Not upheld, recommendations

Summary

Mr C said that until the age of 14 months, his son (child A) attended A&E at the Royal Hospital for Sick Children on several occasions. Mr C said that staff unreasonably failed to investigate child A's symptoms at these attendances and did not provide a correct diagnosis. Mr C believed that child A had had a lung infection since birth until the point at which he began to recover.

We took independent advice from a medical adviser who specialises in paediatrics. We found that there was no indication that either a chest x-ray or the prescribing of antibiotics during child A's attendances were necessary and that the care and treatment given to child A was reasonable. The adviser noted that children under one often have symptoms of viral upper respiratory tract infection during nearly half of their first year, and that the diagnosis and treatment decisions at each attendance at hospital were reasonable. We therefore did not uphold Mr C's complaint. However, we found that there were shortcomings in relation to assessment of risk factors and made a recommendation to address this. We noted these did not have an effect on the outcome of the standard of care received.

Recommendations

We recommended that the board:

• ensure the shortcomings identified in this investigation are addressed with relevant staff through training and supervision (where appropriate) and through audits.

Summary

Mr C had an occupational therapy assessment which recommended changes to his bathroom, including a new shower. The council facilitated the appointment of a contractor to do the work, although the instruction and contract for the work was between Mr C and the contractor. The council gave a grant for part of the work. Once the work was complete, the council inspected the work and signed it off as complete. Mr C was unhappy with the quality of the workmanship. He had an architect inspect the work and his report indicated that the installation was dangerous. Mr C felt that the council were ignoring this report and complained that the council failed to properly ensure that the work done in his bathroom met his assessed need before signing it off as complete.

We investigated Mr C's complaint in relation to the council's role and obligations. We explained that we could not consider a complaint about the contractor and the quality of workmanship by them as, ultimately, he had instructed the contractor and the contract for work was between him and them.

In investigating the complaint, we reviewed the documentation and information provided by Mr C and the council. We also reviewed the council’s ‘Scheme of Assistance for Private Homeowners and Tenants of Private Landlords’ (the SoA) which sets out the process to the followed by the council. The SoA indicated that, when work was complete, an occupational therapy visit should take place to make sure that the adaptation meets the client's assessed needs. A final inspection by the private sector housing team should also take place. Generally speaking, we considered that the council had fulfilled these obligations. We noted that there was no evidence that Mr C had raised concerns that his assessed needs were not met at the final inspection and we considered that the council's responses to his subsequent concerns had been reasonable. For these reasons, we decided not to uphold his complaint.

We did have concerns that following their visit to Mr C, the occupational therapist did not record or inform the private sector housing team whether or not they were satisfied that the adaptation met the his assessed needs and, therefore, the council could not fully demonstrate compliance with the process set out in the SoA. We also felt that the council’s SoA and associated paperwork did not accurately reflect the council’s current handling of these cases and did not provide clear information about their limited role. We made recommendations as a result.

Recommendations

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

• To show compliance with the process set out in the Council’s Scheme of Assistance, following their visit, the occupational therapist should clearly record and inform the Private Sector Housing Team whether or not they are satisfied that the adaptations meets the client’s assessed needs.
• The council should review their SoA (specifically in sections 3.1.6 to 3.2.2) and associated paperwork and make sure that they accurately reflect the council’s current handling, as well as providing clear information about their limited role.

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 that there had been a delay in transferring her mother (Mrs A) from Uist and Barra Hospital to Western Isles Hospital. Mrs A had a stroke and after the emergency services were called, she was taken by ambulance to Uist and Barra Hospital. The Scottish Ambulance Service had been called prior to her admission, and a plane to transfer Mrs A to Western Isles Hospital then left the mainland. Because of adverse weather, the plane was unable to land at the nearby airport and as a result, the transfer could not take place that evening.

In response to Ms C's complaint, the board explained that there is a four and a half hour window to assess a patient who is suspected of having had a stroke and judge the potential benefit of thrombolysis (clot busting) treatment. The board said that the delay in transfer was caused by bad weather, which meant that the cut-off time for potential treatment with thrombolysis medication had passed.

We took independent advice from a specialist in emergency medicine. They did not find evidence of a delay in contacting the ambulance service regarding air transfer and said that the decision whether it was safe to fly or not, and the assessment of the likelihood of being able to land, rested with the aircraft captain. The adviser said that once it became apparent that the plane was unable to land, the opportunity to get Mrs A to Western Isles Hospital, complete a CT scan and consider the possibility of thrombolysis in under four and a half hours had passed. Whilst the adviser considered that the care surrounding the transfer was reasonable, they considered that the doctor's records should have been more detailed. We did not uphold this complaint, but we made a recommendation.

Ms C also raised concern about the communication during the transfer process. We found that the board had apologised for any upset and distress Ms C's family experienced. Having considered the evidence available, the adviser concluded that the communication was reasonable. We did not uphold this complaint.

Recommendations

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

• Medical staff should maintain sufficiently detailed medical records in accordance with General Medical Council Good Medical Practice guidance.

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

Miss C complained that the board unreasonably refused her breast reduction surgery. She maintained that this should have been done, not for reasons of appearance, but because of her extreme back and neck pain. The board did not agree and said that Miss C failed to meet the criteria necessary for the operation to be carried out.

We took independent advice from a consultant in plastic and reconstructive surgery. We found that in consideration of Miss C's case, the board had followed current Scottish Government advice. We did not uphold her complaint. However, we also found that the board had not told Miss C what to do should she continue to suffer severe back and neck pain, and so we made a recommendation about this.

Recommendations

What we asked the organisation to do in this case:

• Advise Miss C what to do in the event of non-surgical methods failing to improve her back and neck pain.

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 prison health centre's decision to reduce and remove his prescribed medication was unreasonable and had caused him to be left in pain. The board said that two nurses had witnessed Mr C attempting to withhold his medication and for that reason a decision had been taken by clinical staff to reduce and remove his medication. They said this was in keeping with an agreement Mr C had previously signed which stated that a failure on Mr C's part to take his medication properly may result in it being reduced or stopped.

Our decision, after taking independent advice from a GP adviser, was that the board had acted reasonably and that the alternative medication Mr C had been prescribed was also reasonable.

However, we were critical of the board's handling of Mr C's complaints. They had failed to follow their complaints handing process, and had failed to address all of Mr C's main points of complaint. We made several recommendations to address the failings we identified.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to handle his complaints properly and for failing to reply fully to him.

In relation to complaints handling, we recommended:

• Staff should recognise when a complaint has been made and should be aware of the correct process for dealing with it. Complaint responses should cover all significant points raised in the complaint.

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 that the Care Inspectorate had published an inspection report on his nursery that was inaccurate. He stated that there were a large number of errors in both the draft report and the final published report. We found that although there had been errors in the draft report, there was a process in place to correct these and the corrections had been made in line with this process. Mr C said that a number of discussions referred to in the inspection report had not taken place, but there was evidence in the inspector's notes that a number of these issues were discussed. We found one minor error in the report in relation to snacks being provided by the nursery and asked the Care Inspectorate to amend this. However, other than this point, there was no evidence that the report was inaccurate and we did not uphold this aspect of the complaint.

Mr C also complained that the Care Inspectorate had failed to reasonably investigate and respond to his complaints. Whilst we were critical of the confusion caused by the comments made by a manager at a meeting with Mr C, we were satisfied that when Mr C subsequently requested clarification in relation to this matter, this was provided to him. We did not consider that another senior member of staff had misinterpreted the Care Inspectorate's own guidelines in an attempt to justify a requirement in the draft report, or that this member of staff's actions had been unreasonable when he met Mr C to discuss his complaint. We also considered that the Care Inspectorate had carried out a reasonable investigation into Mr C's complaint and we did not uphold his complaint to us about this matter.

Recommendations

We recommended that the Care Inspectorate:

• amend the paragraph in the inspection report available online in relation to snacks.

Summary

Mr C, a council tenant, complained that he had been experiencing odours in his house for several years and he believed that these odours were coming from his next door neighbour's house. Mr C complained that the council had not taken reasonable steps to investigate and stop the odour ingress.

During the investigation, we carefully reviewed all the information provided by Mr C and the council. We found that the council had carried out a number of investigations and repairs, including installing air quality monitoring equipment and using a smoke machine to determine where the odours were ingressing, sealing stair treads and skirting boards, replastering walls, and repairing the solum (the area underneath the floorboards). Whilst we found that the council had taken reasonable action to investigate the odours and make repairs to the house, we recommended that the council consider whether there was any further action they could take as a smoke bomb test had revealed some ingress from one house into another.

Recommendations

We recommended that the council:

• consider whether there are any further actions available to them that would be appropriate to implement in this case, given the results of the smoke bomb test.

Summary

Mr C complained that the housing association responded unreasonably to his concerns about the maintenance of the communal garden areas at his home.

We did not uphold Mr C's complaint about the association's response to the concerns he had raised. We found that the association had responded in line with the requirements of their complaints procedure and that, in the main, they had met their guidelines in relation to the work that should be completed in the garden areas. They had shown that they had made efforts to complete a thorough investigation, involving all relevant parties, and they were committed to identifying areas for improvement. We made recommendations to support the improvement of this service.

Recommendations

We recommended that the association:

• complete an improvement plan for the communal garden;
• complete their review of the Estate Management Policy; and
• review their Open Space Maintenance Standard Specification.

Summary

Miss C said her mother (Mrs A) had a complex medical history and was admitted to the Royal Victoria Hospital with reduced mobility and delirium (a temporary state of mental confusion arising from, amongst other things, infection). Mrs A was discharged to a nursing home eight days later. Miss C complained that Mrs A was not medically fit to be discharged from the hospital. Mrs A died several weeks after her discharge.

We took independent medical advice. We found that Mrs A was medically fit to be discharged and that the care package was reasonable. We therefore did not uphold Miss C's complaint. However, there were shortcomings in the way in which Mrs A was discharged. This included communication about Mrs A approaching the end of her life, meaning that Miss C was unprepared for Mrs A's death. We therefore made recommendations in relation to this.

Recommendations

We recommended that the board:

• review the discharge policy and communication with relatives in light of the failings identified;
• raise the failings identified with relevant staff; and
• apologise for the failings this investigation has identified.

Summary

Mr C received treatment from the board over a two-year period for urinary incontinence and erectile dysfunction, which he developed following surgery at the Western General Hospital for prostate cancer. After communicating with the board about his dissatisfaction with his treatment, Mr C obtained penile implant surgery privately abroad and asked the board to reimburse him for the cost of his treatment. The board refused.

Mr C complained that the board acted unreasonably when assessing his request for reimbursement, because they failed to take into account that, despite being aware of his concerns about the delay and his intention to seek treatment privately, they did not properly inform him of the alternative options that were available within the NHS.

We obtained independent advice from a consultant urologist. The adviser said that where a patient raises concerns about delays in treatment and their intention to look for treatment elsewhere, the board should advise the patient of the options to obtain treatment elsewhere in the NHS or the European Union. It was clear that Mr C made the board aware of his concerns about the delays in investigation and treatment of his conditions. However, Mr C advised the board that he had already agreed private treatment with a urologist outwith the UK, that he would be pursuing that course of action and that he did not expect a response from the board on this matter.

The adviser noted that the board said Mr C should have had a full assessment of his urinary incontinence and agreed treatment plan (which had yet to be completed), prior to undertaking any surgery for erectile dysfunction. The adviser said this was entirely reasonable. While we acknowledged the delays in Mr C's treatment, we considered that the board's assessment of Mr C's request for reimbursement was reasonable, as the equivalent treatment in the UK or EU at that time would have been to continue to treat his urinary incontinence rather than perform implant surgery. We therefore did not uphold Mr C's complaint. However, we found that the board did not respond to one of Mr C's letters to them and made a recommendation regarding this.

Recommendations

We recommended that the board:

• apologise to Mr C for failing to respond to a letter during their handling of his complaint.