Not upheld, recommendations

Summary

Mr C, who is a solicitor, raised a complaint on behalf of Ms A about the university's handling of her academic appeal. In particular, he said that the university failed to take all relevant material into account and failed to share information with Ms A during the appeal process.

During our investigation we considered the academic appeals procedure, which had two stages - faculty appeal and senate appeal. We found that, in line with the procedures, at faculty level neither the student making the appeal or the department had any right of appearance before the committee considering the appeal. The appeal at that level was considered on the basis of written information submitted by the student and the relevant department. In this case we were satisfied, based on the available evidence, that the written information provided by Ms A was taken into account during the academic appeal.

However, while we were satisfied that they had followed the academic appeals procedure we were concerned that, while the department responded to the written submission submitted by Ms A, she was not given an opportunity to respond to the submission submitted by the department, and we made a recommendation to address this. We were aware that Ms A could have requested the information that was considered at the faculty level before submitting an appeal to senate, but had not done so.

Recommendations

We recommended that the university:

• review their procedures for information sharing when dealing with appeals to ensure both parties have the same access to information; and
• should (if Ms A considers there are inaccuracies in the department's submission to the committee that have not been addressed and raises these with the university) provide evidence to demonstrate that they have fully considered these.

Summary

Mr C complained that the board failed to take reasonable steps to fund travel and accommodation costs for his mother (Mrs A) following his father's emergency transfer to a hospital on the mainland. Mrs A wished to accompany her husband but there was no room in the ambulance, and so she made arrangements to travel to the mainland herself. Mrs A's GP had signed a post-dated escort authorisation form for her. Because of this she submitted an expenses claim, expecting the board to pay her costs, but they refused to do so.

Our investigation found that the board's policy says that they will only fund costs when someone is required to escort a patient who needs their support when travelling. This does not apply where the patient has travelled by ambulance, nor where family members to travel to be with someone who had been taken to hospital, and so the GP had incorrectly signed the form. Because of this, we did not uphold Mr C's complaint. In responding to our enquiries, the board also explained that they intended to highlight the requirements of the patient travel policy to all GPs in their area to ensure that the correct information is provided to families in future.

Recommendations

We recommended that the board:

• provide the Ombudsman with evidence that they have reminded GPs in their area about correct use of the patient travel policy.

Summary

Mrs C was unhappy with care and treatment she had received from a doctor at the medical practice, and had tried to avoid consulting him. However, she had to see him for a medication review. She was unhappy about this and raised concerns about the treatment she received from him when she attended the review. In particular, she complained that he changed her medication. To investigate the complaint, we took independent advice from a medical adviser. Their advice was that it was entirely appropriate for the practice to have made arrangements to review Mrs C's medication, and that the decision to change her medication was reasonable. We, therefore, did not uphold this complaint. We noted that the practice said that they had asked Mrs C to attend for review several times before an appointment was eventually arranged, but Mrs C said she did not receive such requests. As the practice had not kept records of the requests, we made a recommendation about this.

Mrs C also complained about a further consultation with the doctor when she was taken ill and had to arrange an urgent appointment. She said the doctor failed to examine her, instead passing her on to the practice nurse, and that he had panicked her by discussing the possibility of norovirus (winter vomiting virus). The doctor said that he did examine Mrs C, with the assistance of the practice nurse, and that he diagnosed a chest infection and made arrangements to have her admitted to hospital. Mrs C disputed this, maintaining that she was not examined and that a chest infection was not mentioned. The advice we received was that the records suggested an appropriately managed chest infection. This did not accord with Mrs C's account of events but we were unable to reconcile this account with the documentary evidence and we did not uphold her complaint.

Recommendations

We recommended that the practice:

• remind staff to ensure that all attempts to contact patients are appropriately recorded.

Summary

Mr C made three complaints about the treatment that the board's mental health service gave his brother (Mr A). Mr A had long term mental health difficulties including paranoid schizophrenia (a condition that may cause hallucinations, delusions and muddled thoughts and behaviours). He lived independently and had been prescribed Modecate (an antipsychotic medication administered by injection) for many years. Mr C said this had resulted in severe physical impairment for Mr A including paralysis and locked muscles. He also felt it had been detrimental to Mr A's mental health and was inappropriate because he had suffered a head injury at a young age.

We did not uphold any of Mr C's complaints. We took independent advice from one of our medical advisers, and found that in order to manage this condition, it was often necessary to prescribe medication on a long term basis. We found that in Mr A's case, consideration had been given to the side effects of the drug, which had been balanced against the benefits of managing his psychiatric condition. We also noted that Mr A had been prescribed other medication to combat the side effects. We also found that the doctors treating Mr A had taken into account his head injury when deciding what medication he should be prescribed.

Mr C had also complained that Modecate was inappropriately stopped suddenly, and replaced with Olanzapine (an oral medication). We found that this was done appropriately. Olanzapine had less side effects than Modecate, and the change was made because Mr A was going to receive increased home support. This meant that he could be supervised in taking oral medication. We also noted that the change happened while Mr A was in hospital on a long term basis, and so the transitional period could be monitored.

Finally, Mr C had said that a doctor had suggested that he apply for a power of attorney in respect of Mr A, but had then carried out an assessment that found that Mr A did not have the capacity to make a decision about that. Our investigation found no evidence that the board had unreasonably suggested Mr C apply for this and also found that the general assessment of Mr A's capacity was conducted appropriately. However, as we noted that Mr A had not been assessed specifically on his capacity to consent to medical treatment, we made a recommendation about this.

Recommendations

We recommended that the board:

• conduct an assessment of Mr A's capacity to consent to treatment and ensure the results inform his treatment plan.

Summary

Mrs C complained about the care and treatment her husband (Mr C) received in hospital during two separate admissions. Mrs C was dissatisfied that her husband was discharged from the hospital despite being advised that he would be undergoing further tests at a second hospital while an inpatient. She was also dissatisfied with the care Mr C received during a second admission because she said there were communication problems between two doctors about arrangements for Mr C to have a coronary artery bypass graft (CABG - a surgical procedure to treat coronary heart disease) at the second hospital. Mrs C said that in response to the complaint, the board acknowledged her frustration at the length of time Mr C waited for the CABG but advised that they did not consider there had been any mismanagement by the first doctor.

Our investigation found that there was evidence to support that the first doctor provided appropriate care during Mr C's first admission and made reasonable attempts during the second admission to transfer Mr C to the second hospital with a view to having a CABG carried out. We also established that the second doctor had to ensure that Mr C was fit to undertake major cardiac surgery, because of a number of underlying health conditions. Although we did not uphold the complaint, we made a recommendation to address the issue of joined-up care between hospitals.

Recommendations

We recommended that the board:

• review how they share information about a patient's management plan between hospitals to ensure timely care and treatment.

Summary

Mr C complained that the council unreasonably denied him access to their library service. The council had excluded Mr C from their libraries for a year because he had breached their computer use policy by accessing inappropriate websites and because of his attitude towards some members of staff. However, because Mr C had stated that he would not be returning to the library, the council excluded him informally, rather than formally under the relevant legislation. The council then reviewed this at the end of the year and extended the exclusion by another year. After a further year, they reviewed it again and decided that he could have conditional access to a library for an interim period.

The Scottish Public Services Ombudsman Act 2002 says we cannot question a decision that a council was entitled to make (a discretionary decision) where there is no evidence of maladministration (of anything being wrong in the taking of that decision). We can, however, consider whether the council followed the relevant policy or policies. In Mr C's case, the council did not have a policy on informal exclusion from their services, so there was no policy to compare their actions against. We did, however, consider whether they should have formally excluded Mr C from the library under the relevant legislation. We were, however, satisfied that the council were entitled to decide to exclude him from the library and, in view of the fact that Mr C said that he would not be returning to the library anyway, it was reasonable for them to do this on an informal basis.

That said, we found that the council had delayed in reviewing their decision at the end of each year. We found that they should have been more proactive in making these reviews and that their delays could potentially have delayed Mr C's return to the library. We also found that one of their letters should have offered Mr C the opportunity to make representations against their decision to extend the exclusion. Although we did not uphold his complaint, we made recommendations to address these matters.

We also considered whether it was reasonable for the council to impose conditions when they decided that Mr C could return to the library. The council has a duty of care towards their staff and we considered that it was reasonable for them to initially impose the conditions.

Recommendations

We recommended that the council:

• consider whether they should have a policy on excluding members of the public from public buildings whether formally or informally; and
• ensure that letters issued to members of the public about exclusions provide information on how they can make representations against the decision.

Summary

In December 2011, Mr C received eight invoices from Business Stream requesting significant sums of money for water and water services backdated to April 2008. Mr C disputed these, as there was no water available in his basement premises and he only had use of communal kitchen and bathroom facilities elsewhere in the building. Business Stream, however, said that Mr C had been receiving and using water services from April 2008, when the water industry opened to competition and they became default providers. They said he had used water, and was required to pay for it. They added that as there was no meter in the property, under the relevant legislation his water usage had been calculated on the rateable value of the property he occupied. Mr C was unhappy about this and complained to us.

Our investigation found that what Business Stream had said was correct, so we did not uphold his complaint. However, the investigation also showed that they had not dealt well with Mr C's representations and had failed to provide proper explanations about the amount due, or the reasons why it was due.

Recommendations

We recommended that Business Stream:

• apologise for the fact that Mr C was not given written notice and explanation that a significant number of invoices were to be sent;
• consider introducing explanatory letters as a matter of course; and
• apologise to Mr C for their failure to address properly his concerns and provide him with a detailed explantion of why his bill was as it was.

Summary

Mr C lives near an open cast coal site which has been subject to several applications for planning consent covering specific areas of the site. Mr C made three complaints about the council's recording of operational complaints made by residents and the council's investigation of issues of dust and noise emissions from the site. He also complained about the council's failure to review relevant planning conditions to ensure effective monitoring.

Our investigation did not uphold any of Mr C's complaints. We found that the council provided a reasonable explanation of how reports of noise nuisance and dust emissions and complaints were recorded by the relevant planning and environmental services. We found that the council responded appropriately to a specific complaint of dust emissions in March 2012 and with regard to a query made by Mr C in submitting photographic evidence. We also found that, when noise complaints had been made, these had been brought to the operator's attention. A sizeable number of mitigation measures (actions to reduce the noise or the impact of the noise) had been installed. Despite these, Mr C and other residents had continued to make complaints of inappropriately loud noise levels, which the council had investigated. In the autumn of 2012 the council sited noise equipment in Mr C's neighbour's property and the initial results suggested to the council that further controlled monitoring was required. At the end of our investigation the results of this monitoring were still awaited, and so we made a recommendation relating to this.

Recommendations

We recommended that the council:

• complete their current noise monitoring exercise, analyse the results, and inform Mr C of any action they intend to undertake.

Summary

Mrs C complained that the council failed to notify her when her neighbour applied for an amendment to planning permission for an extension. She also said that the council issued a completion certificate for the extension although the works were not completed, and had failed to rectify this. Mrs C also complained that the council delayed in investigating her complaint and did not investigate it properly.

Our investigation found that the council granted the original planning permission in 2010, and that they had already apologised to Mrs C for failing to notify her about this. We also found that the planning permission had never been amended and so there had not been any further fault in providing Mrs C with neighbour notification. The work that had not been completed in accordance with the approved plans was to paint the wall facing Mrs C's garden. We found that the building warrant granted for the works said that the wall was to be finished in render but, as the colour of the render was not relevant to the warrant, the fact that it was not painted did not impact on the granting of a completion certificate. The council had in fact tried to negotiate with Mrs C's neighbour to have her paint the wall, and although she had said she would do so, this had not yet happened. Any formal action (enforcement) is a matter for the council's discretion. The council had decided, as they were entitled to do, that they could not justify taking formal action to enforce a colour change on a wall that was not open to public view, so we did not criticise their actions on this. We did, however, make recommendations about their notification process and about how they take the matter forward.

We found that there was a slight delay by the council in responding to the complaint, but that they had already explained the reason for this and apologised to Mrs C. We did not find any other faults in their complaints handling.

Recommendations

We recommended that the council:

• review their neighbour notification process to ensure it is robust and ensures relevant neighbours are notified of planning applications; and
• continue their efforts to have Mrs C's neighbour comply with the approved plans.

*due to an administrative error, the subject of this case was updated 5 December 2013

Summary

Ms C complained that a hospital failed to provide her late mother (Mrs A) with appropriate nursing care and treatment towards the end of her life. Ms C told us that several issues arose that caused her concern. These included the lack of support Mrs A received in order to help her to eat; visiting times; the method by which paracetamol was administered; the treatment of a skin rash; the lack of information given to Ms C about Mrs A's diazepam medication; communication with the charge nurse; financial harm; funeral parlour arrangements; the documentation of private conversations and a missing page of Mrs A's clinical records.

We took independent advice from one of our medical advisers, and took account of this alongside all the documentation provided by Ms C and the board. Our investigation found no evidence of failures in the overall nursing care or standard of record-keeping so we did not uphold any aspect of Ms C's complaint.

However, we were critical of the comments made by and the general tone of the written records of one of the nursing staff, and of the inflexible attitude towards Ms C and family members about visiting times and assisting at mealtimes, and so made recommendations to reflect this.

Recommendations

We recommended that the board:

• ensure that staff are familiar with all aspects of person centred care;
• ensure that staff are reminded that relatives and carers should be included in decision making and where appropriate involved in care planning;
• ensure staff are reminded that rules for visiting and meal times are for the benefit and care and treatment of patients, but should be flexible to allow individual care for patients and their families;
• ensure that consideration is given to the individual personal circumstances of those who wish to be with terminally ill relatives/patients;
• ensure effective and sympathetic communication is made with those who wish to be with terminally ill relatives/patients; and
• ensure that wherever possible leaflet information about undertakers is available on the ward to assist relatives at times of bereavement.