Some upheld, recommendations

Summary

Mr C was contacted by the council regarding outstanding council tax arrears in 2009. He began a payment plan with one of the council's debt collection companies (company 1) and continued to pay them until December 2013. In December 2013 Mr C was contacted by another of the council's debt collection companies (company 2). They told him that his arrears were with them and said he needed to set up a payment plan with them.

Mr C contacted the council to confirm that he should pay company 2, rather than company 1 as he had been doing previously. The council responded telling Mr C that his arrears had been passed to company 2 much earlier than December 2013.

Mr C complained that the council had not kept him reasonably informed about where his arrears were and whom he was meant to pay. He also complained that company 1 had not cancelled his original payment plan when his arrears had moved.

Our investigation found that the council could not provide evidence that Mr C had been told about the change of debt collection company from company 1 to company 2. They had also given contradictory information about when Mr C's debt had moved and where to. Because of this, Mr C was not sure whether the council had received all the payments he had made. They also had not followed their complaints handling procedure in responding to his complaint. We upheld Mr C's complaint that the council had not kept him reasonably informed about his arrears and made recommendations to address this.

However, we found that according to the terms of the contract company 1 and company 2 have with the council on collecting arrears, the responsibility to notify the customer of a change in arrangements lies with the new company rather than the old. As such, we did not uphold this aspect of Mr C's complaint.

Recommendations

We recommended that the council:

• arrange a meeting with Mr C to clarify what payments have been received and what arrears they have been applied to;
• remind relevant staff of the importance of investigating complaints thoroughly, with regard to all relevant evidence;
• review data sharing agreements with debt collection companies to ensure access to evidence for complaint investigations; and
• apologise to Mr C for the failings identified.

Summary

Mr C submitted a quote to the council to provide them with equipment for a piece of work they were doing. He explained that he prepared a specification and submitted the quote on the basis that he would be considered a 'specialist supplier' and that, as a result, no other tenders would be sought for this work. He made clear in his quote that it included a fee for the preparatory work which would only be payable in the event that he was not considered a 'specialist supplier'. He said that the council subsequently sought two further quotes and awarded the tender to another party. He complained to us that the council had said he would be considered as a specialist supplier and yet they awarded the contract elsewhere, that they did not treat all three companies who tendered in a consistent way, and that they refused to pay his fee.

The council said that Mr C was never told he would be the sole bidder and that they were unable to tender in this way. They said that they did treat all three companies consistently and that they would not pay the fee as they did not agree to the specialist supplier status.

We could not say whether Mr C was advised that he would be considered a specialist supplier. We did find, however, that the council had not followed the correct procedure as they approached him for a quote before seeking two further quotes. They should have obtained all three simultaneously. We also found conflicting comments about the extent to which Mr C's tender was used to develop the brief and specification for the other quotes, and we questioned the council's assumptions that tenderers may not be able to complete the work within the deadline. We also noted that they did not notify Mr C of the outcome of the tender. As the council had not followed the correct process when tendering for the contract and as, on balance, we were not convinced that all tenderers were treated in the same way, we upheld this aspect of his complaint. We recommended that they review their procedures for tendering, apologise to Mr C and pay his fee.

Recommendations

We recommended that the council:

• confirm to us that steps have been taken to ensure that future procurement/tendering processes will be carried out in a fair and consistent manner;
• pay Mr C the requested service fee for their specification and design work; and
• apologise to Mr C for the process failings which this investigation has highlighted.

When it was originally published in January 2015, this case was wrongly categorised as 'fully upheld'.  The correct category is 'some upheld'.

Summary

Mr C complained to the council that they had not taken action in response to reports of health and safety issues at a residential caravan site, including abandoned vehicles, and piles of wood and debris that could be a fire hazard. The council first handled Mr C's complaint as a service request. He then wrote to the council again, asking for his original letter to be treated as a complaint. The council told Mr C that he would need to agree with them what he was complaining about and that after this they would respond to his complaint within 20 working days. The council met with Mr C three weeks later and agreed the points of the complaint. They investigated his complaint and gave him a response another four weeks later.

Mr C was not satisfied with the council's response, and brought his complaint to us. He complained that they had failed to deal with his complaint in line with their procedures, failed to take action in response to health and safety concerns at the site, and failed to consider formal action under the legislation to revoke the site owners' licence.

We investigated Mr C's complaint, and found that the council had not dealt with it in line with their procedures. They had wrongly interpreted the complaints handling timescales and there were unreasonable delays in responding to him. They also gave some incorrect information in their investigation report and failed to clearly respond to all of the agreed points of complaint. We also found, on balance, that they had not taken reasonable action in response to Mr C’s concerns about health and safety. While they had responded well to these at first, there was no evidence that they then followed up appropriately on the measures they put in place. However, we found that the council had not failed to consider taking action under the legislation, as they were waiting for action by a third party, which could resolve the issues, before considering formal action themselves.

We issued a decision in which we recommended, amongst other things, that the council consider developing a policy in relation to their health and safety enforcement obligations. In response, the council provided copies of several policies relating to health and safety, which they had not provided before. We pointed out that they should have sent us these during our investigation, and we issued a revised decision on the complaint, with new recommendations.

Recommendations

We recommended that the council:

• remind staff of the requirements of the model complaints handling procedure in relation to timeframes;
• raise the complaints handling failings our investigation identified with the relevant staff to ensure a similar situation does not re-occur;
• apologise to Mr C for the failures our investigation identified;
• demonstrate to us that action has been taken in relation to the health and safety concerns Mr C raised;
• remind staff of the requirement in the enforcement policy to inform a person requesting action of the outcome of their request, including where the officer feels that no action is required, or the request is not justified;
• review the enforcement policy, to ensure that there is no unintentional overlap with the complaints handling policy; and
• undertake an internal audit to ensure that requests for action on health and safety issues and reports of accidents are handled in line with the enforcement policy and service delivery plan, including record-keeping requirements, and notify us of the findings.

Summary

Ms C complained that her child had been racially abused by another pupil at school. Ms C said the school had not contacted her on the day of the incident – unlike the other child's parents - and she found out about it from her child that evening. Ms C said she spoke with the head teacher the next day, who confirmed that the other child involved had been punished but would not confirm the specific punishment. Ms C also complained that her younger child had also suffered from bullying on a number of occasions.

Although we fully recognised the significance of Ms C's concerns, the law does not allow us to consider complaints about conduct, curriculum or discipline within schools. This meant our role was to consider whether the council had followed the relevant policies, one of which said that both sets of parents should have been told about the incident. Although Ms C said the school did not contact her, the council said the school had tried to do so without success. While the school's paperwork appeared to indicate that they had tried to phone Ms C, the policy was clear that she should have been informed. Had they been unable to contact Ms C on the phone (or leave a message asking her to contact them), we considered the school could reasonably have sent a brief note home with Ms C's child asking Ms C to contact them or, alternatively, they could have sent a letter. Either of these steps would have demonstrably satisfied the policy and so, taking everything into account, we upheld this complaint.

Ms C told us she had no supporting evidence for her second complaint. The council said the school confirmed there had been no reports (either from Ms C or her children) of any other incidents involving Ms C's children and the head teacher said Ms C had not reported bullying of her younger child, prior to her written complaint. There was no additional evidence of bullying or racial abuse for us to consider and, although we recognised the seriousness of the underlying allegations, we could not establish, on the basis of the evidence available, that the issue with Ms C's younger child was raised with the school. We did not, on balance, uphold Ms C's second complaint.

We made three recommendations with a view to ensuring good record-keeping in the future.

Recommendations

We recommended that the council:

• consider amending their policy to require a record of attempts to contact parents by phone be made;
• remind staff if they cannot contact a parent over the phone they consider contact by other means; and
• remind staff of the importance of completing the relevant forms in terms of their policy.

Summary

Mr C had a fall at home. An ambulance crew attended and examined him for a possible dislocation of the shoulder. It was decided that he did not need to be admitted to hospital, as there were no indications that his shoulder was dislocated. Three days later Mr C contacted his GP, who came out to see him, and advised that he attend A&E. Mr C did this and was found to have a dislocated shoulder.

Mr C complained that he was not given a reasonable assessment by the ambulance crew. He also said that when he had complained, the Scottish Ambulance Service (the service) had told him that a clinical review of his treatment would be carried out. However, he had not heard anything further about this.

The service told us that they thought Mr C may have experienced another fall in the intervening days between being seen by the ambulance crew and the visit from his GP.

We took independent advice from one of our GP advisers about Mr C's injury and assessment. The adviser said that it was not possible from the medical records to say with certainty when Mr C's dislocation injury occurred. The adviser also said that there was nothing in the ambulance crew's report to suggest the assessment Mr C received was unreasonable so we did not uphold this aspect of Mr C's complaint.

We did, however, have concerns about the clinical review that the service said they would carry out. This was conducted nine weeks after the complaint response letter to Mr C and five days after we initially contacted the service about Mr C's complaint. We were concerned that there was no formal procedure and that it may be unclear to complainants whether or not they are still in the complaints process or not. We upheld this complaint and made recommendations.

Recommendations

We recommended that the service:

• review procedures for clinical reviews, having regard to our findings; and
• apologise to Mr C for the delay in conducting and communicating the clinical review outcome.

Summary

A number of years ago, Mr C had an operation on a hernia (a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall). A few weeks after the procedure, he thought that mesh involved in the operation had burst so his GP referred him back to hospital. Mr C was examined but there was no sign of a recurrence of his hernia. Mr C continued to complain about his suspicions but nothing was found. More recently, when clinicians were exploring other possible reasons for his pain, he was sent for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body). This showed a suspicion of a possible recurrent hernia, although again examination did not reveal this. Mr C said that if clinicians had listened to him at the outset and given him a scan, as he said he requested, he would not have spent years in pain receiving treatment which he said had been unsuccessful.

We obtained independent medical advice from one of our advisers, who is a consultant surgeon. The adviser said that Mr C's care and treatment, including physical examinations, was reasonable and that clinicians acted appropriately in the circumstances. While Mr C said that he had requested an ultrasound after his hernia operation, there was no evidence of this. There were other possible reasons for his pain and these were explored appropriately. Furthermore, the detection of the type of hernia Mr C had, especially a recurrent one after the previous surgery, was difficult. We did not uphold Mr C's complaint about his care and treatment.

Mr C also complained about the board's handling of his complaint. We found that, in basing their response solely on information received from the surgeon that Mr C complained about, the board had not thoroughly investigated the complaint. We upheld his complaint about this and made recommendations.

Recommendations

We recommended that the board:

• make a formal apology to Mr C for their failure in this matter; and
• further consider the terms of their complaints policy and review their internal investigation processes.

Summary

Mr C was diagnosed with lung cancer that had spread to other areas of his body. The board advised Mr C that this was incurable and offered him palliative chemotherapy (treatment provided solely to prevent or relieve suffering). Mr C was told that this might prolong his life but that his survival was likely to be measured in months and was very unlikely to exceed a year or two. Mr C had chemotherapy and, nearly two years after the initial diagnosis, was advised that his cancer had gone into remission. This led Mr C to complain to the board about the original diagnosis and the information he was given about survival rates.

The board responded to Mr C's complaint and advised him that, for his type of lung cancer, he had had an unusually good response to the chemotherapy but there was no reason to doubt the original diagnosis. They also explained that due to the nature of his disease Mr C had been advised that survival rates often have a poor prognosis (forecast of the likely outcome of the condition) and outcome. They said that this is standard for patients in Mr C's situation and although his cancer was in remission, it did not mean that he had been cured.

When Mr C complained to us, he also complained about the board's response as they had used medical terminology, which he felt could have been better explained. After taking independent advice from one of our medical advisers, who is a consultant clinical oncologist (a doctor who specialises in treating patients who have cancer), we did not uphold Mr C's complaints about his original diagnosis or the information he was given on survival rates. Our adviser reviewed Mr C's medical records and said that there was no evidence that he was given an incorrect diagnosis. He also considered that the information that the board provided on survival rates was accurate and truthful. We found, however, that the board's response did use medical terminology that could have been explained more clearly, and as this was not in line with their policy on complaints handling, we upheld this part of Mr C's complaint.

Recommendations

We recommended that the board:

• apologise for providing a response to Mr C's complaint that is not in line with their own policy; and
• take steps to ensure that staff who draft letters of response adhere to the policy on style.

Summary

Mrs C complained about the care and treatment she received at Aberdeen Royal Infirmary for autoimmune haemolytic anaemia (AHA - a blood disorder). Mrs C's medical history included high blood pressure for which she had been prescribed simvastatin (used to treat high cholesterol, which can cause high blood pressure). When Mrs C was diagnosed with AHA, she was treated by the haematology team (specialists in blood disorders). She was prescribed steroids (a group of drugs used to treat various conditions) to stabilise her haemoglobin levels (a measure of the red blood cells in the blood). This is the accepted first-line treatment for AHA. The accepted second-line treatment is removal of the spleen (an organ which helps to fight infection) and this was recommended to Mrs C. She agreed to this reluctantly, as she thought that the simvastatin tablets were causing the AHA symptoms.

Our investigation included taking independent advice from one of our medical advisers, who is a consultant haematologist (blood specialist). The adviser found no evidence that the simvastatin tablets were linked to the AHA, although some of their common side effects are similar to AHA symptoms. The adviser said it was reasonable that doctors did not tell Mrs C to stop taking the simvastatin before her spleen was removed. Although Mrs C felt that her condition was unchanged after the operation, our adviser noted that doctors were then able to reduce her steroid dosage to zero.

We did, however, find problems in communication between the medical team and Mrs C, and in the taking of her consent for the operation. She had reluctantly agreed to the operation and signed a consent form. However, as she was sure the simvastatin was the cause of her symptoms, she then tried to discuss this with hospital doctors. She felt that she was being ignored, and spoke to her GP who contacted the hospital to say that Mrs C had changed her mind about the operation. However, when she next went to the clinic, the hospital doctor that Mrs C's GP had spoken to told her that she had to have the operation which then went ahead. Our adviser was concerned that although the consent form would still have been legally valid, doctors did not revisit the issue of consent in the light of Mrs C's concerns. We were also unable to find a record in Mrs C's notes of the discussions about the pros and cons of the operation.

Recommendations

We recommended that the board:

• ensure that all the staff involved in this complaint are reminded of the importance of patients giving a fully informed consent to any procedure or treatment, and that appropriate records are kept of any discussions;
• bring this decision to the notice of the staff involved so that they may reflect on the failings identified in relation to Mrs C's treatment; and
• issue a written apology for the failings identified during this investigation.

Summary

Mrs C's stepfather (Mr A) was diagnosed with advanced bowel cancer and received chemotherapy (a treatment where medicine is used to kill cancer cells). Mrs C said that he attended the medical practice regularly over the two years leading up to his diagnosis, during which time his health deteriorated. Mrs C believed that his symptoms were indicative of cancer and that he should have been investigated for this sooner. She also complained that the GP made a routine - instead of an emergency - referral for a colonoscopy and gastroscopy (a fibre-optic telescope looking into both the upper and lower parts of the bowel). After Mr A was diagnosed with bowel cancer, he attended the practice with a sore leg. His wife contacted the oncology department (who specialise in treating patients who have cancer) at the local hospital (the first hospital), who arranged a scan that showed that he had a blood clot in his leg and lung, and the following year his health began to deteriorate significantly.

Mrs C said that there was a failure by healthcare professionals in the community to provide a discussed and implemented care plan about support throughout Mr A's illness and end of life care. Mr A wanted to receive end of life care at home but at no time was he consulted about his wishes or preferred place to die. He had a number of admissions to hospital due to blood clots and his deteriorating condition. In the last month of his life, it was noted in the GP records that chemotherapy treatment had stopped due to progression of the disease. During his last admission to the first hospital, Mrs C said a doctor told them surgical intervention was not possible and the aim was to get Mr A's pain under control and discharge him home. However, Mr A's wife received a phone call several days later saying that her husband would be transferred to a second hospital where he would be under the care of his GP practice. Mr A remained unresponsive for several days, and his GP said Mr A was dying, but did not tell the family that he had decided that Mr A should no longer be given oral medication. Several days later, the family became distressed at Mr A's condition, and his GP told the family it was difficult to say how much longer he had to live. Mr A died shortly after.

Mrs C complained that the practice failed to refer Mr A to a specialist consultant within a reasonable time, failed to diagnose the blood clots he developed and that the communication and support was not reasonable. In relation to her complaint about the care provided by GPs when Mr A was a patient at the second hospital, Mrs C said she had concerns about prescription of medication and that Mr A was unresponsive for an unreasonable length of time.

After taking independent advice from one of our medical advisers, we found it was unlikely that Mr A would have had bowel cancer symptoms until around 18 months before his diagnosis, and there was no evidence that his medical problems were not reasonably assessed and dealt with. However, the medical adviser said that Mr A should have been referred urgently to hospital at one point in light of his warning symptoms and we upheld this complaint. We found that the practice's management of Mr A in relation to his blood clots was reasonable. We upheld the complaint about end of life care, as our adviser said that while it was not the sole responsibility of the GP to have such discussions with patients, they should ensure it was done within a reasonable time. In this case, the practice's failure to coordinate an appropriate end of life care plan compounded Mr A's and his family's distress at what was happening.

Our adviser said that there was a shared responsibility between the practice and the consultant oncologist (a doctor who specialises in treating patients who have cancer) to ensure that Mr A and his wife understood why chemotherapy was stopped. While we found that communication was on the whole reasonable, particularly in relation to stopping all medication and likely timescale of death, the failing around the decision to stop chemotherapy was significant because it meant that later discussions about treatment involved palliative care (care solely to prevent suffering), and we upheld this complaint.

Finally, we did not uphold Mrs C's complaint that medical staff at the second hospital (which was provided by GPs from the practice) failed to provide Mr A with appropriate medical care, as we found that the care and treatment provided in relation to pain relief was reasonable.

Recommendations

We recommended that the practice:

• review their process for referrals where referral symptoms are present in light of the medical adviser's comments;
• bring the failures this investigation identified to attention of the relevant staff; and
• apologise for the failures this investigation identified.

Summary

Mr C complained because he felt a nurse had inappropriately disclosed his medical information at a meeting with prison staff. He also complained about the way the board handled his complaints.

In response to our enquiries, the board confirmed the nurse discussed issues in relation to Mr C at the meeting but she did not disclose any medical information. They also confirmed that Mr C had given instructions to the board that his information should not be shared but those instructions were given after the meeting in question had taken place. The board provided a copy of a patient registration form that Mr C signed when he was received into the prison healthcare system which advised him that the NHS may need to share information about his health and medication with people outside the NHS, such as prison staff. In light of this, we did not uphold his complaint about this.

However, in looking at the board's handling of Mr C's complaints, the evidence available confirmed that they did not respond to some of them and for those they did respond to, they could have provided a fuller reply. We upheld this part of Mr C's complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for not responding fully to his complaint; and
• advise us of the steps that have been taken to improve the handling of healthcare complaints from prisoners.