Not upheld, no recommendations

Summary

Mrs C complained about the care and treatment provided to her late relative (Miss A). Miss A attended the GP practice with an abdominal swelling and was urgently referred to the gynaecology department at a hospital. Surgery was subsequently carried out to remove an ovarian cyst. Over the course of the following year, Miss A attended the practice on several occasions with various symptoms and ultimately attended the emergency department at a hospital. After various attendances at hospital, tests identified that Miss A had advanced cancer and she died within a few weeks. Mrs C believed that tests could have been carried out sooner if the practice had not ignored a family history of bowel cancer.

We took independent advice from GP adviser. We found that, prior to final visits to the practice, Miss A had not presented with symptoms that required urgent investigation or referral to a colorectal specialist (a doctor specialising in the colon and the rectum), in accordance with the relevant guidelines. We considered that there was no indication for genetic screening. We also found that it was reasonable of the practice to accept hospital staff's advice that the ovarian cyst that had been removed was non-cancerous and did not require follow-up. In light of these findings, we did not uphold Mrs C's complaint.

Summary

Mr C complained to us about the fact that his medical practice had not carried out a home visit. He had phoned twice on the same day with severe back pain. The duty GP made a diagnosis over the phone and recommended a course of action, but did not arrange a home visit. The next day, Mr C's back pain persisted and he experienced numbness after suffering a fall. The GP on duty that day arranged for a home visit to be carried out and Mr C was transferred to hospital and subsequently diagnosed with cauda equina syndrome (a disorder that affects the nerves). This required surgery which has left him with ongoing difficulties. Mr C feels that the consequences may not have been as severe had the original GP arranged for a home visit to be carried out. In addition to this, Mr C complained about some aspects of the practice's complaints handling.

We considered the information provided by Mr C and the information provided by the practice. We also took independent advice from a GP adviser. We found that the original duty GP's actions were appropriate on the basis of Mr C's presenting symptoms. When further symptoms developed, it was appropriate to arrange a home visit but it was reasonable not to on the basis of the original phone calls. We concluded that the original duty GP's actions were in line with the relevant guidance and regulations. We did not uphold this aspect of Mr C's complaint.

In respect of the practice's complaints handling, we agreed that there were some measures they could put in place to improve the customer experience. However, we considered their handling and response to Mr C's complaint to be reasonable on the whole. Although we did not uphold Mr C's complaint about this, we did offer some feedback to the board about how they can improve their complaints handling.

Summary

Miss C complained that her GP practice was not recognising her mental health problems and that they refused to carry out home visits. Miss C told us that she believes she has agoraphobia (a fear of entering open or crowded places, of leaving one's own home, or of being in places from which escape is difficult), although she has not been given a formal diagnosis.

Miss C wanted a diagnosis of agoraphobia and also had various concerns about her physical health. Given her condition, she wanted to be seen at home. In their response to our enquiry, the practice confirmed that Miss C had been referred to mental health services and that they had prescribed appropriate medication. They explained that they would always discourage home visits as they are not the correct setting for most medical problems. They said that in Miss C's case, they had concerns about visiting at home due to a mental health assessment which identified a concern that home visits could have a negative effect on Miss C's wellbeing.

We took independent advice from a GP adviser. We found that the treatment provided to Miss C was reasonable and the adviser had no concerns about the care provided by the practice. In relation to the home visit requests, the adviser noted that Miss C had not been diagnosed with an acute mental illness which would stop her from attending the surgery. They said that unless the patient is housebound, patients are best seen in a practice environment. We found that the practice had taken reasonable measures to support Miss C by offering quiet appointment times, phone consultations and offering home visits from a community psychiatric team. We noted that Miss C had declined to engage with services or treatment to help her, and considered that there was no further action the practice could reasonably take. Therefore, we did not uphold either of these complaints.

Summary

Mr C complained about the way the council handled complaints he had made.

Firstly, Mr C complained that the council unreasonably refused to investigate his complaints about a member of staff regarding the treatment of his son at school and the way this had been investigated. We identified that the council had already undertaken a number of investigations in relation to matters concerning Mr C's son's treatment at school and the way in which subsequent investigations were dealt with. This had included some investigation of the member of staff Mr C had specific concerns about. We considered the council's refusal to investigate Mr C's complaints further to be reasonable. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that, when the council contacted him to tell him that they would not be investigating his complaints, they said that they had 'comprehensively' scrutinised his complaints about his son's treatment at school, and the subsequent investigations. Mr C complained that this unreasonably implied that his complaints about the staff member had already been comprehensively scrutinised, and that this was not the case. We considered that the council were referring to matters more broadly, noting that the matters that they said had been comprehensively scrutinised encompassed some of Mr C's concerns about the member of staff. We did not uphold this aspect of Mr C's complaint.

Lastly, Mr C complained that what he considered to be the false implication above had been broadcast by the council to a number of parties in response to an email from him which he had copied to a distribution list. Given that we had not upheld the second complaint above, and had not found that what the council had said was unreasonable, it followed that we also did not uphold this aspect of Mr C's complaint.

Summary

Mr C was concerned that the council had not reasonably assessed whether the structural stability and provision of natural light to his house met the tolerable standard in terms of the Housing (Scotland) Act, and that the council had not reasonably considered whether to exercise powers under the Roads (Scotland) Act in relation to a footpath outside his home.

We found that no request for an assessment of tolerable standard had been made by Mr C, and did not uphold this complaint. We also found that the council had correctly concluded that the Roads (Scotland) Act did not apply to the footpath outside Mr C's house, as it had not been adopted by them and they were not responsible for its maintenance. We did not uphold this complaint.

Summary

Mrs C complained about the council on behalf of her sister-in-law (Mrs A). Mrs C and Mrs A previously lived together in a private let along with their respective husbands and six children between them. Mrs C also provided care for Mrs A. After receiving a notice to quit from their landlord, Mrs A presented as homeless and asked for both family units to be rehoused together. The council advised that they were not able to provide temporary accommodation large enough and would struggle to provide permanent accommodation if they were rehoused together. After carrying out further assessment, including an occupational therapy assessment, the council insisted that Mrs C and Mrs A would have to submit two separate homeless applications. Mrs C complained that they were not able to submit a single homeless application. In addition to this, she complained about the staff attitude and the service they had received from the council.

After reviewing the council's records and the relevant legislation and guidance, we decided that it was reasonable for the council to insist on two separate homeless applications. We considered this to be reasonable as the families had only started living together relatively recently and that, in the council's opinion, there was no clear medical or social care evidence indicating that the families could not live apart. We also found that being rehoused together may result in both families having to stay in temporary accommodation for an indefinite period of time. Therefore, we did not uphold this aspect of the complaint.

In regards to the service received, we found that one record of phone contact used inappropriate wording when describing Mrs C's actions. We highlighted to the council the importance of using neutral, non-subjective language in their records. However, we concluded that there was not enough independent, verifiable evidence to suggest that the council's service was inappropriate or unreasonable. It was also noted that the council had attempted to find a suitable housing outcome for both families. Therefore, we did not uphold this aspect of Mrs C's complaint but did provide feedback to the council about how they record contact with service users.

Summary

Mr C, who works for an advocacy and support agency, complained on behalf of his client (Miss A). Miss A had complained to the council that they should have allowed her an extension to her tenancy to allow her to clear out her belongings when she was vacating her property. She had also complained that the council did not properly charge her for the rechargeable works they carried out to clear the property after she vacated. She also complained that the council coerced her to agree to leaving her belongings and did not disclose to her how much she would be charged for the removal of her belongings.

In their response to Miss A's complaints, the council confirmed that they had extended Miss A's tenancy to allow her time to remove her belongings and that she had not made them aware of any exceptional circumstances to grant a further extension. They did not consider they had coerced Miss A to agree to leave her belongings and they believed that the works carried out to clear her property were properly incurred given the condition of the property at the time. They did, following an inspection of the invoiced works, reduce the amount due by Miss A as they identified works that she should not be responsible for. Miss A was not happy with this response and Mr C subsequently brought her complaints to us.

We established that the council had provided Miss A with an extension of two weeks to her tenancy. We did not find any record of Miss A noting any exceptional circumstances to the council at the time, indeed Miss A had communicated to the council confirming the dates by which she would remove her belongings. On this basis, we concluded that the council had provided Miss A with an extension to her tenancy and had acted reasonably in the circumstances. With respect to the rechargeable repairs carried out by the council, we saw evidence that the property was inspected and that Miss A was aware of the works she was to carry out prior to leaving. We were satisfied that photos of the property provided evidencing the condition of the property when Miss A left, together with the details of the inspection, indicated a significant amount of work needed to be undertaken to clear the property. We found that the council acted correctly in reducing their invoice following the complaint made by Miss A, but we were satisfied that the works completed were reasonable and reflective of the condition of the property. As such, we did not uphold Mr C's complaints.

Summary

Due to raised levels of carbon dioxide in her home, Miss C was decanted to a new permanent home by the housing association. She complained to us that the association failed to manage her decant in line with their policy and that they failed to communicate with her in an appropriate manner throughout the process.

The association told us that, at an early stage of the carbon dioxide incident arising, they identified that they did not have a policy on decant and home loss allowances which covered an incident the scale of that experienced by Miss C. They took steps to put one in place and confirmed that they took guidance for the amounts to offer for home loss and furnishings from Shelter (a charity which offers advice and advocacy regarding poor housing) and other housing associations. The association also explained that they agreed with Miss C what work they would complete in her new home. In addition, Miss C received the appropriate home loss payment and she also received additional payments for replacing her floor coverings and curtains. The amounts Miss C received were in line with the allowances set out in the association's decant policy. As such, we did not uphold Miss C's complaint that the association failed to manage her decant in line with their policy.

We also did not identify any evidence to suggest the association failed to communicate with Miss C in an appropriate manner throughout the process. We saw evidence that staff had taken reasonable steps to keep in contact with Miss C throughout the process. In light of the evidence available, we did not uphold Miss C's complaint about the association's communication with her throughout the process.

Summary

Mr C complained that the council unreasonably prevented him from having contact with his mother who was living in a care home. The council informed Mr C that his mother did not want to see him and continued to prevent contact after his mother was assessed as not having capacity. Mr C believed his mother did have capacity and that she had expressed wishes that she wanted to see him.

We took independent advice from a social worker. We found that, when Mr C's mother first said she did not want to see her son, she had the capacity to make that decision. When Mr C's mother showed signs of confusion and disorientation, the council took the appropriate action and arranged for a consultant psychiatrist to assess her capacity. Mr C's mother was found to not have capacity to make decisions about her welfare. The adviser noted that the council acted appropriately following this result and arranged an Adult Support and Protection case conference to discuss whether Mr C should continue to be prevented from having contact with his mother. We found that the council thoroughly considered this matter and that their decision was reasonable. We did not uphold Mr C's complaint.

Summary

Mr C complained about a consultation he had at the fracture clinic at Perth Royal Infirmary and the following care and treatment he received. Mr C was referred to the clinic after he fell and injured his hip. Prior to attending the consultation, an x-ray of Mr C's hip had been arranged by his GP, whilst an MRI scan had been carried out privately. Mr C brought the written MRI report to the consultation, but did not bring the imaging CD. After examination, the surgeon decided that conservative treatment (medical treatment avoiding radical therapy or an operation) was appropriate and they arranged to review Mr C in three months' time. Mr C obtained a different opinion on the treatment of his injury from a surgeon at a different NHS board. Mr C then agreed to have surgery on his hip at this same NHS board and said that this improved his condition.

Mr C raised concern that the surgeon at Perth Royal Infirmary failed to carry out an appropriate assessment of his condition. Mr C felt that the surgeon should have reviewed the MRI images and spoken to the radiologist who carried out the MRI privately. We received independent advice from a consultant orthopaedic surgeon. They said that Mr C was responsible for providing the MRI images, if he wished for them to be considered. The adviser considered that the assessment carried out was reasonable, and we did not uphold the complaint.

Mr C also complained that the board had failed to provide him with the same care that he subsequently received from another health board. In response to our enquiries, the board said that, based on the information available to them, they could see no reason for surgery and were satisfied that conservative treatment was appropriate. The adviser was satisfied that the surgeon's diagnosis was reasonable and consistent with Mr C's symptoms and the radiological findings. The adviser said that it was appropriate for the surgeon to arrange to review Mr C again, but suggested that an earlier review might have been more reassuring for Mr C. The adviser did not consider the different treatment by another NHS board to reflect failure in care on the part of the board, and they were satisfied that the care and treatment provided by them was reasonable. We did not uphold this complaint.

Finally, Mr C raised concern about the quality of the board's complaint investigation. We found that the board's complaint response did provide an explanation about the surgeon's findings and a reason for the treatment they suggested. We noted that an independent clinician had reviewed the surgeon's findings and the medical records, which informed the board's response to the complaint. We were satisfied that the approach taken to investigating the complaint was reasonable, and we did not uphold this complaint.