A’s worsening symptoms. However, they acknowledged incidences where A had not been given the opportunity to bring support to out-patient appointments where clinicians reported a deterioration in their symptoms. They apologised to C for A's poor experiences and agreed to take a number of improvement actions in response. They acknowledged A’s end of life care had been highly distressing for C and their family but did not consider that this had fallen below a reasonable standard.

We took independent advice from a consultation clinical oncologist. We found that the communication surrounding A’s diagnosis and progressive disease could have been better. We also noted a lack of documented Clinical Nurse Specialist support, but overall felt A’s treatment following metastatic (when cancer cells spread to other parts of the body) diagnosis had been appropriate. We did not uphold this aspect of the complaint.

With regards to A’s end of life care, we found that although the board’s handling of A’s DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) and discussions around their deterioration were appropriately documented, the communication around this did not meet C’s own expectations or needs. However, we found no evidence to support that decisions taken in respect of A’s end of life treatment, including their nursing care, had been unreasonable. For these reasons, we did not uphold this aspect of the complaint.

We did, however, provide feedback to the board on complaint handling matters, specifically in relation to adhering to response timescales and updates to the complainant during a complaint investigation.

Summary

C complained about the care and treatment that their partner (A) received during an emergency admission to hospital for treatment of a back injury following a fall at home. During admission, C reported that A’s abdomen became very swollen which they were advised by staff was due to constipation and a build-up of faeces, and which was appropriately being treated with laxatives. A’s condition deteriorated and they were subsequently diagnosed with a perforated colon which required emergency surgery. This resulted in a stoma (a surgically made pouch on the outside of the body) and a prolonged period of recovery in hospital.

C complained that the board had failed to diagnose and treat A’s abdominal symptoms earlier. They considered that this may have resulted in a better surgical outcome for A, with no stoma being required. C also complained that the board failed to identify or treat a deep laceration on A’s arm, and they complained about the board’s failure to respect A’s dignity by discussing personal matters in the open ward.

The board’s response advised that A’s abdominal symptoms were timeously managed and treated, particularly noting that there had been no evidence during the admission assessments of a problem with A’s bowel. The board apologised that A’s arm injury had gone unnoticed and for personal matters being openly discussed, which they had provided as feedback to the ward charge nurse for learning and improvement.

We took independent advice from an upper gastrointestinal and general surgeon adviser. We found that A’s bowel perforation had been timeously diagnosed and treated, and the procedure that they received was appropriate to their presenting condition at the time. In relation to A’s arm laceration, we were critical of the board’s failure to identify and treat this as part of the assessment process. In relation to there being open discussion of private matters on the ward, we acknowledged the apology and action taken by the board in response to C’s complaint. On balance, we did not uphold C’s complaint.

Summary

C complained about the care and treatment provided to their spouse (A). C said that the board’s actions or inactions caused unnecessary suffering and stress to A and their family through misdiagnosis of A’s condition, poor administration of treatment, and failure to provide care in a proper manner whilst following health and safety guidelines.

We took independent advice from a consultant radiologist, consultant in emergency medicine and a consultant oncologist.

We found that, overall, the board provided reasonable care and treatment to A, there were no avoidable delays in A’s diagnosis, and the care and treatment prior and after their diagnosis was reasonable, with the exception of a case of poor documentation on a particular admission and poor communication in relation to A’s diagnosis. We did not uphold the complaint.

Summary

C complained that the council failed to provide their grandchild (A) with reasonable support following an incident at primary school.

It is accepted by the council that the school should have held a second Child Protection Meeting (CPM). This was a clear oversight from the school, and it is not clear why this happened. This oversight led to C not being given feedback from the educational psychologist who had planned to feed back at the next CPM.

We found that the support offered to A was documented, evidence based and well thought out. An educational psychologist did not have any concerns about A, following their observation of them in class, that would have indicated further support measures were needed.

When C escalated their complaint with the council, we found that the council provided reasonable answers to the questions put to them in a reasonable timeframe. When it became clear that a CPM that had been cancelled had not been rescheduled, the council offered a further meeting which we consider was a reasonable remedy in the circumstances. Therefore, we did not uphold C's complaint.

Summary

C complained about the council's drainage assessment for a planning application. They said it only considered the likely impact of flooding on the planning site, with no Flood Risk Assessment (FRA) being undertaken to determine the potential off-site impact of excess drainage on the surrounding area, or downstream from the development site. C advised of there being a noticeable increase of water draining from the site and flooding on completion of the first of the three planned plots, and they complained about the longer term impact on the surrounding pathways including of a bridge which was C's only route of access to their home.

The council's response to C's complaint advised that there had been no known problem with flooding in the local area and that they had referred to SEPA flood maps to inform their decision on the level of assessment required for the application. As flooding was not a known problem in the area, there was no requirement to undertake an FRA for the planning application in keeping with the policies in place at the time. The council also advised any possible solution involving third party land would be a civil matter and not one which the council would pursue.

We took independent advice from a planning adviser. We found that the council had reasonably considered the impact of excess drainage on the area surrounding the planning site in keeping with the guidance. Therefore, we did not uphold C's complaint.