Some upheld, recommendations

Summary

Ms C complained that the council unreasonably failed to carry out parenting capacity assessments to establish whether Ms C was able to look after her child (Child A). Ms C also complained that the council failed to carry out reasonable assessments to inform decisions about Child A's care.

We took independent advice from a social work adviser. We found that decisions made regarding the parenting assessments were reasonable. Therefore, we did not uphold this aspect of the complaint. However, we noted that changes to the planned actions in relation to these assessments should have been discussed and recorded with 'Looked After Child' (LAC) review minutes, with the reasons recorded as to why the plan had changed.

We found that while the assessments of Child A's parents were reasonable, based on the information available, the kinship carer assessment was unreasonably delayed, which was a key assessment to inform future decisions about Child A's care. It was also found that not all LAC reviews were appropriately documented or carried out in a reasonable timescale. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the delay in the kinship carer assessment and the statutory LAC reviews being carried out. 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:

• A kinship care assessment should commence within three days of the placement and be concluded within 12 weeks.
• LAC reviews should be held within six weeks of the placement, then a further review three months from that date and then every six months thereafter.

Summary

Mr C is a kinship carer and he approached the council to apply for kinship care allowance. The council approved his application to the date of application; however, they did not agree to backdate his payment to the date that the Scottish Government introduced a change to the eligibility for kinship care assistance. The council explained they were not required to backdate the payment as the Scottish Government did not legislate on the matter and only issued guidance, therefore they had discretion as to whether to follow that guidance. Mr C complained that the council unreasonably failed to follow national guidance when considering his request to backdate kinship care payments and that they failed to provide the appropriate information about entitlement to kinship care assistance in line with their obligations.

We found that while the council are required to consider the guidance, they do have discretion as to whether they apply it as it is not statutory legislation. We found that the council failed to provide contemporaneous evidence which they based their decision on to not backdate Mr C's application for kinship care assistance. The council only provided retrospective accounts of how those decisions were made. We considered that decisions about whether to follow Scottish Government guidance should be carefully documented and in this case it was not. We upheld this aspect of the complaint on the basis that the council failed to clearly record the rationale for their decision.

However, our investigation found that the council provided appropriate information about entitlement to kinship care assistance in line with their obligations when the Scottish Government introduced changes to the legislation. We did not uphold this aspect of the complaint.

Recommendations

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

• The council's policy about whether they should follow Scottish Government guidance on kinship care allowances should be considered for decision at an appropriate senior level, eg at Council Committee or by whichever means the council make such policy decisions.

What we asked the organisation to do in this case:

• Following the review of their policy on whether to follow Scottish Government guidance, the council should reconsider requests for kinship care assistance to be backdated.

Summary

Mr C complained on behalf of his partner (Ms A) who had been diagnosed with lung cancer. She also suffered from other illnesses.

Ms A had experienced shortness of breath and fatigue. It was established that she had anaemia and was referred to St John's Hospital for a blood transfusion by the oncology team at another hospital. When Ms A arrived at St John's Hospital there were no beds and before being transferred to the Medical Assessment Unit (MAU) she spent seven hours on a temporary bed in the corridor. She was eventually transferred to MAU and was given a blood transfusion later that night. Later, she was moved to an observation ward and the next day she was discharged home.

A few days later, Ms A was unwell again and she was admitted to St John's Hospital once more. Again, she spent a number of hours in a corridor before being admitted to the MAU. Mr C complained that these events were unacceptable given Ms A's serious illness. The board recognised that the situation had not been ideal but said that on both occasions the hospital had been extremely busy. They apologised but said that they could not give assurances that the same situation would not occur again. They confirmed that Ms A had been treated in accordance with the cancer treatment helpline advice. They added that St John's Hospital had asked the referring hospital whether the transfusion could be deferred the first time Ms A attended hospital but were told that it could not.

We took independent advice from consultants in general medicine and oncology (cancer). We found that although the board had no control over the number of patients arriving at the same time, it was, nevertheless, unreasonable that a cancer patient like Ms A should have had to wait so long (seven hours each time) before being transferred to MAU. We also found that there was no clinical reason why Ms A should have been given a blood transfusion late at night. For these reasons we upheld the complaint. Although Mr C had also complained about the cancer treatment helpline, this was a national helpline run by another public body and the board could not be held responsible for the policy of another organisation.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for the time required to wait before transferred to MAU. The apology should meet the standards set out in the SPSO guidelines on apologyavailable at www.spso.org.uk/information-leaflets.
• Apologise to Ms A for giving a blood transfusion late at night when there was no urgent requirement to do so. The apologies should meet the standards set out in the SPSO guidelines on apologyavailable at www.spso.org.uk/information-leaflets.

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

• Cancer patients in particular should be admitted to MAU in a timely manner.
• Blood transfusions should be given in line with National Institute for Health and Care in Excellence guidelines.

Summary

Ms C, who works for an advice and support agency, complained on behalf of Mr B about the care and treatment provided to his late wife (Mrs A) at Queen Elizabeth University Hospital. Ms C raised concerns about the medical and nursing care and treatment provided to Mrs A, about the decision to transfer Mrs A to another hospital, and that Mrs A's family were not advised of the transfer.

We took independent advice from a consultant physician/geriatrician (a medical doctor who specialises in medicine of the elderly) and a nursing adviser. We found that the medical treatment provided to Mrs A was reasonable, and did not uphold this aspect of Ms C's complaint.

In relation to nursing care, we found that whilst many aspects were reasonable, there was a failure to swab Mrs A's leg ulcers on admission to the hospital and this was a breach of the board's standard operating procedure on

meticillin-resistant Staphylococcus aureus (MRSA - a type of bacteria that is resistant to several widely used antibiotics). Mrs A's leg ulcers were found to be MRSA positive when she transferred to another hospital. We upheld this aspect of Ms C's complaint. However, we were unable to conclude if this could have been avoided if Mrs A had been swabbed on admission.

We found that the decision to transfer Mrs A to another hospital was unreasonable given Mrs A's condition and we upheld this aspect of Ms C's complaint. However we found that her family were appropriately advised of this and did not uphold the complaint about communication of the transfer.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B for failing to swab Mrs A's leg ulcers for MRSA on admission and unreasonably transferring Mrs A to a different hospital. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• The multidisciplinary team should satisfy themselves that a patient is suitable and fit before being transferred.
• Staff should follow the board's MRSA Standard Operating Procedure.

Summary

Ms C complained about the board's assessment of a referral that was made for her child (Child A) to the child and adolescent mental health services. Ms C considered that it was clear from the referral that Child A had not been appropriately assessed by the GP and that the board had failed to appropriately risk assess the situation based on Child A's history of suicidal ideation and

self-harm. We took advice from a consultant in child and adolescent psychiatry. We found that the assessment and action taken when the board received the referral was reasonable and therefore we did not uphold this aspect of Ms C's complaint.

Ms C also complained about the board's handling of her complaint. We found that there were delays in responding and some information was not provided. We found that this was in part due to the complexity and scope of the investigation, however, we upheld this aspect of Ms C's complaint.

Recommendations

In relation to complaints handling, we recommended:

• As far as possible, complaints should be responded to in a timely manner, and should be responded to in full. Where a complaint is complex or involves more than one service, a process for handling this should be determined from the outset.

Summary

Mrs C complained about a number of issues with the care and treatment she received from the board. Mrs C had a complex medical history and had accessed a number of different services provided by the board.

Firstly, Mrs C raised concern that the board had not provided her with timely and appropriate maxillofacial (relating to the jaws and face) care and treatment. Mrs C was referred to the maxillofacial service for extraction of a tooth. After an initial consultation, Mrs C was listed to have the tooth extracted. At the subsequent consultation, a different doctor found that the tooth was vital and could be restored with further treatment. Mrs C was discharged from the service. Mrs C's general dental practitioner made a further referral to the service and after further consultations Mrs C's tooth was extracted. She felt that the board's actions had prolonged her pain. We took independent advice from a speciality doctor in oral and maxillofacial surgery. We considered that the care provided to Mrs C was reasonable. We did not uphold this complaint. However, we found evidence of issues with record-keeping in the service and we made a recommendation in relation to this.

Mrs C also raised concern that the board had not provided her with timely and appropriate orthopaedic (the branch of medicine involving the musculoskeletal system) care and treatment. Mrs C had a number of consultations in the orthopaedic service and was unhappy with the way clinicians investigated her orthopaedic condition and managed her care. In response to Mrs C's complaint, the board acknowledged that she had experienced delays and they described that they were reviewing the referral process to reduce delays. We took independent advice from a consultant orthopaedic surgeon. We found no medical failings in Mrs C's orthopaedic care, however, we noted that there was evidence of a significant delay in Mrs C being offered an appointment following a referral from her GP. We upheld this aspect of Mrs C's complaint.

Mrs C further complained that the board had not provided her with timely and appropriate physiotherapy treatment. She said that the self-management exercises recommended to her by the board were not helpful and she wanted to receive additional treatment, including hands-on therapy. In response to this complaint, the board said that the treatment provided had been appropriate. We took independent advice from a musculoskeletal outpatient physiotherapist. They said that it was standard practice to provide exercises to a patient to

self-manage chronic musculoskeletal pain, and hands-on treatment was of little long-term benefit in this situation. We considered that Mrs C received a reasonable standard of physiotherapy care and treatment and found no evidence of a delay in providing this. We did not uphold this aspect of Mrs C's complaint.

Mrs C was unhappy that the board failed to carry out timely and appropriate investigations into her facial/head pain symptoms. Mrs C had been reviewed by clinicians in a number of departments over a number of years in relation to this issue and she was unhappy with the investigations carried out and the lack of liaison between various specialties. We took independent advice from an oral surgeon with expertise in facial pain. We found that a number of appropriate investigations had been performed, yet there was limited evidence that appropriate haematology (related to blood disorders) investigations and investigation into temporomandibular disorder (a problem affecting the muscles and joints in the jaw area) were performed. We were also critical about the coordination of investigations between different disciplines and found that tests had not been carried out to exclude a specific type of headache. Therefore, we upheld this aspect of Mrs C's complaint.

Finally, Mrs C was dissatisfied with the way the board handled her complaints. While we acknowledged that Mrs C's complaint was exceptionally complex, we did not find evidence that the board provided a clear timescale within which they aimed to respond to Mrs C. We considered that the delays in complaint handling were unreasonable and also noted that in once instance, the board did not appropriately acknowledge one of Mrs C's complaints or inform her of her right to complain to us. We upheld this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the unreasonable delay in providing an appointment to her, not investigating her orofacial pain reasonably, failures in record-keeping, and the delays in complaint handling. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Where multiple specialties are involved in investigating a clinical issue, the care should be well coordinated with effective communication between disciplines.
• Neurology staff should be mindful of the possibility of neurovascular and migrainous causes in patient's presenting with complex orofacial pain.
• Patient care should be documented in line with the requirements within the General Medical Council and General Dental Council standards. Temporomandibular joint disorder should be managed in line with contemporary clinical guidance.

In relation to complaints handling, we recommended:

• Complaints should be handled in accordance with the NHS Complaints Handling Procedure.

Summary

Mrs C complained to us that nursing staff failed to document her concerns appropriately at a pre-operative assessment before she had a wisdom tooth surgically removed. She said that she told them that she was extremely anxious and that it was agreed that she would be taken first on the list for surgery. However, when she attended hospital to have the surgery, she was not first on the list and this made her extremely distressed.

We took independent advice from a nursing adviser. We found that there had been a failure to document the concerns Mrs C raised at the pre-operative assessment and that this had made her extremely anxious on the day of the surgery. We upheld this complaint.

Mrs C also complained that nursing staff had been rude and dismissive about her concerns when she attended the hospital for the surgery. We did not find any evidence to support this aspect of her complaint and we did not uphold the complaint.

Mrs C complained that she had not been given adequate pain relief after the surgery. We found that the board had not documented Mrs C's request for stronger pain relief at the pre-operative assessment and upheld this complaint.

Finally, Mrs C complained that she had been discharged from hospital without antibiotics. We took independent advice from a dental adviser. We found that it had been standard practice and reasonable to discharge her without antibiotics. We did not uphold this complaint.

Recommendations

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

• The documentation that is completed at a pre-operative assessment should include a section for any concerns raised at that assessment.
• Pain relief medication prescribed should be appropriately recorded. All medicines on discharge should be clearly and accurately recorded on discharge documentation.

Summary

Mr C owned a flat in a block of properties. The council also owned flats in the same block of properties. Mr C complained that the council unreasonably charged him for a share of the repair costs to a communal path.

We found that all owners have duties and responsibilities in respect of repairs and maintenance of shared parts of property, normally set out in title deeds. As owners, both Mr C and the council shared responsibility for communal areas. Given this, it was reasonable for the council to conclude that private owners, such as Mr C, should bear a proportion of the repair costs and be invoiced accordingly. We saw no evidence that Mr C was not responsible for paying a share of common repairs. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the council failed to communicate reasonably with him about the communal path repairs. We found that the majority of the council's communication was reasonable. However, we found that the council's communication with Mr C about the availability of an inspection report should have been clearer. We upheld this part of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for not making it clear that an inspection report was not available. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• The council should communicate clearly with owner-occupiers regarding the availability of inspection reports for assessed communal repairs.

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 complained about the secondary school his child (Child A) attended. He said that after his family had told the school of an incident which Child A had witnessed, the school failed to communicate reasonably with him regarding their progress and wellbeing. We found that the evidence showed that following the school being informed of the incident, this was appropriately discussed with Child A, and teachers were reasonably alert to any change in their behaviour or wellbeing. We determined that as there did not appear to be any cause for concern, there was no need for the school to communicate with Mr C. We also noted that Mr C and his family could have discussed any concerns they had with the school and they had appropriate opportunity to do so. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that following Child A's exam results, there was an unreasonable failure to communicate with him. We found that whilst the majority of communication was reasonable and timely, there was a failure to alert Mr C of the exam board's position on the potential to apply in retrospect for 'exceptional circumstances'. On this basis, we upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to alert him to the Scottish Qualification Authority's position on exceptional circumstances in a timely manner. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Communication regarding post-results matters should be timely, open, and transparent.

Summary

Mr C complained about the nursing care and treatment his father (Mr A), who had dementia, received when he was admitted to University Hospital Monklands. He also complained that Mr A had been unfit for discharge on the day of his planned discharge. In addition, Mr C complained about the level of communication with Mr A's family from the board.

We took independent advice from a nursing adviser and a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that the nursing care Mr A received had been reasonable and we did not uphold this aspect of Mr C's complaint.

Mr A's planned date for discharge was modified due to his deteriorating health. We found that there had been a failure to assess Mr A's mental health and the possible presence for delirium prior to the original date for discharge, and as a result, the consultant geriatrician advised that staff could not be confident, or show, that Mr A had improved to a level where it was safe to consider discharge. We were particulary concerned that a dementia test was not carried out. We found that the board had unreasonably considered Mr A fit for discharge on the date of the planned discharge and upheld this aspect of Mr C's complaint.

In relation to communication, we found that the nursing communication was reasonable but the board had identified some failings. We also found failings in the medical communication in the initial part of Mr A's admission to the hospital. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C and the family for the failings this investigation has identified. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

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

• Ensure older people in hospital have their cognitive status assessed and documented. Older people in hospital experiencing an episode of delirium should be assessed, treated, and managed appropriately.