Some upheld, recommendations

Summary

C, parent of A, complained to the council that during A's time at school the council had failed to address bullying and racist incidents. The complaint raised a number of incidents which C considered had not been investigated or responded to appropriately, and that as a result A was unsafe and their education had been impacted.

C also complained that the council failed to offer any assistance as promised, from an educational psychologist, which was required to help A in response to the racist bullying, including the aftermath of an assault which occurred in school.

The council, in their response to the complaint, said that records demonstrated actions taken by staff to address bullying and racist incidents reported to them were timely, appropriate and in line with council policy. The educational psychologist met with C and a commitment was given that they would meet A in person. Two appointments were arranged but A was absent for one, and for the second A was in hospital. The council acknowledged follow-up was not offered, and identified a breakdown in communication in rearranging the meeting.

We found that the school in question had investigated and taken action with respect to incidents of bullying and racist bullying. We therefore did not uphold this aspect of the complaint.

We found that there was evidence that the council had appropriately considered support for A involving an educational psychologist, however following an initial meeting the council failed to appropriately communicate subsequent appointments and failed to re-arrange the appointment for A to meet an educational psychologist. Therefore, we upheld this aspect of the complaint.

In accordance with our powers to consider complaints handling, we found that the council's response to C's complaint in relation to bullying should have been more detailed and specific and was therefore unreasonable. We made recommendations to the council in this regard.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure to provide a full and detailed response to all issues of complaint, specifically those relating to incidents of bullying and racial harassment. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• Relevant staff should be aware of the requirements of the complaints handling procedures, particularly with respect to identifying and responding to relevant issues in a complaint.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the council's handling of their complaints about their child (A) being bullied at their school by another child. They advised that the bullying had persisted for a number of years and complained of the school repeatedly using the same strategies with little effect or of them being stopped prematurely. They also complained that the council had failed to keep proper records of the incidents of bullying. C said that this lack of documentation had contributed to the school continually using the same anti-bulling strategies despite them not working.

C made two formal complaints to the council, both of which were partially upheld by the council and which identified failings and described actions for improvement.

We found that the council had implemented anti-bullying strategies following C's first complaint which had had a positive impact on behaviour, however they did not keep this under review in line with their policies and the bullying recommenced during a period when no measures were in place. This led to C making a further complaint. Following C's second complaint, we found that the council were now monitoring the behaviour and adhering to their anti-bullying policies. However, as C had been required to make a second formal complaint to achieve this outcome, we upheld this complaint.

In reference to the council's record-keeping of the reported incidents of bullying, we found that the council had improved their documentation since C's first complaint about this and incidents of bullying were now being recorded on the appropriate systems. As this was no longer a problem at the time of C's second complaint, we did not uphold this complaint.

As C had advised of being unaware of the stage at which their complaints were being handled, we provided feedback to the council to ensure that the complaint handling procedure was clearly explained to complainants.

Recommendations

What we asked the organisation to do in this case:

• The council have been asked to apologise to C for failing to manage reports of bullying in line with their policies and procedures. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained to us regarding the treatment that they had received from the board relating to a diagnosis of liver cancer. They told us that there had been significant delays in carrying out appropriate tests and that they considered that their care had been very self-driven, stating that they had to chase up and request treatment on a number of occasions. They told us that they had received an unreasonable prognosis when being given their cancer diagnosis, being told that they were terminally ill with only months to live. They told us that they were only referred to a liver surgeon at their request, who was subsequently able to operate successfully.

They also complained that a consultant had written an unreasonable letter to their GP about one consultation, suggesting that their appearance had given cause for concern.

We took independent advice from a consultant oncologist (cancer specialist). We found that there had been unreasonable delays in carrying out C's tests. In particular, a failure to appropriately refer on the results of a scan, resulting in C having to chase this up and request a referral through their GP, and, a failure to mark the request to carry out a biopsy as urgent, resulting in a further delay.

These failures contributed to a delay in providing both diagnosis and treatment for C which was well out with normal guidelines for cancer treatment. In addition, the fact that C was required to seek a referral from their GP to further consider the results of their scan was considered to be evidence that their care had been unreasonably self-driven. We also found that an unreasonable prognosis had been given to C, as it was clear that the consultant in question was not best placed to provide a prognosis and further consultations were required before an accurate prognosis could be given. We therefore upheld these aspects of C's complaint.

However, while we noted C's strongly held view that the consultant's assessment of their appearance had been unreasonable, we were unable to find sufficient evidence to refute the consultant's record of that consultation. We therefore did not uphold that aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for unreasonably delaying investigations into C's liver lesion, for failing to refer their MRI results to the Multi Disciplinary Team (MDT), and for providing an unreasonable prognosis. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Discussions about prognosis should take place with the appropriate clinician in light of a full consideration of the treatment options available.
• Requests for liver biopsies should be marked as urgent where necessary.
• The board should ensure all investigations into possible cancer are completed within the timescales set out in guidelines, wherever feasible.
• Where appropriate, MRI results should be referred to the MDT and actioned promptly.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the community nursing care their parent (A) received for leg ulcers which had become infected. We took independent nursing advice, which highlighted that inappropriate dressings were applied to A's wound for a period, and also appropriate supplies of dressings were not obtained in a timely manner. When the wound did not improve, there was initially a failure to escalate the matter. We noted that there was appropriate escalation later and the wound management was reasonable from this point. On balance, we upheld this complaint.

C also complained that A was discharged from University Hospital Hairmyres (UHH) with an infection still present. We noted that A was receiving antibiotics and a follow-up plan was in place, and that the discharge was reasonable even in the presence of infection. We did not uphold this complaint. C also complained that A was not reasonably assessed when they attended UHH emergency department. C was unhappy that A was assessed without removal of their bandage, and that no swabs were taken. We took independent advice from a consultant in emergency medicine. We noted that there was a reasonable focus on A's knee pain/swelling and no unreasonable omission in terms of examining the leg wound. We did not uphold this complaint.

Finally, C complained that the board's response to their complaint failed to refer to A's fall in hospital. In responding to our enquiries, the board offered assurances that A had not fallen, but rather experienced a feinting episode due to low blood pressure. We confirmed that this was supported by the medical notes. We considered the board to have reasonably explained why this was not referred to in their complaint response, and we did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to appropriately manage A's leg ulcers for a period. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Appropriate dressing products are used for leg ulcer management with wound dressings being available at the time of dressing changes.
• Nursing staff make timely referrals to the Leg Ulcer Service if a wound is not progressing.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of a business, which operated out of two neighbouring premises. C complained about Castle Water Ltd's management of the business's water account. The business had been a customer of Castle Water Ltd for a prolonged period and paid a monthly direct debit for their water and waste water usage. The business began to receive invoices from Castle Water Ltd that C disputed. Over a number of months, C attempted to clarify why the invoices had been issued and what amounts were due to Castle Water Ltd. C met with a representative of Castle Water Ltd who advised that the business's account was up-to-date and that they were, in fact, in credit. However, a payment of £505.47 was subsequently taken from the business without notice. Castle Water Ltd explained that this amount had previously been overlooked and that it was owed by the business.

C complained that the business was issued with numerous invoices and credits that did not add up to the amounts taken from the business's bank account. C noted that the business had always paid the monthly amounts set by Castle Water Ltd in line with their tariffs and questioned why the business was being charged additional amounts without explanation. The business remained in dispute as to the amounts owed, due to a lack of clear explanation regarding the reasons for the additional invoices. C was also dissatisfied with the way that their complaints to Castle Water Ltd were handled.

Whilst we were satisfied that the provider handled C's complaints in line with their complaints procedure, and did not uphold this aspect of C's complaint, we were however concerned by a number of aspects of their handling of the business's account. We found that the provider began issuing invoices to the business, treating them as an unassigned premises, without realising that the business had already been paying the provider for water services for a number of years.

When C questioned the invoices, the explanations that they were given caused additional confusion rather than providing clear information as to what the charges were for. The billing situation was complex due to there being multiple premises and a mixture of annual and monthly billing schedules. We were critical of Castle Water Ltd for failing to set out their charges in a clear and understandable way. The invoices that were issued bore no relation to the amounts that the business was being charged. Whilst Castle Water Ltd's internal records of the account were accurate and the business was ultimately billed correctly, this was not evident from what was sent to their customer.

We recognised that Castle Water Ltd ultimately acknowledged and apologised for the errors in communication and the lack of clarity in their invoices. They also took steps to improve their services for future customers. However, we were critical of the fact that C had to spend a significant amount of time and effort seeking clarification of the charges that the business owed and the fact that the information provided repeatedly made the situation less clear. Therefore, we upheld the aspect of the complaint that the business's billing account was unreasonably handled.

Recommendations

What we asked the organisation to do in this case:

• Consideration to be given to making a further good will payment.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained that the council failed to properly administer a grants administration process. C also complained that the council failed to handle their complaint properly, by appointing an individual who was directly involved in the complaint as the complaints officer.

The council said that C had previously been made a grant offer, which had been extended. They had then been offered a further extension, but C had not felt able to accept this. We found that the council had followed its procedures correctly. The decision on C's grant had been made by an officer operating under delegated authority. This was in line with the terms of reference for the project board which administered the grants. Therefore, we did not uphold this aspect of C's complaint.

In relation to complaints handling, the council said that they were entitled to appoint the investigating officer for C's complaint. In their view, the officer appointed had the greatest knowledge of the issues under investigation. We found that the council's explanation that the investigating officer was not named in C's complaint was irrelevant. The investigating officer was directly involved in the decision C was complaining about. C had raised this with the council, but it had not been addressed. We found that C's complaint had been handled unreasonably and upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for appointing an investigating officer with a conflict of interest. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Apologise to C for failing to respond appropriately to their concerns about the appointment of the investigating officer. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• The council ensure that investigating officers do not have a conflict of interest over the complaint they are investigating.
• The council should ensure that when considering concerns about an investigating officer, they do so in line with the appropriate complaints handling guidance.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C's relative (A) required residential care in a care home. A's care was arranged and monitored by the partnership. C and their two siblings held joint power of attorney (POA) for A's financial affairs and welfare. Relations between the siblings broke down and C ultimately relinquished their POA status. C complained that the partnership subsequently failed to communicate with them reasonably, including failing to tell them when A was relocated to a new care home.

C also raised a number of concerns regarding A's care home placement and the way that this was managed by the partnership. C contended that the new care home was not suitable for A's needs and complained that the partnership failed to ensure that A was not at risk.

C submitted a complaint to the partnership regarding their experiences. C complained that there was an unreasonable delay to the complaint being confirmed and that there was also a delay to the partnership's final response.

We found that, having been made aware of allegations from C of potential financial abuse and welfare issues affecting A, the partnership conducted full and thorough investigations and reached reasonable conclusions based on the evidence available to them. We did not uphold this aspect of the complaint.

C officially remained as a POA for two months after verbally advising that they had relinquished their POA status. The partnership failed to communicate with C as a POA regarding A's transfer to a new care home. However, we were satisfied that the partnership had already acknowledged and apologised to C for this. We did not uphold this aspect of the complaint.

We found that there was an initial delay assigning an investigating officer to deal with C's complaint and that this contributed to an overall unreasonable delay to confirming the complaint and issuing a decision. We upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise for the initial delay in progressing the complaint. The apology should meet the standards set out in theSPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Feedback to staff to ensure complaints are progressed in line with the Model Complaints Handling Procedure.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C had power of attorney (POA) for their late spouse (A) and complained about the care and treatment provided to A when they were admitted to hospital from a care home. During their admission, A was detained under the Mental Health (Care and Treatment) (Scotland) Act 2003 due to the severity of their dementia. A's health deteriorated and they died in hospital. C complained about various aspects of A's medical care, nursing care and staff's communication with C.

We took independent advice from a consultant geriatrician (a doctor specialising in medical care for the elderly) and a registered nurse. In respect of C's concerns about the medical care provided, we found that while the treatment provided in the earlier part of A's admission was reasonable, staff should have sought C's views about the additional investigations undertaken immediately prior to A's death. We upheld the complaint on that basis.

We concluded that while the nursing notes could have been more explicit on some aspects of A's care, the nursing care overall was of a reasonable standard. We also concluded that the communication with C about A's detention and deterioration was reasonable. We did not uphold these complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide a reasonable standard of medical treatment to A. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The board should ensure that carers are consulted when making decisions about medical treatment.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C underwent a bowel operation. They were told that scarring from the surgery would affect their ability to start a family in the future. C attended the board's fertility clinic and asked for fertility preservation treatment. This was denied on the basis that this treatment was only being offered to cancer patients at that time. C complained that they were denied access to this treatment, despite it being approved for other patients who had had the same surgery.

Following their surgery, C experienced complications that ultimately led to them developing sepsis and requiring further surgery. C attended their local A&E, but was discharged home after an examination. C complained that they were discharged despite showing clear signs of postoperative complications and infection.

We found that, although C had been advised that fertility preservation treatment was only being considered for cancer patients, this was not the reason that they had been denied access to this treatment. Rather, a National Complex Case group had reviewed C's case and concluded that they would have alternative options for starting a family in the future and that fertility preservation was, therefore, unnecessary. We found that the reasons for the board's decision in this respect was reasonable and did not uphold this aspect of the complaint.

With regard to C's attendance at the A&E, we found that reasonable investigations were carried out to check for infection. There was no obvious sign of infection at that stage. However, we were critical of the board for failing to identify that C was displaying signs of postoperative complications. Staff failed to carry out an abdominal examination. We noted that C should have been urgently referred for follow-up investigations with their surgeon and the board failed to do this. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings identified in our decision. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• Share this decision with A&E staff with a view to ensuring that patients describing post-operative complications like this (where clinical examination does not rule out there being a complication) are discussed with, or referred to, their surgical teams.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of their client (A) who underwent a cystoscopy (bladder examination using a narrow tube-like telescopic camera). C said that the procedure had life-altering consequences for A, causing bleeding for nine days and leaving them permanently incontinent and susceptible to ongoing urinary infections.

C complained that the board had no urology (a specialty in medicine that deals with problems of the urinary system and the reproductive system) specialists available over the period of A's procedure and that this caused a delay in recognising the symptoms A was experiencing and their significance.

C submitted a complaint to the board regarding A's experiences. C said that, whilst the board apologised to A, they provided little explanation as to what happened or any potential treatment options that may have been available to A.

We found that A's medical history meant that they were at an increased risk of complications such as bleeding and incontinence following surgery. We were critical of the board for a lack of evidence of A being made aware of these risks when consenting to the surgery. We also found that, whilst the board were aware that there would be no specialist urological support available within the hospital following A's surgery, this was not communicated to A. Support was available from a neighbouring health board, however, we found that the board's staff did not seek their input as early as they could have when A began to show signs of postoperative complications. We upheld this aspect of C's complaint.

We also found that there was a lack of accurate record-keeping with regard to A's care at Borders General Hospital and upheld this aspect of the complaint.

We were satisfied that the board handled C's complaint reasonably and did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A's family for the issues highlighted in our decision. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• That the board conduct a review of the information provided to patients prior to surgery and take steps to ensure patients are fully informed before providing their consent.
• That the board remind urology staff of the importance of maintaining clear and detailed patient records at all times.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.