Some upheld, recommendations

Summary

Ms C complained about the care and treatment provided to her by the board. She complained that, when she suffered a slipped disc in her back, she was not given appropriate neurosurgical treatment during two periods of care. Ms C also complained that she was later not provided with reasonable treatment by the department for infectious diseases, cardiology, or rheumatology.

We took advice from a neurosurgeon, a consultant in infectious diseases, a cardiologist and a rheumatologist. We found that, whilst overall the neurosurgical care given to Ms C was reasonable, there was a failure to properly document an appointment; that there was no evidence that the likely outcome of surgery was discussed with Ms C; and that there was a delay in follow-up after Ms C underwent surgery. We upheld this aspect of Ms C's complaint.

We found that the care and treatment provided by the department for infectious diseases, cardiology, and rheumatology was of a reasonable standard and we did not uphold this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the documentation of the neurosurgical appointment falling short of the standard expected; for the lack of evidence that that the likely outcome of surgery was discussed with Ms C as part of the consent process; and for the unreasonable delay between surgery and Ms C's follow-up appointment. 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:

• Documentation of appointments should be in line with General Medical Council guidance. The likely outcome of surgery should be discussed and documented as part of the consent process. Follow-up after surgery should be carried out in a timely manner.

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 complained to us on behalf of her late mother (Mrs A). Mrs A was admitted to Victoria Hospital with stomach pain, which was thought to have been gallstones (small stones that form in the gallbladder). Mrs A was later diagnosed with cancer. Miss C complained that there was an unreasonable delay in diagnosing Mrs A's cancer.

We took independent advice from a consultant surgeon and a consultant radiologist. We found that the board carried out appropriate investigations into Mrs A's condition. However, we found that the board's interpretation of a scan was not reasonable as the scan results raised the possibility that Mrs A had liver cancer or a liver infection and that further investigations should have been recommended as a result of this. We found that there was an unreasonable delay in giving Mrs A an appointment to discuss those scan results and we noted that the board had identified this failing. We considered that the failings in the interpretation of Mrs A's scan led to an unreasonable delay in diagnosing her cancer. Therefore, we upheld this aspect of Miss C's complaint.

Miss C also complained about an unreasonable delay in proceeding with surgery on Mrs A's gallbladder. We found that it was appropriate that the board tried to treat her without surgery first. We, therefore, did not uphold this aspect of Miss C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the delay in diagnosing Mrs A's cancer. 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:

• As far as possible, scan findings should be accurately reported.

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 clinical and nursing care and treatment she received when she was admitted to Victoria Hospital. In particular, that there was an unreasonable delay in surgery being carried out to remove her ovaries and an unreasonable delay in arranging surgery for the repair of an incisional hernia (a type of hernia caused by an incompletely-healed surgical wound). Mrs C also complained that the nursing care and treatment of her wound following surgery was unreasonable.

We took independent advice from a consultant in obstetrics and gynaecology (the medical specialty that deals with pregnancy, childbirth, and the post-partum period and the health of the female reproductive systems and the breasts), a consultant general surgeon and a nursing adviser.

In relation to the clinical care and treatment provided to Mrs C, we found that the delay in carrying out surgery to remove Mrs C's ovaries was not unreasonable. However, we were concerned that some of Mrs C's medical records were missing. We did not uphold this aspect of Mrs C's complaint but made a recommendation about the missing medical records.

With regard to arranging surgery for the repair of an incision hernia, we found that the board failed to meet the legal treatment guarantee time, which states that health boards should take all reasonable steps to ensure that patients receive in-patient and day case treatment within 12 weeks of treatment being agreed. We also found that there was no evidence that Mrs C was advised of her options given the failure to meet this guarantee. Therefore, we upheld this aspect of Mrs C's complaint.

In relation to the nursing care and treatment provided to Mrs C's wound, we found that there was no evidence of failings in care and that the treatment she received was reasonable. Therefore, we did not uphold 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 arranging surgery for the repair of an incisional hernia. 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:

• Records should be kept in accordance with the Scottish Government Records Management: NHS Code of Practice (Scotland).
• The board should inform patients as soon as possible of any inability to meet treatment targets and provide them with information about the options available to them in the circumstances.

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 allegations in her academic appeal that she was victim of racial discrimination, both in the marking and supervision of her dissertation. The university refused Mrs C's academic appeal and failed to address the allegations of racial discrimination. Mrs C complained to us that the university failed to consider and respond to her allegations of racial discrimination and that they had inappropriately appointed a member of staff to mark her dissertation.

We found that the university unreasonably failed to consider the allegations raised during the academic appeals process or register them as a complaint. The university should have identified the complaint and dealt with this appropriately, as part of either the academic appeal or complaint process. Therefore, we upheld this part of Mrs C's complaint. However, we were satisfied that this would not have affected the outcome of her academic appeal.

In relation to the university staff marking her dissertation, we found that Mrs C had not raised a complaint against the member of staff in question, despite being advised to do so if she had concerns. Therefore, we found that the university did not act inappropriately when appointing the markers of her dissertation. We did not uphold this part of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to address the allegations that she raised in her academic appeal. The apology should comply with the SPSO guidelines on making an apology, available at https://www.spso.org.uk/leaflets-and-guidance.

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

• University staff considering academic appeals and complaints should be reminded of the academic appeals procedure and the complaints handling procedure, together with the importance of identifying and addressing all allegations and concerns brought to their attention.

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 lives near the site of a former opencast mine where works were taking place. He accesses his home via a road running adjacent to the site. Mr C complained that the Scottish Environment Protection Agency (SEPA) failed to properly consider an application he made to them. He was also unhappy that SEPA had accepted the local authority's view that the works involved had permitted development status. Mr C said that, as a result of SEPA dealing incorrectly with the application he made to them, his access to his home was sometimes impeded by flood water.

We took environmental health advice. We found that, with regards to the application, the developer had made an explicit statement that planning consent for the site was not required, and that this statement had been confirmed by the local planning authority. We found that SEPA, as a licencing authority, had no capacity in the matter of flood risk that Mr C had complained about, and that this was a matter for the planning authority. As such, we did not uphold the complaint.

Mr C also complained that SEPA had not dealt reasonably with his complaint. We found that there had been delays in SEPA handling Mr C's complaint, and that it had not been dealt with in accordance with the stated complaints handling process. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the delay in responding to his complaint. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• Complaints should be dealt with in accordance with the stated complaints handling procedure.

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 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.