Not upheld, recommendations

Summary

Mrs C complained to us about orthopaedic treatment (treatment of conditions involving the musculoskeletal system) that she had on her foot. A surgeon at the Southern General Hospital operated on it twice. The operations were nearly two years apart, and both left her with ongoing symptoms. When her symptoms persisted, she was referred to another surgeon, and had a different operation. This was successful, and Mrs C's symptoms significantly improved. At this point she became concerned about whether the previous treatments had been appropriate, and complained to the board.

The board did not respond to Mrs C's complaint, as they considered it to be outwith their timescales. The surgeon provided a statement, however, in which he reviewed his assessments and treatments for Mrs C. He also referred to clinic appointments that were not appropriately recorded.

We took independent advice on this complaint from one of our medical advisers, a consultant orthopaedic surgeon. He reviewed Mrs C's orthopaedic treatments, and while he was critical that the first surgeon had not maintained appropriate clinical notes, he considered that the operations Mrs C had were appropriate. He said that the operation carried out by the second surgeon was a more complex and risky procedure, and that it was appropriate for alternative approaches to be tried first. He also noted that the last operation was normally only carried out by specialist foot surgeons. Having taken this advice, we decided that the treatment had been appropriate, and that it was reasonable for the first surgeon to try less complex and risky procedures before considering more complex treatment.

Recommendations

We recommended that the board:

• ensure that the doctor involved maintains appropriate clinical records in line with the standards set by the General Medical Council, bearing in mind the comments made by this office, and discusses any learning points at his next appraisal.

Summary

Mr C's neighbour was granted planning consent by the council for a single storey rear extension and the addition of two dormer windows to their property. Other renovations to the existing property were also carried out at this time including replacing windows in the lounge. Mr C complained that in granting planning permission, the council did not follow their own policies and guidelines in relation to the amenity of his property.

After taking independent advice from one of our planning advisers, we found that the council had considered all the relevant policies and guidelines when assessing the application. However, we also found that, in responding to Mr C's complaint, they had referred to different considerations for the distances between windows in neighbouring properties and habitable/non-habitable rooms in any new development. These considerations were not mentioned in any of their existing policies or guidance. We also found that the council had incorrectly advised Mr C on two issues when responding to his complaint. He was wrongly told that the kitchen in his neighbour’s extension was a non-habitable room, and that the replacement windows in the existing lounge did not require planning consent. Although we did not uphold Mr C's complaint, we made recommendations to the council about the incorrect advice he was given.

Recommendations

We recommended that the council:

• apologise to Mr C for initially incorrectly advising him that the kitchen was classed as a non-habitable room;
• ensure that at the next review of guidance, the different considerations for habitable and non-habitable rooms are clearly set out; and
• apologise to Mr C for incorrectly advising that him the replacement windows in his neighbour's property did not require planning consent under the terms of the relevant legislation, and make the relevant staff aware of our adviser's comments about this.

Summary

Mrs C attended at an out-of-hours (OOH) service at Monklands Hospital on two separate occasions suffering from pain across her lower back and abdomen. The OOH service provides access to GPs outwith normal working times. On the first occasion Mrs C was diagnosed with a possible abdominal aortic aneurism (a weak point in the large artery that carries blood from the heart, causing it to balloon out) or lower abdominal pain with an unknown cause. She was referred directly to a surgeon at the hospital. Tests ruled out an aneurism and Mrs C was sent home with antibiotics for a urinary tract infection.

On the second occasion, just over a month later, two potential diagnoses were recorded, renal colic (pain caused by kidney stones) or a possible pelvic mass. Mrs C was given a painkilling injection, encouraged to drink lots of fluids and sent home with advice to return if her pain worsened. She was also advised to contact her own GP on the next working day to arrange an ultrasound scan of the possible mass.

After a referral from her GP, Mrs C was discovered to have an ovarian cyst (a swelling on the ovary) and was diagnosed with cancer of the left ovary. She complained that neither of the doctors who examined her admitted her to hospital for assessment and that, had this happened, the ovarian cyst would have been picked up earlier.

After taking advice on this case from one of our medical advisers, we did not uphold Mrs C's complaint. Our adviser explained that both the doctors who saw Mrs C at the OOH service provided a reasonable standard of care and that her symptoms had not been typical of ovarian cancer.

Recommendations

We recommended that the board:

• ensure that the adviser's comments regarding the management and investigation of suspected pelvic mass (including the benefit of pelvic examinations) are fed back to the relevent doctor.

ummary

Mr C complained that the council did not reasonably assess his and his wife (Mrs C)'s income and expenditure when determining their entitlement to a discretionary housing payment (DHP). He complained that the income and expenditure figures on the application form had been tampered with without his permission. He said some of the expenditure figures had been ignored completely and the council failed to ask him for further proof of the figures he submitted. Mr C also said the council's figures did not give a true level of monthly expenditure for food, heating and clothing.

The Department of Work and Pensions guidance says that it is for a council to decide whether they provide applicants with financial assistance with their housing costs and how they treat an applicant's income or expenditure when doing so. The overriding principle is that a council should act reasonably. The evidence showed that the council converted Mr and Mrs C's monthly income and expenditure figures to weekly figures - which we found reasonable. In the instances where the council's figures differed from Mr and Mrs C's, there was documentary evidence to show that the figures the council used were accurate.

The evidence also showed that the council disregarded £100 per month that Mr C listed for personal items. It was for the council to decide how they treated an applicant's income or expenditure when assessing their entitlement to DHP, and we did not consider their reason for disregarding the £100 to be unreasonable.

In their reconsideration process, the council had advised Mr C to include any special factors or items of essential expenditure that he thought they had not taken fully into account. This was Mr C's opportunity to explain the figures he submitted for heating, clothing, food and personal items. Mr C did not appear to provide any information on special factors in these areas to support his case. The fact that the council did not ask for supporting documentary evidence did not, in our view, have an adverse effect on their consideration of this. The evidence also showed that the council acted in accordance with their guidance for expenditure on food, heating and clothing.

Recommendations

We recommended that the council:

• ensure that, in future, where their income and expenditure figures differ from an applicant's, they explain their reasons for this in their DHP claim decision letters.

Summary

Mrs C complained that staff at the Royal Hospital for Sick Children failed to provide her baby (Baby A) with a reasonable standard of clinical treatment. Baby A was born with hypoplastic left heart syndrome (a complex congenital heart condition) and needed surgery shortly after birth. Baby A became unwell and on the advice of her GP Mrs C took the baby to the hospital for assessment. Staff there considered whether intussusception (a condition in which one segment of intestine 'telescopes' in to an adjacent segment) might have been the problem but discounted this. They carried out additional investigations, including blood tests, but Baby A died shortly after this.

Mrs C said the blood tests were unnecessary and caused her baby distress. She felt that if medical staff had recognised the problems sooner and started treatment earlier, then the outcome might have been different.

We took independent advice from one of our medical advisers, who is a consultant paediatrician. The adviser explained that Baby A was born with a complex and very serious heart condition. Despite the surgery received following birth, this heart condition meant that Baby A was particularly susceptible to sudden and unexpected death.

The adviser said that a diagnosis of intussusception was immediately suspected when Mrs C took Baby A to hospital, but a cause is not always found for the condition. Our adviser also could see no evidence that a delay in a registrar reviewing Baby A had any impact on the final outcome. There was no evidence that Baby A suffered from a treatable or correctable problem that was missed or that treatment was delayed because of the delay in the availability of a registrar. There was also no evidence that a blood sample should have been taken earlier or that earlier involvement of the cardiology (heart) team would have made a difference. While the adviser considered that Baby A's oxygen saturation level should have been constantly monitored, it was impossible to say whether this would have made a difference. In light of the evidence, we found that, on the whole, the actions of the medical staff who treated Baby A were reasonable.

Recommendations

We recommended that the board:

• share with the relevant staff our adviser's comments in relation to the monitoring of Baby A's oxygen saturation and the early warning score now in use.

Summary

Mrs C is the secretary of a group that used a local community facility. The council decided to use some of the space there for their staff and sought a principal tenant for the remaining space. It was planned that the tenant would manage the use of the community space to ensure that other local groups could continue to use it. Mrs C told us that the council had not consulted appropriately and so had failed to involve the local community and tell them about decisions on the future management of the facility. She also complained that the council had not made the local community aware of the process to become the principal tenant.

During our investigation, we found that the council had considered carrying out a consultation and had decided it was unnecessary. We found that there were no policies or procedures that they were expected to follow for this, and that they were entitled to use their judgment to make the decision. We noted that they had developed a new framework for staff to help them with consultations, including deciding when to consult. Although we did not uphold the complaints, we were critical that the council did not erect a To Let sign at the facility. We also considered that the property marketing material could have been sent to respondents of a previous community engagement exercise but, overall, we were satisfied that the council acted reasonably.

Recommendations

We recommended that the council:

• provide us with a time-frame for the implementation of the new consultation framework; and
• consider developing a procedure for the future marketing of the community space.

Summary

Mr C had an accident at work and injured his shoulder. He was diagnosed with a sprain at A&E in Falkirk and District Royal Infirmary. No x-ray was taken and Mr C was told to see his GP if the pain continued. Mr C was referred to a specialist who suspected that he might have a rotator cuff tear (a tear to one of the tendons that stabilise the shoulder). The specialist arranged for a scan but no tear was found. Some time later, Mr C was referred to another specialist at Forth Valley Royal Hospital who carried out further tests and a second scan. Mr C was diagnosed with impingement syndrome, a condition where the bone and tendons of the shoulder rub together painfully. He was offered surgery and advised that this had a 60 to 70 percent chance of success. During the operation, the surgeon discovered that Mr C had an abnormality in his shoulder where pieces of bone had not fused together when he was a child. There was an unfused fragment of bone about three centimetres long, which the surgeon could not remove without causing damage. Mr C was advised that if his symptoms did not improve after the operation, he would require further surgery to fix the piece of bone using a screw. Although he was still in pain, Mr C decided not to go ahead with another operation. He then complained that an

x-ray or other imaging should have been carried out earlier as this would have highlighted the unfused fragment of bone. He was particularly concerned his surgery went ahead without this being done.

After taking independent advice from two of our medical advisers, we found that normal x-rays would not have shown the unfused piece of bone in Mr C's shoulder, as it would only have been visible on a special view x-ray that would not normally be requested. Although our accident and emergency adviser told us x-rays should have been taken after the accident and a review at the fracture clinic offered if Mr C's pain did not get better, our surgical specialist said that, even if it had been identified, an unfused piece of bone like that would not have been considered to be the cause of his pain and the treatment would have remained the same. This is because unfused fragments of bone in the shoulder do not usually cause any symptoms. Our surgical specialist also told us that

x-rays would not be carried out before such surgery and that scans are commonly used.

We found that Mr C's shoulder should have been x-rayed after his accident but there was no evidence that this would have resulted in an earlier diagnosis of the unfused piece of bone. We also considered it unlikely that an earlier diagnosis would have changed the treatment he received. Although we did not uphold his complaint, we made a recommendation.

Recommendations

We recommended that the board:

• take steps to ensure that A&E staff are made aware of our adviser's comments on x-rays and the offer of review at the fracture clinic in this case.

Summary

Mrs C's late father (Mr A) had a rare type of lung cancer and was admitted regularly to the Victoria Infirmary for problems related to this, particularly chest infections. In early 2013, he was admitted there and started on antibiotics to cover the possibility of another chest infection. A few days later, a doctor described him as being frail and it became apparent, as Mr A deteriorated further, that he was at the end of his life. He received palliative care (care provided solely to prevent or relieve suffering), and he was reviewed by several doctors and prescribed pain relief for agitation. Mr A died two weeks after being admitted to hospital.

Mrs C complained about the end of life care her father received, saying that he was not given reasonable pain relief or antibiotic treatment and that there was a lack of senior clinical input. She also said that nursing staff failed to assess his pain and keep comprehensive records. Mrs C said that her father was screaming out in pain during the latter stages of his illness, and she was extremely concerned that staff failed to respond to this appropriately.

We took independent medical advice on the case from two of our medical advisers, one of whom is a doctor specialising in care for the elderly, and the other a nurse, after which we did not uphold Mrs C's complaint. We found that we were unable to reconcile the different accounts of the level of pain that Mr A experienced, and the advice we received was that Mr A had symptoms of breathlessness, anxiety and agitation, which were treated adequately. There was no evidence in the medical records or statements from staff of Mr A screaming in pain. We noted that a delay in providing antibiotics and failure by senior staff to review Mr A had been raised with the staff concerned, but our medical adviser (a doctor specialising in care for the elderly) said that these did not affect what happened or the management of Mr A's condition. Our nursing adviser also noted a lack of documentation in relation to pain assessment and end of life care, and we made a recommendation about this. However, again these did not impact on the care Mr A received, which she said was of a reasonable standard.

Recommendations

We recommended that the board:

• ensure the failures in record-keeping, in particular completion of SEWS (Scottish early warning system - a set of patient observations) are raised with relevant staff.

Summary

Mr C complained about how a company acting on behalf of the Scottish Prison Service (SPS) handled his complaint about his experiences in a sheriff court cell.

As our investigation found that the company had reasonably investigated the complaint and replied to Mr C, we did not uphold his complaint. We noted, however, that in their replies the company had not included information to signpost him to us or to tell him of our usual timescales within which we need to receive complaints. As this is contrary to the requirements of the Scottish Public Services Ombudsman Act 2002, we made a recommendation.

Recommendations

We recommended that the Scottish Prison Service:

• arrange for the company to include SPSO signposting information in their responses to complainants, and demonstrate to us that the company have taken this action.

Summary

Mr C obtained planning permission to build a house and garage. After construction work began, a neighbouring property owner complained, and the council's planning enforcement officer made a site visit. The officer considered that there was a breach of one of the conditions of the planning consent, which required landscaping plans to be submitted before work started on the site. He also found that the building was not being constructed in accordance with the approved plans, potentially leading to an unacceptable increase in the overall height of the finished building. He advised the builders to cease work, then issued a temporary stop notice requiring all work to stop pending submission and approval of the required landscaping plans. The plans were later submitted and approved, and work recommenced, but Mr C encountered further delays when he was told that he would need approval from the Scottish Environment Protection Agency (SEPA) for his proposed drainage system. Mr C complained that the council were heavy-handed in their approach to planning enforcement and did not work with him to resolve the problems on site.

We found that the council did not take formal enforcement action against Mr C's development. However, they did take reasonable steps to halt work on site to ensure that an acceptable building was being constructed. Although we were satisfied with their approach to planning enforcement, we were critical of their communication with Mr C. We found no evidence to suggest they consulted with him to check that parties were working to the correct set of plans. We also found that the council raised enforcement issues in a piecemeal fashion rather than providing Mr C with a comprehensive assessment of the development against what they considered acceptable. Finally, we found evidence of inadequate communication between the council's planning and building control services. Although we did not uphold Mr C's complaint, we made two recommendations.

Recommendations

We recommended that the council:

• conduct a review of their handling of Mr C's project with a view to identifying ways of improving communication between planning and building control and with applicants; and
• consider providing information regarding the need to consult with SEPA on planning decisions relating to developments using septic tanks and soakaways (gravel-filled channels or pits that help manage surface water).