Some upheld, recommendations

Summary

Mr C complained that, following the completion of a new school behind his property, his garden was experiencing flooding during heavy rain. Mr C was unhappy with the council's handling of his complaints about this and said that they had unreasonably failed to resolve the problem. He was also unhappy with the council's handling of his representations.

During our investigation we were satisfied that the council had provided evidence that they had taken action in an effort to resolve the problems. While Mr C remained dissatisfied, they were satisfied there was no other work they could reasonably carry out. They had said that maintenance work would be carried out to ensure the drainage system continued to function as designed. We, therefore, did not uphold this complaint. We did uphold his complaint about how they had handled his representations, as we found evidence that the council had failed to deal with Mr C's complaint in line with their complaints procedure.

Recommendations

We recommended that the council:

• apologise for their overall handling of the complaint.

Summary

Mrs C raised her concern about the council's handling of a planning application submitted by her neighbour to extend his property. In particular, she was unhappy that, following the submission of amended plans that included an area of decking, Mrs C was not renotified of these. She also complained about the handling of her representations.

After taking independent advice from one of our planning advisers we upheld the complaint that the council had failed to renotify Mrs C following the submission of the amended plans. As a result she was prevented from submitting her concerns about the amendments. We also found no evidence that the council had assessed the area of decking while processing the application. The council accepted that by mistake they had failed to notify Mrs C of the amended plans and that there was no evidence that the decking had been assessed. We did not uphold the complaint about her representations, as we found no evidence of fault in the council's handling of Mrs C's correspondence.

Recommendations

We recommended that the council:

• ensure that there are clear guidelines for the acceptance of amended plans to ensure that reiteration of neighbour notification, press advertising or other consultation or publicity is not overlooked;
• review their procedures on householder and delegated applications to ensure all material elements of a development are not overlooked during the processing of an application and are properly assessed before making any determination; and
• take steps to identify what action they can take using any available statutory powers or by negotiation to improve the current situation, and report back to the Ombudsman on the action they propose to take.

Summary

Miss C complained about aspects of the care she received during the birth of her son. She was unhappy with the time taken to allocate her a midwife on admission and to give her pain relief. She was also concerned about the attitude of staff in the labour ward, which she felt was dismissive and unprofessional at times. Miss C had a forceps delivery (where the baby is delivered using a surgical instrument resembling a pair of tongs). She complained that the care provided by the labour ward doctor and the surgeon in the theatre during the procedure was abrupt and overly forceful. In particular she was concerned about the physical damage that she and her son sustained during the birth.

We took independent advice on Ms C's complaint from two medical advisers. We upheld her complaints about delays and about unprofessional behaviour on the ward, noting that the board had already apologised for these, although we concluded that her overall treatment was reasonable in the circumstances. We did not uphold the complaint about the staff in the operating theatre, as we found no evidence of failures there, although in relation to this complaint we identified a concern with the quality and accuracy of the board's investigation it, and made recommendations accordingly.

Recommendations

We recommended that the board:

• review the consent form for operative vaginal delivery, to consider including all the common risks given in the Royal College of Gynaecologists Consent Advice No 11 (Operative Vaginal Delivery) July 2010;
• apologise to Miss C for the failure to adequately investigate her concerns and provide her with an accurate response to her complaint; and
• provide the Ombudsman with the outcome and details of any actions arising from their investigation into the failures of their original investigation into this complaint.

Summary

Mrs C's late father (Mr A) was admitted to hospital in late 2011 with recurrent abscesses. In October 2011, he was transferred to another hospital for audiology (hearing) tests. He was transferred without an escort and wearing only pyjamas and a cardigan. Mr A was doubly incontinent during the journey and also suffered a fall.

In November 2011, Mr A was referred to a specialist colorectal (bowel) surgeon and a loop colostomy (a procedure whereby the loop of the bowel is pulled through the thickness of the abdomen wall) was planned. Mr A had bowel surgery several days later. During the operation, Mr A’s bowel suffered a trauma, which the board said the surgical team did not know about at the time. He returned to the ward with a temperature which was treated by antibiotics (drugs to treat bacterial infection). His condition deteriorated and he started to show signs of sepsis (blood infection). Further investigations (chest x-ray, ECG, blood tests and blood cultures) were carried out and he was prescribed a strong antibiotic intravenously. Just over an hour later, staff noted that Mr A might be showing signs of sepsis, and an abdominal examination showed tenderness. An anaesthetic review noted that surgical emphysema (formation of bubbles of air in the soft tissues) was present. He was taken back to the operating theatre, where the surgeon discovered that Mr A’s bowel had been perforated and this had caused peritonitis (inflammation of the tissue lining the abdomen). Mr A needed further operations, and was transferred to intensive care, but his condition deteriorated and he passed away several weeks later. The cause of his death was recorded as acute peritonitis and perforation of colon (bowel) during colostomy operation.

Mrs C complained about Mr A’s care and treatment at the hospital including aspects of his transfer to the other hospital. In particular, she complained about the surgeon's failure to detect that Mr A’s bowel had perforated during the original operation and that the post-operative complications were not recognised and treated within a reasonable time. Mrs C also complained that the board failed to handle her complaint within a reasonable time and failed to respond to her questions reasonably. After taking independent advice from two of our advisers - a surgeon and a nurse, we upheld two of Mrs C's complaints. Our investigation found that the board failed to provide adequate nursing care for Mr A during his transfer and that he should have had an escort and a blanket or outdoor clothes on. We also found that there was a significant delay of five months by the board in responding fully to Mrs C's complaints. As, however, the board had taken steps to address most of the shortcomings identified in these complaints we made only one recommendation. We did not uphold Mrs C's complaint about the operation and after-care, as we found no evidence that the surgical team failed to perform the operation in a reasonable way and we were satisfied that the post-operative complications were identified and dealt with appropriately within a reasonable time.

Recommendations

We recommended that the board:

• bring the shortcomings in record-keeping to the attention of staff concerned.

Summary

Ms C, who is an advocacy worker, complained on behalf of her client (Mrs A) about the care and treatment that Mrs A’s husband (Mr A) received from the medical practice. Ms C said the practice failed to take appropriate steps to lead to an earlier diagnosis of Mr A’s cancer and assured the couple that Mr A's 'bloods' had been checked when they had not. She also said that one GP unreasonably failed to follow up on blood tests and a second GP failed to deal with Mrs A in an appropriate manner when she went to the practice for support.

We took independent advice from one of our medical advisers on this case. Our adviser said that the practice had tried to care for Mr A in this very difficult situation. He said that the care and treatment they provided was appropriate and there was no evidence to suggest that they should have referred Mr A to hospital earlier or made a diagnosis of cancer themselves. The adviser said the evidence in the records did not suggest that the practice failed to take appropriate steps to lead to an earlier diagnosis.

We upheld the complaint about the assurance given to Mrs A about 'bloods'. We found that both parties agreed that the first GP at the practice indicated that she had ‘checked Mr A’s bloods'. However, we took the view that when the GP spoke to Mrs A, a layperson, it was reasonable for Mrs A to interpret this as meaning that the GP had checked Mr A’s blood test results and not simply that she had taken blood samples for testing, which is what the GP suggested she meant. Given the language used, we considered that, on balance, the centre did tell Mrs A that Mr A’s bloods had been checked when they had not.

On the matter of follow-up, the first GP had said that she went online to see where Mr A’s blood test results were. She found that the results were not there and Mr A had been admitted to hospital. Our adviser indicated that this seemed reasonable, as from the point at which the first GP discovered that Mr A was in hospital, there would no longer have been any need for her to follow up on blood test results. We accepted the adviser’s views and did not find that the practice unreasonably failed to follow up the blood tests.

On Mrs A’s appointment with the second GP, the notes the GP made at the time did not contain any information that supported Mrs A’s account of what had happened, and we could not uphold this complaint. It was Mrs A’s word against the GP’s and there were no independent witnesses or other means for us to verify whose version of events was correct.

Recommendations

We recommended that the practice:

• provide Mrs A with a written apology for not explaining clearly what had happened to Mr A's blood samples;
• feed back our views on the communication and record-keeping to the staff involved in this case;
• take steps to ensure that in future, clear language is used when communicating with patients and summaries of phone calls are recorded in patients’ medical records;
• feed back our adviser’s comments on significant event analysis/audit to the staff involved in this case; and
• amend their procedures to include a requirement for significant event analysis/audit in future instances of this type.

Summary

Mr C, the secretary of a bowling club, complained that it was unreasonable that Business Stream did not read the club's meter for sixteen months. The bills during that period had been based on estimates. After the meter was read, the club received a bill for £1,978.21, which was far in excess of any previous bills.

Our investigation found that Business Stream are required to submit two actual meter readings each year, one of which may be supplied by the customer. We asked them to explain why the meter was not read during the sixteen-month period. In their response, they said that there was a note on their computer system showing that the meter reader was unable to gain entry to the club grounds to take a meter reading on one occasion. However, there were no other notes on the computer system to explain why there was such a gap in reading the meter, so we upheld this aspect of Mr C's complaint.

Mr C also disputed that Business Stream had taken actual meter readings for the large bill, and considered that it was based on estimates. He said that the club had traced the area in which the meter was housed, and they had to clear foliage and debris to access it. He said that this confirmed that no access had been made for some time. However, the club had subsequently provided a meter reading that was higher than those that Business Stream had taken. Business Stream also sent us photos of their readings. Although these did not show the serial number of the meter, we were satisfied that the bill was based on actual rather than estimated readings.

Recommendations

We recommended that Business Stream:

• apologise to Mr C for the delays in responding to his complaints;
• consider awarding him a compensation payment in line with their service standards for the delays in responding to his complaints; and
• consider issuing a reminder to meter readers that, where possible, they should include the serial number of a meter in photos.

Summary

Mr C owns a house which is reached by a lane. The properties on the lane were built before the present council came into existence in 1996. At that time, in readiness for the reorganisation of local government, the former roads authority had sent the council a computer list of public roads, on which the lane was identified as one. Mr C did not know about this when he bought his property in 1997, and does not have a property enquiry certificate (a document produced by a council with information about the status of a property) from the time of his purchase. In 1998 a neighbour (neighbour D) bought a property there. His property enquiry certificate suggested that the lane was a public road, as did a plan he was later sent. In 2011, however, Mr C found out that the council considered that the lane was not a public road, and was unhappy about this.

In response to the complaint, the council said that, by 2004, they had realised that the property enquiry certificate issued to neighbour D was wrong, and had told him and apologised. (This meant that the council considered that the lane was in fact private and that the home-owners had the responsibility of maintaining it.) There was, however, a scheme under which owners could apply to pay half the cost (with the council paying the other half) of bringing a road up to the standard where the council would adopt it (take responsibility for it). This had been raised with the council before, but nothing had come of it. In 2011, Mr C made another enquiry about this, and was given costs but then learned that the council had no money for this in their budget. When Mr C was speaking to other residents about the project, neighbour D had provided a copy of his original 1998 property enquiry certificate. After seeing this, and knowing that the council had been maintaining the road verges etc, Mr C was unhappy with the council’'s insistence that the lane was private. He pursued this with the council, through solicitors and through a councillor and a Member of the Scottish Parliament.

When he brought the matter to us, we explained that where there is a dispute about status, it is not our role to make a definitive ruling. We did not uphold Mr C's complaints that the council failed to inform him of potential funding options or that they had unreasonably claimed that the lane’s inclusion in the council’'s list of adopted roads was in error. We noted their reasons in support of their stance on this. We did, however, uphold Mr C’s complaint that the council failed to follow the correct process to remove the lane from their list of adopted roads. This was because we found there was a lack of transparency about how this happened, and we made a recommendation about this.

Recommendations

We recommended that the council:

• further consider the status of the list passed to them on 27 February 1996 and take such action to regularise the matter as they deem appropriate.

Summary

Ms C complained about various aspects of the council's handling of a repair under the Tenements (Scotland) Act 2004. Ms C questioned whether the original repair to the roof had ever been done and, even if it had, the standard of the workmanship. This was because no one remembered the work having been done; the chronology of the notices and repair did not correspond; and another repair was required soon after. The council acknowledged administrative errors in their handling of the repair, but maintained that the work was carried out in 2010. They also felt that the time that had since passed made it impossible to confirm whether the latest repair was related in any way to the 2010 repair.

The fact that the work was carried out under the Tenements (Scotland) Act 2004 meant that we could not look at the first two aspects of Ms C’s complaint, as these were outwith our jurisdiction. However, we investigated the third aspect, about how they handled Ms C's complaint. The council acknowledged to us that they had not met their own timescales in doing so. They explained that they had reviewed their processes and had given feedback to the relevant members of staff. They had also recently adopted the model council complaints handling procedure recommended by our Complaints Standards Authority. However, we also found evidence that a council employee had told Ms C that the council would conduct the later repair at its own expense. This contradicted the council’s final response which said that they would only pay their individual share (as a part-owner of the building), so we asked the council for more information about this. In the light of the evidence received, we found there had been maladministration. We upheld this aspect of Ms C’s complaint and made a relevant recommendation.

Recommendations

We recommended that the council:

• consider whether it would be appropriate to reimburse the residents for their respective shares of the repair conducted in 2010.
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Summary

Ms C, a mature student, started a postgraduate degree. She had been living on her own in a two bedroom private let and had previously received 25 percent single person’s council tax discount. When she started studying, she applied for, and was granted, exemption from council tax during her studies. In November 2010, with the written consent of her landlord she sublet the extra bedroom to a lodger. The lodger was not a student but applied for, and was granted, housing benefit which continued until August 2011. Ms C did not ask the council about how having a lodger might affect her student exemption. In July 2011 after completing her second year of studies, Ms C herself applied for housing benefit, and it was then held that she as tenant was responsible for full council tax (less 25 percent single person’s discount) dating back to when her lodger arrived. By the time that the council had calculated this and told Ms C about it, however, her lodger had left. Ms C also moved out in November 2011 but the council then pursued her for substantial arrears of council tax for 2010/11 and 2011/12 and for an amount of overpaid housing benefit.

When Ms C pursued this with the council before submitting a complaint, they told her that they had issued a demand for the council tax in January 2011. They could not, however, provide a copy of the relevant demand or covering explanatory letter. Ms C made two complaints about the council: that they unreasonably failed to remove a student exemption from her council tax and notify her at the time of the revised council tax charge; and that they did not make it clear to her that subletting a room in her flat would affect her claim for housing benefit.

Although it is generally a claimant's responsibility to tell the council about potentially relevant changes, we considered that the council’s delay in notification meant that Ms C could not realistically pursue her lodger for the amount due. We upheld this complaint and made a recommendation to put this right. We did not uphold the second complaint, as it was clear that Ms C’s claim for housing benefit was made some seven months after her lodger’s housing benefit claim.

Recommendations

We recommended that the council:

• apologise to Ms C for their omission in not removing her student exemption earlier and in informing her of this; and
• credit Ms C's council tax accounts for 2010/11 and 2011/12 with an ex gratia sum of half the council tax liability incurred during the period of her lodger's occupation of the flat.

Summary

In June 2011, Mr and Mrs C submitted a planning application to build a house in their garden. They complained that planning permission was refused although at the pre-advice stage, the council did not identify any concerns. Mr and Mrs C also said that an application in principle had been made in accordance with council officers' advice. After refusal, Mr and Mrs C asked for the decision to be reviewed but this was also refused. They complained, in general, about the way in which the council dealt with their applications.

During our investigation we obtained independent planning advice from one of our planning advisers, and considered the complaints and planning files. We upheld three of Mr and Mrs C's six complaints. Our investigation found that, throughout the process, Mr and Mrs C had the benefit of planning advice as they had engaged their own planning consultant to assist them with their application. Notwithstanding the advice they said they were given by the council, it was clear that the only way to determine an application was to submit it. Our investigation showed that there was no evidence to suggest that they had been encouraged to submit an application in principle. However, when the application came for validation, our planning adviser said that the council failed to deal with it in terms of the appropriate planning legislation. They also uploaded irrelevant information onto their planning website. However, at the review stage the council followed government guidance. When Mr and Mrs C were unhappy with the outcome and complained, we found the council failed to respond to their concerns in a reasonable manner.

Recommendations

We recommended that the council:

• formally apologise for their error in validating the application;
• reimburse fifty percent of costs as it appears doubtful, given that they did not require design details, that they would have gone on to require drainage information;
• apologise for their error; and
• formally apologise for their shortcomings in the way they handled the complaint.