Some upheld, recommendations

Summary

C complained about the care their parent (A) received at Forth Valley Royal Hospital and Falkirk Community Hospital.

We took independent advice from a nursing adviser. We did not identify any failings regarding the care provided to A at Forth Valley Royal Hospital and so did not uphold this aspect of the complaint. However, regarding the care provided to A at Falkirk Community Hospital we found that:

A was unreasonably transferred to a four-bedded room rather than a single room;

there was an unreasonable delay in A having their dietary/fluid requirements assessed by nursing staff following their admission to Falkirk Community Hospital; and

A was not given prescribed medication while awaiting discharge from hospital.

We upheld this aspect of the complaint.

C also complained about the board's handling of their complaint. We found that the board did not consider whether C had authorised their sibling to raise a complaint on C's behalf. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for transferring A to a four-bedded room at Falkirk Community Hospital rather than a single room; the delay in assessing A's dietary/fluid requirements on their admission to Falkirk Community Hospital; not giving A their prescribed medication while they were awaiting discharge from hospital; and not confirming whether C had authorised their sibling to make a complaint on their behalf about the out-of-hours GP. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets

What we said should change to put things right in future:

• Patients receiving palliative/end of life care should be transferred to a single room. In the event that this is not possible, where appropriate, they and/or their family/carer should be consulted prior to the transfer going ahead.
• Patients should receive prescribed medications while awaiting discharge from hospital.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the board's complaints handling procedure including consideration being given to checking whether individuals have authorised a person to make a complaint on their behalf, particularly where multiple complaints are received from members of the same family.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C's parent (A), who has a diagnosis of Alzheimer's disease (the most common type of dementia), was a patient in Falkirk Community Hospital. On discharge, A was moved to a nursing home, as they required greater care. C questioned the board's care of A while they were a patient in the hospital; in particular about the prolonged use of Risperidone (an antipsychotic drug). C was also unhappy about the delay in issuing a discharge letter and the fact that it was sent to the nursing home. C complained that the letter contained incorrect information.

The board's view was that A had been prescribed Risperidone before they were admitted to hospital and that as they remained agitated and confused at times, in the absence of any clinical indication that they were experiencing side effects, there was no reason to alter the dose that had already been prescribed. Furthermore, they said that the medication was regularly monitored. The board agreed that there had been a delay in issuing a discharge letter and apologised that the letter contained incorrect information.

We took independent advice from an appropriately qualified adviser. We found that Risperidone had been prescribed reasonably and appropriately to A and that its use had been regularly monitored. We did not uphold this aspect of the complaint. However, we found that with regard to the discharge letter, the level of care given to A (with regard to delay and release of sensitive information) fell below the standard they could have expected. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the delay and failing to discuss/obtain consent for the sensitive content of a discharge letter prior to releasing it to the care home.The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/informationleaflets

What we said should change to put things right in future:

• Discharge letters should be issued in a timely way. Sensitive information included in a discharge letter should be discussed with and consent obtained from the patient/guardian prior to its inclusion.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the Child and Adolescent Mental Health Service (CAMHS) care and treatment provided to their child (A). A had an assessment with CAMHS, and following this, the board felt that further CAMHS input was not necessary as they considered the information suggested attachment related difficulties as opposed to a neuro-developmental disorder. C complained that the board had not carried out an in-depth assessment or obtained relevant information from A's school.

We took independent advice from a CAMHS mental health nurse. We found that the assessment of A carried out by CAMHS was reasonable and gathered the appropriate information in order to make a decision that no further input or support from CAMHS was required. We did not uphold this aspect of C's complaint.

C also complained that following A's appointment, the board's communication was unreasonable as they were not told of follow-up appointments in a timely manner and had not fully discussed A's case with C. We found that in all but one case, appointment letters were sent to C in a timely manner. However, we found that the board had failed to explain to C that the school assessments were no longer required and the reasons for this. On this basis, we upheld this aspect of C's complaint.

We also identified that the board had failed to follow up on an action agreed in their complaint response and made a recommendation in relation to this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to explain that school assessments were no longer required and the reasons for this; and for failing to follow up the referral. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets
• The board should consider whether it would still be appropriate to follow up the referral to the area inclusion team at this point. They may wish to contact C to discuss whether this is something A would still benefit from.

What we said should change to put things right in future:

• If decisions are made not to proceed with assessments, this should be explained to the patient/their family.

In relation to complaints handling, we recommended:

• Actions agreed in complaint responses should be followed up and there should be evidence of the actions being taken.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C's adult son (Mr A) has complex care needs and lives at home with her. Ms C complained that the council's care budget unreasonably relied on her being the second person providing him with care. We took independent advice from a social worker. We found that the council had allocated Mr A a care budget, which was equal to the cost of commissioning him support, such as a placement at a residential home. We found that this approach was reasonable and it complied with the relevant statutory guidance. We found that if Ms C was unable to provide Mr A with care, it would have been necessary to consider changing how his care hours were spread during the week or consider a residential placement. We did not uphold this aspect of the complaint.

Ms C also complained about how the council responded to her enquiry about getting a different type of shower chair for Mr A. The council refused her request, as they said his current shower chair was meeting his clinical need. We took independent advice from an occupational therapist. We found that there was insufficient evidence that Mr A's current shower chair was meeting his clinical need and that Ms C was not clearly told the reasons for refusing her request. We considered that the council had not responded reasonably to Ms C's enquiry. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the issues we have identified in how the council responded to her enquiry about a shower chair for Mr A. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets .

What we said should change to put things right in future:

• Service users should be appropriately assessed to ensure their current equipment is meeting their clinical need. Service users and/or their carers should be clearly told why any requests for equipment have been refused; and they should be given appropriate advice and follow-up. This should then be appropriately documented.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C, who is homeless, applied to view properties advertised as being immediately available to let. Mr C considered that the properties were not in a condition to be advertised as being immediately available to let.. In relation to the first property, we found that the electric meter had been read during the void period and therefore it was reasonable for the association to expect that it was working when the property was advertised as being immediately available to let. In relation to the second property, the association offered a paint pack as an incentive to rent this property, and we found that this was in accordance with their policy for properties where décor affected the ability to let the property. We did not uphold these complaints.

Mr C also complained that he was advised that he could obtain immediate entry after viewing the properties and signing the tenancy agreement. We found that in relation to the first property this information was not clear on the website and it would have been reasonable to expect that this would be explained at the outset, given that prospective tenants looking to rent a property immediately may be living in stressful circumstances. We therefore upheld this complaint.

Mr C also complained that he was suspended from the property register because he refused two properties. We found that whilst Mr C understood that he had been suspended, the records did not show that he had and this should have been explained to him. We therefore upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to make it clear that he may not be able to move into the property on the day of viewing as the tenancy agreement required to be signed and any gas uncapped prior to a tenant. The association should also pay Mr C the sum of £50 as a goodwill gesture, for travel expenses in respect of his journey to view the first property.

What we said should change to put things right in future:

• Ensure the website contains information under immediately available properties which states the applicant may not be able to move in on the day of viewing and why. Ensure housing officers state, when arranging viewings of immediately available properties, that the applicant may not be able to move in on the day of viewing and why.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C, a support and advocacy worker, complained on behalf of his client (Ms A). Ms A had been receiving a direct payment to fund a personal assistant to help her care for her child. When Ms A met with the partnership, she said that she had purchased mountain bikes and placed a down payment on a caravan. The partnership said that this breached Ms A's agreement and stopped her direct payment. Mr C complained that the partnership's decision was unreasonable and that they failed to take account of their non-compliance with their statutory obligation to provide Ms A with support and guidance. Mr C also said that the statutory guidance gave the partnership flexibility to consider the use of funds by Ms A to see if they met the family’s broader needs.

We took advice from an appropriately qualified adviser. The partnership acknowledged that Ms A had not received regular support and guidance as required. However, there was no evidence that Ms A had submitted monitoring forms as required by her agreement with the partnership detailing her use of the direct payment. We considered that it was reasonable for the partnership to reach a decision based on the information they had available at the time and that staff appropriately followed the relevant procure. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the partnership failed to respond to his complaint reasonably. We found that the partnership had failed to respond fully to the issues raised by Mr C and upheld this aspect of his complaint.

Finally, Mr C complained that the partnership failed to take reasonable or appropriate follow-up action after their complaint decision. Mr C noted that the complaint decision said that they would reinstate the direct payment. It also committed to entering into further discussions with Ms A about how her child's support needs could be best met. However, four months after this letter had been sent, Ms A had not received any contact from the partnership.

We found that the partnership failed to meet commitments it had made to Ms A by not contacting her, or reinstating her direct payments. We upheld this aspect of Mr C's complaint. However, we noted that the partnership had taken reasonable steps to address these failings and made no further recommendations.

Recommendations

What we said should change to put things right in future:

• Remind staff at the partnership who handle complaints that complaints should be handled in line with the Model Complaints Handling Procedure (MCHP). Stage 2 complaint responses should respond to all relevant points made in the complaint. The MCHP and guidance can be found here: https://www.spso.org.uk/the-model-complaints-handling-procedures .

In relation to complaints handling, we recommended:

• Provide a response which addresses the specific issues raised by Mr C in his complaint letter.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the care and treatment they received from the board. C’s local NHS board referred them to a consultant bariatric (branch of medicine that deals with the causes, prevention, and treatment of obesity) surgeon at Tayside NHS Board. C complained that, although they had made lifestyle and health changes as requested by the multidisciplinary specialist weight management team, they were not put forward for surgery on a number of occasions. C complained that a consultant bariatric surgeon acted inappropriately during consultations with them and that information C provided upon request was ignored when considering their suitability for surgery. C considered the delays to their surgery to have been unreasonable and raised further complaints about the board’s handling of their concerns.

We found that the consultant bariatric surgeon inappropriately required C to bring their test results to a consultation and inappropriately referred to them having made a complaint during a consultation. We found that the decision to postpone the surgery until such time as C’s diabetes was being better managed was reasonable. However, in relation to the decision to postpone surgery, we found that the board’s poor administration of C’s case and poor communication with them led to C not being suitable for surgery. We found, therefore, that this had led to C’s request for later surgery being denied and that the board had contributed to this situation. We found that the board had taken reasonable action in response to C’s complaint but that they had unreasonably failed to advise C of the outcome of a multidisciplinary team meeting. We, therefore, upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C that the consultant inappropriately raised their formal complaint about them during a consultation. The apology should meet the standards set out inthe SPSO guidelines on apology available at www.spso.org.uk/information-leaflets
• That the board invite C to an multidisciplinary team review of their case with a view to forming a clear plan for them with specific targets and timescales for progression to surgery should that remain the best option for them.

What we said should change to put things right in future:

• That the board take steps to ensure specialist weight management team's from other health boards receive clear communication as to what criteria each patient needs to meet to progress to surgery.
• The board’s procedures should ensure bariatric patients are given a clear plan with scheduled review points as to their progression through Tiers 3 and 4, and onto surgery, and the criteria they must meet.
• All board staff should be aware of the importance of allowing the complaints procedure to operate independently of clinical discussions. Patients must be able to raise concerns about services or individuals without fear of confrontation or of their criticisms affecting decisions regarding their ongoing treatment.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C, a support and advocacy worker, complained on behalf of her client (Ms A) who was treated for an abscess in her breast which failed to heal. Subsequently, a tissue sample was sent for tests and Ms A was diagnosed with breast cancer. Ms A considers that there was an unreasonable failure to consider cancer as a possible diagnosis at an earlier stage and that this contributed to the delay in providing diagnosis and treatment. Ms A also considers that concerns she raised about a possible cancer diagnosis were not taken seriously.

We took independent advice from an appropriately qualified doctor. We found that, although it was not reasonable to expect a cancer diagnosis to be considered sooner, excised tissue from two operations should have been sent for examination, which may have facilitated earlier diagnosis. On balance, we upheld this aspect of the complaint.

In relation to communication, we considered that the clinical records evidenced reasonable communication. Therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for failing to send tissue removed during surgical procedures for histological examination, and the likely delay in diagnosis this resulted in. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• All tissue removed during a surgical procedure should be sent for histological examination, unless it is considered not necessary by the operating surgeon and such justification is documented in the patient’s notes.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C was admitted as an in-patient under the Mental Health (Care & Treatment) (Scotland) Act 2003. At this time, Ms C was prescribed an anti-psychotic medication. Following discharge, Ms C continued to take the medication until she stopped the following year. Ms C complained to the board about the dose of the medication and reported that she experienced multiple significant side effects. Ms C also had concerns about the way the board had handled her complaint about her previous Community Psychiatric Nurse (CPN).

We took independent advice from a consultant psychiatrist. We found that treatment had been provided to Ms C in accordance with the relevant clinical guidelines. We did not identify failings in relation to the management of Ms C’s medication. For this reason, we did not uphold this complaint.

We also considered the board’s handling of Ms C’s complaint about a previous CPN. By the time Ms C complained to the board, the CPN had retired, whilst the complaint was also complicated by the fact that it related to a third party. We found that there was a lack of clarity in the reasons the board provided for not investigating Ms C’s complaint. We noted that it appeared that the board could have investigated the complaint, even if only to a limited extent. We upheld the complaint and asked the board to provide a further response to Ms C.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for not appropriately handling her complaint about her previous CPN having a conflict of interest . The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• In line with the NHS Scotland Complaints Handling Procedure, complaint handing staff should support people to decide whether a matter is a complaint or not and explain how complaints are handled. Clear and consistent reasons should be provided where it is considered that an investigation is not possible under the procedure.
• Investigate Ms C’s complaint about her previous CPN having a conflict of interest in line with the NHS Scotland Complaints Handling Procedure and provide Ms C with a response to the extent possible in accordance with data protection legislation.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C brought a complaint to us on Ms A’s behalf about Edinburgh College. Ms A was a student at the college with a diagnosis of Asperger syndrome and is on the autism spectrum. Ms A was suspended from the college following concerns about her behaviour. Ms A was subsequently withdrawn from the course.

Ms C raised concerns that the college had failed to provide Ms A with reasonable adjustments during her studies. We sought independent advice from an equalities adviser. We found that the college did make reasonable adjustments to support Ms A in accordance with their obligations. We did not uphold this aspect of Ms C’s complaint.

Ms C complained that the college did not reasonably follow their own policies and procedures regarding complaints that had been made about Ms A. We found that the college had failed to follow their own policies and procedures. In particular, we found that:

the college did not give Ms A the full details of the reason for her suspension

Ms A was not given five working days’ notice of the investigatory meeting

Ms A was not made aware that she could bring representation to the investigatory meeting

there was no record or minutes of the investigatory meeting

Ms A was not made aware of the outcome of the investigatory meeting within five working days

there is no evidence that the college responded to Ms A’s appeal against the decision to withdraw her from the course.

We upheld this aspect of Ms C's complaint.

Ms C also complained about the way the college handled the complaint. We found that:

Ms C’s complaint was not acknowledged within three working days of the college receiving the complaint

there was a delay in responding to Ms C’s complaint and she was not kept updated on the progress of the complaint or provided with a revised timescale for the response.

We upheld this aspect of Ms C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for failing to follow the college’s Positive Behaviour and Anti-bullying and Harassment Policy and the Positive Behaviour and Anti-bullying & Harassment Guidance and Procedures for Students. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Records should be kept to explain the reasons for changes in approach.
• When the college decide to suspend a student and a call an investigatory meeting they should follow their Positive Behaviour and Anti-bullying and Harassment Policy and the Positive Behaviour and Anti-bullying and Harassment Guidance and Procedures for Students. If a decision is taken not to follow the relevant policies, this should be clearly documented and reasons provided.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the Model Complaints Handling Procedure (MCHP). The MCHP and guidance can be found here: https://www.spso.org.uk/the-model-complaints-handling-procedures

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.