Some upheld, recommendations

Summary

Mr C complained that the council failed to take reasonable steps to ensure that his aunt's hot water and heating system was properly maintained. He was also concerned that the council failed to deal with his subsequent complaints in a reasonable or timely manner.

Our investigation found that Mr C's aunt had had problems with the hot water and heating system for many years. However, in each case where faults were reported to the council, they had arranged for engineers to visit to attend to them. In addition, the council offered to provide a replacement hot water and heating system in January 2012, but council officers had been unable to gain access to allow this to go ahead. Following our contact with the council they offered again to install a new heating system but Mr C's aunt advised that she did not want this as it would be too disruptive. As we did not find evidence to show that the council failed in their responsibilities to maintain the hot water and heating system we did not uphold this element of the complaint.

We did, however, find that the council took longer than their stated timescale to respond to Mr C's complaint and also failed to consider earlier correspondence as formal complaints.

Recommendations

We recommended that the council:

• apologise to Mr C for failing to identify his complaint at an earlier stage, following his emails of 25 and 29 February 2012, and failing to respond to his complaint within the timescales detailed in their complaints procedure.

Summary

Ms C rented a property from a housing association. She claimed housing and council tax benefit from the council. Ms C thought that she was charged too much rent because the housing benefit department did not include an amount for a service charge on her tenancy. She said that she had asked for an explanation of her rent but they did not provide it. In early 2010, the council carried out a joint investigation with the Department for Work and Pensions (DWP), which found that Ms C was not entitled to all the benefits she had been receiving. This meant that the DWP wanted to recover incapacity benefit, and the council wanted to recover housing and council tax benefit from her. Ms C told us that she wrote to the council saying that she wanted to appeal, and they said that they would pass this to the tribunal service. However, they did not do so, as they said that the DWP could not confirm that Ms C had appealed the incapacity benefit decision. The council said that, as it was the primary benefit, Ms C needed to appeal it first before appealing the other benefits. They began recovering overpayments of housing and council tax benefit. Ms C had, in fact, appealed the DWP decision but they had overlooked this until November 2010. In December 2010, it went in front of an appeal tribunal, which upheld the original decision.

In May 2011, however, the council found that the DWP had accepted a further appeal out-of-time. On that basis, the council suspended the recovery of housing and council tax benefit. Ms C asked them to make a discretionary housing payment to write off these two benefit overpayments, but the council told her that they could not consider a discretionary payment for this purpose. Ms C made a further application for a discretionary housing payment in September 2011, as she was suffering hardship. The council did not respond as they were waiting for the outcome of Ms C's incapacity benefit appeal before making a decision. In January 2012, the incapacity benefit appeal tribunal found in Ms C's favour, and wrote off all her incapacity benefit overpayment. The council did not accept the conclusion of the incapacity benefit tribunal but agreed, as a gesture of goodwill, not to recover the remainder of Ms C's other overpaid benefits.

We found no evidence that the council provided the housing association with incorrect information about Ms C's benefit entitlement or failed to respond to her enquiries about the reasons for increases in her rent and deductions from her benefit. Our investigation did, however, find strong evidence that the council did not deal appropriately with Ms C's requests for her overpayment decision to be sent to the tribunal, and for deductions to be stopped. Although they told her that she had not confirmed that she wanted to progress matters to the tribunal, we found that Ms C had quite clearly said she wanted to appeal. In the circumstances, the council should also have considered suspending the deductions, as their policy was to stop deductions when an appeal was outstanding. We found that the council correctly refused Ms C's first application for a discretionary housing payment application. However, we found that they unreasonably delayed on the second application and failed to provide any sort of communication during the application process.

Recommendations

We recommended that the council:

• credit Ms C's rent and council tax accounts with any monies already taken relating to the overpayment, confirming in writing to her when they have done so;
• apologise for failing to suspend payments of housing benefit after her request for an appeal and providing inaccurate information for their failure;
• review their practice relating to accepting appeals and suspending repayment of overpayments to reflect housing and council tax benefit guidance;
• apologise for delaying Ms C's application and for failing to communicate effectively when processing her discretionary housing payment; and
• remind relevant staff of their responsibilities to deal with applications for discretionary housing payments promptly and to communicate effectively with applicants when considering such payments.

Summary

Mr C, complained to us on behalf of his son (Mr A). Mr A suffered a serious leg fracture in late 2010, and underwent treatment in a hospital orthopaedic department until June 2011. At that point, he sought a second opinion and received further treatment from another health board. Mr C had a number of concerns about his son's initial treatment, including about the type of fixator (a device to fix the position of fractured bones) that was used, the pain relief provided and the timing of appointments.

Having taken independent advice from one of our medical advisers, a consultant orthopaedic surgeon, we found that the decision to use an external fixator was in itself appropriate. We noted, however, that the board had not identified that one of the pins used had been placed into one of the fractures. We also noted that Mr A was not seen by a consultant until nearly three months after surgery, although we had no concerns about the treatment provided during this period. On balance, therefore, we upheld the complaint that the initial management of his fracture was inappropriate.

We upheld the complaint that on a number of occasions during his treatment Mr A was not given adequate pain relief, but did not uphold a complaint that it was inappropriate to use a sarmiento cast (a below-knee cast that allows the knee to bend) once the external fixator was removed.

Finally, we upheld the complaint that Mr A was not given timely out-patient appointments. Mr A had review appointments in April and June 2011. He was fitted with a leg brace and advised to use his leg when walking. He was given another appointment for eight weeks later. However, we found that at that stage it was clear that the fracture was not healing and required further management, but that the board failed to recognise this. By June 2011, Mr A was suffering severe symptoms and sought treatment elsewhere. We recognised that this had been a complex injury to manage, and that the orthopaedic department might have recognised that the fracture was not healing had Mr A continued his treatment with them. However, it was clear that he had already received substandard care, given that the fact that during the April and June 2011 appointments it was not recognised that the fracture was not healing.

Recommendations

We recommended that the board:

• provide evidence to the Ombudsman that the orthopaedic department ensures timely consultant review of patients when appropriate; and
• bring our findings to the attention of the staff who treated Mr A on 1, 14 and 15 February 2011 to allow them to reflect on his pain management.

Summary

Mrs C complained about the treatment prescribed by her medical practice for fungal nail infection. In addition, Mrs C was unhappy with the practice's response to her complaint and with their view that she and her husband behaved inappropriately towards staff.

Mrs C has lupus (an autoimmune disease that causes inflammation in various parts of the body). She did not take the prescribed medication after reading on the information leaflet that it was potentially harmful to lupus sufferers, and complained that it had been inappropriately prescribed. Although Mrs C's prescription was subsequently changed, she said that the new course of treatment also had an adverse effect on her health.

As part of our investigation, we took independent advice from a medical adviser. He said that available treatments for fungal nail infection can have a number of side effects, interact with many other drugs and can cause reactions including impairment of liver function. The initial drug Mrs C was prescribed can cause a lupus type effect and the British National Formulary (BNF - national guidance for healthcare professionals regarding the prescribing of medicines) advises caution when prescribing it to patients who suffer from an autoimmune disease. Our adviser said that although the BNF does not advise against prescribing the drug, there was no record to suggest that the medical practice had considered Mrs C's medical history when prescribing it, nor did they note a follow-up plan or request blood tests.

We also found that there was no evidence to show that the medical practice considered any follow-up plan when prescribing the replacement treatment. The BNF recommends that if the treatment is prescribed for more than a month, liver function should be monitored. We noted that the blood tests taken from Mrs C after she complained of being unwell were only carried out as a result of her symptoms, rather than being planned at the time of prescribing.

We concluded that although it was reasonable for the practice to have prescribed both courses of treatment, their care of Mrs C was deficient because there was insufficient evidence to show that they had actively considered the impact on her condition or monitored the effects of the drugs.

We also identified that the practice's response to Mrs C's complaint lacked relevant information about the BNF advice, and upheld this complaint. However, we did not uphold the complaint about the allegation that she and her husband behaved inappropriately towards staff. This is because, due to a lack of independent witnesses, we were unable to know for certain whether the medical practice had acted inappropriately in saying this.

Recommendations

We recommended that the practice:

• apologise to Mrs C for failing to clearly discuss the possible risks and side effects when prescribing both drugs or to actively monitor her liver function; and
• remind relevant staff to ensure that all medicines prescribed are adequately recorded and the associated risks discussed with the patient are also noted.

Summary

Mr C, who is a prisoner, complained that the Scottish Prison Service (SPS) treated him unfairly compared to another prisoner who was allowed to use his own electric typewriter, which his family had brought into prison. He also complained that the SPS failed to explain clearly and fully why he could not have his electric typewriter brought in.

We looked at what Mr C told us about his complaint, the SPS records and policies about personal property in prison. Our investigation found that the dates of Mr C’s request for his electric typewriter and his complaint to the SPS were several weeks apart from the other prisoner’s request. The SPS had treated the other prisoner’s case as an exception, as at that time they had no recognised supplier for an electric typewriter. We concluded, therefore, that it was reasonable for the SPS to treat Mr C’s request in line with their policies and procedures, as they had by then sourced a new recognised supplier. We did not uphold this complaint.

The SPS were not able to provide us with any formal documentation about their final investigation of Mr C’s complaint. Having read the written responses to Mr C’s initial complaint, however, we concluded that he did not receive a clear and full explanation and, therefore, we upheld this complaint.

Recommendations

We recommended that SPS:

• ensure that investigations are carried out in reasonable time and that a record is kept.

Summary

Ms C complained about the council's actions in relation to blasting by the operators of a quarry in her area. She said that the council failed to ensure that a full and complete environmental impact assessment was carried out on the residential area beside the quarry, before they approved blasting at the quarry for 20 years. We did not find any deficiencies in the environmental assessment and the associated process. A specific assessment on the residential area was not required.

Ms C also said that the council failed to ensure that there were adequate planning conditions in relation to the blasting at the quarry. She complained that the council had unreasonably given the quarry operators permission to carry out test blasting at the quarry with inadequate safeguards for public safety and public amenity. The council had allowed the blasting under an earlier planning consent, as the more recent consent had not been implemented at that time. We found that the blasting operations were not excluded from the earlier consent. However, the council had an agreement with the quarry operators that the conditions in relation to blasting in the more recent planning application would apply. We considered that this was to be welcomed from a practical point of view, as it allowed a detailed monitoring scheme for the blasting to be drawn up.

We were also satisfied that the council had put reasonable safeguards in relation to the blasting in place. They had taken the relevant national planning advice into account and there was also a scheme for monitoring blasting vibration in place. We found that it was appropriate for a firm of environmental consultants to monitor the blasts. It was also common practice for the results of the monitoring to be kept at the site and made available for inspection by the planning authority at all reasonable times. In addition, there was a notification procedure in place to inform residents of the blasts. That said, we did comment to the council that they should consider occasionally monitoring the blasts themselves. We also found that the council had delayed in responding to complaints about the blasting and upheld Ms C's complaint about this delay.

Ms C made a further complaint that the council had obtained evidence that a condition regarding the quarry's hours of operation was being breached, but had failed to take enforcement action. The council said that it was their position that they had monitored the noise level at the quarry and no harm was being caused. They stated that the quarry operators had made an application to change the operating hours. They said that no enforcement action would, therefore, be considered until a decision was made on this application.

If a member of the public complains to us that there has been administrative fault or service failure by an authority in reaching a decision, and that he or she has suffered injustice or hardship because of this, we may look at the complaint. We can consider the process and procedures involved. We cannot, however, question the decision if there is no evidence of maladministration. We found that the council had followed the correct procedures in relation to this matter. We were also satisfied that it was appropriate for the council's enforcement officer to advise the quarry operators to make an application to vary the condition in relation to the operating hours.

However, at an early stage in our investigation, the council's chief executive had given assurances that the council would continue to monitor the operations at the quarry to ensure that there was no loading or unloading of lorries outwith the permitted hours. The council had failed to honour these assurances in view of their decision that no harm was being caused and enforcement action would not be taken.

Recommendations

We recommended that the council:

• write to the Ombudsman and Ms C to explain why they failed to honour the assurances given that they would continue to monitor the operations at the quarry to ensure that there was no loading or unloading of lorries outwith the permitted hours.

Summary

Mr C suffers from a chronic, degenerative back condition and had since 2009 been in contact with housing partnership about draughts in his home, water coming in around his front door and the replacement of his solid fuel heating system. He provided evidence from his occupational therapist and GP that he was unable to cope with his heating system and the cold, draughty conditions in his home. The partnership attended Mr C’s property on a number of occasions to carry out repairs to the windows and doors. Mr C considered, however, that the repairs carried out were inadequate and temporary. He said that the partnership should have replaced his windows to resolve the problem.

The partnership told Mr C that they had a programme of replacement windows and heating systems for all of their stock and that his home was on their list for renewal. However, they advised that they would not be able to do either piece of work until after 2015. During the course of his correspondence with the partnership, Mr C had also asked them to resolve a number of issues for him, including making a number of minor disability adjustments to his home, providing flooring and giving him an immediate transfer and moving costs. The partnership carried out a number of adaptations at the request of his occupational therapist, and placed him on their transfer register with medium priority. However, they refused to immediately transfer him, pay for his moving costs or pay for floor coverings.

We upheld Mr C's complaint about the heating system as our investigation found that the partnership’s funding arrangements allowed them to consider replacing the system as a disability adaptation, but that they had failed to consider this. We did not uphold his other complaints as we found that the partnership had taken appropriate steps in relation to repairs to the property and in response to Mr C’s needs. We did not consider that it was reasonable for the partnership to carry out the further changes that Mr C had requested.

Recommendations

We recommended that the partnership:

• review the current practice for dealing with requests for heating replacement under aids and adaptations funding, to ensure that such requests are dealt with taking into account relevant funding guidance; and
• consider Mr C's request for a replacement heating system as an aids and adaptations referral taking into account the relevant funding guidance.

Summary

Mrs C, an advocacy worker, complained on behalf of Miss A, who had hurt her leg by tearing her anterior cruciate ligament (ACL) in a skiing accident in March 2010. Miss A was referred to the hospital where she was seen by a consultant orthopaedic surgeon, who arranged for her to undergo ACL reconstruction surgery about seven months after the accident. Screws were used to reattach tendons between her knee and thighbone.

Two months after the operation, Miss A fell and hurt her knee again. She went to an accident and emergency (A&E) unit and was referred back to the consultant. X-rays taken at A&E showed that the screw in Miss A's thighbone had become dislodged. However, due to the amount of pain she was in, and the level of swelling, the consultant was unable to carry out a full examination. He noted that Miss A had a good range of movement and concluded that the screw was likely in the soft tissue, holding the ACL reconstruction in place. A few days later, Miss A's pain increased and her knee began to lock. She returned to A&E where further x-rays found that the screw was inside her knee joint. Surgery was arranged to remove it and to re-do the ACL reconstruction.

After taking independent advice from our medical adviser, we upheld this complaint. We found that there was very little detail recorded at the time about what procedure the consultant initially performed. However, from the x-ray evidence we were able to establish that the ACL reconstruction had been placed in a less than satisfactory position. We also found that the advice given to Miss A by the consultant after her second fall was inappropriate. Although the x-ray evidence was not conclusive, it was most likely that the screw had migrated into the knee joint, and in any case, it was known that the screw was not in the thighbone. As such, the ACL graft was not performing its intended task and we took the view that revision surgery should have been arranged at that time.

Recommendations

We recommended that the hospital:

• apologise for the issues highlighted in this case; and
• draw our adviser's comments to the consultant's attention.

Summary

Mr C complained about the admisitration processes for outpatient appointments and complaint handling.

The SPSO investigation found that there had been a delay in Mr C being allocated his original outpatient appointment and the board acknowledged this. However, our investigation did not find that the system was 'chaotic' as Mr C claimed. To the extent identified, that is the delayed initial appointment, this complaint was upheld.

On the matter of a verbal complaint made when Mr C attended for an appointment on the wrong day due to a failure to confirm a re-arranged appointment in writing, The investigation could not establish why he was told that a person whom the board have been unable to identify would come to speak to him. No one came to speak to Mr C within 10 minutes at which point Mr C began to suffer chest pains and was taken to the accident and emergency. He was then admitted to a ward for observation for 24 hours. He asked the ward staff to pass a message to Mr A to ask him to come to speak to Mr C on the ward. This did not happen before Mr C was discharged.

Our investigation could not establish who Mr A was. The board told us that there were no male members of the complaints team in the hospital that Mr C had attended. The board tried to establish who Mr A was but no one of that name could be found on the staff lists at the time of the incident.

On the matter of the complaints handling, our investigation found that although some of Mr C's complaints had been responded to in a comprehensive and timely manner there had been some matters that were not addressed. Mr C had also asked to be reassured that the issues he had raIsed had been brought to the attention of senior managers and/or the chief executive of the board. Our investigation established that although the complaints were brought to the attention of the chief executive, Mr C was not informed of this fact. Therefore, to the extent of the failings identified, this complaint was upheld.

Recommendations

We recommended that the board:

• apolgise for the delay in providing the inital outpatient appointment; and
• apologise for the failings identified in the complaints handling.

Summary

Mrs A was an elderly woman with cognitive impairment (a condition that affects the ability to think, concentrate, formulate ideas, reason and remember). She was admitted to hospital in April 2011 after falling at home and had an operation to repair a fractured hip. Mrs A developed an abnormally large volume of fluid in her feet and ankles and a leg infection. In July 2011, she was transferred to another hospital for treatment but was considered too frail for an operation and returned to the first hospital several days later. Mrs A was transferred to a third hospital at the end of August and died several months later. Mrs A's daughter (Ms C) complained about numerous aspects of her mother's care and treatment, including wound management and treatment, falls prevention, loss of hearing aids and teeth, the suitability of the ward and failure to carry out a Doppler test to assess her blood flow.

Our investigation found that the care and treatment in relation to wound management and treatment, the suitability of the ward, and failure to carry out the Doppler test was reasonable. There was no evidence to suggest that a Doppler test should have been carried out earlier, and the tissue viability nurse visited Mrs A at frequent intervals, documented their assessments and plans and took into account the overall requirements of Mrs A’s health and wellbeing. On the loss of hearing aids and teeth, we recognised the impact of this on Mrs A, but we were unable to establish how these were lost. It can be very difficult to prevent the loss of such items and we found staff took reasonable action to find and replace them. However, in relation to falls prevention, we found that the hospital failed to adequately risk assess, keep the assessment under review or have a cohesive falls prevention plan as part of the overall care plan.

Recommendations

We recommended that the board:

• take steps to ensure that ward staff comply with guidance on falls prevention; and
• apologise to Ms C for the failures identified.