Some upheld, recommendations

Summary

Miss C's mother (Mrs A) was admitted to an island hospital with pancreatitis (inflammation of the pancreas), where her condition deteriorated overnight. The next day, it was identified that she was developing organ failure, as a complication of the pancreatitis. She was transferred to a mainland hospital in another health board area. Mrs A died around sixteen days later from multiple organ failure.

Miss C complained about the care and treatment provided to her mother in the island hospital in the two days before she was transferred. After taking independent advice from one of our medical advisers, we found that a prompt and appropriate detailed medical assessment was completed when Mrs A was admitted. There was clear documentation of her vital signs, current drug treatment, physical examination and initial blood tests. The initial diagnosis of acute pancreatitis was correct and was made within a very short time. We also found that the later care and treatment provided to Mrs A was reasonable and appropriate, as was the attention to her pain relief. The deterioration in Mrs A's condition was due to the development of increasingly severe pancreatitis, complicated by early organ failure, rather than inadequate medical care. We did not consider that there were any clinical failings that impacted adversely on Mrs A, and our adviser said that no other specific treatment could have been offered at that time that might have changed the course of events.

Miss C also complained that the board failed to provide her and her sibling (who were both teenagers) with sufficient support when their mother was transferred to the mainland hospital. Miss C decided not to travel with Mrs A when she was transferred by ambulance, and said that when she and her sibling later went to visit their mother, they had to stay in a bed and breakfast without any support.

We found that although it would not have been appropriate for the board to pay their costs, they should have provided Mrs C’s children with advice on how to try to get help with these. We also found that Miss C was not given enough information about her mother’s prognosis to make an informed decision about whether to travel with her in the ambulance. Having carefully considered this matter, we upheld the complaint that the board had not provided Mrs A's children with adequate support when it was decided that she should be transferred.

Recommendations

We recommended that the board:

• issue a written apology to Miss C for the failure to provide her with adequate information about her mother's prognosis and for failing to provide her with adequate advice on how to try to obtain further support with travel costs; and
• take steps to ensure that relatives are given adequate information about how to try to get help with the costs of visiting patients who are transferred to hospital on the mainland.

Summary

Ms C is a transgender woman undergoing gender reassigment (a process of changing from man to a woman). She complained that the assessment process for acceptance for gender reassignment surgery took too long and was unreasonably delayed. She started going to the relevant clinic, attending regularly over the following three years. She was referred for a range of additional treatments including hormone therapy, plastic surgery and speech therapy. She sometimes presented at the clinic as a man and sometimes as a woman, but consistently said she was keen to seek gender reassignment surgery.

After three years Ms C was given a referral for gender reassignment surgery in the UK. Ms C then said she preferred to have this abroad, asked for a referral, and withdrew from the service.

In considering this complaint, we took independent advice from our psychiatric adviser, who reviewed all the consultations that Ms C had as she progressed towards referral for surgery. While he acknowledged that it had taken some time for Ms C to gain her referral, he did not identify any specific delays on the part of the board. The timescales involved were partly due to referrals to other services and partly due to inconsistencies in the way Ms C was presenting at the clinic.

Ms C also complained that the board unreasonably refused to refer her for surgery abroad. She said that the criteria for referral were the same, and she would be paying for the surgery. The board said that the decision not to refer Ms C was taken on policy grounds, as international referrals are only made when specialist skills are not available in the UK. Our adviser noted that it would have been appropriate to make an exception to policy on this occasion, given that payment for surgery was not an issue, and we upheld the complaint. However, we noted that before gaining a new referral, Ms C would need to provide evidence that she was ready for surgery now, as she does not currently meet the referral criteria because she withdrew from the service.

Ms C also complained about the standard of plastic surgery on her jaw. She said that it had left her jaw heavier on one side, and that this was deliberate on the part of the surgeon. We took independent advice on this from a facial surgery adviser, who found that the technique used during surgery was appropriate and that the results were of an acceptable standard. He noted that all faces are asymmetric and that patients who have had plastic surgery are much more aware of their appearance after surgery than they were before.

Finally, Ms C complained that there were factual inaccuracies in the board’s response to her complaints. We reviewed the correspondence, and found that there appeared to be some confusion around the use of the word ‘ambivalence’, which was used by Ms C’s psychiatrist to describe her approach to her gender reassignment when she was not consistently presenting as female. However, our psychiatric adviser considered these assessments to be appropriate. We also found some inconsistency around the information presented in relation to her attendance at appointments and some confusion caused by a statement from the board’s plastic surgeon. However, we could not find any significant inaccuracies in the board’s correspondence, and did not uphold this complaint.

Recommendations

We recommended that the board:

• ensure that all patients attending/receiving the services of the clinic are, at their first appointment, given verbal and written information of the policies and procedures followed there in relation to gender reassignment surgery; and
• apologise for not referring Ms C for surgery abroad when it would have been appropriate to do so.

Summary

The council had approved a planning application for a new house on a site close to Mr C's home, although the application was subject to certain planning conditions. Mr C complained that since then the council had failed to enforce a condition about a landscaping scheme. He also complained that they had not properly dealt with his complaints about this.

Our investigation found that although Mr C was unhappy about it, the council had taken adequate steps to enforce the condition about which he was concerned, so we did not uphold his complaint about that. However, we also found that when he complained to them, the council did not deal with his complaint in accordance with their procedures, as they took too long to respond.

Recommendations

We recommended that the council:

• formally remind their staff that when dealing with complaints, there are stated timescales to be adhered to.

Summary
Mr C complained that he and his wife (Mrs C) had experienced antisocial behaviour from their neighbours for a number of years. This included dog barking and noise. They were unhappy that the council had not taken action against these neighbours. Mr and Mrs C were also unhappy about a warning letter that the council sent to them about their own behaviour in 2009. They said they had not seen this and were unaware of it until 2011. Mr C felt that it had been issued without proper investigation and in the absence of any evidence against them.

In our investigation we considered events from 2008 onwards. We considered the council's response to our detailed enquiries, and how they had dealt with Mr and Mrs C's complaint. We reviewed their investigations and examined relevant policies and procedures, including the council's antisocial behaviour policy, keeping of pets policy and complaints procedure.

Having considered all this information, we did not uphold Mr C's complaint about the council's actions or the warning letter. We found that they appropriately investigated Mr C's complaints according to their antisocial behaviour policies and took adequate action about his complaint. 
We also found that the warning letter had been correctly issued.

However, our investigation revealed that the council had not followed the relevant sections of the keeping of pets policy that related to keeping more than one pet. We, therefore, upheld this aspect of the complaint about the lack of explanation of the situation regarding the neighbours' dogs.

Recommendations
We recommended that the Council:

• ensure that Sections 2.1 and 2.2 of the keeping of pets policy are correctly followed;
• give us an update on the number of pets authorised (following the keeping of pets policy) to remain in the neighbours' property; and
• apologise to Mr C for the failures in both adhering to the keeping of pets policy and the council delay, to acknowledge Mr and Mrs C's concerns about this aspect in their initial complaint.
   

Summary

Ms C complained that Business Stream had treated her unreasonably, in that she had been sent a bill for her property that was far too high.

Our investigation found that Ms C's treatment had been unreasonable. The high bill could have been caused by a number of factors other than the reason given and these had not been fully investigated. In particular we found that the failure to test a water meter that was acknowledged to be faulty had deprived Ms C of a legitimate opportunity to challenge the bill. Given the size of the sum disputed and its implications for Ms C's business, we took the view that it was unreasonable for Business Stream not to have carried out further investigation. We also found that Ms C's complaint was poorly handled and subject to unnecessary delay and that there had been poor internal communication between the different departments at Business Stream.

We found that it was reasonable for Scottish Water to carry out a dye test without giving advance warning of their attendance.

Recommendations

We recommended that Business Stream:

• provide evidence to the Ombudsman that staff in customer facing roles have been appropriately advised about Scottish Water's policies regarding visits;
• review their charges with a view to charging for water consumption estimated on previous and current usage for the period in question;
• apologise in writing for the inconvenience and distress caused by their failure to handle the complaint in a timely fashion; and
• provide evidence to the Ombudsman that they have reviewed inter-departmental communication to ensure that the customer relations and collections departments share information in a timely manner so that disputed invoices are not pursued until the complaint has been resolved.

Summary

Mr C, who is a prisoner, had appeared before the Parole Board for Scotland, but they did not direct that Mr C should be released. He complained to them that they had not made their decision in line with the relevant rules, as it was based solely on risk assessment reports. The Parole Board advised that they had taken a wide range of information into account in reaching the decision, and gave examples of this.

Mr C was dissatisfied and raised his complaints with us. After investigating the matter, we decided that the Parole Board had reasonably followed the rules, and did not uphold Mr C's complaint about this. We did, however, uphold his complaint about how they had handled his complaint to them, as they had not included a reasonable level of detail in order to provide a clear explanation of their decision.

Recommendations

We recommended that the Parole Board:

• apologise to Mr C for not responding reasonably to his complaint; and
• review their complaints handling guidelines to ensure that complaint responses include a level of detail to ensure reasonably clear explanations of their decisions are provided.

Summary

Mr C's late mother (Mrs A) was a council tenant before her death, and he complained to us about the way the council had handled a request for his mother's carer to move into the house shortly before his mother died. Although the request appeared to come from his mother, he told us that she had dementia and that the council did not establish if she had the capacity to make this decision when they allowed the carer to move in. He was also unhappy with the way the council handled the situation when, after his mother died, the carer was allowed to succeed to the tenancy.

As it was clear that the council knew that Mrs A had dementia, we were concerned that they accepted the request without making certain specific checks. We took the view that this meant they had failed to safeguard the interests of a vulnerable tenant and we upheld this part of the complaint. The council told us that it was impossible to say whether a further check would have changed the decision in this case. They apologised, however, that their procedure was not as robust as it could have been. They agreed to revise their procedures to provide guidance and ensure that in future there would be a home visit and further checks before a carer could move in. We found no evidence, however, that they failed to follow the correct procedure in handling the succession to the tenancy.

Recommendations

We recommended that the council:

• ensure that the interim arrangements are now in place and that the new policy and guidance is completed and in place as soon as possible.

Summary

Mr and Mrs C have lived in their home for many years. It was separated from the next house by a small grassy amenity area. In 2005, a developer applied for planning permission for a housing development on a site behind the existing homes. Mr and Mrs C, along with many others, objected to this. In early 2006, the plans were amended to include footpath links from that development, with one such link running through the amenity area. The council refused the proposals in May 2006, but the developer appealed, and an inquiry reporter approved them, on condition that the developer entered into an agreement to contribute to the footpath links. As they thought at that point that there would be other developments in the area, and to reduce the risk to children walking to school, the council amended primary school catchment areas, in the anticipation that early completion of the housing site would provide part of the footpath link. A road construction consent (RCC) was obtained in 2008, but the recession in house building then prevented the developer from building the houses and providing the footpath link.

Faced with the agreed changes to the catchment areas from August 2012, the council's education service proposed that the council divert money from a local budget to provide the footpath link. After securing the necessary agreement from the landowners, in June 2012 the council hand-delivered a letter giving Mr and Mrs C about two weeks' notice of the start of construction of a council-funded footpath next to their home.

Our investigation did not uphold the first of Mr and Mrs C's complaints - that the council had failed to notify them of the footpath. We found that they had been aware of the housing development plans in 2005. There was no requirement to notify them of the RCC application, and the works undertaken by the council were similar to the planning consent issued on appeal and did not require further notification. We did uphold a second complaint, about the council's failure to respond to Mr and Mrs C's complaints.

Recommendations

We recommended that the council:

• apologise for the shortcomings in dealing with Mr and Mrs C's complaint.

Summary

Mr C owns a house in the grounds of a former hospital. In considering an application for outline planning consent for the estate in 2000, the council considered that a design brief should be prepared for subsequent development, and this was later approved by the relevant committee. The council also decided to suspend permitted development rights in respect of proposals within the curtilage of dwellings (the land immediately around the houses).

Mr C was unhappy with the council's handling of subsequent applications and that they did not take enforcement action when wire fencing was erected in an area of amenity woodland immediately behind his home. He complained that the council had unreasonably delayed in dealing with planning issues since he first complained about the erection of fencing by a neighbour; inconsistently applied planning conditions and regulations to planning applications for urban fencing in a rural location: provided conflicting information about erecting fences within the woodland area; and failed to act in dealing with unauthorised fences there despite a prior commitment to take enforcement action. He also said that the council's planning service wilfully neglected to act on the findings of a recent relevant report by the Directorate of Planning and Environmental Appeals and had made selective use in support of their failure to take action about unauthorised development.

Our investigation upheld the first, second and fourth elements of Mr C's complaint as we found evidence of delay, inconsistency and a lack of thoroughness in considering some of these issues. We did not uphold the other complaints as we did not find evidence to support Mr C's view on these.

Recommendations

We recommended that the council:

• urgently review the terms of the original planning permissions for the estate with specific reference to all planning documents and their related planning conditions and agreements which deal with design, landscaping and woodland management; this review to include all consents, agreements and approvals issued under relevant conditions and the current status of any planning or management agreements, and to form a briefing for development management staff responsible for applications and enforcement in the area and for residents;
• reconsider their position following this exercise, with regard to the material planning background accompanying reports on applications; and
• urgently review their guidance for the preparation of officer reports on planning applications, to ensure that material considerations taken into account always include the terms of briefs, planning conditions and other forms of approved guidelines that apply to a site under any pre-existing consent or agreement.

Summary

Ms C had complained for some time about the antisocial behaviour of her neighbours, including noise and disturbances from them and their frequent visitors, and the council's antisocial behaviour team had opened two files as a result of this. More recently, Ms C had also complained about the untidy and overgrown state of their garden, and other related matters. She told us that the council had not acted on her complaints.

We did not find that the council had unreasonably failed to deal with her complaints about the neighbour's antisocial behaviour. Our investigation found that the council had followed their policy and had issued letters of caution, but that this had not progressed to more serious warnings. We did, however, uphold her second complaint, that the council had unreasonably failed to deal with repeated complaints about the garden, as we found that the housing department had not followed their procedure on estate supervision with specific regard to untidy gardens.

Recommendations

We recommended that the council:

• apologise to Ms C for their deficiencies in securing a practical improvement in the condition of her neighbour's garden; and
• review the current condition of the garden to assess whether there is a need for formal intervention to ensure that it meets an acceptable standard.