Some upheld, recommendations

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.

Summary

Mr C complained about the care and treatment his late brother (Mr A) received from the medical practice. Mr A had been suffering from a cough, shortness of breath and chest pain and died of a pulmonary thromboembolism (a blood clot which forms at one point in the circulation, becomes detached and lodges at another point) in April 2014. Mr C said that he believed the practice had contributed to the death of his brother.

Mr C complained that Mr A's GP did not treat his condition as worsening on his last visit to the practice. He also said that the day before Mr A's death, a receptionist had not allowed Mr A to speak to, or see, a GP when he called the practice to get the results of tests.

Mr C complained to the practice but was unhappy with the response he received. He said that there were several things which he felt were inaccurate or incorrect in their response. Mr C questioned why the GP had not considered or recognised that Mr A's condition was worsening and disputed the practice's version of what was said during the phone call with the receptionist.

We took independent advice from one of our medical advisers, who is a GP. We found that the medical records depicted a series of events consistent with a chest infection with some additional signs which needed further investigation and that the appropriate tests had been arranged, so we did not uphold Mr C's complaint about his brother's treatment.

However, our adviser also said that the role of reception staff is to facilitate communication between a patient and a GP, and, therefore, they should not be making a decision that a patient who has specifically asked to speak to a GP should not have this option. Our adviser said the information should be passed to the GP who has clinical knowledge and responsibility for patient care to make the decision as to how to proceed. On this basis, we upheld the complaint about the care given to Mr A by the practice.

Recommendations

We recommended that the practice:

• carry out a significant event analysis paying particular attention to their system of contacting an on-call doctor;
• ensure GPs involved in Mr A's care discuss this complaint at their next appraisal;
• apologise to Mr C for the failings identified;
• establish, using the practice's appointment system, which receptionist spoke to Mr A on the date in question;
• review the details of the GP's complaint response in relation to the information received from reception staff, and write to Mr C to explain the findings;
• review and revise where appropriate the practice system for passing requests by patients to speak to a doctor; and
• consider enhanced staff training for the receptionists in terms of their interactions with patients and practice guidelines on responding to patients who request to speak to a doctor.

Summary

Mrs C complained that the college failed to explain why, after an admission interview, she was sent texts telling her that she had missed her interview, that the course was full and she did not have a place. She phoned to ask what had happened, and was not satisfied with the college's response. The college admitted that as a result of human error, text messages had been sent to people who should not have got them and they had apologised for this. We investigated and did not uphold her complaint, as we found that the college had adequately investigated it. They explained why this had happened and what they had done to stop it happening again. We considered the college's response to be reasonable.

Mrs C also complained that the college failed to explain the bursary application process to her, and did not assist her during the process. She met with staff on several occasions about her application, and also emailed and wrote to the college. We found that when she met with staff they explained the information needed to process her bursary application and that she did receive appropriate assistance. However, we upheld her complaint about the explanation, as they did not provide the information in writing or ensure that she had access to the relevant student handbook.

In addition, Mrs C was unhappy with the college's investigation of her complaint. She was concerned that it had not been investigated in an impartial way, because it was investigated by a member of staff who was part of her complaint. We upheld this complaint as we agreed that her complaint should have been investigated by another member of staff to ensure that the decision was as impartial as possible. We also noted that the final response was not signed off by the college vice-principal, as required by the college's complaints handling procedure.

Overall, Mrs C felt that the college had discriminated against her because she was not born in the United Kingdom. After reviewing the information provided about her other complaints, while we noted the college's failings in relation to Mrs C's situation, we did not find evidence of discrimination.

Recommendations

We recommended that the college:

• ensure that students making enquiries about bursary applications have access to the student handbook on Education Maintenance Allowance, and that staff highlight the relevant sections when students request information; and
• ensure that staff are aware of their responsibilities in relation to the complaints handling procedure, and that senior staff are considerate of any conflicts of interest and handle these appropriately.

Summary

Mr and Mrs C objected to their next-door neighbour's planning application for an extension. The council granted the application, and Mr and Mrs C complained to us that the application process had been handled unfairly. They raised a number of concerns, including that some information on the application was inaccurate and/or provided after the deadline for comments; that the council had not responded to their correspondence asking questions about the planning application process; that the application had been decided by an officer using delegated powers, when it should have been decided by a committee; and that the officer had failed to take relevant planning considerations and guidelines into account in deciding the application.

After taking independent advice from one of our planning advisers, we upheld one of Mr and Mrs C's complaints - that the council failed to respond to their correspondence asking questions about the planning process. We found that, although the council upheld the complaint about this, they had not apologised or made any recommendations to improve their practices, and we were critical of this failure to learn from what had happened.

We did not uphold the other complaints, as there was no evidence that the council had failed to comply with relevant procedures in allowing additional information to be provided after the deadline for comments, or in deciding the application using delegated powers. While there were minor inaccuracies in the plans the council used, we found that it was reasonable for them to rely on these as the inaccuracies were not so significant that they would affect the decision. The officer had also undertaken a site visit and taken photos to ensure they had accurate information about the site and its surroundings. We also found evidence that the council had taken all of the relevant planning considerations and guidelines into account.

Recommendations

We recommended that the council:

• issue a written apology to Mr and Mrs C for failing to reply to their correspondence;
• review the guidance to case officers to ensure that members of the public receive a response to any questions of fact about planning applications; and
• remind complaints handling staff of the importance of addressing any failings identified in complaints investigations, including by apologising where appropriate.

Summary

Mr and Mrs C made several complaints to the council about the way their child, who has autism, was dealt with at school, in particular where physical intervention had been used. The council investigated and fully or partially upheld many of their complaints. Mr and Mrs C were not, however, satisfied with how the investigation was conducted or the outcome. They complained to us about the investigation and the remedial action taken by the council as a result of the complaints.

Our investigation found that the handling of their complaints was unsatisfactory, in that the council should have taken control more promptly, there were matters that could have been agreed and investigated (as outlined in the council's complaints procedure) at a much earlier stage, and it appeared that the council took no action on the complaints during a period of some eight months. We upheld Mr and Mrs C's complaint, noting that much of the delay was due to the complexity of the issues involved, the large volume of documents that needed to be reviewed and the fact that additional complaints were added during the process.

We also noted that it was originally agreed that an internal investigation would take place as an initial fact-finding exercise, followed by an external investigation. However, after some 250 hours of work, the internal investigation had identified failings in several areas and the majority of Mr and Mrs C's complaints had been either fully or partially upheld. The council, therefore, decided to concentrate on addressing the issues this raised, rather than expending further resources on an additional external investigation. Our view was that this decision was reasonable and proportionate, although it was obviously disappointing for Mr and Mrs C.

On the issue of the remedial action, Mr and Mrs C complained that they had only been provided with a copy of an action plan. Our investigation found, however, that they had been kept updated on the progress of the plan through meetings with the director of the relevant service and a letter from the council's chief executive. We found that the majority of the action points had been implemented but that a few (with city-wide implications) are still ongoing, which we considered reasonable.

Recommendations

We recommended that the council:

• in line with the requirements of the model complaints handling procedure they adopted, demonstrate they have learned how to take responsibility for establishing and managing complaints successfully;
• confirm the learning and improvement measures identified as a result of the findings in relation to two of Mr and Mrs C's complaints, and how these have been implemented;
• provide Mr and Mrs C with a copy of the arrangements for the council's co-ordinated support plans;
• contact Mr and Mrs C to arrange a meeting to share new documents relating to the council's physical intervention policy; and
• issue a written apology to the family for not handling one of their complaints appropriately.

Summary

Mr C complained that the council had not dealt properly with his application for planning permission. He said that they had unreasonably declined to engage with him and respond to his pre-application enquiry, dealt with this as if it was a planning application for detailed consent (when it was for permission in principle), and that the reply to his complaint wrongly said that they had asked him for drawings of the elevation of his proposed building as part of the assessment of his planning application.

We found that the council had responded to Mr C's pre-application enquiry and, although it might not have met his expectations of engagement with them, it did provide relevant advice. This service is discretionary and it was for the council as planning authority to decide what resources they spent on it. We found nothing to suggest that they had dealt with Mr C's application as if it was for detailed consent rather than in principle. However, it was unclear whether they had given him advice about providing drawings of the elevation of the proposed building, which suggested that their reply had been incorrect, and we upheld this element of his complaint.

Recommendations

We recommended that the council:

• remind staff of the importance of keeping a record of phone calls they have with customers; and
• review their response to Mr C's complaint about the drawings, and provide either an apology and correction, or details of when and by whom such a request was made.

Summary

Ms C was considering making an offer to buy a property and called the council to ask if the property was eligible for a parking permit. When she was told that it was, she asked that they confirm this by email. Ms C received an email shortly afterwards, and instructed her solicitor to submit an offer. She then read the email and discovered that it did not confirm that the property was eligible for a permit. She got in touch with the council, who said that the property was not eligible for a permit, but accepted that she had previously been given incorrect information. Ms C also believed that the council promised her compensation during a phone conversation, but then did not offer this. Ms C complained but the council remained of the view that compensation was not merited.

Ms C complained to us and we reviewed the available recordings of phone conversations. We upheld her complaint that the council had given her incorrect information about the criteria for the issuing of parking permits. However, we found no evidence that she was promised compensation, and did not uphold this complaint.

Recommendations

We recommended that the council:

• remind all relevant staff of the criteria for the issuing of parking permits.