Not upheld, recommendations

Summary

Mrs C's daughter (Ms B), was a looked after child subject to a Compulsory Supervision Order (CSO, a legal document that means that the local authority is responsible for looking after and helping the young person). Ms B had a child (Child A) and spent time living with family and in foster care. While in care, Ms B attended school and Child A attended nursery with financial help from the council. This accommodation did not work out and Ms B and Child A returned to live with Mrs C. This was in breach of the CSO but the council agreed to a temporary move.

Ms B then enrolled at school in the area where Mrs C lived (a different council area). Mrs C sought permission to place Child A with her own childminder and expected the council to cover the costs as they had before. The council refused and Mrs C said that as a consequence she incurred a debt for which she held the council responsible. Ms B and Child A later moved out and returned to her previous council area where she was supported to live independently. Mrs C complained that the council unreasonably refused to cover child-care costs while Ms B and Child A lived in the family home.

We took independent advice from a social worker and found that there was no evidence of an agreement that the council would cover the child-care costs. Mrs C knowingly breached a CSO. Although there had been a looked after child (LAC) review to consider Ms B's circumstances, there was no record of what had been discussed. A note provided by a social worker appeared to show that child-care costs had not been discussed. However, once Ms B returned to the family home, there was an expectation that she would be supported by her family as this was one of the guiding principles of national legislation (that parents should normally be responsible for looking after their children). Therefore, we did not uphold Mrs C's complaint. However, we were critical of the fact that the council did not hold a minute of the LAC review and we made recommendations in relation to this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for their failure to record the LAC review. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• A formal record should be available for every LAC review.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Having been referred to Forth Valley Royal Hospital by her GP with a worsening tremor, Mrs C was diagnosed with possible Parkinson's disease (a progressive neurological condition in which part of the brain becomes more damaged over many years) and was started on medication to ease her symptoms. She received regular hospital reviews over the following years and her diagnosis was re-evaluated around seven years later. Further to a scan, it was retracted and replaced with a diagnosis of essential tremor (a benign tremor disorder). Mr and Mrs C complained about this misdiagnosis. They considered that there should be more timely follow-up to check patients with Parkinson's disease. The board noted that Parkinson's disease is difficult to diagnose and that there is no definitive test for it. They advised that it is with time, when people are not following the expected course, that the diagnosis will be reviewed.

We took independent medical advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly), who considered the initial diagnosis of Parkinson's disease was reasonable based on Mrs C's symptoms at that time. They highlighted the difficulties in differentiating between Parkinson's disease and other conditions such as essential tremor. Whilst we found that it took a long time for the Parkinson's diagnosis to be reviewed and retracted, we did not identify any failings in the adequacy or appropriateness of the follow-up that took place. We did not uphold the complaint.

However, we noted that the initial Parkinson's diagnosis had been recorded as a possible diagnosis, but this uncertainty did not appear to have been explained to Mrs C. We considered that the difficulties in diagnosing Parkinson's disease in the early stages should have been conveyed to her, in line with the Scottish Intercollegiate Guidelines Network (SIGN) guidance on Parkinson's disease which state that this uncertainty should be considered when giving information to the patient. We, therefore, made some recommendations for action by the board.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr and Mrs C for the failure to make the uncertain nature of the Parkinson's disease diagnosis clear to Mrs C when it was made. The apology should mete the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• The consultant who made the diagnosis should ensure any diagnostic uncertainty is clearly communicated to patients in future, in line with SIGN guidance. This should be included as a learning point in the consultant's annual appraisal.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained that the council failed to adopt definitive criteria for cleaning roads that have been fouled by farmers and farmworkers and their activities, and about the council's handling of his complaint.

We found that the council were not required to adopt the definitive criteria Mr C wanted. The council already had in place a Road Inspection Guide, which was informed by relevant legislation and national standards, and provided a framework for the inspection of roads, including reactive safety inspections initiated by reports from the public. We also found that the council took Mr C's complaint seriously, made appropriate enquiries, came to a reasonable conclusion, and suggested a remedy for a failing that they identified. We did not uphold Mr C's complaints.

However, we found that council officers did not make records of inspections in response to Mr C's reports of mud on the road. It also appeared that the council may not have provided advice to their technical staff on how such situations would be managed across the council area, which they told Mr C that they would do. Therefore, we made a recommendation to address these points.

Recommendations

What we said should change to put things right in future:

• Remind council officers of what the Road Inspection Guide says about recording all reactive safety inspections.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained on behalf of his late wife (Mrs A) that the practice failed to provide a reasonable standard of care and treatment. Mrs A attended the practice with pain in her right chest wall which was thought to be related to an injury. The practice noticed a small lump over her clavicle (collar bone) and requested an x-ray, which showed no significant abnormality. Mrs A attended the practice again with worsening shoulder pain and was referred to orthopaedics (the branch of medicine involving the musculoskeletal system). Mrs A was later diagnosed with bone and liver cancer. Mr C complained that the practice failed to note Mrs A's history of breast cancer on the x-ray request form and that they had not chased up the orthopaedic referral.

We took independent advice from a general practitioner. We found that there was no indication for the practice to consider cancer as a possible diagnosis. The practice had been investigating Mrs A's shoulder pain and lump as an injury and we considered that the practice's diagnosis was reasonable. We did not uphold Mr C's complaint. However, we identified failings in the way the practice handled his complaint and made recommendations in light of this.

Recommendations

In relation to complaints handling, we recommended:

• The practice should ensure that they have adopted the model complaints handling procedure and all staff should be aware of this. The model complaints handling procedure and guidance can be found here: http://www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mrs C complained about the support provided to her children (Child A and Child B) by their primary school. In particular, she considered that Child A did not receive enough support to cope with stressful situations. Mrs C considered that Child B was not appropriately monitored to see if they needed additional support. Mrs C also complained about the primary school's communication with her and other agencies about this, as well as about their record-keeping. In addition, she was dissatisfied with how her complaint was handled by the council.

We found that the primary school followed the appropriate staged intervention process to identify and implement the children's additional support needs. We did not find evidence of the primary school's communication being unreasonable. Although we found some errors in the school's minutes of meetings Mrs C attended, we did not find evidence that their records were significantly inaccurate. We found that there was a delay in the council acknowledging Mrs C's complaint and that they should have condensed their requests for information from Mrs C into a more manageable format. However, overall we found that their complaints handling was reasonable. We did not uphold Mrs C's complaints.

We considered that, given the concerns that Mrs C raised, the council should have informed her that she could request an assessment for a coordinated support plan and that they should have signposted her to the Additional Support Needs Tribunal, so we made a recommendation about this.

Recommendations

What we said should change to put things right in future:

• Where appropriate, information should be provided on how to request an assessment for a coordinated support plan. There should also be appropriate signposting to the Additional Support Needs Tribunal.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained about the care and treatment his late father (Mr A) received at Perth Royal Infirmary (hospital 1). Mr A was suffering from a chest infection and was also experiencing periods of delirium. Mr A was discharged from hospital 1 to a community hospital (hospital 2) in another health board area, but they refused to admit him due to his condition and he was transferred by ambulance to another hospital (hospital 3). Mr A was later admitted to hospital 2, where he died a short time later. Mr C complained that the decision to discharge Mr A from hospital 1 was unreasonable and that there was an unreasonable delay in replacing his hearing aids which were lost during his admission.

Mr C raised concerns that hospital 1 had treated Mr A for a chest infection, and hospital 2 also identified a chest infection. Mr C therefore considered that Mr A was discharged from hospital 1 with an unresolved infection and he questioned whether this was appropriate. We took independent medical advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that Mr A's observations were stable leading up to his discharge from hospital 1. We did not consider that there was any evidence to suggest Mr A was not fit for discharge. We noted that Mr A quickly developed a further infection but we did not consider that this was identifiable, or could reasonably have been predicted, at the time of discharge. Therefore, we did not uphold this aspect of Mr C's complaint. However, the adviser noted that there was no evidence of medical staff having formally assessed Mr A's delirium using a recognised screening tool and we therefore, made a recommendation regarding this.

In relation to the hearing aids, the board apologised to Mr C for the loss of these. In responding to our enquiries, they offered a fuller explanation of the steps followed in replacing them. We found that the timescale described for replacing the hearing aids was typical for such a process. Therefore, we did not uphold this aspect of Mr C's complaint, but we were critical of the level of explanation offered to Mr C when responding to his complaint. We provided some feedback to the board in this regard.

Recommendations

What we said should change to put things right in future:

• Medical staff should formally assess patients' delirium using a recommended screening tool, such as those recommended by Healthcare Improvement Scotland.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr B) about the care and treatment provided to Mr B's wife (Mrs A) at Gilbert Bain Hospital. Mrs A had pancreatic cancer and when she was admitted to hospital she could not eat. She was later assessed for palliative surgery (surgery which provides relief, but not a cure) at a different hospital, and was ultimately unable to have this surgery. Mr B felt that the reason his wife could not undergo the surgery was because she was not given adequate nutritional support (the giving of nutrients, either intravenously (directly into a vein) or by drip feeding through a tube placed in the digestive system) at Gilbert Bain Hospital.

We took independent advice from a consultant physician. We found that it was reasonable not to give Mrs A nutritional support until a decision was made to assess her for palliative surgery at the second hospital. Therefore, we did not uphold the complaint. However, we found that there were discussions between the two hospitals that were not recorded, so we made a recommendation to address this.

Recommendations

What we said should change to put things right in future:

• Medical staff should maintain records of verbal conversations with staff at other hospitals in the medical records.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mrs C presented to the practice with weakness and pins & needles in her limbs and head. The practice reviewed her and arranged blood tests. She was informed that these came back normal and no further action was taken. Mrs C's symptoms began to improve over the following months and had resolved by the end of the year. However, her symptoms returned and she presented to the practice again, nearly two years after her initial appointment. She was referred to neurology and, following an MRI scan, was diagnosed with relapsing remitting multiple sclerosis (MS). Mrs C complained that this could have been diagnosed sooner, had she been referred for further tests following her first appointment at the practice.

In responding to Mrs C's complaint, the practice said that the possibility of MS was considered but due to the fact that this was Mrs C's first presentation, that there was a lack of symptoms and that there was an absence of positive family history, they felt that the symptoms were unexplained. They said that the plan was to 'book bloods and review' and they apologised that they did not express clearly enough to Mrs C that she was expected to return for review. They observed that she was referred promptly at her second appointment as this was a second presentation of sensory symptoms, and that she was also exhibiting further symptoms.

We took independent medical advice from a GP, who considered that an appropriate level of assessment and investigation took place for a first presentation of such symptoms. We found that it is generally accepted that MS is suspected if there are two or more episodes of suspicious symptoms. We noted that it would have been reasonable for the practice to have clearly explained to Mrs C that they wished to follow up her symptoms following the blood tests. The General Medical Council's Good Medical Practice (GMC GMP) guidance refers to this as 'safety netting'. However, the adviser did not consider this to be a serious oversight, as it is reasonable for GPs to expect patients to return if their symptoms persist. Mrs C's symptoms subsequently resolved and she did not present again until around 22 months later. We found that the practice acted reasonably and did not uphold Mrs C's complaint. However, we made a recommendation to the practice in light of our findings.

Recommendations

What we said should change to put things right in future:

• The practice should familiarise themselves with GMC GMP guidelines on 'safety netting' and ensure that they clearly communicate follow-up arrangements to patients.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C complained on behalf of her daughter (Miss A) about the care and treatment she received from her psychiatrist. Miss A has a diagnosis of bipolar affective disorder (a mental health condition marked by alternating periods of elation and depression) and received care and treatment from the board's Child and Adolescent Mental Health Services for a number of years. Miss A was later transferred to general adult services under the care of a consultant psychiatrist, who met with Ms C and Miss A on three separate occasions. Ms C complained that the treatment Miss A received during this period was unreasonable. Ms C's concerns related in particular to treatment decisions, management plans, communication and attitude.

We took independent advice from a psychiatrist. We found that the consultant acted reasonably in relation to treatment decisions and management, and that, while there was evidence that one of the consultations was challenging for all concerned, there was no evidence that communication was of an unreasonable standard. Therefore, we did not uphold this complaint. However, we made recommendations to the board in regards to record-keeping and the transition from adolescent to adult services.

Recommendations

What we said should change to put things right in future:

• The board should ensure that adequate records are made of important meetings and filed in patients' medical records.
• The board should improve communication by providing more information about frequency of reviews and expectations, and consider scheduling more frequent reviews to help patients adjust to adult services in similar cases.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained to us about the psychiatric care and treatment his daughter (Miss A) had received from board staff. Miss A was subject to compulsory measures in a care home under mental health care legislation.

Mr C complained that the board had failed to consider the family's requests for Miss A to be moved to a different care home. We took independent advice from a consultant psychiatrist. We found that the board had acted reasonably in relation to the family's requests for Miss A to be moved. We found that the issue was discussed with the family and that attempts were made to identify and understand Miss A's views on the subject. We also found that the board had made reasonable efforts to listen to and respect the family's views. We did not uphold this aspect of the complaint.

Mr C also complained that the board had failed to provide Miss A with adequate psychiatric care while she was in the care home. He considered that this led to her admission to a psychiatric hospital. We found that there were no significant failings in the psychiatric care provided to Miss A in the care home. Her care plan had been reasonable and she had received adequate psychiatric care and supervision during the relevant period. Additional attempts to monitor or supervise Miss A would not have changed the outcome and board staff had acted reasonably in relation to this. Although we did not uphold this aspect of Mr C's complaint, we found that Miss A's records about her care plan were not of an adequate standard and we made a recommendation in relation to this.

Recommendations

Sector: health

Subject: clinical treatment / diagnosis

Decision: not upheld, recommendations

• Summary
• Mr C complained to us about the psychiatric care and treatment his daughter (Miss A) had received from board staff. Miss A was subject to compulsory measures in a care home under mental health care legislation.
• Mr C complained that the board had failed to consider the family's requests for Miss A to be moved to a different care home. We took independent advice from a consultant psychiatrist. We found that the board had acted reasonably in relation to the family's requests for Miss A to be moved. We found that the issue was discussed with the family and that attempts were made to identify and understand Miss A's views on the subject. We also found that the board had made reasonable efforts to listen to and respect the family's views. We did not uphold this aspect of the complaint.
• Mr C also complained that the board had failed to provide Miss A with adequate psychiatric care while she was in the care home. He considered that this led to her admission to a psychiatric hospital. We found that there were no significant failings in the psychiatric care provided to Miss A in the care home. Her care plan had been reasonable and she had received adequate psychiatric care and supervision during the relevant period. Additional attempts to monitor or supervise Miss A would not have changed the outcome and board staff had acted reasonably in relation to this. Although we did not uphold this aspect of Mr C's complaint, we found that Miss A's records about her care plan were not of an adequate standard and we made a recommendation in relation to this.
• Recommendations [1]

What we said should change to put things right in future:

• Care plans in care programme approach documentation should be clear and the objectives should be focussed and specific, with responsible persons or agencies identified. There should also be a clear discussion of the outcomes of each objective recorded at each crae programme approach review. Where the board is working with another care provider, there should be a clear record of the discussion around care plan objectives allocated to such care providers and the attempts to meet these objectives.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.