Some upheld, recommendations

Summary

Mr C raised concerns with the council about revisions to a local bus route and the turning manoeuvre buses performed outside his house as part of the revised route. He considered that this was unsafe and that the revision, which included the turn, should not be permitted. Mr C also raised concerns that, given the number of buses performing the turn every day including in the early morning and in the evening, this posed risks in terms of public health and created a noise nuisance.

The council communicated with Mr C regarding these issues, noting that they did not have any concerns regarding the turn and had not raised this with the bus operator. After an exchange of correspondence the council agreed to carry out an observation and assessment of the turn. Following this, they concluded that they did not have any concerns and would not look to prohibit the turn. Mr C was not satisfied with the response and brought his complaint to us.

Mr C complained to us that the council unreasonably failed to follow correct procedures when permitting the revision to the bus route. We found that the council had considered the revised route when it was proposed by the bus operator. We concluded that it was reasonable for the council not to have raised any concerns with the bus operator, given that the turn was not against road traffic law, and that existing bus routes already carried out the same turn. We found that the council responded appropriately when it agreed to carry out an assessment of the turn following Mr C's concerns. We did not uphold Mr C's complaint that the council failed to follow correct procedures in permitting the bus route.

Mr C also complained that the council failed to respond to his complaint in accordance with their obligations. We found that the council failed to respond to his concerns under their complaints handling policy. In addition, we found that they failed to signpost him to the council's environmental health team to consider his complaints about noise and fumes. We also concluded that the council failed to diligently follow up commitments made to Mr C that they would liaise with the bus operator with a view to seeking amendments to the bus route. We upheld Mr C's complaint the council failed to respond to his complaint in accordance with their obligations.

Recommendations

What we asked the organisation to do in this case:

• Provide an apology for the complaints handling failings that complies with the SPSO guidelines on making an apology, available at www.spso.org.uk/leaflets-and-guidance.
• The council should progress discussions with the bus operator regarding seeking amendments to the bus route, as they had told Mr C they would do. They should update Mr C regularly with their progress and communicate the outcome to him.
• The council's Environmental Health team should investigate concerns that Mr C has raised about noise and pollution, in accordance with their 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.

Summary

Mrs C raised four complaints relating to a charging order (a charging order means that a property could be used to repay a debt) taken over her mother's home by the council.

Mrs C complained that the council failed to advise her that her mother's care would be financed by a deferred payment, with a charging order being taken over the property. Mrs C also raised concern that the council failed to reasonably advise her that the charging order would rank ahead of other chargers. We found that the council wrote to Mrs C advising her that her mother was required to pay for a shortfall in funding, and that this could be covered by a deferred payment with a charging order being taken over the property. We found that the council also wrote to Mrs C to advise her that a charging order was being taken and that the property could not be sold until the council's debt, which was covered by the charging order, was repaid. We also found that the council advised that Mrs C should take independent legal advice on these issues. We did not uphold these two aspects of the complaint.

Mrs C also complained that the council failed to provide her with a reasonable explanation regarding the charges incurred by the council which would be repaid on the sale of the property. Whilst we found that the council had provided information on some issues, we found that they did not explain specifically what Mrs C's mother would be charged for her weekly care. The council also charged Mrs C's mother to discharge the charging order and did not advise her up front that this was a cost she would be required to meet. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Issue an apology to Mrs C for failing to provide her with reasonable information regarding the charges incurred by the council on behalf of her mother that would be repaid on the sale of the property.
• Return to Mrs C the sum of money she paid to discharge the charging order.

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

• Ensure that documentation issued to a client or their representative at the outset sets out clearly the costs that the client is responsible for paying either up front or as a deferred payment under a charging order.
• Ensure that the client is notified in advance if they are required to pay the legal fee for the discharge of a charging order.
• Consider whether or not it would be possible to more promptly and proactively alert clients to accruing dent under a charging order.

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 that the council failed to provide a reasonable standard of care to his elderly father (Mr A). Mr C said that care provision was often changed at short notice and that his father was left unattended for unreasonable periods of time. Mr C was concerned that contact with the council was always by phone and he felt that inadequate records had been kept of his concerns about the service. Mr C complained that communication from the council was inappropriate as mail was sent to Mr A, despite his lack of capacity and repeated requests for it to be sent directly to him instead. Mr C was also concerned that the council failed to handle his complaints reasonably.

We found that the overall standard of care provided to Mr A by the council was reasonable and we did not uphold this aspect of Mr C's complaint. We also found that the standard of record-keeping, on their electronic records system 'Caretrack', was inconsistent and that the council had failed to communicate reasonably with Mr C by not providing confirmation of changes in planned care provision in writing. Therefore, we upheld these aspects of Mr C's complaint. However, we noted that Mr C now had an email contact he could use.

Finally, we found that Mr C's complaints had not been handled reasonably as there was no clear evidence that the council had followed through on the actions they had said that they would take. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Mr A's care provision should be monitored for eight weeks to ensure that notification is provided when a carer is likely to be late or his care appointment time has to be changed.

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

• Staff should ensure that Caretrack is an up-to-date and complete record of all contact.
• The operations team should provide a response to Mr C's request for written confirmation of contact with them.

In relation to complaints handling, we recommended:

• The council should include the definition of a complaint contained within the SPSO model complaints handling procedure in their care service handbook.

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

Mrs C complained about aspects of the physiotherapy care provided to her child (child A), who has complex care needs.

Mrs C complained that the physiotherapy provided to child A did not reflect their needs. We took independent advice from a physiotherapist. We found that, for the most part, child A received appropriate physiotherapy for their condition. Although we found some gaps in the record-keeping, we concluded that, on the whole, the care and treatment provided to child A was reasonable. We did not uphold this aspect of the complaint.

Mrs C also raised concern that the board failed to provide appropriate physiotherapy input to child A following administration of a treatment at a hospital in another health board's area. We found that the board had appropriately liaised with the other health board, and that child A received an increase in physiotherapy following the treatment. We found this to be reasonable and we did not uphold this aspect of the complaint.

Lastly, Mrs C complained that the board had not communicated with her reasonably about a change in physiotherapy service provided to child A and that child A would no longer be working with a physiotherapy assistant. We found that the board had arranged an event to update families about changes in the physiotherapy service. However, we found that, in the period prior to this, there was no evidence to suggest that Mrs C was informed that child A would no longer be working with the physiotherapy assistant. The advice we received also noted that there was no evidence that a reduction in the frequency of physiotherapy input was discussed with Mrs C. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C and child A for the lack of documented reasons for the change in frequency of physiotherapy input; the lack of communication in relation to this; and failure to inform Mrs C that child A would no longer be working with the physiotherapy assistant. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

• Physiotherapy staff should explain decisions and ensure children, young people and families fully understand them and their implications, especially if the final decision is not what they hoped for. Staff should also document decisions and the communication of these in the records.

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 suffers from post-traumatic stress disorder and has a longstanding difficulty leaving his house as a consequence. Mr C complained that the practice unreasonably decided that he was not housebound. Mr C's psychiatrist wrote to the practice noting their view that his longstanding mental health difficulties effectively rendered him housebound. The practice had previously refused a request from Mr C for a home visit on the basis that he had managed to attend the surgery in the preceding months. Mr C contacted the practice to ask them to clarify their position in light of his psychiatrist's letter, and they maintained that he is not housebound.

We took independent advice from a GP, who considered that the practice's home visit policy was overly rigid in that it appeared to require a purely physical inability to travel and did not give due regard to Mr C's mental disability. Therefore, we upheld this complaint.

Mr C also complained that the practice failed to disclose relevant information to his psychiatrist when discussing his situation over the phone. This pre-dated the psychiatrist's letter and the psychiatrist appeared to agree with the practice at that time that Mr C was not housebound. Mr C considered that the conclusions drawn by his psychiatrist would have been altered if the long standing nature of his condition and its symptoms had been discussed. However, we noted that the psychiatrist was already aware of Mr C's long term symptoms and medical history from previous assessments by them. The purpose of the call was to find out if there were any current issues that they needed to be aware of. We found that it was reasonable for the practice not to refer to more details of Mr C's past medical history during the phone call. Therefore, we did not uphold this complaint.

In addition, Mr C complained that the practice did not advise him of his right to approach us on completion of their complaints process. The practice complaints policy and NHS complaints handling procedure states that complainants must be notified of their right to approach our office at the end of their internal complaints procedure. Therefore, we upheld this complaint. However, we noted that the practice accepted this failing and they proposed changes to the way they do things to prevent this happening again, therefore we did not make any further recommendations in relation to this.

Recommendations

What we asked the organisation to do in this case:

• The practice should apologise to Mr C for the fact that their policy on home visits did not give appropriate weight to the nature of his mental health disability. The apology should meet the standards set out in the SPSO guidelines on apology available at: https://www.spso.org.uk/leaflets-and-guidance.

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

• The practice should review their home visit policy and ensure that it has due regard to mental health as well as physical health disability, as defined by the Equalities Act 2010.

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

Mrs C complained about the care and treatment her late husband (Mr A) received at the Western General Hospital during two admissions. Mr A had been admitted to hospital with side effects of chemotherapy that he was receiving for plasmablastic lymphoma (a rare and aggressive form of blood cancer). During his first admission, Mr A had a couple of falls and was later discharged. Mr A was then readmitted and died a short time later. Mrs C complained that communication with the family about Mr A's condition was unreasonable and that nursing staff did not administer his medication properly. Mrs C also complained that the medical care and treatment Mr A received was unreasonable and that the board failed to handle her complaint appropriately.

We took independent advice from a consultant haematologist (a doctor who specialises in medicine of the blood) and from a registered nurse. We found that there had been communication failings with the family during Mr A's hospital admissions, in particular towards the frailty of his condition. Therefore, we upheld this aspect of Mrs C's complaint. However, we noted that the board had acknowledged these failings and had apologised.

In relation to Mr A's medication, we could not find any evidence to show that his medication had been administered inappropriately by nursing staff. Therefore, we did not uphold this aspect of Mrs C's complaint.

Overall, we found that the care and treatment Mr A received was reasonable and we did not uphold this aspect of Mrs C's complaint.

Finally, we found that the board's response to Mrs C's complaint was generally of a good standard. However, they had not kept her informed of delays in their response and they did not address a new issue that was raised. On balance, 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 failing to handle her complaint to a reasonable standard. 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:

• There should be proper discussions about advanced care planning with patients and their relatives/carers, where relevant, and these discussions documented clearly.

In relation to complaints handling, we recommended:

• Updates should be provided where the 20 working day timescale for complaints cannot be met; and follow-up correspondence should be carefully reviewed and appropriately responded to.

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

Mrs C complained that the practice failed to provide appropriate care and treatment to her late husband (Mr A). Mr A, who had type 2 diabetes, had thought he was suffering from a urine infection but the practice dismissed the suggestion and did not provide medication. Mr A subsequently developed chest and back pain over the next week. A house visit was then requested early in the morning but it took until early evening for a GP to visit. The GP felt that Mr A required a hospital admission and an ambulance was called to take Mr A to hospital. He died the following day. Mrs C complained that the practice failed to diagnose that Mr A had a urine infection and that, on the day he was taken to hospital, there was an unreasonable delay in a GP making a home visit.

We took independent advice from an adviser in general practice medicine and found that the practice provided Mr A with reasonable treatment regarding his perceived urine infection. The practice carried out an appropriate assessment, including testing for a urine infection, which was reported as negative. Therefore, we did not uphold this aspect of Mrs C's complaint.

In relation to the home visit, we found that there was an unreasonable delay in arranging the home visit to Mr A as there was a breakdown in communication when the request for a home visit was considered. Initially, it was felt that an advanced nurse practitioner should visit but they felt that it was outwith their remit and there was a delay in the request being picked up by the GP. Therefore, 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 delay in advising the duty doctor that a home visit had been requested. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

Miss C was referred for an endoscopy (a camera test into her stomach) by the practice to investigate stomach pain she was suffering from. She complained that this was not appropriately followed up and that further specialist investigation was not arranged. The practice said that all relevant investigations appropriate to Miss C's condition were undertaken by them. Miss C disputed this, noting that her psychiatrist had referred to anticipated follow-up investigation for her stomach issues, in a letter to the practice. Miss C said that this follow-up was not arranged by the practice.

We took independent advice from a GP, who considered that the investigations arranged by the practice were appropriate. We found that the psychiatrist's letter was written in advance of the endoscopy appointment and that it referred to this investigation. It did not suggest that further investigation was expected. Therefore, we did not uphold this aspect of Miss C's complaint.

Miss C also complained that some of her prescription requests were not appropriately responded to and that she had to go for long periods without her pain-killing and anti-anxiety/depression medication. The practice acknowledged that one monthly prescription for Miss C's anti-anxiety medication was missed and they apologised to her for this oversight. They also acknowledged some recording and communication issues, meaning some of Miss C's medication requests were not responded to appropriately. In particular, they recognised that an improved system was required for communicating with patients where medication requests have been declined. We upheld this aspect of Miss C's complaint, however, noted that the practice had appropriately reflected on the communication issues highlighted by this complaint and had instigated a reasonable plan to avoid similar future problems.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the identified failures to clearly communicate with her regarding her medication requests; to issue her with her medication; and to respond to her complaint about her medication. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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 that his late mother (Mrs A) did not receive appropriate physiotherapy and rehabilitation whilst she was a patient at Tippithill Hospital. He was also concerned that the consultant in charge of Mrs A's care had unreasonably refused consent for another doctor to examine her. Mr C also complained that the board's response to his complaint was inadequate.

We took independent advice from a consultant in old age psychiatry. We found that Mrs A had advanced dementia and that she did not have the potential for further rehabilitation as a result. We found that there had been appropriate referrals and assessments for physiotherapy, which took reasonable account of the risks involved in Mrs A's case. We did not uphold Mr C's complaint about physiotherapy and rehabilitation.

We also did not uphold Mr C's complaint that consent had been refused to allow a further doctor to examine Mrs A. We found no evidence that consent had been refused, although it was confirmed that an examination by the further doctor did not take place. The advice we received was that, in the particular circumstances of Mrs A's case, it was reasonable that this examination was not carried out. We found that the doctor in question had previously reviewed Mrs A and did not consider this to have been of any assistance to the management of her care.

Regarding the board's response to Mr C's concerns, we found that they had not directly addressed Mr C's complaint and that, when Mr C alerted them to this, they advised that they had nothing further to add. We considered this response to be inadequate and 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 adequately respond to his complaint. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• Complaints responses should address the key issues raised.

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

Mrs C, an advocacy worker, complained on behalf of her client (Mr B) regarding the care and treatment of his late father (Mr A). During an admission to Hairmyres Hospital, Mr A was assessed and deemed not to meet the criteria for hospital-based complex clinical care (HBCCC), as it was considered that his needs could be met in a nursing home. He was transferred to Stonehouse Hospital for interim care while awaiting completion of a community care assessment. Before a transfer to a nursing home could be arranged, Mr A died. Mrs C complained that the decision to transfer Mr A to another hospital was unreasonable as he was not well enough and that the hospital was not equipped to meet his needs. Mrs C also complained that the decision that Mr A was fit to be discharged to a care home was unreasonable. Finally, Mrs C felt that communication with Mr B surrounding the transfer and fitness for discharge decisions was poor.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that the hospital was equipped to meet Mr A's need and that the need for acute hospital care was not indicated. In particular, we noted that the medical input into Mr A's care following the transfer was reasonable. Therefore, we did not uphold this aspect of Mrs C's complaint.

In regards to the decision to discharge Mr A to a care home, we found that a second opinion was arranged by the board. This was followed by a formal appeal of the decision, both of which maintained that the criteria for HBCCC was not met. We found that this decision was reasonable. We did not consider that Mr A's subsequent deterioration and death suggested that there had been a requirement for HBCCC. Therefore, we did not uphold this aspect of Mrs C's complaint.

Finally, we found that there was appropriate communication with Mr B in advance of Mr A's transfer between hospitals. We noted that the initial communication following the transfer was good, with medical staff having met with Mr B to explain the HBCCC criteria and their views on why Mr A did not meet this. However, while the outcome of Mr B's subsequent appeal was verbally communicated to him within a reasonable timescale, he had to request formal written confirmation of this and there was an unreasonable delay in this being provided. We considered that the board need to clarify their process for formally communicating the outcome of HBCCC appeals. Therefore, we upheld this aspect of Mrs C's complaint.

Recommendations

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

• The board's HBCCC appeals process should make clear how decisions will be formally communicated to appellants, including the timescale for doing so.

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.