Not upheld, recommendations

Summary

Mrs C complained about the way the council handled a planning application for an extension to the property next to hers. She said that the site visit was inadequate, and the plans and report inaccurate as they said her property was north, rather than west, of the proposed development. She said that this meant the council could not have taken full account of the impact of the proposed extension on the daylight and sunlight to her home. She also said that they had not taken account of guidance about overshadowing and loss of outlook, as there was no evidence that they had made full calculations of the proposal, as set out in that guidance. She also said that she was told that her complaint would be investigated independently, but the response came from the planning department, which she did not consider sufficiently independent.

We reviewed the information from Mrs C and from the council, and took independent advice from our planning adviser. Our adviser said that the site visit was sufficient to establish the impact of the proposed extension on Mrs C's property, and provided enough information to decide the application. The plans were also sufficient for the council to have assessed the impact on the amenity of Mrs C's property, including the daylight calculations specified in guidance. He was critical that the council did not provide evidence of these calculations but, based on the planning report, he considered that they were assessed as part of the planning decision. On the basis of this advice, we were satisfied that the planning application was handled appropriately, although we did make recommendations.

We also considered the communication that Mrs C had with the council, including an acknowledgement of her complaint and their final response. The council's procedure did not specify who should respond to a complaint, and there was no evidence of Mrs C being told who would do so. We considered that it was appropriate, and in line with policy, for the council's response to come from the department involved, and that an independent view on the complaint was best achieved through coming to us. We were, therefore, satisfied that the council handled Mrs C's complaint appropriately.

Recommendations

We recommended that the council:

• review the information on 'loss of outlook' provided to the public, including on their website, to ensure that it gives a clear explanation; and
• remind staff of the importance of keeping records of all calculations undertaken during the assessment of a planning application.

Summary

Miss C complained that when she agreed to move a smaller new build house, the council told her they would cover the costs of her move under the transfer incentive scheme (TIS). She was then, however, charged much more than she had been led to expect for repairs to her former council property after she moved out. This used up a considerable amount of the money available under the TIS, and so some of the costs with which the council had said they would assist could not be met. She also complained about problems with items in her new home, and about the council's handling of her representations.

During our investigation we were provided with evidence that the council had explained to Miss C that they would assist with the costs of the move up to the maximum allowed under the TIS. They had also explained before the move that they would not be able to meet all of the costs involved. They had, however, offered to exceed the budget allowed under the TIS to meet the costs of new laminate flooring, but Miss C did not accept this offer. The council confirmed that there was no money available within the new financial year to meet the costs of floor coverings. They also provided details of the repairs required to Miss C's former property.

During our investigation the council took action to replumb Miss C's washing machine and to install a rotary dryer at her new property. They confirmed that a number of other issues had been identified relating to the new build houses and that the developer would address these. We were, therefore, satisfied that the council had responded to Miss C and addressed her concerns, in line with their complaints process. We did not uphold Miss C's complaints, although we made recommendations as we were concerned that administrative omissions meant that not all the information about what happened was available, including that there was no written record of their extensive communication with Miss C by phone and during meetings.

Recommendations

We recommended that the council:

• remind staff of the need to ensure that the pre-transfer form is signed by the tenant prior to the transfer;
• consider keeping a written record of any phone call or meeting with a tenant where a decision/agreement is reached; and
• ensure that when a repair is cancelled a record of the reason for the cancellation is recorded.

Summary

Mr C complained about the level of support and help that school staff provided to his child, who had additional support needs as well as other disorders. Mr C also said that staff (who he said were not properly trained) had inappropriately restrained his child, and that had adequate support been in place, events could have been avoided. He was particularly unhappy with the handling of one specific incident. Mr C also complained that the council had failed to reasonably investigate and respond to his concerns.

We did not uphold Mr C's complaints. Our investigation found that staff had used physical restraint on one occasion when staff at the school assessed that the child was a danger to themselves and to others, and the council said minimum force was used. We recognised that this had been an extremely stressful and upsetting situation, but found no evidence that school staff had failed to act in line with the risk assessment in place. We also found no evidence to support Mr C's position that physical restraint was used on a number of occasions. The council were satisfied that, prior to the child's needs escalating, staff had been sufficiently trained to meet those needs and had put support in place to do that. We were satisfied that the school responded appropriately to the incidents Mr C complained about and that as a result of the complaint the council had carried out several reviews and used his child's case to highlight learning and improve practice. We were also satisfied that the council had carried out a detailed investigation into Mr C's concerns and had provided reasonable responses to the points he raised.

Recommendations

We recommended that the council:

• consider their current procedures to decide whether incident reports should be shared with parents.

Summary

Mrs C had suffered from knee pain for a number of years. She was diagnosed with degenerative changes in her knee and a meniscal tear (a tear in the pad which provides shock absorption and other functions in the knee). She also had a meniscal cyst (a cyst often found in the presence of a meniscal tear and which can cause pain and discomfort). Following an initial course of physiotherapy, Mrs C had surgery at Perth Royal Infirmary to treat her meniscal tear and decompress the cyst. Although she experienced some initial improvement, her knee pain returned. She had further physiotherapy and a second operation. However, again her pain returned and in fact became worse. She complained that the board did not adequately treat her knee problems or provide appropriate follow-up care.

We took independent advice from one of our medical advisers, who explained that meniscal cysts can return and knee pain can persist following surgery. We were satisfied that this was explained to Mrs C before her first operation. We could find no mention of the cyst in the notes for the first operation. Whilst this could have indicated that the cyst could not be found, or that it was treated successfully, the absence of records meant we had to conclude that the cyst was not treated during the first procedure. That said, we found that it was treated appropriately during the second procedure and overall, we were satisfied that Mrs C was discharged and re-referred to the orthopaedic department appropriately as required when her knee pain flared up. We were also satisfied that physiotherapy was used appropriately. We did not uphold Mrs C's complaint, but we did ask the board to apologise to Mrs C in relation to the uncertainty surrounding her first operation.

Recommendations

We recommended that the board:

• apologise to Mrs C for the uncertainty surrounding her initial operation.

Summary

Mr C complained on behalf of his daughter (Ms A) about the care and treatment she received at Perth Royal Infirmary and Ninewells Hospital. In particular, he said there was a protracted period of complacency by the staff involved in his daughter's care. At the time Mr C complained to us, Ms A had been experiencing severe and debilitating pain for over 18 months. A number of diagnoses had been suggested, and while treatments were ongoing, no single definitive cause had been found for her pain and other related symptoms. Mr C said that the medical team had ruled out endometriosis (a condition where cells similar to those that line the womb lie outside it) without adequate investigation or involving a colorectal surgeon.

In response to the complaint, the board apologised for the delays and the lack of communication between departments. They explained the reasons for and outcomes of the various tests that had been arranged, along with organising further clinical review for Ms A.

We took independent advice from three specialist clinical advisers - a gynaecologist, a gastroenterologist (a specialist in the treatment of conditions affecting the liver, intestine and pancreas) and a radiologist (a specialist in the analysis of images of the body). The radiologist said that a scan had been incorrectly interpreted, as he considered it did not show evidence of endometriosis. However, he did not consider this to be a major error of judgement requiring further action. In addition, whilst we identified that there was some confusion over referrals and some delays in arranging treatment, our advisers said that the tests and treatments offered were all appropriate in light of what was known at the time. On balance, we did not uphold Mr C's complaint as we found that although there were some errors in Ms A's care, no department had acted unreasonably and there were no serious failings. However, we did make a number of recommendations to the board.

Recommendations

We recommended that the board:

• apologise for the failings identified;
• ensure that the radiologist responsible for reporting the scan is made aware of the views of our radiology adviser on the interpretation of that scan and given an opportunity to reflect on this; and
• reflect on the potential role of multi-disciplinary team meetings in complex cases such as Ms A's and consider how this might be embedded into clinical practice, and advise us of the outcome of their consideration.

Summary

Mrs C complained on behalf of her late husband (Mr C) that there was an unreasonable delay in taking him from their home to an ambulance. Mrs C said that the ambulance crew spent too long trying to get her husband to respond to them and should have taken him to the ambulance and conveyed him to hospital straight away. Mrs C also raised concerns that the crew were unable to insert an intravenous line (a plastic tube introduced with a metal needle into a vein to allow the delivery of medications to assist resuscitation).

We took independent advice from one of our medical advisers, who is a GP. The adviser said that the time taken at the scene (22 minutes) was not excessive. They explained that as Mr C had 'shut down' (when a patient is in the extremes of a medical crisis and their peripheral veins collapse) it would have been very difficult for the paramedic to have inserted an intravenous line. This was not unusual and in itself did not make the paramedic's actions unreasonable. The adviser explained that, when the insertion of an intravenous line fails, it is reasonable to use an intraosseous needle (a large bore needle pushed into the bone marrow of the shin to allow the introduction of drugs and fluids to assist resuscitation). However, in this case the crew attending Mr C did not have access to such a needle and the adviser said that even had one been available and the conditions appropriate, its use would have been unlikely to have changed the outcome for Mr C.

The evidence suggested that the ambulance crew acted appropriately and in accordance with their organisation's and national guidelines in their treatment of Mr C. However, we were concerned that the service told us that use of intraosseous needles was not their custom and practice, given that national guidelines on resuscitation say that if intravenous access cannot be established within the first two minutes of resuscitation, consideration should be given to intraosseous access.

Recommendations

We recommended that the Scottish Ambulance Service:

• consider reviewing the use of intraosseous needles to take account of national guidance in this area.

Summary

Ms C complained that the board had not followed the correct diagnostic and prescribing guidelines for her condition. She said that she was wrongly diagnosed with Graves' disease (a condition in which the body produces too much thyroid hormone) at St John's Hospital, and that what she was prescribed was harmful to her. Ms C was also unhappy that other clinicians were made aware of the diagnosis of her condition as being non-physical rather than physical, and said this had an adverse effect on her care and treatment. This diagnosis was retracted after Ms C complained, but she was unhappy that there was reference in her medical records to her complaint. She was also unhappy with the way her complaint was handled and said that the board had failed to carry out action they had agreed.

We took independent advice from one of our medical advisers, who is a consultant in endocrinology (a branch of medicine dealing with hormones). The adviser found no evidence that the board failed to follow the correct diagnostic and prescribing guidelines for Ms C's condition. He did say, however, that her disease was mild and was not the cause of her symptoms, and that the board should have looked more actively for other causes for Ms C's ill health. We found that Ms C had received attentive care and that the conventional guidelines (British Thyroid Association guidelines) were followed. We found no evidence that diagnosis of her condition as non-physical rather than physical had an adverse effect on treatment.

We were also satisfied that the board had responded to Ms C's concerns and had met with her to try to address her concerns. They had clearly explained that because the issues were about events from a number of years ago they were not going to investigate her complaint on a point by point basis. We were also satisfied that the board had done what they said they would, although we were concerned about the reference to the complaint in Ms C's medical records. Although we did not uphold her complaints, we made three recommendations to try to ensure good practice in future.

Recommendations

We recommended that the board:

• ensure that the medical advice we received in relation to this complaint is brought to the attention of the relevant clinicians;
• remind all staff that information about a patient's complaint should not be contained within medical records; and
• ensure that, in this case, the procedure for dealing with disagreements about entries on medical records has been followed.

Summary

Mr C was a student with additional support needs. He complained that the university unfairly terminated his studies, and did not support him through the appeals process. Mr C's studies had previously been terminated three times, but he had successfully appealed each decision. On the fourth occasion, when the university terminated his studies Mr C appealed again, but this time the university did not uphold his appeal and he was withdrawn from his course. Mr C said that he had not been supported through the terminations and appeals process, which had caused him additional stress that affected his performance. Mr C also complained that the university failed to consider his circumstances in handling his final appeal.

Our investigation found that the university had carried out a professional assessment of Mr C when he first attended there and had put in place adjustments to which he had agreed. These adjustments were reviewed during his time at the university. We were satisfied that the university had taken action following the second termination of his studies (the subject of his complaint to us) to try to minimise the impact of the appeals process on his studies. The third and fourth terminations had occurred outwith term-time. We were satisfied that the university provided Mr C with reasonable support to meet his needs through the process of his appeals and the decisions to terminate his studies. We were also satisfied that they gave adequate consideration to all the material Mr C submitted as part of his final appeal against the fourth and final termination of his studies. Although we did not uphold Mr C's complaints, we did make a recommendation.

Recommendations

We recommended that the university:

• consider the termination of studies procedures and confirm to us that they are satisfied that they are suitable for students diagnosed with learning difficulties.

Summary

Mr C was given notice to quit his rented accommodation, so he contacted the council about alternative housing. They assessed him as being involuntarily homeless. Mr C told the council that he had health issues that meant his accommodation needed certain kinds of fixtures and furnishings and that he could not share accommodation. The council, however, told him that they required a medical opinion supporting this before they would offer him only accommodation meeting these criteria. Mr C was offered various properties over the following twelve months before he accepted a temporary accommodation and, soon after, a permanent accommodation. He complained to the council that the accommodation he had been offered was unreasonable given his health issues. The council responded that they had not received any medical opinion that indicated the offers had been unreasonable. Mr C brought his complaints to us.

We found that Mr C had not supplied the council with any medical evidence that supported his views about what sort of accommodation was suitable. Given this, we decided that the council's offers were reasonable and we did not uphold his complaints. However, we did note that the council had not responded to a complaint specifically about the temporary accommodation even though they had considered and investigated it, and we made a recommendation about this.

Recommendations

We recommended that the council:

• remind all relevant staff of the importance of responding to all matters raised and investigated as complaints.

Summary

Mr C, who is a solicitor, brought a complaint on behalf of his client (Mrs A) about the service she received after her GP referred her to a psychiatric department. Mrs A complained that the board failed to meet their targets and that her treatment did not meet any reasonable standard of care. She explained that she had requested referral to a psychologist.

During our investigation, we took independent advice from a mental health adviser. The adviser said that the Scottish Government's referral-to-treatment waiting time target of 18 weeks did not apply to mental health services. However, Mrs A had received treatment from a community psychiatric nurse (CPN) 12 working days after they received the referral. She was also seen by a consultant psychiatrist ten weeks after the GP referral. Both these appointments fell within the target times. Mrs A was also offered further appointments with a CPN and a senior charge nurse trained in cognitive behaviour therapy (CBT), but Mrs A declined these.

The adviser said that there were delays in relation to the referral for a psychology assessment to be carried out and, thereafter, in re-referring Mrs A to the local CBT service. We found that both these periods of delays were unreasonable, but we were satisfied that lower intensity psychological therapy had been progressed from the outset and higher intensity therapy was not initiated because Mrs A declined an appointment with the senior charge nurse trained in CBT.

The adviser was also satisfied that the care offered and delivered was reasonable. However, we were concerned that Mrs A had not signed the care plan that had been prepared, and which set out her presenting difficulties, the goals of the nursing care and the interventions planned, and that there was no evidence in the medical records that she had agreed the plan. We were satisfied that it was reasonable to refer Mrs A to a CPN in the first instance and that it had been explained to her that referral to a psychologist was not the only treatment option open to her.

Recommendations

We recommended that the board:

• review Mrs A's case with a view to identifying the reasons for the delay in referral for a psychology assessment and take action to prevent a recurrence; and
• in line with recovery-focused good practice and the principle of participation set out in the Mental Health Act, consider asking patients to countersign their care plans to demonstrate their understanding and agreement, and providing the patient with a copy of the care plan.
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