Some upheld, recommendations

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.

Summary

C complained to us on behalf of their parent (A) who has dementia. A was admitted to Glasgow Royal Infirmary (GRI), after falling at home. A's condition improved and they were discharged home. After a few days, A was readmitted to GRI and treated for pneumonia (inflammation in the tissue of the lungs). Although A responded well to the treatment, their family was concerned about their mobility and pain when moving. A was referred for imaging of their pelvis and hip, which did not find a skeletal injury. Later that month, A was transferred to Stobhill Ambulatory Care Hospital. Around a week later, A was given a lumbar x-ray, which found a vertebral wedge fracture (a fracture of the bones commonly called the lower back). C raised concerns about A's medical care and their nursing care at both hospitals.

We took independent advice from a consultant physician in geriatric medicine (a specialist in medicine of the elderly). We did not consider that there was an unreasonable delay in carrying out A's lumbar x-ray. In particular, we found that it was appropriate that the medical staff had focused on ruling out A having fractures that might be treatable with surgery. We did not uphold this aspect of C's complaint.

We also took independent advice from an acute nursing specialist. We found that A's pain was not assessed appropriately, as nursing staff did not use the correct tool for someone with cognitive impairment (a condition that affects the ability to think, concentrate, formulate ideas, reason and remember). We also found that A fell at a time that they should have been under enhanced supervision by nursing staff due to their high risk of falls. We upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings identified in A's nursing care. 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:

• Patients with cognitive impairment should have their pain levels assessed using an appropriate tool so it can be managed appropriately.
• When patients are considered to require enhanced observations in a cohort room, there should be appropriate nursing staff (in terms of both skill mix and staffing levels) to implement this.

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 made a complaint on behalf of their partner (A), who had a cancer diagnosis. C complained that there was a failure to keep A reasonably informed about appointments for treatment. C considered that the board had failed to ensure that they had A's address correctly recorded on the patient database. C also raised concerns about a delay in responding to the complaint, and a failure to provide a consistent explanation about why A was not reasonably informed of appointments for treatment.

We found that the board were able to provide copies of letters with the correct address, and whilst these had not been received by A, it was not possible to say that they had not been sent. In addition, whilst A turned up for an appointment that A did not know had been cancelled, the consultant did see A to carry out a full consultation. We did not uphold this aspect of C's complaint.

We found that the board provided conflicting accounts of what address information was held on the databases for C and for SPSO and whether or not this required to be corrected/had been corrected.

We also found that there was a delay in responding to C's complaint. We noted that the complaints department had moved, but we considered that it was reasonable to expect that the board would have in place a mechanism to forward the mail addressed to the complaints department to the new location within a reasonable period of time. We upheld these aspects of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for (i) a failure to ensure they had correctly recorded on their patient databases A's address which he had lived at since August 2015, (ii) a failure to provide a response to C's complaint within a reasonable period of time and (iii) a failure to provide a consistent explanation regarding why there was a failure to ensure A was reasonably informed of appointments for treatment. The apology should meet thestandards set out in the SPSO guidelines on apology available atwww.spso.org.uk/information-leaflets.

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

• Ensure patient addresses are accurate on all databases.

In relation to complaints handling, we recommended:

• Ensure complaint correspondence received is directed to the correct department.
• Ensure a thorough investigation is carried out before a stage 2 response is sent to a complainant.

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 local secondary school. They referred to a number of incidents which they reported to the school. They complained that the school failed to investigate these incidents adequately. They also complained that the council failed to investigate their complaint about the handling of the reports of bullying appropriately.

We found that the school took steps to investigate the incidents in line with the relevant guidance and were helpful and supportive. However, in some instances it appeared that the school failed to speak to the pupils being accused of the bullying, failed to keep records of the steps taken in this regard and to provide C with follow-up contact in line with the relevant guidance. We also found that the council failed to respond to C's complaint about the handling of the bullying allegations in line with their complaints handling procedure. Therefore, we upheld these aspects of C's complaint.

C also complained that the council failed to appropriately handle administrative aspects of their appeal against the council's decision, following C's placing request for A to attend another school. We did not find evidence of any failings in this regard and did not uphold this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and A for failing to handle C's complaints about bullying in accordance with their guidelines. Additionally, apologise for failing to acknowledge and respond to C's complaint timeously and address all the issues raised by C in their complaint and identify emails from C to the school as complaints and deal with them under the Complaints Handling Procedure (CHP), or escalate the matter to the council to deal with under the CHP. 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:

• Complaints about bullying should be handled in line with council guidance. In particular, where appropriate, pupils accused of bullying should be spoken to, records made of the steps taken in this regard kept and parents who reported the incidents provided with follow-up contact, in accordance with the guidelines.

In relation to complaints handling, we recommended:

• The council should acknowledge and respond to complaints in line with the timescales set out in the CHP, address all the issues raised in complaints and demonstrate that each element was fully investigated, in line with the CHP and correctly identify emails from pupils' parents which are complaints to be dealt with under the CHP, or escalate the matter to the council to deal with under the CHP.

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 failure of emergency mental health services to treat them during crisis admissions. C stated that they had been brought to the hospital on multiple occasions by police but that an assessment was not always carried out. C also complained that they had not been allocated a psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness) or a community psychiatric nurse.

The board responded by advising that services treated C appropriately when they attended and completed assessments when required. They also stated that C previously was supported by a psychiatrist but disengaged from this service and did not re-engage with services in the intervening period. C was unhappy with this response and brought their complaint to us.

We took independent advice from a psychiatric adviser and a mental health nurse. We found that the medical records showed that the board had acted reasonably and occasions where full assessments were not completed were appropriate and in keeping with strategies put in place to treat C. We considered that the plan to manage C's crisis contacts was in their best interests and we found no evidence of mental health assessment's being unreasonably withheld. Therefore, we did not uphold this aspect of C's complaint.

In relation to the allocation of a psychiatrist, we found that C had disengaged with services. However, proposed actions suggested by a psychiatrist to re-engage and support C did not appear to be actioned and records showed an unexplained gap in contact between C and services of around 18 months. Therefore, we upheld this aspect of C's complaint.

C requested a review of our decision and the case was reopened for further consideration. Details of this are explained below.

C was admitted to A&E at the Royal Infirmary of Edinburgh (RIE). After being transferred to an acute medical unit (AMU) from A&E, they left the ward and returned to their home. The police were contacted and they visited C at their home. C was detained under the Mental Health (Care and Treatment) (Scotland) Act 2003 (the Act) and returned to the RIE the following morning. C complained that the assessment carried out following C being detained and taken to hospital was unreasonable.

We took independent clinical advice from a consultant psychiatrist. We found that, while the board met the minimum requirement of the Act in terms of undertaking a medical assessment, there was no clear documentation detailing the mental state examination. We considered, given the complexity of the case, the lack of recent review and the presentation of C at the time, a formal assessment undertaken by an appropriately trained clinician from psychiatric services would have been reasonable and this did not take place. As such, we upheld this aspect of C's complaint.

C also complained that the assessment that was undertaken into their capacity was unreasonable. We found that there was no evidence to suggest that C did not have capacity to make their own decisions at the time. We noted that informal assessments are undertaken in every clinical interaction and we would not expect a formal capacity assessment to have been undertaken when clinicians considered C retained capacity. The psychiatric team had advised that in terms of C's mental health they considered C had capacity to make decisions on their care. The focus was then on whether C's physical injuries required care but C had consented to treatment for the same. Therefore, it was determined that there was no reason to detain C or undertake a formal capacity assessment. As such, we did not consider the lack of a capacity assessment to be unreasonable in these circumstances. We did not uphold this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to undertake a formal assessment of them by an appropriately trained clinician from psychiatric services. 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 that the agreed actions and proposed strategies were not pursued. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Individual clinicians will reflect on the outcome of this investigation as required within their annual appraisal process.
• The board should take steps to ensure that treatment plans devised are effectively followed through, in order to try and foster trusting relationships, minimise a sense of rejection, demonstrate service consistency and reliability and show a willingness to work in an open, engaging and non-judgemental manner.

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 relative (A) about the treatment A had received from the board. A had emergency surgery to repair a dissected aorta (a tear in the heart) and was discharged following treatment. A developed an infection in their surgical wound and was readmitted to hospital for further treatment. C complained that in treating A's infection, the board incorrectly administered A with penicillin (an antibiotic) to which they are allergic. Following intravenous Co-Amoxiclav (antibiotic used for bacterial infections), A developed a skin rash. C also complained that A was administered ibuprofen which should not have been prescribed to A due to the heart medication they were taking.

We took independent advice from a clinical adviser. We found that there was no evidence in A's medical records of a penicillin allergy prior to the development of their skin rash following intravenous Co-Amoxiclav. We also found that the board's use of a penicillin derivative was reasonable and an appropriate choice of antibiotic for A's wound infection. We noted that the potential adverse effects of taking ibuprofen did not mean that it could never be used in patients taking A's heart medication. In A's case, the use of ibuprofen postoperatively had not been sufficiently documented, therefore we were not able to determine whether its use was appropriate. On balance, we found that the board had provided a reasonable standard of treatment to A and did not uphold this aspect of C's complaint.

C further complained that the board had not provided A with clear information regarding their cardiology (area of medicine concerning diseases and defects of the heart and blood vessels) rehabilitation and aftercare, resulting in a delay in A receiving appropriate follow-up appointments.

We took independent advice from a cardiologist. We found that the board had not correctly processed A's referrals for cardiology follow-up and cardiac rehabilitation or done so in a timely manner. The board had not correctly identified a discrepancy in A's nutritional assessment scoring or followed this up at the time. Therefore, we upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A and A's family for not correctly processing the referrals for their cardiology follow-up and cardiac rehabilitation, and for providing A with aftercare that fell below a reasonable standard. 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:

• Ensure a process or system is implemented so that discrepancies with patient malnutrition universal screening tool (MUST) scores/nutritional assessments are easily identifiable so that follow-up dietetics reviews can be requested.
• Ensure appropriate referral pathways are in place to ensure patients receive timely cardiology and cardiac rehabilitation follow-up as noted in a patient's post-surgical discharge summary.

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.