Some upheld, recommendations

Summary

Mr C complained that the council had not reasonably investigated and responded to his concerns about what he considered to be discriminatory treatment of his child by a teacher. He complained that the school had allowed the practice to continue and also believed that incidents and meetings/contact with school staff to discuss his concerns were not logged or recorded.

We upheld part of Mr C's complaint. Our investigation found that the council had carried out a reasonable investigation, considered all available evidence and responded to the issues raised. We also found, however, that the school had not recorded incidents and contacts in the appropriate way.

Recommendations

We recommended that the council:

• apologise for not ensuring adequate record-keeping; and
• emphasise to the school the importance of adequate record-keeping.

Summary

Mr and Mrs C’s child was diagnosed with autism. Their child was placed in a primary school, as they had wished, and received 25 hours learning assistance support a week, in the primary two year. There were, however, problems in managing the child's behaviour in class. As the primary three class would be larger, a meeting was held at the primary school during the summer, attended by Mr and Mrs C, their advocate, and various professionals. They discussed the child's imminent transfer and issues that school staff were having with managing the child's behaviour.

Mr and Mrs C’s child started primary three in a mainstream class but the following month the head teacher decided that the child's schoolday should be reduced to five hours, with two learning assistants supporting the child together. During the year, following further incidents, the head teacher excluded the child, and called Mr and Mrs C in for a meeting. Mrs C attended and after discussing matters with her husband, told the head teacher that they would not accept the terms set out for readmittance. Their child did not return to the primary school, and Mr and Mrs C appealed to an exclusion appeals committee. After the committee met, Mr and Mrs C were offered ,and eventually accepted, a place elsewhere.

Our investigation upheld Mr and Mrs C’s complaints that the council failed to take the appropriate steps in following their exclusion process and, in particular, that an out-of-date leaflet had been issued and that the council failed to keep adequate records. We did not uphold their complaints that the council failed to follow a clear plan for their child's inclusion, that staff had unreasonably restrained their child, and that the council had unreasonably pressured Mr and Mrs C into sending a placing request.

Recommendations

We recommended that the council:

• review its children and families department's current procedures for convening meetings similar to that held in Mr and Mrs C's case, to ensure that adequate notice is given, the agenda specified, the duration estimated and appropriate caveats given about the scope of note taking; and
• provide confirmation that steps have been taken to ensure that all obsolete information sheets on the process of appeal against exclusion have been destroyed and replaced with the current document.

Summary

Mr and Mrs C live near tenants of a housing association. Over a number of years, they told the association about continuing antisocial behaviour by their neighbours. They were dissatisfied with the time the association took to respond, the actions taken to address their concerns, and the way the executive committee conducted their investigation of the complaints.

We found that on numerous occasions the association did not interview Mr and Mrs C as they should have done, in line with their antisocial behaviour policy. They had not, therefore, responded appropriately to their concerns, so we upheld the complaint about responses and made four recommendations. We were generally satisfied that the association's other actions were reasonable, although we made two further recommendations in relation to monitoring.

Recommendations

We recommended that the association:

• apologise for failing to meet their published timescales in relation to Mr and Mrs C's reports of antisocial behaviour;
• apologise to Mr and Mrs C for failing to respond to a statement about maintenance of their neighbours’ garden;
• review their training and procedures to ensure that relevant staff are aware of the commitment to hold interviews in relation to reports of antisocial behaviour, and the timescales for these;
• review their procedures to ensure actions taken in relation to reports of antisocial behaviour are properly recorded;
• review their procedures to ensure that performance in relation to timescales for action following reports of antisocial behaviour is monitored and that the results of this monitoring are fed back to senior management on a regular basis; and
• review their procedures to ensure that any monitoring of garden maintenance beyond bi-annual walkabouts is properly recorded and the records retained for a reasonable period.

Summary

Mrs C complained about the care and treatment that a hospital provided to her brother (Mr A) after he was admitted with increasing confusion and suspected pneumonia. Mrs C, who was her brother's welfare guardian, was concerned that he was not given enough fluids and food; he was discharged prematurely and was readmitted a few hours later; there was a failure to diagnose his fractured leg; changes were made to his medication; and about poor communication.

After taking independent advice from three of our medical advisers (a nurse, a consultant physician and a consultant psychiatrist), we found that nursing staff did not fully take into account Mr A's specific needs. He had a long standing mental illness and, despite knowing that there was a problem with him eating and drinking, there was no specific information on how to manage this. We found that Mr A's fluid intake was not properly monitored and there was a lack of consideration given to blood test results that indicated possible signs of dehydration.

We did not consider that Mr A's discharge was unreasonable, because dehydration is difficult to diagnose. Hospital staff had taken steps to speak with Mr A's community psychiatric nurse (CPN) to establish his usual behaviour, and it was agreed that the CPN would visit him at home later that day to see if he needed psychiatric review. In addition, when it was known that his blood test results were abnormal, he was readmitted to hospital. Although we could not be certain when Mr A fractured his leg, he was promptly reviewed and diagnosed after bruising and swelling were identified.

We were also of the view that it was appropriate to stop some of Mr A's medication (which had a sedating effect) because this could make his pneumonia worse. However, we considered that medical staff could have explained this to the family when Mr A was first admitted to hospital. In addition, although we found that the hospital obtained appropriate information from Mr A's GP, we thought that nursing staff could have sought advice sooner from the CPN about Mr A's eating and drinking.

Recommendations

We recommended that the board:

• review fluid intake and output monitoring for patients with communication difficulties who have suspected or actual dehydration, and audit their documentation of patients from the ward Mr A was in;
• ensure that the educational and training needs of nursing staff in the ward have been met in terms of holistically managing patients with mental illness;
• draw to the attention of relevant staff involved in Mr A's care the importance of ensuring that relatives, particularly those with welfare guardianship, are fully informed of the reasons for any changes in treatment in a timely manner and that the content of discussions are sufficiently documented; and
• apologise to Mrs C and Mr A for the failings we identified.

Summary

Miss C suffers from an anxiety disorder, and had been prescribed diazepam (a medicine which helps to control feelings of anxiety) for a number of years. When she requested a repeat prescription, Miss C was told to call the practice. Miss C said she was then told in a phone conversation with her GP that her prescription for diazepam would be stopped after a period of reduction and that, in future, she would have to attend an appointment at the practice before a repeat prescription would be issued. Miss C told us that her prescription had not previously been monitored, and had been increased over the previous years. Miss C considered that it was wrong to stop the medication. She was dissatisfied with the explanation provided by her GP and also the manner in which he responded to the complaint, which she considered to be inappropriate and unsympathetic.

We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the practice had not failed in their care of Miss C in relation to prescribing medication. However, in relation to the complaints handling, we found that although the GP provided reasonable explanations, the tone of his letters was unnecessarily sharp and at times insensitive, and his response could and should have been more considerate and empathetic.

Recommendations

We recommended that the practice:

• ensure that they and the GP reflect on the handling of this complaint to ensure that in future complaints are handled in an appropriate manner; and
• apologise to Miss C for the failures identified by this investigation.

Summary

Ms C complained on behalf of an elderly lady (Mrs A) who was admitted to hospital as an emergency. Mrs A had terminal cancer and diabetes and a number of other health problems. Ms C complained that the standard of nursing care was unreasonable, and that Mrs A was discharged in an inappropriate manner. We took independent advice on this complaint from our nursing adviser and our hospital adviser.

In terms of nursing care, Ms C said that Mrs A was given no food or fluids while she was in the hospital's accident and emergency (A&E) department waiting to be admitted to a ward. Our nursing adviser said that these should not generally be provided in A&E, as this may compromise later treatment but that, given her circumstances, Mrs A should perhaps have been offered a drink of water. We saw nothing to suggest that the wait had an adverse impact on Mrs A’s health, but we drew this matter to the board’s attention. Ms C also complained that a nurse on the ward administered the wrong eye drops and did not follow hygiene procedures, and that a disruptive patient received attention while others were ignored. Our investigation found no specific evidence to show that the nursing care was unreasonable. We noted, however, that the board had acknowledged Mrs A’s negative experience and had put in place an improvement plan and a period of supervision for the nurse, which we considered a reasonable response to Ms C's concerns.

On the day Mrs A was expected to be discharged, she did not see a doctor until late in the day. By that time, her husband (Mr A) - who would have driven her home - had left. Mr and Mrs A lived 75 miles from the hospital, and so, although Mrs A was considered fit to go home, the doctor agreed that she should not be discharged until next day. Despite this, Mrs A was discharged that evening, and was sent home alone in a taxi dressed in her bed clothes. The board said this happened due to a breakdown in communication between the ward and the bed manager. When Mrs A arrived at her house, her husband was not there and, as she had no keys with her, she had to wait for a short time in the taxi until he arrived.

We upheld this part of the complaint. Our medical adviser noted that the discharge documents were incomplete, and he was not able to identify who authorised the discharge. As Mrs A required a walking aid, he considered it particularly inappropriate for her to be discharged alone in a taxi. The board had already acknowledged that Mrs A’s discharge was handled inappropriately. They had apologised, and reviewed their policy of discharging patients in taxis without outdoor clothing. However, we made recommendations as we took the view that there were wider issues to be addressed in their approach to discharge, in particular that checks that should be made and patients' individual circumstances recognised.

Recommendations

We recommended that the board:

• further review their discharge planning arrangements in the light of the comments in our decision letter and provide the Ombudsman with a copy of their revised arrangements;
• review communications between wards and the bed manager to ensure that a situation like this does not happen again; and
• draw our decision letter to the attention of the staff involved in Mrs A's discharge to ensure that they learn from the failings identified.

Summary

Mrs C, who is an advice worker, complained to us on behalf of her client (Mrs A). Mrs A was referred to a gynaecology clinic, as she had been experiencing some loss of bladder control. It was agreed that Mrs A would have an operation to try to resolve this. However, after the operation Mrs A was left in pain, and with a feeling of great urgency to pass urine at times. Mrs C complained that Mrs A was not reasonably informed of the risks before the operation and that it had worsened her situation.

After considering Mrs A's clinical records and taking independent advice from one of our medical advisers, we found that Mrs A had been counselled appropriately about the risks and benefits of the operation. She signed a consent form that identified the risks and was given a patient information leaflet about the operation, which was clear and informative. This included information about the risk of long-term pain and the risk of developing irritable bladder symptoms.

Although it was clear that the operation had not been successful, we found that that it was reasonable for the board to carry out the procedure, which was performed appropriately and by surgeons with adequate training and expertise. We did not identify any failings by the board that led to the problems Mrs A experienced.

Mrs C also complained about the care provided to Mrs A after the operation. We found that her initial post-operative care was reasonable and appropriate. However, Mrs A had to wait too long for appointments and we found that the aftercare should have been provided in a more timely fashion. It was only when Mrs C complained on her behalf that an appointment with a consultant was brought forward, a complication was recognised and Mrs A was then referred to the pain clinic. Even then, the appointment with the pain clinic initially given to Mrs A was more than three months later.

Recommendations

We recommended that the board:

• issue a written apology to Mrs A for the delays in providing appointments once the complication had been recognised; and
• confirm to the Ombudsman that they have learned lessons from this case and will ensure that, in future, patients who suffer complications after having this type of surgery do not face similar delays in getting appointments.

Summary

Mrs C had her gall bladder removed by laparascopic (keyhole) surgery. She complained that although she felt ill and breathless the board had insisted on discharging her, as she had only been admitted for day surgery. Mrs C also complained that when she was then re-admitted as an emergency, this was under the care of the respiratory medicine department rather than the consultant who had carried out the operation. Mrs C continued to have medical issues, which she blamed on the surgery, and about which she spoke to the consultant the month after her operation. Although she felt he was rude and abrupt, she said he agreed to see her in his clinic. However, despite a letter from her GP, she did not receive a letter until three months later, for an appointment the following month. Mrs C also said that the board’s response to her complaint was inaccurate and did not answer all the points she had raised.

After taking independent advice on this case from three medical advisers, we upheld only one of Mrs C's complaints. After considering her medical records, the advice we received was that the decision to discharge Mrs C after surgery was appropriate, as was the decision to readmit her under the care of the respiratory medicine department. However, it was not reasonable that Mrs C was not seen for over three months by the operating consultant, given that she had discussed her problems with him personally. We found that although the complaint response was delayed and contained some typographical errors, it had appropriately addressed all the points Mrs C raised.

Recommendations

We recommended that the board:

• apologise for the failings identified in Mrs C's care; and
• review their procedures to ensure that following laparascopic surgery, patients are followed up appropriately.

Summary

Mrs C was referred to a hospital chest clinic in 2008 with a troublesome cough, breathlessness and wheezing. A diagnosis of chronic obstructive pulmonary disease (an airways disease) was considered, but excluded several months later following further investigations. A diagnosis of asthma was considered and Mrs C was prescribed treatment to see if this improved matters. Mrs C also had episodes of palpitations and her medical records noted that she had a faster than normal heartbeat (supraventricular tachycardia - SVT), and had been prescribed verapamil (a drug widely used to treat this) from 1991. When she was reviewed by the respiratory consultant in 2011, it was noted that she had different symptoms to the previous ones that might have been related to SVT. She was referred to a consultant cardiologist and tests were carried out. These did not show any abnormalities and the prescription of verapamil was stopped.

Mrs C complained that she was treated for asthma for two and half years when there was no definitive diagnosis, and prescribed verapamil for over 23 years without being routinely reviewed by the hospital cardiology department to update the diagnosis and consider treatment options that might be more relevant. Mrs C also said that the board failed to fully respond to her complaint, to respond within a reasonable time and to take appropriate action.

Our investigation took account of the information Mrs C provided, alongside her medical records, and we took independent advice from one of our medical advisers. The advice, which we accepted, was that both the diagnosis of Mrs C's symptoms and potential conditions, and the resulting treatment, were reasonable. In 2009, it appeared that Mrs C's symptoms were well controlled by treatment for asthma. As soon as it became apparent in 2011, however, that this was potentially exacerbating the symptoms of her fast heart rate, she was referred promptly to cardiology. In relation to the prescription of verapamil, we found that the care and treatment provided by the relevant consultants was reasonable. Our adviser said that where medication controls the symptoms, as in Mrs C's case, then it can reasonably be continued without regular review. As soon as her symptoms could be interpreted as relating to her heart, the medication was stopped and alternative treatment was considered. We did not, therefore, uphold Mrs C's complaints about her care and treatment.

We did uphold her complaint about the complaints handling. We were satisfied that the time the board took to deal with the complaint at first was reasonable. They responded within 20 working days and addressed three of the issues, saying that the consultant would address the remaining issues. The consultant then said that these would be difficult to put in writing and easier to discuss. As our adviser confirmed that the issues were extremely complex, we took the view that this was reasonable. In addition, the consultant followed up the discussion with a written record, which was good practice. The board, however, did not at first tell Mrs C that they could not address a complaint she raised about her GP practice, although they later told her about the practice’s position and arranged a meeting with them. We also found that the board failed to respond to Mrs C's complaint about the long-term prescription of verapamil, until we investigated this. Given the significance of the issue in her complaint, we criticised the board for this.

Recommendations

We recommended that the board:

• take steps to ensure that, in future, all elements of a complaint are responded to; and
• apologise to Mrs C for failing to fully address her complaint.

Summary

Mrs A had Parkinson's disease (a progressive neurological condition in which part of the brain becomes more damaged over many years) and an Alzheimer's-type condition and needed help with a number of day to day tasks. Her son (Mr C) was her next of kin, carer and power of attorney. He complained that when Mrs A was admitted to hospital, staff failed to recognise his status and include him in discussions about her treatment. Mr C felt that he had to actively seek information from staff, rather than this being openly discussed with him. He also complained about the quality of the nursing care and the appropriateness of a decision to discharge Mrs A.

We found that, although Mr C was eventually appropriately included in discussions about Mrs A's treatment, he was not adequately involved during the first days of her admission. As such, important background medical information was not gathered, as Mrs A could not provide this herself. We noted that the board have useful tools for staff to establish whether there is a carer available, but these were not used. We were satisfied that appropriate consideration was given to Mrs A's suitability for discharge and that there was clear evidence of Mr C being consulted and of his comments influencing the decision-making process. However, we were critical of the board's handling of Mr C's complaints, as their investigation into his concerns was substantially delayed.

Recommendations

We recommended that the board:

• review their processes for establishing and communicating the level of involvement in care for patients with a welfare guardian or power of attorney;
• introduce a process that ensures that the relatives or carers of any patient who lacks capacity or is confused are engaged in meaninful communication from the earliest point practicable following admission; and
• ensure that they have a structured process in place to act upon all points of learning arising from complaints.