Some upheld, recommendations

Summary

Mr C complained to us that the council's report on a planning application to their planning committee contained a number of factual inaccuracies. We took independent planning advice on Mr C's complaint. We found that any inaccuracies in the report were minor and were not significant to the overall assessment of the application. The report did not mislead the members of the committee and we did not uphold this aspect of Mr C's complaint. However, we found that the manner in which the council had handled an economic statement that the planning applicant had submitted to support the application had been inadequate and we made a recommendation to the council in relation to this.

Mr C also complained to us that the council had not reasonably handled his enquiries to them about why they had notified residents that the previous application had been withdrawn after they were notified of the new application. We found that the council's response to Mr C on this matter should have included more information about why the problem occurred and the steps they had taken to try to prevent this happening again. We upheld this aspect of this complaint. We also made a recommendation to the council about the letter used to advise planning objectors of the withdrawal of an application in expectation of the submission of a new one.

Recommendations

We recommended that the council:

• review their procedures for requesting or passively receiving supporting economic statements; and
• review the letter used to advise objectors of the withdrawal of an application in expectation of the submission of a new one.

Summary

Mr C raised concerns about the way the council responded to his reports of noise nuisance from his neighbour's heating equipment. Part of this equipment was subject to a planning application, which was approved by the council's planning service following input from the council's environmental health department. This permission was subject to three conditions, two of which related to noise output and one of which related to the erection of a fence around the equipment. Mr C felt that the equipment was being operated in breach of all three conditions and that the noise from the equipment was a statutory nuisance. He was not satisfied with the way the council responded to these concerns and he complained to the council about this.

In response to Mr C's complaint, the council said that these matters were jointly investigated by the planning service and the environmental health department. We took independent advice from a planning adviser and an environmental health adviser. The planning adviser noted that enforcement action was a discretionary power, and was satisfied that the council's planning department took reasonable steps to investigate whether there had been a breach in planning permission. However, they noted that one of the planning conditions could have been specified more precisely, which would have reduced the scope for misinterpretation. Although they did not consider that the condition was unenforceable, they noted that this was a learning point for the council. Although we did not uphold this aspect of Mr C's complaint, we made a recommendation in relation to this.

During our investigation, we found an instance where a council officer made inappropriate comments about one party of the planning enforcement investigation. We did not consider that the officer had failed to act impartially, yet we felt the council should apologise to Mr C and take steps to remind officers of their responsibility to maintain appropriate communication. We also noted that the planning service had not provided a clear explanation to Mr C regarding the reasons for the outcome of the planning enforcement investigation. We asked the council to remind officers of the importance of this.

The environmental health adviser considered the actions of the environmental health department in relation to the monitoring of the planning conditions related to noise and the investigation of the statutory noise nuisance. They noted that the environmental health officers had sought appropriate technical information about the applicant's equipment and had undertaken visits to monitor the noise output. On the basis of these actions, the adviser considered that the environmental health department had taken appropriate steps to provide the planning service with information about whether conditions had been breached, and to investigate whether a statutory noise nuisance was present. We therefore did not uphold this aspect of Mr C's complaint. The adviser noted a number of learning points for the council, and referred to recommended methodologies for investigating low-frequency noise complaints. Although these measures were over and above the statutory requirements for investigation of noise nuisance, we made a recommendation in relation to this.

Mr C also complained that the council failed to reasonably respond to a letter he had sent to the building standards department. We were critical that the council did not respond to Mr C's initial letter until he sent a further letter five months later. However, we noted that the council had apologised to Mr C for this and had eventually taken reasonable steps to address Mr C's letters. To the extent that there was a significant delay in providing this response, we considered that the council acted unreasonably and we upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the council:

• feed back the planning adviser's comments in relation to the wording of the planning condition to officers in the planning service;
• remind staff in the planning service to maintain appropriate communication with all parties to a planning application, and to ensure that complainants are clearly informed of the reasons for the outcome of an enforcement investigation;
• feed back the environmental health adviser's comments to officers in the environmental health department; and
• apologise to Mr C for inappropriate comments made. The apology should comply with SPSO guidance and should also set out what consideration the council has given to ensuring they have systems in place to prevent similar situations from arising in the future.

Summary

Mrs C complained on behalf of her late husband (Mr A) about the orthopaedic care he received at the Royal Infirmary of Edinburgh and about the length of time it took for the board to respond to the complaint. Mrs C complained that the board unreasonably failed to offer Mr A the opportunity to obtain a second opinion within the NHS, that they unreasonably failed to arrange a scan and that they failed to respond to complaints in a timely manner.

We took independent advice from an orthopaedic adviser. Although the board had said that Mr C had preferred to be seen privately for a second opinion, we did not identify sufficient evidence to indicate whether any discussion had taken place around the option of an NHS referral for a second opinion. We upheld this aspect of the complaint.

We considered that the standard of Mr C's assessment by the orthopaedic staff at the hospital was of an entirely reasonable standard where an accurate diagnosis was reached without the need to perform a scan to confirm this. We did not uphold this aspect of the complaint.

We found that the board had appropriately apologised for the time taken to respond to the complaint and have since accepted the delay was unreasonable. We also identified that they did not provide proactive updates regarding the delay or inform Mr C of his right to contact this office after the 20 working day response time was exceeded. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to demonstrate that discussion took place with Mr A about a second NHS opinion.
• Upon submission of the appropriate invoice, reimburse Mrs C for the cost of the private consultation for a second opinion.

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

• The orthopaedic doctor involved should be reminded of the importance of record-keeping.
• Staff who deal with complaints should reflect on and learn from Mr A's experience.

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 about the care her mother (Mrs A) received at the medical assessment unit at the Western General Hospital. Mrs A was admitted to the hospital after her GP noted that she had a low pulse.

Miss C raised a number of concerns about the nursing care her mother received. In particular, Miss C complained about the cleanliness of the cubicle where her mother was assessed, the delay in providing a bed, the lack of provision for Mrs A to raise her legs, the uncertainty of nursing staff in relation to cardiac monitoring and a delay in nursing staff inserting a cannula (a very small tube which is placed into a vein, usually in the back of a patient's hand or in their arm). We took independent advice from a nursing adviser and a medical adviser. We found that the board had apologised to Miss C for a number of failings and had identified actions to improve care. The nursing adviser considered that the board should take further steps to improve care. We upheld this complaint and made a number of recommendations.

Miss C also raised concerns that there had been a delay in doctors prescribing her mother intravenous medication. We found that Mrs A had been prescribed oral medication on the day of admission and that the following day she had been prescribed intravenous medication. The medical adviser considered that the doctor's decision to prescribe oral medication rather than intravenous medication on the day of admission was reasonable. The adviser concluded that Mrs A received good overall care, and said she did not have a life threatening degree of heart failure to justify the need for immediate intravenous treatment. We did not uphold this complaint.

Recommendations

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

• Documentation of cannula care should be carried out in accordance with national guidelines.
• Systems should be in place to monitor the number of complaints concerning chair and trolley allocation to identify whether this is an ongoing problem within the department.
• The impact of changes that the board has made, including changes to the cleaning schedule, should be monitored to ensure progress is made towards quality improvement.

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 a number of concerns about the care and treatment provided to his father (Mr A) whilst he was a patient at Hairmyres Hospital. Mr A had prostate cancer and was admitted to the hospital with symptoms of abdominal pain and diarrhoea. Mr A received treatment from the hospital's palliative care team and input from physiotherapy, occupational therapy and dietetics as staff sought to progress him towards discharge. Mr A's condition deteriorated throughout the admission and he died whilst an in-patient.

Mr C complained that staff did not provide Mr A with appropriate pain relief. We took independent advice from a nursing adviser and a medical adviser. The nursing adviser was satisfied that nursing staff monitored Mr A's pain in accordance with relevant guidance. However, they considered that the response to his pain, including prompting Mr A to use additional medications as required, was lacking on occasions. The medical adviser found that, for certain periods, medical staff had not achieved a good combination of painkillers for Mr A, and considered that there had been a delay in recognising that Mr A was reluctant to request additional medications when he felt he required them. We upheld this complaint and made a number of recommendations.

Mr C also raised concerns that staff inappropriately considered Mr A as being suitable for transfer to a care home. We found that the decision to transfer Mr A from hospital changed after his condition deteriorated. However, the medical adviser considered that it was appropriate for the board to have referred Mr A for transfer based on his condition at the time of the referral. We could not conclude that the board acted inappropriately in relation to plans to transfer Mr A to a care home and we did not uphold this complaint.

Mr C further complained that staff did not discuss the decision to give Mr A hormone therapy for his prostate cancer with Mr A's family. Having reviewed the records, the medical adviser considered that Mr A had the capacity to decide about further treatment for his cancer. The adviser explained that it was therefore reasonable for staff not to have discussed this decision with family members first. We did not uphold this complaint.

Finally, Mr C raised concerns that staff failed to communicate with Mr A's family about a DNACPR decision (do not attempt cardiopulmonary resuscitation – a decision taken that means a healthcare professional is not required to resuscitate the patient if their heart or breathing stops). We found evidence that a doctor discussed DNACPR with Mr C's wife, who is Mr A's daughter-in-law. The medical adviser said that the conversation about DNACPR should have been with Mr C or Mr A's wife, who were Mr A's next of kin. The adviser did consider that it was pragmatic to discuss goals of care and DNACPR with the most appropriate person available at the time, and noted that this was Mr C's wife. However, the adviser did not find evidence that doctors discussed DNACPR with Mr A and noted that there had been a delay in the senior clinician completing the DNACPR form. On balance, we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to appropriately manage Mr A's pain.

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

• Nursing staff should be aware of the mental health changes associated with pain, as well as the observational changes with pain, so that patients are prompted to use pain relief when appropriate.
• Medical staff should recognise when a patient is reluctant to request pain relief and provide timely management to ensure that the patient receives appropriate pain relief for the recorded levels of pain.
• Communication and decision making surrounding DNACPR should be in accordance with the latest 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

Mrs C complained to us about a sterilisation procedure she underwent and the events afterwards. Mrs C had chosen to have a procedure to make her sterile which involves putting devices (called Essure devices) in the fallopian tubes to block them. When Mrs C had the procedure, she became faint and therefore the procedure was stopped. Mrs C complained that she was told that one of the devices had not been placed and therefore she was not sterile. She said that due to how distressing she had found the procedure, she did not want to undergo it again to have the second device placed, and therefore she was told her only option was to have her fallopian tubes completely removed. Mrs C had this operation and afterwards was told that in fact both devices had been in place. Mrs C complained that the board did not investigate whether both devices had deployed, and that they did not reasonably communicate with her about the deployment of the devices.

During our investigation, we took independent gynaecological advice. We found that whilst the original mistake in thinking that one device had not deployed was not necessarily unreasonable, the consultants involved should have acknowledged that they could not be sure and should have offered Mrs C a scan before she underwent further treatment. We also found that whilst the records from the time of the original procedure were written as if the consultants were sure that one device had not deployed, the board's complaint response to Mrs C said that they had been unsure. We considered that due to the incorrect assumption at the time of the procedure that one device had not deployed, Mrs C underwent a potentially unnecessary operation to remove her fallopian tubes. We upheld this complaint.

Mrs C also complained that several months after she underwent the operation to remove her fallopian tubes, she developed a severe infection. She felt that this was due to poor post-operative care. However, we found that there was no evidence to suggest that the post-operative care she received was unreasonable or that the infection she developed was due to the operation. 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 failing to investigate whether both devices had deployed, and for failing to communicate with her reasonably regarding the deployment of the devices.

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

• Consultants should be aware of the possibility of being mistaken about non-deployment of Essure devices.
• Patients who have undergone Essure device placement should be offered a scan before deciding on further treatment, and this should be documented in the medical records.

In relation to complaints handling, we recommended:

• Complaint responses should be based on the contemporaneous 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 complained about delays in being seen by the gastroenterology (medicine of the digestive system) department at the New Victoria Hospital. He considered that there was an unreasonable delay in contacting him after he was referred by his GP and that the board's communication in relation to appointments was insufficient. Mr C complained to the board but remained dissatisfied and brought his concerns to us for further investigation. Mr C considered that the board's handling of his complaints was unreasonable.

After taking independent advice from a consultant gastroenterologist, we upheld Mr C's complaints about delay and communication. We found that the 12 week waiting time target had been far exceeded and that communication about this was unreasonable. The board acknowledged these failings and apologised during their own consideration of the complaints.

We did not uphold Mr C's complaint that his concerns had been handled unreasonably by the board. We found the board had offered appropriate apologies and looked at ways to improve the service going forwards.

Recommendations

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

• Patients should be advised in a timely manner that they may not be seen within waiting time targets.

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 she received at the Queen Elizabeth University Hospital. She had been admitted to the hospital for routine bladder surgery, but due to complications, she had to remain in hospital for four months. She complained that the board failed to ensure that her nutritional needs were appropriately met during her time in hospital. We took independent advice from a consultant urologist. Mrs C had been referred to a dietician after she had been in hospital for around a month and staff had then commenced feeding nutrition directly into her blood stream. However, we found that she should have been referred to a specialist dietician to address her nutritional needs earlier in her admission. We upheld this aspect of Mrs C's complaint.

Mrs C also complained about the catheter care management she received in hospital. Her catheter had fallen out and the procedure to put this back in was carried out by a junior doctor. However, the catheter went into her bowel. Mrs C said that, as a result of this, she had to have an ileostomy (where the small bowel is diverted through an opening in the stomach abdomen). We found that this problem could not have been foreseen and that it could not be concluded that this would not have happened if a more senior doctor had carried out the procedure. The follow-up care Mrs C subsequently received had also been appropriate. We found that the actions of staff in relation to this matter had been reasonable and we did not uphold this aspect of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise in writing to Mrs C for not referring her to a specialist dietician earlier. The apology should comply with SPSO guidelines on making an apology.

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

• Patients who will have a prolonged recovery time due to post-operative complications, particularly when it impacts their bowel and their nutritional requirements, should be assessed by a specialist dietician at the appropriate time.

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 complained on behalf of her late father (Mr A) about the failure to provide him with an appropriate scan following his presentation with significant weight loss over a short period of time. Ms C said Mr A had not been contacted about an appointment. Mr A was then phoned by a doctor who took the decision, without seeing Mr A, that a scan was unnecessary. Ms C said she believed that had Mr A been scanned, then the lung cancer he had would have been discovered and treated. Mr A had died suddenly of heart failure, and Ms C believed his heart had been under strain due to the untreated condition.

The board said that Mr A had been phoned on several occasions without success. He had then been written to, offering him an appointment. When the doctor had phoned Mr A it had been to ascertain if a scan was still necessary. The doctor's recollection was that Mr A had not wished to proceed with a scan and that he had stated that he had regained a small amount of weight. The board did not feel that Mr A's medical outcome was affected by the decision not to give him a scan.

We took independent medical advice and found that it would have been appropriate to review Mr A in clinic, given his symptoms. We noted that there was a significant gap between the phone conversation and the doctor writing to Mr A's GP, which meant that there were not appropriate records kept of the phone call. The advice we received was that this was in breach of General Medical Council guidelines on communication with patients. We found that there was evidence that the board made reasonable efforts to contact Mr A about his appointments, and so we did not uphold this aspect of Ms C's complaint. However, we considered it a failing that the doctor was unable to access Mr A's appointment schedule when he phoned him, and as such he could not advise him of the length of time Mr A would wait before his next appointment. We therefore upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to contact Mr A's GP in a reasonable amount of time and for failing to arrange a scan.

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

• The staff involved should reflect on the advice we received in relation to Mr A's need for an appointment for a scan.
• Staff should adhere to reasonable timescales when dictating clinical correspondence. At a minimum, these timescales should be in line with General Medical Council guidance.
• Clinical staff should be able to access the in-patient appointment viewing system to check appointments.

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 complained on behalf of her late mother (Mrs A) about the care and treatment she received from the board. Specifically, Ms C complained about a consultant geriatrician's assessment of Mrs A's condition, as well as their communication with Mrs A and her family about her condition and treatment options. Ms C also complained that an out-of-hours doctor failed to communicate appropriately about Mrs A's condition and treatment options.

During our investigation we took independent medical advice from a consultant geriatrician and from a general practitioner. We found that the out-of-hours doctor's communication was reasonable. We also found that the consultant geriatrician's assessment of Mrs A's condition was reasonable. As a result, we did not uphold these aspects of Ms C's complaint. We did find that there were failings in how the consultant geriatrician communicated with Mrs A and her family. We, therefore, upheld this aspect of Ms C's complaint and made recommendations in light of our findings.

Recommendations

What we asked the organisation to do in this case:

• Apologise in writing to Ms C and Mrs A for failing to communicate appropriately about Mrs A's condition and treatment options. The apology should comply with the SPSO guidelines on making an apology.

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

• Consultants should attempt to communicate with patients during their assessments, in order to respect the patient's dignity.
• Patients or family members should be told of their right to a second opinion, or be given the opportunity for a further discussion with the clinician, if they feel dissatisfied with a clinician's assessment.

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.