Not upheld, recommendations

Summary

Mrs C complained that Business Stream had charged her for water at her business premises. She took the view that her lease meant that water charges were her landlord's responsibility, and pointed out that her unit had no direct water supply.

We found that although Mrs C may have been unaware that Business Stream were the default water supplier, this did not make the charges invalid. In addition, Business Stream had explained to her that, in line with their billing policy, although she had no direct water supply, the communal water supply (for example to the toilets) was apportioned among the tenants.

During our investigation, Business Stream provided us with a copy of their billing policy, which we found they had applied correctly. They had also considered Mrs C's lease, although they had taken an alternative view of its meaning. As only a court could give a ruling on the rights and responsibilities under the lease, and as Business Stream had taken the lease into account and acted in line with their policy, we did not uphold Mrs C's complaint. We did, however, make two recommendations.

Recommendations

We recommended that Business Stream:

• consider waiving their recovery charge; and
• take steps to ensure frontline staff provide accurate information about Business Stream's charges.

Summary

Mr C complained that the council had failed to respond fully to his complaint about the standard of service they provided when he applied to them for a letter of comfort (a document provided to satisfy a buyer that the local authority will not take action to have work remedied) for a property he owned. He said that the house sale did not complete on time because of the council's delay, and that he was dissatisfied because the council had maintained that they had dealt with the matter competently. He considered that their actions showed that they had no commitment to customer experience.

Our investigation found that the council had looked into the matter by reviewing the contact between Mr C and their officers, and the level of service provided. They told us that there were no specific timescales for inspections and responses to letters of comfort, but that there was guidance in the application form that Mr C had completed. This indicated that they aimed to complete a request within two weeks of receipt of an application, although the service provided was usually quicker than this. The evidence showed that they had responded to Mr C in eight working days (ie within two weeks). They accepted that they had not acknowledged all of Mr C's emails, and although they said that they had phoned him, we were unable to verify this because of a lack of records of calls made. They also said that the reply was delayed as it had to be signed off, but we found no evidence that this was not done on the day the visit to the property took place. As the time taken from the request being made to the letter being provided was within the timescale provided to the public about the service, we did not uphold the complaint. We did, however, recommend to the council that they take steps to review their record-keeping.

Recommendations

We recommended that the council:

• take steps to review their record-keeping, especially with regard to letter of comfort inspection sheets and phone calls.

Summary

Ms C was operated on at the Western Isles Hospital for a labial abscess (a painful swelling caused by a build-up of pus in part of the female genitals). Ms C had undergone a kidney and pancreas transplant in 2007. She complained that although her medical records said that the transplant team should be contacted prior to any surgical procedures, this had not happened. Ms C said that this had placed her at great risk, as the drugs she took to prevent her body rejecting the transplant suppressed her immune system, meaning she was at increased risk of infection.

Ms C also complained that she was not provided with reasonable care after the surgical procedure. She was discharged, despite being in great pain, and was then readmitted as the wound had become infected. Ms C suggested that she should not have been operated on in the first place and said her view was supported by the fact that on her second admission she was transferred to another hospital for treatment.

We took advice from two medical advisers, a specialist in the management of transplant patients and a specialist in gynaecological surgery (surgery of the female reproductive system). They said that the records showed that attempts had been made to contact Ms C's transplant team. However, the advisers said that the nature of the infection, combined with Ms C's suppressed immune system, meant it would not have been reasonable to delay her operation. They said that a reasonable care plan had been put in place, and the medical record showed that she was free of infection at the time of her discharge.

Our investigation found that Ms C had undergone the appropriate surgical procedure for a labial abscess, and that the care she received after the procedure and the decision to discharge her had both been reasonable. We found it would not have been appropriate to delay surgery whilst awaiting the response of the transplant team. Our investigation also found, however, that the attempt to obtain advice from the transplant team was not followed up, which would have been appropriate, so we made a recommendation about this.

Recommendations

We recommended that the board:

• remind all staff of the importance of obtaining advice from the appropriate specialist transplant unit when treating patients who have a compromised immune system as a consequence of transplant surgery.

Summary

After Mrs C had surgery in a hospital outside the area of her own health board, complications arose that led to irreparable damage to one of her kidneys. She believed that there was unreasonable delay in identifying these and that had they been diagnosed sooner her kidney might have been saved. Mrs C also believed that the care she received (after an attempt to prevent further damage to her kidney) was inadequate. She said that, although her husband was trained to change the type of dressing she was given, no-one in the community nursing service responsible for her care was familiar with it. Mrs C felt that she and her husband were not provided with adequate support following her surgery.

After taking independent advice from one of our medical advisers, we found that the complications arising from the surgery could not have been identified sooner. We also found that the board had offered alternatives to the dressing, but that Mrs C had requested that she be allowed to keep the one provided. The board had supported the couple in this decision and had acted reasonably when Mrs C indicated that she and her husband were experiencing difficulties. We also found that although the board had met with Mrs C informally and had not signposted her towards the formal complaints procedure, their response had addressed the concerns she raised about her treatment.

Although we did not uphold this complaint, we made two recommendations for improvement.

Recommendations

We recommended that the board:

• consider whether there are any other means of receiving discharge and other types of referral information from hospitals elsewhere; and
• remind relevant staff of the importance of signposting to the complaints procedure.

Summary

Mrs C's daughter (Miss A) damaged her teeth in an accident on a Sunday evening. Mrs C took her to hospital where Miss A was assessed, and they were advised to visit their dentist as soon as possible for emergency treatment. Mrs C told us that she tried to leave a phone message with the dental practice that evening to let them know this, but was unable to do so. After they went there the next morning, Mrs C was unhappy about a number of issues, including that the practice was closed for staff training, meaning that they had to wait outside in the cold for a time. She was unhappy with the attitude of the staff and said that the dentist seemed angry that they were there and shouted at them; and she also felt that her daughter was treated inappropriately, including the way she was spoken to and the fact that the dentist felt that her mouth was too swollen to treat at that time.

We based our investigation on the available documentary evidence, which meant that, in the absence of entirely independent witnesses, we could not reach a robust conclusion on what was said and by whom. We took independent advice from a dental adviser, who explained that, generally speaking, he would have expected a dentist, exercising professional experience and judgment, to display a sympathetic attitude to try to put Mrs C and her daughter at ease as much as possible. However, he said there were no definitive instructions that a dentist would be expected to follow when treating a child in these circumstances, and that the available evidence appeared to indicate that Miss A was reasonably treated. On balance, in light of the advice received, we did not uphold Mrs C's complaint. However, we made a recommendation as a result of Mrs C's experience.

Recommendations

We recommended that the dentist:

• confirm that they will ensure that patients are able to leave out-of-hours messages and that their voicemail message reflects days where the practice may open later (for example for staff training).

Summary

Miss C complained about the dental treatment she received from the board following a referral from her dentist. She said the board did not provide her with reasonable care and treatment during her four appointments at the board's clinic and did not reasonably respond to her attempts to complain about the care and treatment they provided. Miss C explained that shortly after her treatment was completed, one of her teeth cracked, went black and eventually had to be removed.

We took independent advice on the case from our dental adviser, a general dental surgeon. The adviser said that the treatment Miss C received from the clinic appeared to have been carried out to a satisfactory standard and within the terms of the referral from Miss C's dentist. The adviser explained that following her root canal treatment, the clinic advised Miss C that the crown on one of her teeth could be replaced to improve aesthetics but noted that she declined this treatment. The evidence suggested that the clinic completed the treatment in the referral from Miss C's dentist as far as Miss C would allow them to go. However, based on the information in Miss C's records, we were not satisfied that the clinic advised Miss C that replacement of the crown could have improved the long term health of her tooth and were critical of the clinic in this regard.

The evidence showed that over a year after her treatment was completed, Miss C made multiple phone calls to her own dentist and phoned the clinic twice about her treatment. There was no documentary evidence that Miss C made contact with the clinic in the year after her treatment. The adviser explained that the clinic's response to Miss C's attempts to complain about her treatment was reasonable and that as Miss C was under the care of her own dentist at that time it would not have been reasonable for the clinic to see her again without her being referred there by her own dentist.

Although we did not uphold this complaint, we made two recommendations for improvement.

Recommendations

We recommended that the board:

• ensure that reasons for treatment provided to patients are fully explained and documented; and
• ensure that discussions of potential risks and benefits take place when a patient has not had sedative drugs administered so that the patient is fully capable of making an informed choice.

Summary

Mr C was accused of acting inappropriately when visiting his mother in a care home. He was dissatisfied with the care home's investigation into the incident and complained to the Care Inspectorate. They agreed to investigate two elements of Mr C's complaint, focusing on the care home's application of their policies and procedures, rather than the incident itself. They were satisfied that the care home had followed their procedures appropriately when investigating Mr C's complaint and deciding what action to take. Mr C complained that the Care Inspectorate's investigation was not thorough and demonstrated a bias towards the care home.

We found that the Care Inspectorate had ruled out all aspects of Mr C's complaint that related to the incident at the care home, but we considered that decisions about the extent of their remit for investigating complaints were a matter for their discretion. We were satisfied that they had given due consideration to their governing legislation when reaching this decision and that the conclusion they reached was reasonable. That said, we were critical of the explanation they gave Mr C about why certain aspects of his complaint were ruled out. Mr C had raised a number of concerns about the incident and how it had been handled, and he was not given a detailed explanation as to why the Care Inspectorate's investigation reports did not address these concerns. We were satisfied that the investigation did not have a bias toward the care home, but we felt that the report could have better acknowledged Mr C's side of the complaint.

Recommendations

We recommended that the Care Inspectorate:

• review their email correspondence with Mr C with a view to identifying ways of improving how they communicate decisions regarding their remit and procedures to complainants; and
• apologise to Mr C for the lack of detail and clarity in their correspondence with him.

Summary

Some years ago, a developer submitted a planning application to build a block of flats behind Mr C's home. The application included a plan showing an intention for plants to be used as a screen at the boundary between the flats and Mr C's property. During the application process, the council's development quality sub-committee carried out a site visit and issued a report requiring that a condition be included in any planning consent, requiring formal approval of landscaping plans with particular regard to screening at that boundary. Mr C complained on behalf of a number of local residents that existing plants were removed from there, and no screening was introduced. He said that the council had not enforced the planning condition.

We took independent advice on the complaint from one of our planning advisers. Our investigation found that the planning department approved the application and the associated landscaping plans, and had the appropriate delegated authority to do so. Revised landscaping plans were submitted that did not include screening at that boundary. As there was no specific planning need for this (daylight and privacy requirements had been comfortably met), and a strip of land to the east of the development was required for access to a gas main, the planning department approved the revised plans.

It was clear from the evidence submitted to us that the sub-committee were strongly of the view that screen planting should be used between the development and existing properties. Although we acknowledged that the final position taken by the planning department was reasonable, we were concerned that the planning department acted without taking account of the fact that the submitted landscaping plans were clearly at odds to those originally submitted and the intentions of the sub-committee. In response to our enquiries, the council had told us that the condition proposed by the sub-committee was unenforceable and did not meet the basic standards for planning conditions. That being the case, we considered that there was ample opportunity for the planning department to have highlighted this to the sub-committee before the planning decision notice was issued. The condition could have been amended or removed, avoiding expectations being raised that screen planting would be in place when the development was completed. We also considered that, as this had been a contentious development, which attracted a large number of objections, the council should have done more to ensure that their decision-making was transparent.

Mr C also raised concerns about the council's handling of his complaints, but we found this to be satisfactory.

Recommendations

We recommended that the council:

• review their communication procedures so that in situations where approvals under planning conditions are clearly significantly at odds with the terms of the decision on the application itself, an explanation of the reasons is provided to interested parties; and
• review their procedures for identifying planning conditions that they consider do not meet the standards set out in planning circular 4/1998 and addressing such matters before decision notices are issued.

Summary

Mrs C attended the medical practice as she had a swollen, discoloured and painful varicose vein in her right leg. She was initially seen by the practice nurse, who prescribed antibiotics (drugs to treat bacterial infection) and anti-inflammatory medication after consulting one of the practice doctors. The following day, as Mrs C’s leg continued to be very painful, she again phoned the practice and was advised by one of the doctors that she had not allowed enough time for the medication to work. Over the next 12 days, Mrs C was visited at home twice, as she felt she was not improving. On the afternoon of the second home visit, the doctor who visited Mrs C arranged for her to be seen by a vascular specialist at hospital. Mrs C requested an ambulance to take her there. She was offered a non-emergency ambulance but due to the possibility she might wait a number of hours for it and miss the appointment, the practice told her that she might wish to make her own travel arrangements, which she did. At the hospital, an ultrasound scan of Mrs C's right leg revealed a blood clot from the ankle to the groin, and she required emergency surgery. Mrs C was admitted to hospital the same day and discharged several days later.

Mrs C complained that the practice failed to appropriately assess and treat her symptoms, and that she should not have had to make her own way to the hospital. She was dissatisfied with the explanations provided by the practice and the way in which they dealt with her concerns and complained to us, saying that she had no faith in them.

We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the practice had not failed in their care of Mrs C. Indeed, the adviser considered the prompt referral of Mrs C to a vascular surgeon was evidence of excellent practice. The adviser also said that Mrs C did not need an emergency ambulance to take her to hospital and the reason that she was given as to why she might wish to make her own way there was reasonable. However, we also accepted that the practice may not have given Mrs C clear explanations and reassurance about her diagnosis and treatment. In addition, while there were clearly conflicting views about the reasons for the breakdown in Mrs C‘s relationship with the practice, we took the view that they should reflect on whether they had fully considered the reasons for Mrs C’s dissatisfaction and loss of faith, and how these could be resolved, particularly as she remains a patient there.

Recommendations

We recommended that the practice:

• review the way they communicate with their patients; and
• invite Mrs C to a meeting to discuss her concerns.

Summary

Mr C complained about Business Stream's handling of his account. He was unhappy that Business Stream had not told him that they were his licensed provider, and complained that it was not until some years after moving into the property that he became aware of this. He was also aggrieved that he then received a bill backdated to when he moved into the premises. Mr C applied for a reassessment of his charges but was again unhappy when he was told that this would not be backdated to when he moved in.

During our investigation we found that it was the business's responsibility to establish the position about water supply arrangements when they moved into the premises. In this case there was no evidence that the delay in issuing Mr C's invoices was due to Business Stream failing to act on information available, or that they were aware his company were in the property and had failed to act. When Business Stream were told that Mr C's company was in the property they issued an invoice the same month. Although we did not uphold Mr C's complaint, we were concerned that Business Stream failed to apply the reassessed charges to his account, and made a recommendation for action.

Recommendations

We recommended that Business Stream:

• take action to process the banding offer and apply it to Mr C's account.