Some upheld, recommendations

Summary

Mr C complained that the council did not ask for his permission before authorising the building of an access ramp for a neighbour, which affected Mr C's garden path. He also said that they had not responded to his complaint about the member of staff who authorised the work, and he was unhappy with the council's complaints handling. He said that there was delay in resolving a problem with a leaking pipe, which he believed was associated with the work.

Mr C also complained that the council unreasonably told him to resolve this with the contractor, rather than with them, and did not honour their commitment to restore his path to its original condition after the ramp was removed. Finally, he said that he had been denied a right of review under the social work complaints procedure.

Our investigation found that the council had already investigated and apologised to Mr C for failing to obtain his permission before the work began. They had acted on his complaint about a member of staff, but did not record or follow up on it, so we upheld that complaint.

We did not uphold the complaints about the problem with the leaking pipe, and that the council unreasonably instructed Mr C to resolve the matter with the contractor. The evidence showed that the council had not delayed in responding to Mr C's complaint nor had anything gone wrong in their handling of the matter. We also did not uphold the complaint that the council failed to restore Mr C's path after the ramp was removed. We found that they had restored his path and any dispute about liabilities that he claimed arose from that work was not a matter within our remit.

However, we upheld Mr C's complaints about the delay in responding to his complaint, and about being denied a right of review. Whether Mr C should have been allowed to appeal through the statutory complaints procedure is a matter of interpretation of the law and we could not comment on this. However, we did find fault in the council's handling of the complaint. We also found that, having decided that Mr C did not have a right of review through the social work complaints procedure, they had failed to tell him that his complaint could in fact be considered under the council's complaints procedure.

Recommendations

We recommended that the council:

• apologise to Mr C for their oversight and for the shortcomings in the handling of his complaint;
• take steps to ensure that the errors in dealing with the complaint are addressed and make any necessary improvements to the social work resources complaints procedure; and
• ensure that staff handling complaints in social work resources have guidance which makes clear the criteria for both the social work and the council's complaints procedures.

Summary

Mr C raised a number of concerns about the handling of both his planning application and his representations. In particular, he complained about the time taken to process his application.

Our investigation found that while Mr C's application was not determined within two months that was not, in itself, maladministration. The law provides for such delays and gives applicants an avenue of appeal. However, we found that there had been a breakdown in communication within the council which had added to the delay in dealing with the application, which we considered unreasonable.

We also found that the council did not handle Mr C's complaint in line with their complaints process. However, there was no evidence that they had failed to provide a reasonable response to the issues raised by Mr C.

Recommendations

We recommended that the council:

• apologise for the delays identified in the complaint.

Summary

Following a complaint from a member of staff, the housing co-operative served a notice of proceedings against tenants Mr and Mrs C. This notice was cancelled when Mr and Mrs C appealed, as the appeal panel said the notice was too harsh.

Mr and Mrs C then complained that the co-operative had not followed their procedures when deciding to issue the notice, that there was no apology for their actions; and they did not give proper notice when they wrote to Mr and Mrs C requesting them to attend the meeting to discuss the matter.

We found that the co-operative did not follow its own procedures and did not apologise, so we upheld these complaints. We also found that the procedures and guidance provided, in relation to how policies should be implemented, were unclear. We did not uphold the complaint about not receiving proper notice of the meeting as we found that enough information was supplied to make Mr and Mrs C aware of the circumstances.

Recommendations

We recommended that the association:

• apologise to Mr and Mrs C for the failings identified; and
• consider conducting a review of the procedures in place that support the implementation of their antisocial behaviour and harassment policy and dignity at work policy, to ensure clarity and consistency in their application.

Summary
Mr C complained on behalf of his wife (Mrs C) about delay in getting a hospital appointment, treatment at the pain clinic, and poor complaints handling. Mrs C had had pain in her back and leg for ten months and pain in her neck and arm for eight months, and Mr C thought she should have been seen at the hospital more urgently. Her GP referred her to the neurosurgery department in July 2011, and followed this up with a further referral two months later, including a request that she should have a scan on her neck before attending her scheduled appointment. No scan was taken, however, even though Mr C also wrote to the board. Mrs C was seen in neurosurgery as scheduled in November and was referred to the pain clinic, where she was eventually seen in December. Mr C complained that although the GP made an urgent request for Mrs C to be seen at the pain clinic, because the referral from the department of neurosurgery was classed as routine she was not prioritised.

We did not uphold the complaints about delay and treatment. Our investigation, which included taking advice from our medical adviser, found that it was reasonable for the GP to refer Mrs C on a routine basis as she had no 'red flag' symptoms that would have triggered an urgent referral. Mrs C was seen by a specialist within 17 weeks. This was just within the national target of 18 weeks and there was no evidence of avoidable delay. The reclassification of the referral to the pain clinic was also reasonable. Our adviser said that although Mrs C had been in pain for some time, she was not displaying the sort of symptoms that would have needed an urgent referral. It is also the responsibility of hospital specialists to fully assess and categorise referrals. In Mrs C's case, this was done appropriately by the on-call pain consultant.

We found, however, that there were unreasonable delays in providing a response to Mr C's complaint. The board did not respond for two months and provided no acknowledgement, explanation or apology for this. We found that the delay was partly due to the board calculating response times wrongly - not from the original date Mr C complained, but from the date of a later email that he had sent. We upheld the complaint and made a recommendation about this.

Recommendations
We recommended that the board:

• apologise to Mr C for the complaints handling failings we identified.

Summary
Mrs C had surgery in hospital to remove a soft tissue lump from her right thigh. She said that a few days later the wound had become red and infected. She contacted NHS 24 who referred her to an out-of-hours (OOH) GP service where a nurse prescribed antibiotics. Mrs C returned home, but her condition worsened and later that day NHS 24 arranged for an ambulance to transfer her to hospital where she was diagnosed with a skin infection and an infection of the thigh wound. Mrs C had a further surgical excision and drainage, and the wound was left open to heal from the inside. She received antibiotics intravenously (directly into a vein) and was discharged on oral antibiotics.

Mrs C complained that the hospital failed to prescribe her with antibiotics after the initial surgery, which she believed might have prevented the infection she later contracted. She also said that the OOH service failed to take her seriously and recognise the seriousness of her condition. Mrs C said that as a result of the failure to provide antibiotics and the failures in the care and treatment she received from the OOH service, she has struggled to recover from her operation and continues to have difficulty in walking.

After taking advice from our medical adviser, we found that the hospital's decision not to prescribe Mrs C antibiotics after her initial surgery was reasonable. However, we also found that the OOH nurse failed to recognise the significance of Mrs C's symptoms and admit her to hospital, although our medical adviser said that this would not have affected the outcome.

Recommendations
We recommended that the board:

• have the relevant staff review the management of this case in light of the findings; and
• apologise to Mrs C. 

Summary

Mr C is a patient in a mental health facility. He complained that in documentation the board stated as fact information which had not been investigated or confirmed. He also said they had not sent reasonable responses to his letters of complaint.

Our investigation found that information had been incorrectly presented as fact, although it had not been clearly established what happened. A police investigation into the matter could not be progressed as a key witness refused to cooperate. We upheld this complaint and made a recommendation to address this.

Mr C was also unhappy with the response that the board gave to his complaint. However, we found that it was clear that the responses had fully explained the reasoning and the fact that the police investigation had stalled. We did not uphold this complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for their actions in this matter and update, correctly, the information held on their care plan.

Summary

Mrs C's husband (Mr C) was ill and she called NHS 24. However, she complained that the board failed to respond to her call and that the out-of-hours (OOH) doctor who came did not treat her husband appropriately. She also doubted that the doctor properly recalled the visit.

We considered all the relevant information and obtained advice from our medical adviser. We found the information about the telephone calls inconclusive. Mrs C said that the board had not called, however, the board's records said that attempts to call Mrs C were made, but were unsuccessful. We did not see any records of these specific calls, and in the absence of evidence, could not uphold this complaint.

We agreed that the OOH doctor had not properly treated Mr C in accordance with his symptoms and had kept poor records of the visit. This meant that the information that the board gave Mrs C when she complained was confusing. We made recommendations to address the failures identified.

Recommendations

We recommended that the board:

• apologise to Mr and Mrs C for their oversights in this matter; and
• emphasise to the OOH doctor the importance of taking a full record and, if it has not already occurred, the OOH doctor should prepare a significant event audit on this case and discuss it at their next appraisal.

Summary

Mr C and Mrs D complained about the care and treatment provided to their late mother (Mrs A) by her medical practice. Mrs A attended the practice in May 2011 complaining of pain over the previous four months. Her GP arranged a number of tests including a pelvic ultrasound scan, which was inconclusive.

In June and July, Mrs A continued to attend the practice complaining of pain. Her GP prescribed antidepressants, and medication for her spasms and pain. After further visits, the GP referred Mrs A for a routine surgical out-patient consultation in August. This referral was upgraded to an urgent priority following another GP consultation in September. Before she could attend her out-patient appointment, she was admitted to hospital by emergency services. She was diagnosed with pancreatic cancer after a scan, and died at the end of October.

Mr C and Mrs D complained that no follow-up action was taken following the inconclusive results of the pelvic scan and they believed that, given the severity of their mother's pain and the number of times she attended the practice, she should have been referred urgently to hospital for further investigation. They also said that the practice failed to prescribe pain relief within a reasonable time and they raised concerns that their mother was diagnosed with anxiety and depression. They said that anybody suffering pain of this severity would understandably be anxious and depressed and felt that this distracted the practice from properly investigating the causes of her pain.

We found that although the practice could have been more proactive in searching for the cause for Mrs A's pain, the time taken to refer her was, on balance, reasonable particularly as there was no evidence of abnormalities available to the GP in August. We also found that although there may have been an over-emphasis on the psychological aspects of Mrs A's condition, the suggestion that she was suffering from anxiety and depression was not in itself inappropriate. We did not uphold either of these complaints. However, we found that while the practice attempted to manage Mrs A's pain, pain relief was prescribed relatively late and we upheld the complaint about this.

Recommendations

We recommended that the practice:

• review the management of this case in light of our findings; and
• apologise to Mrs A's family.

Summary

Mr C was unhappy about the suspension of his psychological therapy. He complained that the suspension took place on the basis of a tentative change of diagnosis which was later discounted. The advice from our medical adviser suggested that the suspension of treatment was premature, and we upheld the complaint.

Mr C also complained of a delay in his referral for alternative psychological therapy. He was referred in 2010 despite his psychiatrist having first considered a referral in 2009. We acknowledged the psychiatrist's concerns that Mr C may not have been ready for the treatment, but noted that a referral would only have been to assess whether he was a suitable candidate. We, therefore, concluded that the delay was unreasonable and upheld the complaint.

Mr C was prescribed anti-depressant medication, which had potentially serious side effects when mixed with alcohol. His psychiatrist informed him of the risks and referred him to a pharmacist for specialist advice. The pharmacist also provided Mr C with guidance from the drug manufacturer which said that alcohol presented a moderate risk. Mr C complained that this advice was inconsistent with the other advice offered. He felt that it had not been made sufficiently clear that alcohol should be avoided. We were satisfied that Mr C was appropriately told about the risks, so we did not uphold this complaint. However, we found that the pharmacist had not recorded details of her contact with Mr C or the advice given, and we made a recommendation to address this.

Finally, Mr C complained about the board's handling of his complaint. He felt that his complaint had a negative impact on his treatment but we found no evidence to support this. However, we found an unexplained delay in responding to his initial complaint and also that his last letter of complaint did not receive a response at all. In addition, complaints handling staff tasked Mr C's psychiatrist with gathering information on his complaint during a clinical appointment, which we considered to be inappropriate use of a therapeutic consultation. In these circumstances, we upheld this complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for prematurely suspending his treatment;
• remind clinicians to ensure that, when writing to a patient's GP, they copy in other relevant professionals involved in the patient's care, especially when the content of the letter suggests a change of diagnosis and/or treatment direction;
• remind clinicians that, where there is a clear diagnosis, patients need to know what that is, and where there is uncertainty, they need to know why;
• apologise to Mr C for the delay in referring him for an assessment for further psychological therapy;
• remind pharmacists who have therapeutic contact with patients of the importance of recording their interactions and, in particular, any medication advice provided;
• ensure that, where they are unable to respond to complaints within their target timeframe, they explain the reason for this to complainants and advise of when they expect to be able to respond;
• ensure that they respond to all correspondence from complainants and provide clear guidance on what steps they should take if they remain unhappy;
• highlight to complaints handling staff that it is not appropriate to use therapeutic consultations for complaint information gathering purposes; and
• apologise to Mr C for the inappropriate handling of his complaint, as identified in our investigation.

Summary

Mrs A, who was elderly and disabled, was admitted to hospital. While in hospital she fell. Mrs A was seen by a doctor, who did not suspect any broken bones. Later, it was determined that she had broken her hip. Her solicitor (Mr C) complained that although her mobility problems were recorded, she was not given enough assistance. He said that as the fracture was not diagnosed at the time, Mrs A was caused additional pain.

We carefully considered all the available information provided by Mr C, Mrs A's son and the board. Our investigation found that the board failed to carry out an adequate mobility assessment when Mrs A was admitted to hospital. However, we found no evidence that she was not offered appropriate assistance. We also found that the board's care and treatment of Mrs A was satisfactory.

We upheld Mr C's complaint that the board unreasonably failed to respond when he questioned the outcome of their investigation.

Recommendations

We recommended that the board:

• offer a sincere apology for the failing identified; and
• emphasise to staff concerned the importance of following and acting upon guidance available to them concerning the prevention of falls.