Some upheld, recommendations

Summary

Mrs A had been treated in the community for a urinary tract infection, confusion and dehydration, but the treatment did not address her condition and she went into Ayr Hospital for further treatment. Mrs A's daughter (Miss C) then complained on her mother's behalf about nursing care, prescribing of antibiotics (a range of drugs used to fight bacterial infection) and complaints handling.

During their complaints procedure, the board had already acknowledged some failings in the nursing care, and our investigation, which included taking independent advice from our nursing adviser, confirmed these failings. On balance, we upheld this complaint, although our nursing adviser explained that some of the nursing care and treatment was appropriate.

On one occasion during Mrs A's admission she required to be prescribed intravenous (directly into the vein) antibiotics and a medical review had been requested. There was a delay of four hours before a doctor attended to review her, and a further delay of seven hours before the antibiotics could be given as that doctor did not write up a prescription. We took independent advice from our medical adviser, who reviewed the evidence and was critical of these delays.

Miss C also complained that the board had not made a timely response to her complaint. Our investigation found that, while they did not respond within the 20 working days recommended in the NHS complaints handling procedure, there was no evidence of any avoidable delays and Miss C was kept informed. Although some of the communication with Miss C took place at her instigation, overall we found that the handling of her complaints was reasonable.

Recommendations

We recommended that the board:

• take action to ensure that all staff involved in this complaint are reminded of the need for effective communication with patients, relatives and carers;
• review their discharge procedures and documentation to ensure that relevant information is passed on to those involved in a patient's ongoing care; and
• issue a written apology for the additional failings identified during this investigation.

Summary

Ms C works for a company providing care services to people who rented accommodation individually from a housing association. The company had use of a room on the premises, where staff could stay overnight when helping residents. The valuation assessor had categorised the premises as residential, apart from the room, which had a commercial rateable value.

Ms C complained that Business Stream applied charges for water and waste water services on the basis of a care home. Her company was charged for all water passing through the shared water meter, whether it was used for domestic or non-domestic purposes. She argued that the domestic water was already covered by council tax for the residential parts of the premises, and that the company should only be charged on the small rateable value of the commercial element. Business Stream had applied their dual-use policy, used where a single property has both residential and commercial components. This requires commercial residents to ask domestic residents to cancel the water charges from their council tax and pay the company for water that they use. However, Ms C said that the residents were exempt from council tax (and, therefore, water charges). Business Stream challenged the charges with Scottish Water on Ms C's behalf, but Scottish Water said that they were correct.

We upheld Ms C's complaint as we had a number of concerns about this approach. Scottish Water considered the premises to be a care home, implying that all water was used for the operation of the care home. Under such circumstances, the dual-use policy would not be applicable. The fact that they had applied this policy reflected the fact that the assessor differentiated between the domestic and non-domestic parts of the premises. The dual-use policy also made no provision for the fact that the residents were not liable for council tax. We considered it unreasonable to expect the company to ignore this and charge the residents for water (at the higher commercial rate), or to absorb the cost of the water used. The policy was applied without considering the specific circumstances at the premises or whether the company was being charged only for the water it used.

We did not uphold a second complaint from Ms C about the handling of her complaint.

Recommendations

We recommended that Business Stream:

• share our comments with Scottish Water and work with them to ensure that water charges at the premises accurately reflect the amount of water used for non-domestic purposes; and
• share our comments with Scottish Water regarding the appropriateness of applying the dual-use policy in this case.

Summary

Ms C complained about the way the council handled changes to her council tax when she started work and stopped getting employment support allowance. Ms C contacted the council to tell them about the change in her circumstances. She knew that she was no longer entitled to a council tax reduction and wanted the necessary adjustments to be made to her council tax payments, which she made by direct debit.

We found that the council did not act efficiently on the information provided and were responsible for confusion in the administration of Ms C's council tax. The team responsible for council tax reduction had not acted on an electronic notification from the Department of Work and Pensions and when Ms C contacted the council's customer contact centre she was given mixed messages about the process by which changes would be made to her account. Each time Ms C phoned the council she should have been transferred to the benefits service or invited to join the service phone queue in line with the council's agreed call-handling process. There was no evidence that this process was followed. Consequently it took more than 12 months for the council tax reduction to be removed so that the team responsible for council tax could adjust Ms C's account, by which time she had accrued significant arrears.

Ms C also complained that the council unreasonably took a payment from her bank account without prior warning. We did not uphold this complaint because there was no evidence that the council told Ms C when she made an additional payment by phone that the usual amount would not also be taken by direct debit.

Recommendations

We recommended that the council:

• apologise to Ms C for the confusion caused in handling her complaint calls and in responding to her complaint about poor communication; and
• remind staff of the importance of the agreed process for transferring calls or inviting people to join the service queue.

Summary

Mrs C applied for a crisis grant for a door entry system. The next day the council told her that her application had been declined, and Mrs C asked immediately for the decision to be reviewed. She told us that she did not hear from the council for over two weeks so she asked them what had happened to the review. The council told her that the review took place on the day she asked for it, and it was declined again. Mrs C did not believe that the council could make a decision and then review it within 24 hours. She also said that they did not explain to her why a door entry system could not be funded by a crisis grant.

The council confirmed that the review was indeed dealt with within one working day, as they were up to date with these at that time. This was reasonable and we did not uphold this complaint. We also found, however, that Scottish Government guidance says that the council should have explained why they refused the application. They admitted to us that they did not do this in Mrs C's case so we upheld that complaint.

Recommendations

We recommended that the council:

• apologise to Mrs C for failing to explain why a crisis grant cannot be given for a door entry system when they communicated their decision; and
• explain to Mrs C why a crisis grant cannot be given for a door entry system.

Summary

Mrs C complained that the association did not provide appropriate information on how to use her heating system. She reported that this led to higher than necessary heating bills. She said that the heating system went wrong on several occasions, and she considered that there was a systematic problem which was not being addressed by the association.

Our investigation reviewed the information given to Mrs C about her heating system, from the manufacturer and the association. The manufacturer visited Mrs C's property three years after she moved in. They did not find a systematic fault but they did provide additional information to Mrs C about the operation of her heating system. They showed her seasonal adjustments which would have reduced her electricity bills. However, the association said that this information was not available at the time Mrs C moved into her tenancy. Given the evidence available in relation to the heating system and the actions of the manufacturer, we considered it likely that the information relating to seasonal adjustments had not been available to the association when Mrs C moved into her property. We concluded that the association provided reasonable information at the start of the tenancy, given the information available to them, but that they could have done more to explore the impact of the lack of information when Mrs C complained.

We were given information about the staff training provided in relation to the operation of Mrs C's heating system. We also noted the involvement of other professionals to fix the heating system at different times, who did not raise any concerns about the overall operation of the heating system. The evidence we saw indicated that maintenance staff had the appropriate skills to maintain Mrs C's central heating system.

We reviewed the evidence in relation to the problems which Mrs C experienced with her heating system, and the actions taken by the association. We reviewed the customer care policy to identify what action they should have taken, and could not find any faults with the association's responses to the problems that arose. They responded promptly and took into account Mrs C's availability when arranging for repairs. All repairs were completed within the expected timescales.

Mrs C also complained about the way her complaint had been handled. She had expected to discuss her complaint with staff before they investigated. We concluded that it would have been in line with their complaints handling procedure to have discussed the complaint prior to an investigation. However, we noted that amendments would be made to the association's complaints handling procedure which would clarify the situation in relation to such discussions in future complaints.

Recommendations

We recommended that the association:

• consider putting a case to the manufacturers of the heating system for compensation for the excess cost of electricity paid by Mrs C as a result of insufficient information from them on the running of the exhaust air heat pump.

Summary

Mr C was a former tenant of the association. After moving out of his property, he was sent a bill for rechargeable works, which were identified during an empty property inspection and carried out by a contractor on behalf of the association. This included removing laminate and vinyl floor coverings from the property and disposing of personal belongings left in the back court. Mr C disputed the charges, saying that he was not aware that he was responsible for removing the flooring and that he had asked a friend to have the items collected from the back court. He complained that the association had not made him aware of his responsibilities before the end of his tenancy, had not told him about the rechargeable works before invoicing him and had not treated his case sensitively.

After investigating Mr C's complaints we found that, at an inspection before he moved out, the association had not made a clear record of any advice he was given on removing flooring or of any works he should carry out before the end of his tenancy. Although they had written to Mr C about his responsibilities before he moved, he told us that he had not received this, and we noted that his postcode was not included in the address. We did, however, find that the tenancy agreement made it clear that all belongings had to be removed and we took the view that he should have been aware of his responsibilities in relation to the items left in the back court.

On balance, we found that the association did not take reasonable steps to give Mr C formal notice of his responsibilities to remove the flooring and we upheld this element of his complaint. We found that they had taken reasonable measures to ensure that he was aware of the rechargeable works and we did not uphold this part of his complaint, as a detailed letter was issued the day after he moved out. We upheld the last aspect of Mr C's complaint as we found that his concerns were not treated as a complaint at an early stage and that the tone/language of some of the association's letters was not sensitive to his situation.

Recommendations

We recommended that the association:

• highlight the need for staff to complete the pre-end-of-tenancy inspection form appropriately to avoid confusion for tenants;
• deduct all costs associated with the removal and disposal of floor coverings from the outstanding bill;
• remind staff of the complaints handling procedure guidance on the identification of a complaint; and
• apologise for the way that Mr C's complaint was handled.

Summary

Mr C complained that there was an unreasonable delay in the prison health centre providing appropriate treatment for his chest infection. He said he submitted a number of referral forms to see a nurse but despite this, no one saw him. In addition, Mr C complained about the board's handling of his complaints.

The evidence available confirmed that nursing staff attempted to see Mr C regularly in response to his referral forms but because he was not always in the hall at those times, it was not always possible to see him. In addition, the prison health centre took sputum (mucus from the lower airways) samples from Mr C and sent them away for analysis. They also prescribed an antibiotic.

In response to Mr C's complaint, the board indicated that he should have remained in his hall to be seen by a nurse. We asked the Scottish Prison Service (SPS) if it was acceptable for a prisoner to do that and they advised us that prisoners are required to attend work or education each day and they would only be allowed to remain in the hall if they were clearly unfit to report for work or education. In addition, we took independent clinical advice from our medical adviser for their view on the treatment provided to Mr C. They noted that he had been reporting a persistent cough for some time, and because Mr C was an ex-smoker, our adviser questioned the appropriateness of the health centre only taking sputum samples instead of considering whether an x-ray of his chest was needed as outlined by national guidelines.

We were satisfied that appropriate attempts were made by nursing staff to see Mr C in response to his referral forms but in light of the comments we received from the SPS, we did ask the board to ensure that everyone was clear on the process in place. In addition, because Mr C continued to report a persistent cough, and because of our adviser's comments, we upheld Mr C's complaint about the treatment he received.

In looking at the way the board handled Mr C's complaints, we were satisfied it was reasonable and so we did not uphold this aspect of his complaint.

Recommendations

We recommended that the board:

• ensure healthcare staff and prisoners are aware of the process that has been agreed with the SPS in relation to self-referral forms; and
• reflect on this case in light of our adviser's comments and provide feedback to us.

Summary

Mr C complained that the board unreasonably refused to prescribe him a specific type of medication, that his prescription was stopped without him seeing the prison doctor, and that the board had failed to respond to his complaints appropriately.

Mr C had fallen one evening and cut his head, which resulted in him attending hospital for stitches. When nursing staff attended his cell, Mr C had fewer tablets of his prescribed medication than he should have had but he said this was because the remaining tablets were in a safe in his friend's cell. Mr C said he had previously had his medication stolen and, to try to prevent this from happening again, his friend kept some tablets for him. Mr C provided the remaining tablets the next morning but said he was then told his medication would be stopped. Mr C felt this was unfair.

As part of our investigation we took independent medical advice from one of our GP advisers. They said if the board had a policy about concealment of medication or patients not keeping their own medication - and Mr C had been made aware of it - then they could not say refusing to prescribe the medication was unreasonable. The board provided a copy of a contract Mr C had signed and it said he would neither give his medication to anyone else nor keep another person's medication in his possession. It also said if Mr C breached its terms then his medication would be reviewed and possibly stopped. Although Mr C outlined his concerns about his medication possibly being stolen, we considered the contract clear that he should not have given it to someone else. We did not uphold this complaint.

Despite this, our adviser said they would have expected additional records relating to the decision to have stopped Mr C's medication. They were concerned Mr C had to seek the reason for it being stopped (rather than him being told directly) and pointed to some inaccuracies in one of the prison health centre's responses to Mr C's complaint. That letter had said Mr C was admitted to hospital with a suspected overdose, yet there was no other record of this. We also took independent advice from our nursing adviser, who also saw no evidence that Mr C had been to hospital with an overdose. Although we did not consider these errors automatically meant medical staff had considered inaccurate information when reviewing Mr C's medication – his medical records did not mention a suspected overdose - the advice we received was that it was unreasonable Mr C had to seek the reason for the change to his prescription. We upheld Mr C's second complaint.

Finally, Mr C's complaints should have been acknowledged in three working days. The board's internal records were unclear as to whether this had happened and, as above, one response from the health centre contained factual inaccuracies. The board's responses were almost identical to each other, which we found particularly concerning in light of the apparent errors in the health centre's response. We felt that did little to evidence the thoroughness of the board's investigation and we upheld this complaint.

Recommendations

We recommended that the board:

• ensure that clinical staff are reminded of the relevant General Medical Council guidance for prescribing medication in terms of patient communication;
• review the matter so the prescribing GP, if inaccurate information influenced his decision to stop Mr C's medication (such as him having been admitted to hospital with an overdose), revisits that decision;
• ensure the health centre team reflect on the inaccuracies identified in their handwritten response to Mr C's complaint and take steps to prevent this happening again; and
• conduct a review of their handling of Mr C's complaints and confirm to us any areas for improvement identified for future complaints handling.

Summary

Mr C complained about the care and treatment he received at Hairmyres Hospital after an operation to remove a stoma (a surgically made pouch on the outside of the body) and re-connect his bowel. He also complained that staff (particularly the consultant surgeon) did not communicate well with his wife while Mr C was on a post-surgery ward.

After his operation, Mr C was sick, and his wife raised concerns about his condition. It was initially thought that his bowel had stopped working properly. However, six days after his operation, Mr C's condition deteriorated rapidly. He was taken for a scan, which showed that the join in his bowel was leaking. This led to sepsis (a blood infection). Mr C had an emergency operation to reinstate his stoma and clean his abdominal cavity, and was transferred to intensive care for recovery. He suffered an acute kidney injury as a result of his sepsis.

We took independent advice from our gastrointestinal surgery adviser. The adviser said that the consultant had acted appropriately in terms of the care given to Mr C after his first operation, and that it was reasonable to transfer Mr C to a general post-surgery ward. However, the adviser was critical of the level of communication between the consultant and Mr C and his wife, particularly about the information given to Mr C prior to surgery, and when his condition was deteriorating. We found that the medical notes made no references to discussions between the consultant and Mr C or his wife.

We were satisfied that the care and treatment that Mr C received were reasonable, but the poor standard of communication meant that Mr C and his wife did not fully understand what was happening and why. We were also critical of the consultant's record-keeping, and that the board did not do enough to establish what had happened in their own investigation into the complaint, because they had not sought comments from the consultant, who had been a locum (temporary) consultant.

Recommendations

We recommended that the board:

• remind clinical staff involved in this case of their responsibilities to maintain records of discussions with patients and their relatives;
• take steps to contact the consultant to discuss our findings, in particular in relation to informed consent, communication and record-keeping; and
• apologise to Mr C and his family for their failures in relation to communication, record-keeping and complaints handling, and for the stress and anxiety this caused.

Summary

Miss C, a caseworker for an MSP, complained on behalf of a constituent (Mrs B). Mrs B was unhappy with the care and treatment provided to her late father (Mr A) at Hairmyres Hospital in relation to his symptoms (he had intermittent choking problems and a blocked bile duct), his lung cancer, and related nursing care. Tests in 2010 showed abnormalities in Mr A's lungs, but he was not diagnosed with lung cancer until December 2012. Mrs B was concerned about the delay in diagnosing this, and about the investigations and treatment decisions in relation to her father's swallowing difficulties.

We took independent advice from two medical advisers. Our advisers said that Mr A's cancer was diagnosed within a reasonable time, referrals to hospital were dealt with promptly and related treatment decisions were reasonable. The care and treatment of his blocked bile duct was also appropriate. Both advisers said that Mr A's medical history was complex, and that part of the difficulty was that not all his problems were directly linked and many medical specialities were involved. We did not uphold the complaint about his medical care.

We did, however, uphold the complaint about nursing care. Mrs B was concerned about provision of nutrition and fluids, pain relief, and aspects of personal care. She also complained that nursing staff failed to inform Mr A's GP of his death, which the family found distressing. We took independent advice on this from our nursing adviser, who said that although care in respect of many of the aspects that caused Mrs B concern was reasonable, there were failures in monitoring Mr A's fluid and nutrition. Given the significance of these to Mr A's medical problems, we were critical of this. There were also record-keeping shortcomings - nursing staff failed to record what was done to address the family's concerns about one admission to hospital, and did not contact Mr A's GP to let them know about his death.

Finally, Miss C complained that the family's communication needs were not met and that they were left unclear about what was happening. We found, however, that Mr A's medical records contained a number of entries about communication with him and his family. In relation to one aspect (the advice the family received about Mr A's pacemaker) the board accepted that this was incorrect and apologised for the distress this caused. Having considered all the evidence available, however, we were satisfied that the overall standard of communication was reasonable, and we did not uphold this complaint.

Recommendations

We recommended that the board:

• ensure the failures this investigation identified are raised with relevant health care professionals;
• inform us of the actions taken to address the failures in relation to fluid and nutrition monitoring and record-keeping (including informing relevant healthcare professionals of a patient's death); and
• apologise for the failures this investigation identified.