Not upheld, recommendations

Summary

Mrs C complained on behalf of her brother (Mr B) about the care and treatment his late partner (Ms A) received following a diagnosis of colorectal cancer.

Ms A's family said that had she received treatment sooner, the progression of the cancer could have been slowed. They also questioned whether shrinking her tumour with radiotherapy and concurrent chemotherapy was the best course of action, or whether the tumour should have been removed upon its discovery.

Ms A's family also complained there had been a failure to reasonably communicate her condition and prognosis throughout her care. In particular, they said that Ms A's consultant said she would be free of cancer by a certain date only later to be told her cancer had spread.

We took independent advice from a colorectal surgeon who said Ms A's treatment, based on her symptoms and condition at the time, was timely and had also been carried out within the appropriate national cancer treatment guidelines. The adviser also said the scans taken of Ms A were appropriate and the decision to use chemo-radiotherapy to shrink the tumour was the most reasonable treatment option and in line with the applicable guidance.

We accepted that Mr B and Ms A believed that when they met with the consultant they were told she would be free of the cancer by a certain date. The board, however, said that the consultant would not have given Ms A this information. We consider that it is essential that communication at an important consultation when there is discussion about a patient's prognosis is clear and the patient clearly understands what is being said. It was unsatisfactory this did not appear to have happened in this case. Given the different accounts and in the absence of further evidence, we were unable to conclude that the consultant miscommunicated Ms A's diagnosis during the consultation, but we made a recommendation about communication.

However, taking account of the evidence overall, on balance we did not find there was a failure by the board to reasonably communicate Ms A's condition and prognosis throughout her care, so we did not uphold Mrs C and Mr B's complaints.

Recommendations

We recommended that the board:

• ensure this case is discussed with the consultant as a learning point and consideration is given by them to undertaking communication training as part of their continuing professional development.

Summary

Mrs C complained about the council's handling of complaints about some of their tenants in a neighbouring property, which was used by the council to temporarily house homeless households from 2011 to 2014. Mrs C complained about the way her complaints were handled by the council and, in particular, that the council had failed to investigate the issues raised and had failed to keep her advised of the progress and outcome of their investigations.

Our investigation found that concerns were raised about the tenants of the neighbouring property during 2011, and that the council explained the action they had taken. Incidents continued to be reported to the council, and the council continued to investigate these incidents and take action that they considered appropriate.

The council said they accepted that, during the time they had used the property, residents in the neighbouring block had had cause to complain about anti-social behaviour. They indicated they were sorry for the distress and inconvenience caused, and decided that the property would be returned to the owner and would no longer be used by the council to accommodate homeless households.

We were satisfied that the council took action on the incidents reported and kept the complainants informed of the action taken. While we did not uphold the complaint, we did find that it would have been helpful to support Mrs C by issuing her with an incident diary.

Recommendations

We recommended that the council:

• ensure that they adhere to their procedures in relation to the issue of incident diaries where appropriate.

Summary

Ms C complained to us on behalf of her partner (Mr A), who had a history of gastroenterological problems (problems with the digestive system). Ms C had previously complained to the board about the care and treatment that Mr A was receiving from them. Ms C then made a second complaint which was considered during this investigation. Ms C complained that the board had not provided reasonable care and treatment to Mr A in the period covered by the complaint. Ms C was dissatisfied that they had been unable to reach a diagnosis for Mr A's condition, and was also concerned that her previous complaint had impacted on the subsequent care that Mr A received.

After taking independent advice from one of our medical advisers, who is a gastroenterology consultant, we did not uphold this complaint. The adviser considered that, overall, the care and treatment provided by the board was reasonable. We did find that the doctor/patient relationship with one of the consultants who had been treating Mr A had broken down. Following this, although a letter was sent to Mr A's GP explaining the situation, the consultant did not arrange a referral to another consultant. The adviser said this had no impact on Mr A as the GP made a referral instead, but we have made a recommendation to draw this point to the attention of the relevant consultant. We found no evidence that Ms C's prior complaint had affected the medical treatment provided to Mr A.

Recommendations

We recommended that the board:

• bring the adviser's comments about onward referral when the doctor/patient relationship has broken down to the attention of the relevant consultant.

Summary

Mrs C's late husband (Mr C) was receiving treatment for prostate cancer and had a history of severe allergic reactions. Mrs C complained that, when his condition deteriorated, specialists at the Western General Hospital failed to take into account concerns that the medication to treat the cancer was the cause of the problems. Mrs C said doctors did not listen to her concerns; she said Mr C rapidly deteriorated and then died following a heart attack caused by an allergic reaction to the medication. Mrs C said that she and her husband were not warned about possible side effects of the medication and staff failed to take reasonable action to resolve matters.

We took independent advice from one of our medical advisers. We found that the care and treatment provided to Mr C was reasonable overall and, in particular, that the treatment decisions and management were reasonable. We also found that Mr C died because of heart disease, and there was no evidence that he sustained allergic reactions to the medication prescribed. However, we found that there was a lack of evidence showing that possible side effects of the medication was explained to Mr C at the outset of the process, and so we made a recommendation.

Recommendations

We recommended that the board:

• bring the failing in record-keeping to the attention of the healthcare professionals involved.

Summary

Mr C and Miss A complained about the care and treatment Miss A received during her antenatal period. In particular, they were concerned that their baby had been born at home rather than in hospital as planned. They complained that the responsibility for the birth of their baby occurring at home lay with the board and that the board had failed to stay in control of the birth. They were also concerned about the advice given when they contacted the Maternity Assessment Unit (MAU) at the Princess Royal Maternity Hospital (the hospital) just hours before the birth of their son. Miss A and Mr C also complained about the board's handling of their complaint.

We took independent medical advice from one of our advisers, a consultant obstetrician. We found that the care and treatment given to Miss A during her antenatal period was reasonable and appropriate and that appropriate observations were made at each antenatal clinic attendance which had occured at appropriate intervals. We also found that the advice given by the midwife when they contacted the MAU at the hospital was acceptable and appropriate.

When responding to their complaint, we found that the board had accepted that Miss A and Mr C had experienced poor communication during the antenatal period and following the birth of their baby. The advice we received was that the board had also provided a reasonable and appropriate response to the issues raised by Miss A and Mr C. The board explained that the concerns about communication had been discussed with staff. While we recognised that the board had already apologised to Miss A and Mr C, we made one recommendation.

Recommendations

We recommended that the board:

• provide details on the action taken in this case to ensure improved communication with patients and their families.

Summary

Mr C, who owns a small business, complained to us about the installation of a water meter at his business premises. The water meter was fitted in 2007. Several years later there was a leak on a pipe on land to the rear of Mr C’s property. This pipe turned out to be connected to Mr C’s supply pipe, and he was charged for the water as it had run through his meter. Mr C said that Scottish Water should have surveyed his property when his meter was installed.

In their response, Business Stream said that they were not responsible for leaks in supply pipes on private property. They said that there were no records remaining in relation to any survey of the property in 2007. They had reduced Mr C’s bill in relation to the waste water that had not returned to the sewers, and also made him a goodwill payment. However, they did not consider that they had any responsibility to cover the excess water costs.

While there was evidence of injustice, in that Mr C had to pay for water relating to a leak over which he had no control, we did not consider that Business Stream could be held responsible for this. On this basis, we did not uphold the complaint. However, we were concerned about the inconsistency of information held by both Business Stream and Scottish Water in relation to investigations and site visits at Mr C's property, which had led to the matter being unresolved for a number of years. We also found that both organisations had unreasonably expected Mr C to arrange access to other properties to allow them to carry out further investigations and had unreasonably sought evidence from him of repairs to the pipe when Mr C had consistently explained he did not hold this information. Given the inadequate way Mr C's complaint was dealt with, we made the following recommendations.

Recommendations

We recommended that Business Stream:

• waive the outstanding disputed amount on Mr C's account; and
• conduct a review of how they handled Mr C's complaint to identify service improvements for their complaints handling which can be implemented for the future.

Summary

Mrs C made several reports to the council about anti-social behaviour by a council tenant and her visitors. She complained to the council that they had not taken sufficient action to protect her and asked that they investigate her complaints. The council responded that support services had been involved and that, as there had been no recent reports of anti-social behaviour, they had closed their case. They also said that they had repaired the damage to their tenant’s door after the most recent incident. Mrs C was not satisfied that they had done all that they should to resolve the problems she and her neighbours faced.

We investigated the complaint and the council provided their records. We recognised that, due to confidentiality, the council had not disclosed to Mrs C details of the action taken in response to her complaints. As a result, Mrs C had gained the impression that insufficient action was being taken. However, in response to our enquiries, the council provided us with information about their action.

We recognised that, as it had been agreed that Mrs C would report any incident verbally, the council had not provided an incident diary. However, we felt that the council should have considered the use of such a diary, as this would have enabled Mrs C to have a written statement of the incidents. In addition, while there had been a delay in completing all the repairs to the door, these had now been completed.

While we recognised that Mrs C was only provided with limited information on the action being taken by the council, we were satisfied that, based on the available evidence, the council took reasonable action to address the complaints received. We did not uphold the complaint.

Recommendations

We recommended that the council:

• consider the use of diary sheets in similar situations, in line with the procedures.

Summary

Mr C complained about the council's handling of a planning application for an extension to a neighbouring property. He was concerned that, having received notification of the approval of the planning consent, he discovered that the original plans for the extension had been amended. The plans now included what he considered to be two non-compliant windows (in terms of the separation between the windows) on the front of the extension. Mr C was aggrieved that he had received no notification about this amendment. He also disagreed with the council's decision to accept obscure glazing for these two windows to reduce an element of overlooking. Mr C also still thought that the approved proposal included what he considered to be another non-compliant window in terms of window separation. This window was on the side of the extension. Mr C complained that the extension would result in an unacceptable loss of privacy and amenity (enjoyment of property or surroundings).

During our investigation we took independent advice from one of our planning advisers. We found that the role of the council's guidelines was one of guidance, and that all proposals were different and required to be assessed based on their own individual merits and the local context. We were satisfied that the council had addressed Mr C's concern about the issues he had raised, in particular in relation to the amendment that was made to the proposal to include two obscure glazed windows on the front of the extension, and the separation distance of the window on the side of the extension. We did not find that the decision taken by the council to accept the two obscure glazed windows was unreasonable and we were satisfied that it was for the council, as planning authority, to decide what notice to give other parties of such a variation. We were also satisfied that the council had explained that the side window on the extension did not cause a window-to-window distance issue and that their decision to accept clear glazing on this window was not unreasonable.

We were satisfied that, based on the available evidence, material considerations of 'overlooking' and 'residential privacy' had been dealt with in a manner which was not unreasonable. While we found that it had not been helpful that the report prepared by the council on the planning application had not included basic dimensions relating to window-to-window distances, in the absence of evidence of procedural omissions by the council in their handling of the application we did not uphold the complaint.

Recommendations

We recommended that the council:

• ensure that the comments of our adviser in relation to the omission of dimensions relating to window-to-window distances in the report of handling, and the availability of detailed calculations and diagrams for public inspection, be brought to the attention of relevant staff.

Summary

Mr C complained on behalf of his father (Mr A) who had suffered a stroke following a bleed in his brain which required specialist surgery. He was left with dense weakness in his left side with no active movement. Mr A was an in-patient at Raigmore Hospital for a number of months while he underwent rehabilitation in their stroke unit. When he was discharged, Mr A received physiotherapy at York Day Hospital. He was later seen by a consultant in stroke rehabilitation medicine and a specialist physiotherapist. Mr A also received other physiotherapy in the community. Mr C was unhappy with the range, intensity and frequency of the physiotherapy that Mr A received and complained that the board had failed to provide appropriate rehabilitation following his stroke. The board considered that the rehabilitation they provided was reasonable.

After taking independent advice from a medical adviser who is a consultant in stroke medicine and rehabilitation, we found that the clinical rehabilitation treatment that Mr A had received was appropriate. The advice highlighted an area where communication with the family could have been better but, overall, we considered this element of Mr A's care to be reasonable. We also took independent advice from a physiotherapist specialising in neurological rehabilitation and acute neurology (the science of the nerves and the nervous system, especially of the diseases affecting them). Overall, the range, intensity and frequency of Mr A's physiotherapy was found to be reasonable and the adviser considered that a holistic approach had been taken in relation to his treatment. The physiotherapy advice highlighted a single area of concern where there was no record that an issue identified during an assessment at York Day Hospital was monitored. After taking all the information about Mr A's rehabilitation care and treatment into account, we did not uphold Mr C's complaint but made a recommendation to the board to ensure that lessons are learned from the advisers' comments.

Recommendations

We recommended that the board:

• draw the comments of the medical adviser on communication and the physiotherapy adviser on best practice to the attention of relevant staff.

Summary

Miss C and her partner had complained to the council about alleged anti-social behaviour by one of their neighbours. Miss C complained about the way her complaints were handled by the council and, in particular, that the council had failed to follow their policies and procedures in dealing with the complaints made about her neighbour.

Our investigation found that Miss C and her partner had first raised their concerns about their neighbour during 2011 and that the council contacted them at that time detailing the action taken by them. In line with the council's anti-social behaviour procedure, this included mediation. Miss C and her partner continued to report incidents to the council during 2012 and 2013, and the evidence showed that the council contacted them and provided advice. However, it was clear that, in some instances, Miss C and her partner were not contacted until some time after the incident was reported. There was also a lack of records detailing the action recorded as being taken by the council.

The council explained that, in this case, they had received complaints from Miss C and her partner, but also counter-complaints from their neighbour. The council confirmed that there was no evidence of anti-social behaviour which would justify intervention by them against Miss C's neighbour. They suggested, and continued to suggest, mediation to try to resolve the problems.

While we found that there were shortcomings in the council's handling of the matter in relation to record-keeping we were satisfied that, based on the available evidence, the council took action on the incidents reported and provided appropriate advice. In these circumstances we did not uphold the complaint, but we did make a recommendation about record-keeping.

Recommendations

We recommended that the council:

• remind staff of the importance of keeping comprehensive records of the action taken during the investigation of a complaint about alleged anti-social behaviour.