Not upheld, recommendations

Summary

Mr C was referred to the ear nose and throat (ENT) department at the board by his GP following symptoms of hoarseness. He was examined at an out-patient appointment where no sinister findings were identified and was discharged back into the care of his GP. Mr C's symptoms persisted and his GP made a further ENT referral. This was assessed by a consultant who made a referral to speech and language therapy (SALT). Mr C was seen at a SALT out-patient appointment some time later and potential malignancy was identified in his voice box. An appointment with an ENT consultant was arranged for the following day. Mr C was subsequently diagnosed with cancer and underwent surgery to remove his voice box. Mr C complained that a proper examination had not been carried out during his initial appointment, that it was inappropriate to refer him to SALT following the further referral from his GP and that there was an unreasonable delay in offering him an ENT appointment following the further GP referral.

After taking independent advice from an adviser, who is a consultant surgeon specialising in head and neck cancers, we did not uphold Mr C's complaints. The advice we received was that all necessary examinations had been carried out during the initial appointment and that it was appropriate to refer Mr C to SALT following the further referral from his GP. We found that there was no reference in the ENT consultant's referral to SALT for follow-up after the assessment but noted that Mr C had had an ENT consultation the next day in any case. We made a recommendation to the board to draw the adviser's comments on this to the attention of the ENT consultant.

Recommendations

We recommended that the board:

• make the relevant consultant aware of the adviser's comments on ENT follow-up following SALT referrals and recording neck examinations.

Summary

Mr C complained about the teaching and assessment of a module on his course. He also considered he was treated unfairly and with bias which he said had caused him stress and impacted on his studies.

Mr C complained to the university following the outcome of an academic appeal which was partially upheld. Of the sixteen points of complaint considered, one of the points of complaint was partially upheld, and a recommendation was made for an external independent assessment of Mr C's work on the module to be carried out.

We were satisfied that the university had carried out a proper and thorough investigation of Mr C's complaint including a serious allegation concerning the alleged conduct of a member of staff towards him. We also were satisfied that Mr C's personal circumstances were taken account of.

We also considered whether there was any unreasonable delay by the university in carrying out their investigation of Mr C's complaint. While we accepted there was a delay, we did not consider this was unreasonable given the extent of the investigation carried out and as Mr C had been notified that there would be a delay and the reason for this.

The university told us that there is no requirement under their complaints handling procedure for meetings which take place as part of an attempted frontline resolution of complaints to be documented, nor would it be practical to do so. It was also not departmental policy to record meetings which academic staff have with students to try to ascertain and resolve a student's concerns. However, we are of the view that where a student raises a complaint at a meeting with a member of the university staff, in particular where a potentially serious allegation is made about the conduct of a member of staff, this should be recorded.

Recommendations

We recommended that the university:

• give consideration to staff documenting meetings they have with students where a complaint is raised.

Summary

Mr C's daughter (Ms A) was admitted to Ninewells Hospital three times with severe abdominal pain and swelling accompanied by nausea. Investigations and tests were negative. Mr C complained that Ms A was discharged from hospital unreasonably, and that doctors failed to reach a diagnosis, which led to a great deal of anxiety for Ms A and her family. As a result, Mr C said that Ms A’s health deteriorated.

We took independent advice from a medical adviser who is a specialist in gastroenterology (medicine of the digestive system and its disorders). We found that the board properly investigated Ms A's symptoms, and that the decision to discharge her on each occasion was reasonable because no abnormalities were found. The adviser said that a diagnosis had been reached by doctors. However, we found that this was not clearly relayed to Ms A so we understood Mr C's position that doctors had failed to reach a diagnosis. We therefore made a recommendation to put this right.

Recommendations

We recommended that the board:

• bring the adviser’s comments about functional disorders to the attention of relevant staff; and
• offer to meet with Ms A to fully explain the reasons for the referral to a chronic pain team.

Summary

Mrs C and her husband were participants in an egg-sharing programme (as donor) in the Assisted Conception Unit at Ninewells Hospital. As part of the programme, after fertility treatment, Mrs C retained some of her eggs and some were donated to a recipient. Mrs C complained that the care and treatment given to her was unreasonable, and that staff were primarily concerned with the recipient. She said that communication with the staff was also unacceptable, and that she was given information despite saying that she did not want it. She believed she had been looked down upon.

We obtained independent advice from a consultant obstetrician and gynaecologist (a doctor specialising in pregnancy, childbirth and the female genital tract) who was a reproductive medicine specialist. We found that all of Mrs C's treatment had been conducted in terms of the Human Fertilisation and Embryology Act code of practice. While there had been a slight delay in providing part of the treatment, this had been because the recipient's and Mrs C's menstrual cycles had to be synchronised. The delay was unavoidable. Similarly, the code of practice had been followed with regard to communication with Mrs C, but it seemed that she had not fully understood. We noted that the board had since made changes to prevent a similar occurrence. Mrs C's complaint was not upheld.

Recommendations

We recommended that the board:

• apologise for the delay in responding to the formal complaint.

Summary

Ms C had gallbladder surgery at the Victoria Hospital. She was discharged without further follow-up but started to experience pain from a wound site. She was referred back to the board by her GP and had further surgery to address this. She was discharged the same day by nursing staff. Ms C complained that she had not been given a follow-up appointment following her initial surgery. She complained that her discharge at the second procedure was inappropriate as she was not reviewed by a member of the medical team. Ms C was also concerned that the board had failed to provide her with appropriate treatment following a further referral from her GP.

After taking independent advice from a nursing adviser and a consultant surgeon, we did not uphold Ms C's complaint about discharge. In relation to her concerns about the lack of follow-up after the first surgery, the surgical adviser confirmed that it is established practice not to offer a clinic appointment in such cases. Regarding the second procedure, we found that it is normal practice for patients to be discharged from day surgery cases without being seen by a doctor. The nursing adviser confirmed that appropriate checks had been carried out before Ms C's discharge. We noted that the board had taken learning from Ms C's complaint and were addressing her concerns about information that was provided to patients at discharge. Although we did not uphold this complaint, we made two recommendations to the board about the action they have taken.

We also did not uphold Ms C's complaint about the treatment she received following her GP referral. The surgical adviser considered that this had been appropriately managed.

Recommendations

We recommended that the board:

• provide evidence to confirm what action has been taken to improve the provision of information to patients on discharge; and
• advise us on the outcome of deliberations on offering patients the choice to see a doctor before discharge.

Summary

Mr C complained about Business Stream's handling of his application for a reduction in the return to sewer (RTS) rate applied to his business. In particular, he was unhappy that the calculations submitted with his application had been rejected and that Business Stream did not clarify why the information provided was not acceptable. He also complained that Business Stream, who had advised him of the need to install sub-meters to record the volume of water used, had failed to provide adequate guidance on how to install the sub-meters. Mr C was also dissatisfied that Business Stream would not consider backdating any reduction in the RTS rate to a date before his most recent application. Finally, Mr C was unhappy with Business Stream's handling of his complaint.

We found that the application for a reduction in the RTS rate had been made on Mr C's behalf by an experienced representative. We found that Business Stream had provided information on the need for sub-meters, and had explained why the information provided in the application was inadequate to award a reduced RTS rate. However, during our investigation Business Stream accepted that they could provide more general information to the public on the RTS allowance, and that they could have provided more in-depth information on the need to install sub-meters. Based on the available evidence, we were satisfied that Business Stream were acting in line with their policy about the effective date for a reduction in the RTS rate.

We were also satisfied that, in general, Business Stream had responded to the representations made and had responded to the formal complaint in line with their complaints process.

Recommendations

We recommended that Business Stream:

• consider providing more general information regarding RTS and the type of evidence which should be supplied with any application.

Summary

Mrs C complained about Business Stream's charges. She had owned a farm and had paid for its water consumption but, more recently, had sold part of the land to a third party as a residential property. Mrs C was unhappy that Business Stream had not removed water charges from her bill (for the land she still owned) that would account for the usage of the residential property. She was also unhappy that Scottish Water – the water wholesaler in Scotland - would not adopt the private water meters she had installed.

Business Stream's position was that the issue would not have arisen if, before selling off a portion of her land, Mrs C had amended her private pipe work or arranged new connections. Although we recognised that she may not have known initially about the possible problem, Business Stream's records indicated that they had made Mrs C aware of it. There was no record confirming that she had been told the average consumption of the property she had sold off would be removed from her charges.

As part of our investigation we contacted Scottish Water about possible options for future charges. They raised the possibility of deducting an average household's usage (as distinct from the usage of the specific type of property that was sold), or of them installing a sub-meter. Although we could not comment as to whether such steps would be practical or appropriate in the circumstances, this did not reflect Business Stream's position in their correspondence with Mrs C. However, Scottish Water were clear that the possibility of installing a sub-meter was a move from their traditional position. As we did not use the benefit of hindsight in considering Mrs C's complaint, there was nothing to indicate that Business Stream misadvised Mrs C or were inconsistent given the information available to them at the time. As a result, we did not uphold Mrs C's complaints but, as the underlying position with Scottish Water appeared to have since moved on, we made two recommendations.

Recommendations

We recommended that Business Stream:

• liaise with Mrs C and Scottish Water to explore the relevant options for future charging; and
• liaise with Scottish Water about the installation of sub-meters to ensure up-to-date information is being provided.

Summary

Mr C said the council did not properly consider the local plan, or his objections, when approving a planning application for a nearby development. He also considered that the development did not comply with conditions on the planning approval, and was concerned that the council was not taking formal enforcement action.

The council said the planning officer's report showed they had considered Mr C's objections and the local plan in determining the application. While the council agreed that parts of the development did not fully comply with the approved plans, they said they were taking action to address this. This action included works to improve road safety, as well as requesting a new planning application for parts of the development which had not been built according to the plan. However, the council said they would not consider formal enforcement action until the development was complete (including the approved amendments). The development was completed during our investigation, and the council then issued a formal enforcement notice.

After taking independent advice from a planning adviser, we did not uphold Mr C's complaints. We found that the council had considered all of Mr C's objections and the local plan in determining the application. In relation to enforcement, the adviser said it was reasonable for the council to wait until the development was fully completed before considering formal action. The adviser also explained that the council has a broad discretion in deciding what (if any) enforcement action to take and, therefore, we found the council did not unreasonably fail to enforce the planning conditions. However, we found that on one occasion the council delayed unreasonably in following up action they told Mr C they would take. We also found that one of the planning conditions was unclearly written, and the council acted inconsistently in deciding that the condition was met, although the actual works it specified had not been carried out.

Recommendations

We recommended that the council:

• apologise to Mr C for the unreasonable delay in following through the actions they told him they would take;
• remind relevant staff of the Scottish Government's guidance on planning conditions relating to precision and enforceability; and
• ensure our findings about the inconsistent approach to condition three are fed back to both planning and transportation staff for learning and improvement.

Summary

Mrs C complained to us about some dental treatment she had at the practice that she had been referred to. She had a wisdom tooth removed, and during the process, a filling came out of the adjacent tooth, and part of the tooth broke off. The dentist advised Mrs C to see her own dentist to have the damaged tooth seen to. Mrs C complained that the treatment on her wisdom tooth must have been done badly, otherwise the neighbouring tooth would not have been damaged.

We took independent dental advice in relation to Mrs C's dental treatment. Our adviser noted that both Mrs C's dentist and the dentist carrying out the extraction had told her that she had tooth decay. He said that this made her teeth more vulnerable to damage during a dental procedure. He also noted that Mrs C had been told that the procedure of removing her wisdom tooth involved some risk of damage to adjacent teeth. However, there was no evidence that the tooth adjacent to the wisdom tooth was known to be decayed, and there was no record of Mrs C being warned of the risk to this tooth in particular, given its proximity to the wisdom tooth.

We concluded that there was no evidence that the dental treatment had been carried out inappropriately, so we did not uphold the complaint. However, we were critical that the records indicated that the dentist had not been clear during the consenting process of the risks to the adjacent tooth, or noted specifically whether there was any decay in that tooth.

Recommendations

We recommended that the board:

• feed back the findings of this investigation to the staff involved, for reflection and learning, particularly in relation to ensuring patients are fully informed of the risks of a procedure, and that appropriate records are kept; and
• apologise to Mrs C that they failed to give clear information about the risks involved in the procedure when she was giving consent.

Summary

Ms C complained that a GP and a nurse had acted unreasonably by failing to provide treatment to remove ear wax. Ms C had attended the practice on three occasions with compacted wax. Initially, her ears were not syringed as it was suspected she may have had an infection. On the third occasion, she was referred to a community-based NHS treatment area for ear irrigation, however, there were no appointments available in the following month. We sought independent advice from one of our nursing advisers. Our adviser found that the evidence indicated that the care and treatment was reasonable and in keeping with best practice. We did not uphold the complaint.

Ms C also complained about the way the practice had handled her complaint. Specifically, she was unhappy that there had been a delay in responding to her complaint, and that the response she received to a 16-page letter was inadequate. Ms C sent two letters - the first was responded to within 20 working days. The second (which raised some new issues) took three months to respond to. We recommended that the practice apologise to Ms C for the delay in responding to her second letter. Following careful review of the practice's response to Ms C's 16-page letter, we concluded that the response was appropriate and adequate. We considered that the overall handling of the complaint was reasonable and, therefore, we did not uphold the complaint. However, as the practice's complaints handling procedure was not in line with Scottish Government guidance, we made a recommendation to address this.

Ms C also complained that a member of reception staff failed to tell the truth about what had happened when Ms C returned to the practice after visiting the NHS treatment area. She was also unhappy that the receptionist discussed confidential information in the waiting room in front of other patients. There was no objective evidence to support Ms C's version of events and, therefore, we could not uphold the complaint. We were pleased to note that the practice had issued reminders to staff about patients not being led to believe that discussions have occurred when they have not. The practice had also reminded staff that discussion of sensitive and confidential information should take place in a private area of the practice.

Recommendations

We recommended that the practice:

• ensure the complaints handling procedure is fully compliant with the Patient Rights (Scotland) 2011 Act and the Scottish Government's 'Can I help you?' guidance; and
• apologise to Ms C for the delay in responding to her second letter.