Some upheld, recommendations

Summary

Mr C built a driveway at his property, which is at a junction, but was told by the council that he should not use the pedestrian dropped kerb there as access. As a result Mr C then applied for permission to construct an additional vehicular access away from the junction and requested that the council carry out work to drop the kerb. He then complained about the treatment he received from the council regarding the new driveway he had constructed at the junction and his dropped kerb application. He felt that the council had imposed inappropriate conditions on the consent for the dropped kerb application. Mr C also complained about the council's handling of his complaint.

We found that there had been a considerable amount of correspondence with the council on the matter and Mr C had gained the impression that the council had changed the conditions. However, based on the available evidence we were satisfied that the council had explained why the works they outlined were required and we did not uphold that complaint. We did uphold his complaint about complaints handling, as we found that the council had (in line with their complaints procedure) escalated Mr C's complaint straight to stage two of their process. They had not, however, told him about this.

Recommendations

We recommended that the council:

• remind staff that customers need to be informed as early as possible if their complaint is being escalated straight to stage two of their complaints process, and ensure they are notified of their right to complain to the SPSO;
• remind staff of the need to consider whether a customer should be contacted to discuss their complaint at stage two of the complaints process; and
• apologise to Mr C for their handling of his complaint.

Summary

Mrs and Ms C told us that they registered for the council’s downsizing incentive scheme when it was first introduced, as they no longer needed a three bedroom house. (This was a scheme where tenants were offered a cash payment if they moved to a smaller house.) When they were offered their current property in June 2013 they expected to receive a payment and were shocked to be told that the scheme had ended. An article later appeared in the local press referring to the scheme ‘continuing’ because it had been a success.

Mrs and Ms C complained to the council. They said they felt penalised and discriminated against because they moved during a period when the council said the scheme was not in place. Mrs and Ms C said that had they known that it was to be continued later they could have made a more informed decision about moving house. In reply, the council said that the scheme ended on 31 March 2013 as there was no new money to keep it going. However, new funding later became available and officers decided to seek approval to introduce a new scheme. This was approved in September 2013 and the scheme came into effect on 1 October 2013. Mrs and Ms C then complained to us that the council unreasonably refused to make them a downsizing incentive payment when they moved, and did not reply to their correspondence within the published time limits for doing so.

When we investigated, the council told us that information about the scheme was available on the internet and on posters in council offices. Funding was made available for it on an annual basis, and it was suspended from 31 March 2013 because it could not be funded again at that time. We did not find any service failure or maladministration in the council's decision to suspend the scheme. This was a decision that they were entitled to make and as the scheme was suspended at the time Mrs and Ms C took up the new tenancy, the council’s decision not to make an incentive award was correct.

We understood, however, why Mrs and Ms C felt so aggrieved, and we were concerned that the council did not keep them, or other tenants who had applied for the scheme, directly informed about amendments to it. We also noted an inconsistency of language on the part of the council when referring to the scheme's status. We found no evidence at all of any correspondence with Mrs and Ms C on this matter, or that it was discussed with them when they were offered their current property. We upheld the complaint about the failure to respond, and took the view that putting information on the internet, or on posters in council offices was not sufficient in this case, especially as there must have been only a very limited number of tenants involved. We, therefore, made recommendations to address this.

Recommendations

We recommended that the council:

• review their decision not to make a downsizing payment to Mrs and Ms C in view of their failure to keep them informed of the changes made to the scheme; and
• review their procedures and put in place measures to ensure that tenants are kept better informed in any future amendments to the scheme or any similar initiatives.

Summary

When Mr C took a tenancy with the housing association he was unhappy with the state of the kitchen tiling and replaced it himself, after telling a housing officer he intended to do so. Six months after he moved in, he suffered a lighting and power failure on a winter night and called out the association's emergency electrician service. He received an invoice and reminders for this call-out, with which he disagreed. He complained about this and about dampness in his property. When he felt this was not resolved to his satisfaction, he gave notice that he was terminating his tenancy, and moved out, without paying the invoice. As he left the property before handing in the keys, there was no pre-termination inspection and he left no forwarding address. Five days after he handed the keys back, the association inspected the property and said that the work Mr C had done was of unsatisfactory quality. They instructed plasterboard and tiling repairs and work to replace sockets damaged by grout. After receiving the invoices for this work, and without contacting Mr C at his known email address, the association instructed debt recovery agents to pursue Mr C for the sums they said he owed. He eventually found out about the debt through a relative.

Mr C complained to us that the association were unreasonably seeking to charge for the emergency electrician visit and for works carried out after he left the tenancy, and that they put the matter in the hands of debt recovery agents without first contacting him. Our investigation found that the association had unreasonably sought to recover the charges, as there was no evidence to show that they had raised concerns about the quality of the tiling at any time before Mr C vacated the property. We also found that they had not considered whether it was in fact reasonable for Mr C to call out the electrician under the circumstances, and that they could have first contacted him by email about the debt recovery.

Recommendations

We recommended that the association:

• review their advice to tenants on use of the out-of-hours service and the circumstances where tenants may or will be re-charged;
• consider reducing the recharges sought to recognise the administrative failings identified;
• share the decision with staff involved in this matter to ensure that in future appropriate records are kept of discussions held with tenants;
• remind staff that, where applicable, written permission for carrying out repairs/improvements to a property is provided to tenants as per the tenancy agreement; and
• give consideration to amending their processes so that, where a request has been made by the association for a tenant to bring repairs carried out themselves up to an acceptable standard, an inspection is subsequently carried out to ensure that this has been done.

Summary

Mr C complained on behalf of a relative (Ms B) about the care and treatment provided to her partner (Mr A) during two admissions to Wishaw General Hospital before his death. Mr A was first admitted after being taken there by ambulance late at night. He had a history of cirrhosis (long term liver damage) and gastric varices (dilated veins in the stomach), chronic obstructive pulmonary disease (a lung disease related to narrowed airways), type 2 diabetes and gout. It was identified that he had low blood pressure, dehydration and kidney impairment. He was treated with fluids, his medications were reviewed to try to improve his condition and tests were carried out on a potential abnormality in his bowel. Mr A was discharged from hospital after a week, as his blood tests had returned to normal, but was readmitted three days later, as he was short of breath. The admitting junior doctor noted that Mr A had increasing breathlessness and swelling of his hands and legs. Mr A initially started to improve, but five days after admission his condition deteriorated rapidly and he died three days later.

We took independent advice on Mr C's complaint from two of our advisers, a nurse and a medical adviser. We found that the care and treatment provided to Mr A during his first admission was reasonable and appropriate. He was also adequately assessed by a physiotherapist before he was discharged. Although staff did forget to remove heart monitor cables from his skin before he was discharged, the advice we received was that these were unlikely to have caused Mr A any harm.

We found that in general, the medical and nursing care and treatment provided to Mr A during his second admission was also reasonable. However, staff had noted that blood tests should be repeated the day after Mr A was admitted. There was no evidence that this was done over the next four days, although a later note in the records said that staff were unable to carry out a blood test because of difficulty in finding veins under Mr A's skin to withdraw blood. If this was the reason why blood tests were not carried out over the four days, this should have been documented at the time. We noted that, after examining Mr A's clinical records, our medical adviser explained that it was likely that Mr A's condition would have deteriorated and that he would have died even if the blood tests had been performed as planned. We did, however, uphold this aspect of Mr C's complaint in view of the failure to complete the planned blood tests or to document why these were not carried out.

Recommendations

We recommended that the board:

• issue a written apology to Ms B for the failure to carry out blood tests as planned or to document why this was not done; and
• ensure that the staff involved in Mr A's care and treatment are made aware of our findings on this matter.

Summary

Mr C, who is a prisoner, complained that the board refused to prescribe him suboxone (a prescription medication used to treat opiate addiction). Mr C had been prescribed methadone, but he felt that suboxone would assist in his final recovery from drug addiction and told the board that he wanted to switch to this. However, the board told him that there was no absolute right for any patient to receive a specific form of treatment simply because they requested it. They said that what was important was the prescriber's clinical judgement that a treatment choice was appropriate for the individual, and whether they were at the correct stage of their recovery to support a change of treatment.

In their response to our enquiries, the board said that all patients within the addictions service are regularly assessed using both national and local guidance. They said that some patients may not be offered the drug of their choice, and that Mr C was receiving the most appropriate treatment for his clinical condition. They also explained that they had produced new guidance for prescribing suboxone in the prison after Mr C complained.

We did not uphold the complaint, as we found that the board had acted reasonably in deciding to maintain Mr C on methadone and that this decision had been based on a clinical assessment.

Mr C also complained that the board had not provided a written response to his 'feedback, comments or concerns' form. During our investigation the board accepted that there were failures in their communication with Mr C, and apologised for this.

Recommendations

We recommended that the board:

• formally apologise to Mr C for the handling of his complaint.

Summary

Mr C complained about the board's treatment of his daughter (Miss A). When Miss A was two, she drank some of the contents of a bottle of Calpol (paracetamol-based medicine) and was taken to the emergency department at the Victoria Infirmary. National guidance for paracetamol poisoning requires staff to calculate the amount of paracetamol ingested (taken) per kilogram of the person's body weight (calculated as mg/kg). If the patient is thought to have taken more than 75mg/kg of paracetamol, blood tests should be taken four hours after ingestion to check for paracetamol levels. If more than 150mg/kg has been taken, the patient should be treated immediately with n-acetylcysteine (a drug used to treat paracetamol poisoning) without waiting for blood test results. Based on the available evidence, staff estimated that Miss A had likely taken less than 75mg/kg of paracetamol, and she was discharged home with advice to return if she started to vomit. Later that evening, Miss A vomited and was taken back to the hospital. Staff re-estimated how much paracetamol she might have ingested. Believing she might have had more than 100mg/kg, they arranged for her to be transferred to the Royal Hospital for Sick Children. There, staff assumed the worst case scenario and immediately started treatment with n-acetylcysteine. Blood tests taken later showed that she had ingested a non-toxic amount of paracetamol.

Miss A had a severe anaphylactic (allergic) reaction to the n-acetylcysteine. This was treated successfully, but she was kept in hospital, and later had a seizure. This affected her eyesight. Miss A was diagnosed with cortical blindness (blindness caused by damage to the brain). Mr C complained that the board's staff did not do enough to establish the extent of his daughter's paracetamol poisoning when she first went to the Victoria Infirmary. He felt that, had a blood test been carried out then, his daughter would not have required treatment with n-acetylcysteine, would not have had an allergic reaction and would not have developed cortical blindness.

We found that the national guidance recommended that patients should only be discharged when there is absolute certainty that they have not ingested more than 75mg/kg of paracetamol. After taking independent medical advice on Miss A's case, we did not consider that it was possible for staff to be absolutely certain and as such, blood tests should have been carried out to confirm how much paracetamol she had ingested. This would have shown that she had ingested a non-toxic amount; n-acetylcysteine treatment would not have been required and her anaphylactic reaction would have been avoided. We also found that the n-acetylcysteine had been administered incorrectly, with the first dose being administered over a period of 15 minutes. The national guidance had changed some months earlier and it should have been administered over one hour, specifically to reduce the likelihood of allergic reaction. We were critical of the board's processes for sharing medication guidance updates with clinical staff.

We accepted advice, however, that Miss A's anaphylactic reaction was not the most likely cause of her subsequent seizure and cortical blindness. Whilst this could not be ruled out entirely, we accepted that a virus that Miss A had been suffering from was the more likely cause.

We also investigated a further complaint from Mr C about delays to the board's handling of his formal complaint, and were satisfied that they handled it in line with their complaints procedure.

Recommendations

We recommended that the board:

• apologise to Miss A and her family for their poor treatment of her suspected paracetamol poisoning; and
• review their mechanisms for communicating updated guidance to ensure that staff in all departments are aware of, and working to, the most up-to-date guidance at all times.

Summary

Mr C complained on behalf of his uncle (Mr A) for whom he holds power of attorney (a legal document appointing someone to act or make decisions for another person, with their permission) as Mr A suffers from dementia. Mr A also suffers from a condition that affects his spine and neck and can cause loss of function in the upper limbs. Because of where he lives, Mr A had to travel, accompanied by Mr C, to another health board area for orthopaedic assessment (assessment of conditions of the musculoskeletal system) and treatment. Mr C complained that an operation was cancelled without any alternative treatment being offered or discussed; that a six-month follow-up appointment did not take place until twelve months after Mr A's cancelled operation; that some expenses incurred were not refunded; and the board failed to respond to complaints within a reasonable timescale.

Mr A was assessed by a locum (temporary) consultant orthopaedic surgeon in June 2012 and was told that he needed life-saving surgery for his condition. His operation was scheduled for August 2012, by which time a permanent consultant orthopaedic surgeon had been appointed. When Mr A went to hospital for the operation he was reviewed by that surgeon, who took a different view from the locum and said that more conservative, non-surgical management of Mr A's condition was appropriate. Mr A was told this without his nephew being present, despite Mr C's specific request that no clinical discussions take place without him there. Mr A was discharged the same day and sent home with a promise of a follow-up appointment in six months' time.

Our investigation included taking independent advice from an orthopaedic surgical adviser, who was of the view that the decision not to operate and to review Mr A again in six months was reasonable. The adviser said that the threshold for surgical intervention can vary between consultants, and when a patient is managed by more than one consultant this kind of experience is always a possibility. The adviser was of the view that neither the locum's nor the surgeon's approach was wrong, and we did not uphold the complaint about the cancellation.

We did, however, uphold Mr C's other complaints. When no follow-up appointment date was given, Mr C chased this up but it was not until after he contacted us in April 2013 that an appointment was arranged. This eventually took place in August 2013 - almost a year after the operation was cancelled. Although our adviser was able to reassure Mr C, Mr A and us that Mr A's condition had not progressed in that time, and so the delay had not had a detrimental effect on his condition, we found this delay unacceptable.

On the matter of the expenses, the board acknowledged that as the operation was cancelled at such a late stage Mr C and Mr A had incurred unnecessary expenses, and told us that they were prepared, as a gesture of goodwill, to refund these. However, this did not happen until we chased this up some eight months later.

On the final complaint, our investigation found that the board had not responded to Mr C's complaints within the national or local guidance for complaints handling in place at the time. The board acknowledged this and apologised to Mr C about the handling of his complaints.

Recommendations

We recommended that the board:

• ensure, and provide the Ombudsman with confirmation, that all staff involved in this complaint are made aware of the importance of adhering to the national and local guidance on dealing with patients suffering from dementia;
• consider putting in place a monitoring system for orthopaedic appointments to prevent a recurrence of such a delay in future;
• urgently take action to ensure that Mr C and Mr A's applicable expenses are now refunded;
• ensure that all relevant staff are reminded of the need to keep complainants informed where there are unavoidable delays in the complaints process in accordance with the NHS Complaints Handling Guidance; and
• issue a written apology for the failings identified during this investigation.

Summary

Mrs C's mother (Mrs A) has a long history of various mental health illnesses, including dementia. In August 2008, Mrs A was detained in the Royal Cornhill Hospital under the Mental Health Act. She was there until January 2010, although planning for her discharge began in early 2009. Mrs A was initially discharged to a care home for respite care with a view to going to live with one of her daughters, but this turned out not to be possible, and she was transferred to another care home, where she currently resides.

Mrs C complained that the board failed to carry out appropriate assessments on Mrs A's eligibility for funding for NHS continuing health care (continuing care). She also complained that when she lodged an appeal about the decision not to grant funding, the board unreasonably failed to provide evidence to support their decision.

Our investigation, which included taking independent advice from a specialist adviser on continuing care, found that appropriate assessments of Mrs A's physical and psychiatric conditions were undertaken while she was in hospital and before her discharge, and we did not uphold this complaint. The adviser said that the assessments were used to inform the decision-making process, in line with national guidance on the application of decisions on funding for continuing care, and that there was no evidence that the decision-making process was not properly carried out.

We did, however, uphold the complaint about the information provided to Mrs C after the appeal decision, as we found that insufficient information was provided to Mrs C at both the initial decision-making stage, and the appeals stage. The adviser said that the lack of information provided to Mrs C meant that the process had not been clear and open as required by the national guidance.

Recommendations

We recommended that the board:

• review their NHS continuing health care decision-making process to ensure that it complies with the guidance, in particular in relation to the information provided to patients, carers, and relatives;
• provide Mrs C with all the relevant supporting information upon which the inital decision and the appeal decision were based; and
• issue a written apology for the failings identified during this investigation.

Summary

Mr C, who had previously surrendered his driving licence for medical reasons, complained that a consultant at Dumfries and Galloway Royal Infirmary delayed in writing a report for the Driver and Vehicle Licensing Authority to confirm that he was medically fit to drive. Mr C also complained about the board's response to his complaint.

We found there was an unacceptable delay in writing the report in support of Mr C's licence application, and upheld this part of his complaint. The board explained that there was an administrative backlog, and that the report had to be written by a doctor (as opposed to an administrator). Mr C did not believe this because he was not told about the backlog when he spoke to his consultant's secretary. Our investigation established that there was a backlog, and that the report was something that only a doctor could deal with. The consultant had explained in an internal email that they could not easily delegate completion of the report, due to lack of medically qualified support.

While we took the view that it might have been helpful if the board had given Mr C some of this additional information, we did not uphold his complaint about their response, as we found that it was acceptable. The board also told us they would have expected Mr C to have been kept informed when there was a delay in replying. This did not happen, and the board did not tell us what they have done to stop this happening again. So, although we did not uphold that part of Mr C's complaint, we made a recommendation about this.

Recommendations

We recommended that the board:

• ensure that relevant secretarial and administrative staff keep members of the public updated where there is a delay in dealing with correspondence.

Summary

Mrs C complained about the care and treatment provided to her late brother (Mr A). She said that in summer 2012 his GP urgently referred him to the ear, nose and throat (ENT) department at University Hospital Crosshouse. Mr A had a history of heart disease and ulcers but over recent months had been having difficulty swallowing. An ENT consultant arranged tests, the results of which appeared to be normal, and the consultant wrote to Mr A reassuring him and saying that she did not intend to follow him up. However, Mr A's symptoms did not improve and he was seen again as an emergency in October 2012. He was found to have a large mass in his neck. This was later confirmed to be an extensive tumour, and Mr A died some seven months later. Mrs C complained that Mr A's care and treatment were inadequate and that there had been a lack of urgency to progress this and a failure to diagnose him.

We obtained independent advice on the complaint from one of our medical advisers, and took all the available information into account, including Mr A's relevant clinical records and the complaints correspondence.

Our investigation found that Mr A's lifestyle indicated he was at very low risk from this type of illness and confirmed that initial tests did not reveal anything untoward. It was also clear, however, that although the ENT consultant had later reassured Mr A about his condition, this proved to be a false reassurance. The consultant had since told the board that, with hindsight, it would have been better if she had arranged to see Mr A again. Our adviser agreed that this would have been advisable and said that, when deciding whether to see him again after the tests, the ENT consultant only had sight of a copy of her letter to Mr A's GP and not his notes, in which it was clear she had noted that she intended to see him again. Her letter did not accurately reflect what she had written in the notes and what she had intended, and so we upheld this complaint. Mrs C also complained about the board's response to her written complaint but we did not agree with her that this was inappropriate.

Recommendations

We recommended that the board:

• apologise to Mrs C for the additional stress and anxiety caused; and
• ensure that the ENT consultant discusses these events at her next formal appraisal.