Some upheld, recommendations

Summary

Ms C complained about the care and treatment of her late mother (Mrs A). In 2009, Mrs A received treatment for leg ulcers and various symptoms relating to her underlying vascular condition (condition of the blood vessels). She was admitted to hospital in July 2009 for emergency treatment, including an operation, and discharged in September. After-care services were provided by the board's rapid response team for 11 days after discharge. Mrs A continued to receive treatment in the community for her condition. She was readmitted to hospital that November where she remained until her death in January 2010.

Ms C said that the initial discharge arrangements were inadequate because the after-care services had not been planned in advance. She said that after-care services were essential given the nature of her mother's condition and the length of stay in hospital. She said that the board only arranged services from the rapid response team because she asked about this when she collected Mrs A from hospital. Ms C also complained that the after-care services were inadequate, saying that Mrs A did not receive assistance with personal care, cooking, feeding, medication, getting to the bathroom or physiotherapy.

We found, given the importance in involving family in the process, that the planning and implementation of Mrs A's discharge was deficient because Ms C had not been involved. In all other respects, it was reasonable. We concluded that overall, the board's planning was unreasonable due to the lack of involvement of Mrs A's daughter. However, we found that the records showed that the after-care was comprehensive, individualised and reasonable.

Recommendations

We recommended that the board:

• bring our letter to the attention of relevant staff to ensure lessons are learned; and
• apologise to Ms C for the failures identified.

Summary
Mr C complained that the council had changed the process for issuing Blue European Parking Badges. He said that he had twice before used documentation from 1999 relating to his Disability Living Allowance to renew his blue badge. Because this was no longer accepted he felt this demonstrated that there had been a change about which he had not been advised. He also said that the council had stopped issuing reminders for renewals. We did not uphold the complaint as the council provided evidence showing that their policy had always been that documents in support of an application should have been issued within the previous 12 months. We also found that governmental policy suggested councils could issue reminders but were not required to do so.

Mr C also complained that his complaint about his treatment, when attending council offices, was not investigated properly. We upheld this complaint as we found that the investigation conducted was not sufficiently impartial, and did not consider Mr C’s version of events nor address the allegations made by him.

Recommendation
We recommended that the council:
• apologise to Mr C for the failings identified with the manner in which they dealt with his complaint.

Summary
Mrs C complained on behalf of her daughter that there had been an error in how an examination had been marked. Despite consistently telling the Scottish Qualifications Authority (SQA) that a mistake had been made, Mrs C was unhappy that her representations were treated as an appeal. She complained that the SQA failed to acknowledge that an administrative error in dealing with her daughter's results led to an incorrect result being recorded for her and that the SQA were rude and unhelpful in dealing with her complaint. She also said that they failed to properly investigate the circumstances.

When we investigated, we found that although the SQA made a full clerical check of the circumstances they did not explore the possibility that a error could have been made when originally transcribing Mrs C's daughter's mark. In the circumstances, we could not determine whether or not an error had actually been made. We could not, therefore, uphold this part of the complaint. However, it was clear that the SQA had not made appropriate and full enquiries about the matter. We upheld Mrs C's complaints about this and made recommendations to address the failings identified.

Recommendations
We recommended that the SQA:
• apologise to Mrs C and her daughter for the failures in the handling of the complaint;
• ensure staff receive training to allow them to differentiate between appeals and complaints and that their advice to the public should similarly differentiate; and
• emphasise to staff the importance of fully responding to correspondence from the public.

Summary
Mr C, who is a prisoner, received a visit from his wife and son. Following the visit, Mr C complained to the prison that he was reprimanded for his son's behaviour, while an another prisoner was not spoken to about a similar matter. He also complained that he was asked to clean up the visit area during the visit and that his son was refused access to the toilet. He sought assurances that the conduct of staff was not discriminatory.

In bringing his complaint to us, Mr C said that the prison had not responded to his complaint about toilet access and had not addressed the allegation of discrimination. He also complained that the prison had not carried out an appropriate fact-finding exercise as they had not viewed any available CCTV footage.

In responding to our enquiries, the prison said that the behaviour of the other prisoner's child did not warrant staff intervention. They also said that in line with normal practice Mr C had been asked to clean up after, not during, the visit. They could not recall the request for access to the toilet but they explained the normal practice that should be followed when such a request is made.

We noted that the prison had not addressed this latter issue in their response to Mr C. We also noted the allegations of discrimination were not directly addressed. Given the nature of this allegation, and the fact that there were conflicting accounts of events, we considered that it would have been reasonable for the prison to have examined CCTV footage and drawn upon this in their response. In the circumstances, we upheld this complaint and made recommendations to address this.

Mr C also complained that the prison unreasonably delayed in taking three weeks to respond to his complaint. We noted that a holding response was issued within the seven day target timescale and, following this, we did not consider an additional two weeks to be excessive or unreasonable. We, therefore, did not uphold this complaint. However, we made a recommendation because the holding response did not offer an explanation for the delay and did not provide a specific timescale for responding.

Recommendations
We recommended that the Scottish Prison Service:
• highlight to staff that any allegations of discrimination should be recorded and treated as such, and should be appropriately investigated and addressed in the complaint response;
• apologise to Mr C for failing to respond to all aspects of his complaint; and
• in line with rule 124, the governor should ensure that, where he is unable to respond to complaints within seven days, he takes steps to explain the reasons for the delay and provides a target timescale for responding.

Summary
Mr C, who is a prisoner, submitted his request for a postal order in line with the instructions displayed by the prison in a notice to prisoners. Mr C's request was not actioned and he complained about it. In bringing his complaint to this office, he said hall staff failed to deal with his request for a postal order correctly.

The prisoner notice said that postal order requests ‘must be received by the cash office by Thursday morning to allow processing’. In response to our enquiries, the prison explained that Mr C submitted his request on the Thursday and his request was actioned by reception the same day before being passed to the cash office for processing. The prison said it appeared that when the cash office received Mr C's request, it had missed the morning cut off point and so was not processed until later.

In looking at Mr C's complaint, we considered the steps he took in submitting his request and the information available to him about submitting postal order request. We also considered whether the process in place was clear to prisoners. The available evidence told us that Mr C placed his request for a postal order in line with the instructions given by the prison displayed in the notice. The evidence also appeared to confirm that Mr C's request was processed properly by the prison. Therefore, we did not uphold Mr C's complaint. However, we were of the view that the information available to prisoners, about by when requests should received, was unclear, and made a recommendation to address this.

Mr C also complained about the prison's handling of his complaint. He said he was not given the opportunity to discuss his complaint with a manager; the response provided by the manager was inappropriate; and the internal complaints committee (ICC) and the governor unreasonably failed to take any action on his complaint. In line with prison rules, prisoners must be given the opportunity to discuss their complaint within a manager within the first 48 hours of submitting their complaint. This did not happen in Mr C's case so we upheld this part of his complaint. However, we did not agree that the manager's response was inappropriate or that the ICC and governor unreasonably failed to take any action.

Recommendation
We recommended that the Scottish Prison Service:
• revise the wording of prisoner notice to ensure the information provided reflects the advice given to Mr C in response to his complaint.

Summary
Mrs C runs a business that Scottish Water identified as receiving water without being billed. Business Stream took over the provision of water to the business in November 2010 and in January 2011 sent Mrs C a bill for outstanding water charges, which she found to be excessive. She asked for a water meter to be fitted to the premises so that she would only be billed for water used but, following a survey by Scottish Water, she was advised that this was not possible. Mrs C arranged for a plumber to inspect the pipework and he concluded that a meter could be fitted. This was done in June 2011. Mrs C complained that the water charges that accrued before the meter's installation were unreasonable and that the meter could have been installed several months earlier, lowering the costs.

Where no meter is in place, water charges are calculated on the rateable value of the property. We found it appropriate for these rates to apply up to the date of the meter being installed. In Mrs C's case, we were satisfied that the charges accrued prior to her meter being installed were in line with Business Stream's published rates. That said, during their inspection of Mrs C's premises, Scottish Water failed to identify that her pipework was suitable for the installation of a meter. They maintained this even after she highlighted her plumber's findings. We, therefore, concluded that there was an avoidable delay to the meter's installation.

Where Scottish Water are unable to fit a water meter, they will offer a contribution payment toward the cost of upgrading pipework so that installation can go ahead. Mrs C was offered a contribution of £750 and this was confirmed on more than one occasion. Scottish Water subsequently withdrew the offer, as no upgrade was required. We found Scottish Water’s communication about this to be poor, but that a good will gesture already offered by Business Stream was appropriate recompense. We also upheld Mrs C's complaint that Business Stream's complaint handling was poor and found that they had failed to offer her a £20 credit in line with their service standards.

Recommendations
We recommended that Business Stream:
• recalculate Mrs C's water charges for the relevant period based on her metered usage and adjust the balance of her account accordingly; and
• credit Mrs C's account with a further £20 in light of the failings identified.

Summary
Mr C, an advice worker, complained on behalf of Ms A. Ms A said that since July 2010 she had been regularly complaining about a communal leaking/dripping water tank. She said no effective repairs were carried out because of access problems to the flat above hers. The pipes froze in December 2010. This was reported but because of access problems the necessary repairs were not carried out. Mr C said that Ms A and her family continued to complain and raise their concerns but on Christmas Day 2010, the tank burst. Ms A's flat was flooded and she had to move out, first to her parents' house and then to a furnished flat provided by the council.

Although Ms A made a claim for compensation to the council's insurers, this was refused. Mr C said that the council had not acted on Ms A's complaints about the water tank, nor on her allegations that her upstairs neighbour was not living in the property. He complained that the council delayed unnecessarily in making an appropriate compensatory payment and failed to deal with his complaint in a timely manner.

As part of our investigation we considered the council's complaints file, all relevant emails and the repairs log for Ms A's flat. We also saw a transcript of calls to the council's customer care centre, and the council's complaints policy. We found that there was no record of all the calls alleged to have been made about this. We did, however, find that repair requests made were attended to. The documents also showed that the council had looked into Ms A's concerns that her upstairs neighbour had abandoned the property, but found no proof to substantiate this. However, we found that the council had not made a compensatory payment that Ms A was due in accordance with their usual practice. We also found that they delayed in dealing with Mr C's complaint.

Recommendations
We recommended that the council:
• apologise to Ms A for the delay in making her compensation payment; and
• the chief executive emphasise to all relevant staff the importance of responding to complaints and complainants in a timely manner and, where necessary, providing appropriate updates.

Summary
Mr C lives in a tenement flat. He complained about procedures adopted by the council in connection with a fresh application for a Housing in Multiple Occupation licence for the flat immediately above his own.

The complaint had eight aspects, including that the council delayed unreasonably in replying to Mr C's query about the applicant's display of a site notice and failed to inform him of an available right of appeal to the sheriff.

We upheld these two complaints, as our investigation found that the council failed both to respond to Mr C's query and to properly advise him about the availability of appeal. We did not find any evidence that anything had been handled incorrectly in respect of the other six points.

Recommendation
We recommended that the council:
• review their notes of guidance to applicants cited to attend sub-committee hearings on Housing in Multiple Occupation licence applications to include a warning that failure to attend might have important consequences in respect of making a valid appeal to the sheriff.

Summary
Mrs C complained about the way an ambulance crew treated her mother (Mrs A) who had fainted and had been slipping in and out of consciousness. Mrs C said that the crew had shouted at her mother, handled her roughly and treated her as if she was drunk. Mrs C also complained about the time the Scottish Ambulance Service (the service) took to respond to her complaint.

We did not consider the specific complaint about the crew's manner as this was subject to the differing interpretations of those involved. Having taken advice from one of our medical advisers, we found that the crew carried out an appropriate assessment of Mrs A's clinical condition and that it was correct for them to decide to take her to hospital. We also found, however, that the board took too long to formally respond to the complaint.

Recommendations
We recommended that the service:
• remind staff who have a responsibility to investigate complaints about the timescales in the NHS complaints procedure; and
• apologise for the overall time taken to investigate the complaint.

Summary
Ms C complained about the treatment she received from a GP employed by the board. She visited the medical practice complaining of neck pain, muscle weakness and fatigue. Blood tests were taken and Ms C was told that she was fine. However, she was found to have low levels of vitamin D and was prescribed a calcium supplement. Ms C subsequently developed indigestion, heart palpitations, eyesight deterioration and shortness of temper. She complained to us that the GP was dismissive of her symptoms.

About six weeks after the first consultation, Ms C's condition deteriorated to the extent that she found it difficult to walk. She began taking medication that she sourced on the internet and adjusted her diet. This resulted in some improvement to her energy levels, but she deteriorated again. She went back to the GP, and it was discovered that her original blood tests had shown a vitamin B12 deficiency. Specialist investigations confirmed that this was the cause of her symptoms.

After taking advice from one of our medical advisers, we upheld most of Ms C’s complaints. We found that the board had used a number of locum (temporary) doctors throughout the period in question, which had led to a lack of continuity of care. We found that the medical practice's clinical records were unsystematic and lacked any clear management plan for Ms C. As such, an important diagnosis was missed by incoming staff. Although Ms C's B12 deficiency was overlooked we were, however, satisfied with the efforts that the GP then made to minimise the potential impact of this oversight and we did not make any recommendations about this.

Ms C had also complained about the system the medical practice had in place for requesting, tracking and reporting blood tests. While we concluded that the system in place at the time was not fit for purpose, we found that they have since introduced a procedure which is in line with good working practice. On her complaint about the board’s complaints handling, we found that many of the points Ms C raised went unanswered and we made recommendations to address this.

Recommendations
We recommended that the board:
• remind complaint handling staff of the importance of answering all points raised by the complainant; and
• take steps to ensure their complaint handling staff work in accordance with the NHS Scotland complaints procedure.