Upheld, recommendations

Summary

Miss C complained that the council had failed to provide her with a reasonable explanation about the overpayment to her of housing benefit, and unreasonably delayed in processing the change relating to the end of her childcare costs.

Following our investigation of Miss C's complaint, we found that she was entitled to a statutory right of appeal if she considered that the decision notices she received were incorrect, so we were unable to address whether the council's re-calculation of her benefit claims had been properly undertaken. However, we looked at her complaint to us about administrative fault and found that the council had responded appropriately to her concerns about how the overpayment arose, but upheld her complaint because the council's decision notices had not provided a reasonable explanation about the overpayment. The council had recognised she was not provided with a lot of detail, and told her that revision of the decision notice was under review. We were satisfied that the improvement planned would provide a satisfactory outcome to her complaint. However, we made recommendations for improvements in the process (inclusion in the final letter in the complaints procedure to the claimant's statutory right of appeal to a tribunal, and additional information in the planned revised decision notice to 'time' in the right to apply for a revision of the decision by the council or appeal).

We also upheld Miss C's complaint that there had been a period of delay in processing the change relating to the end of her child care costs. However, as the council had already recognised this and apologised to her, we considered that appropriate action had been taken to resolve Miss C's complaint.

Recommendations

We recommended that the council:

• consider including a reminder within the final letter signposting a complainant to us about their right as a claimant to a statutory right of appeal if they think the council's decision on their benefit claim is wrong;
• share the outcome of this complaint with the relevant staff; and
• include a reference to time in the right to apply for a revision of the decision or appeal against it, in the information which will be made available in the council's revised notice.

Summary

When Mr C moved out of his property, into a larger council property, he was sent a bill for rechargeable repairs that needed to be carried out. Mr C complained that there had not been a pre-termination inspection which would have alerted him to any changes he had made to the property which the council were not satisfied with. Mr C also said he had offered to carry out the repairs himself, as he could not afford the estimated cost the council provided him with. When Mr C did receive the full invoice for the works, they were more than double the estimate previously provided and Mr C also complained about this.

During our investigation we found the reason no pre-termination inspection was carried out was because the council themselves had set a very tight deadline for Mr C to move into the new property, so that he would avoid paying two rents. We also found the council had not responded to Mr C's later offer to correct the work himself. For these reasons we upheld this complaint and recommended the council apologise to Mr C.

We also found the council were unable to specify exactly why Mr C's final bill was so much higher than originally estimated. While they provided general comments that it was difficult to predict exactly how each job would progress, we were not satisfied they could robustly explain what happened in Mr C's case. For these reasons, we upheld Mr C's complaint and made recommendations to address this.

During the investigation we also identified a number of administrative failings, including unreasonable delays, confusion over the appeals route and complaints procedure and made recommendations to address these aspects as well. In light of the failings, we also recommended the council cancel Mr C's invoice.

Recommendations

We recommended that the council:

• apologise for the failings identified;
• cancel the outstanding invoice;
• reflect on the failings identified and how to prevent them occurring again;
• review the rechargeable repairs appeals procedure and ensure that it refers to us at the end of the process; and
• provide us with a copy of the standardised tool for estimating repair costs.

Summary

Mr and Mr C complained about a programme of improvement works carried out by a contractor on behalf of their landlord (the housing association). They complained about the information they were given ahead of the works, and about issues with the quality of the work and damage to their property. They also complained about the way the association and the contractor had handled their complaints.

Our investigation found that the association and the contractor had provided reasonable information ahead of the works taking place, though there was a last minute delay in one element of the work, which was unacceptable. The association had already apologised for this and paid compensation.

We reviewed the time taken to resolve the range of defects at Mr and Mr C's property, and were critical of the time taken to resolve these issues. In particular, we were critical that a meeting to resolve these issues only appeared to take place because Mr and Mr C had brought their complaint to us.

Mr and Mr C complained to both the association and the contractor on different occasions. We found that the responses they received were not proactive and did not reflect the on-going difficulties Mr and Mr C were having. The association went on to conduct a 'lessons learned' exercise, based partly on Mr and Mr C's complaints. This identified several areas of service improvement, though it is not clear that any of these issues would have come to light if Mr and Mr C had complained to us. We were critical of this approach. We were also concerned about the lack of integration between the association's complaints procedure and that of its contractors.

Recommendations

We recommended that the association:

• apologise to Mr and Mr C for the delay in correcting defects at their property following window replacement and cladding works, and for the failings identified in their complaints handling;
• provide evidence that the improvements identified in the lessons learned exercise have been implemented; and
• provide evidence of the improvements in complaints handling.

Summary

Mrs A, who had cancer, was admitted to Monklands Hospital as an emergency. Her daughter (Ms C) complained that although it was known that Mrs A was at risk from Deep Vein Thrombosis (DVT - a blood clot in a vein), she was not given preventative drugs. Ms C said that as a consequence, Mrs A developed DVT with bilateral emboli (blood clots on both lungs) and required painful, daily injections until her death a few months later.

We took independent advice from a consultant physician and the complaint was investigated. This showed that Mrs A had been at risk from DVT and accordingly, she should have been started on preventative medication in line with standard guidelines. Despite the board saying that their decision not to give the preventative medication was likely to have been because Mrs A was anaemic and they were concerned about blood loss, there was no record which stated this in her medical notes, nor had any alternative, mechanical methods of prevention been discussed. In light of our findings, we upheld Ms C's complaint.

Recommendations

We recommended that the board:

• make a formal apology in recognition of their failure to treat Mrs A appropriately; and
• consider incorporating printed boxes for preventative medication into their notes and drug charts - and adding a prompt to ask the doctor to annotate a reason if this was not prescribed.

Summary

Mr C complained that for a period of over three months he attended the practice with symptoms of a painful and swollen foot and that they did not refer him to hospital for specialist advice. Initially he was referred to A&E where he was diagnosed as suffering from deep vein thrombosis (a blood clot in the vein). The pain became so unbearable that Mr C again attended A&E where an MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone) was arranged and this showed that he had peripheral artery disease (narrowing of the arteries which affects the legs). Mr C had had to endure surgery and believed that the practice should have referred him back to the hospital sooner.

We took independent advice from a GP adviser. The adviser said that it appeared that Mr C had developed acute ischaemia (lack of blood supply) of his right limb and that this usually occurs as a sudden event on the background of a patient having peripheral vascular disease (a common condition in which a build-up of fatty deposits in the arteries restricts blood supply to leg muscles). However, although the practice had recorded Mr C's continuing symptoms (indicative of peripheral vascular disease) they failed to undertake appropriate investigations themselves or make a referral to the vascular clinic. Our adviser pointed out that although the practice failed to provide Mr C with reasonable care for his peripheral vascular disease his requirement for surgery was as a result of an acute event which could not have been predicted. We upheld the complaint.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings we identified; and
• share this report with all GPs at the practice and reflect on the adviser's comments.

Summary

Mr C complained about the care his father (Mr A) received at the Royal Alexandra Hospital's A&E department after attending there with a severe headache. Specifically, Mr C complained that Mr A was not reviewed by a doctor for several hours and there was a delay in taking a CT scan of his head (computerised tomography scan: a specialised x-ray). Mr A had a subarachnoid haemorrhage (SAH: a bleed on the brain). He was transferred to a hospital with specialised services where he suffered a seizure and died.

The board said that Mr A was seen by a doctor within ten minutes of arriving at A&E and that an immediate CT scan had not been performed as Mr A's neurological examination was normal. However, he was admitted to a medical ward with the intention of carrying out a CT scan. The board considered whether there were any lessons to be learned. Consequently, the department have lowered the threshold for when a CT scan should be arranged if a SAH is suspected when neurological examination is normal.

We took independent advice from two of our medical advisers and found that Mr A was assessed promptly by an emergency doctor who had suspected a SAH. However, we were critical that the board would normally only arrange a scan if there was a neurological decline. We considered a scan should have been arranged as soon as the doctor suspected a SAH in line with national guidance. In any case, when Mr A's condition declined in A&E, a CT scan was not arranged until a further decline happened several hours later on the ward.

We were also critical that there was no record to show that the doctor had discussed the merits of arranging a CT scan with the on-call consultant. This was not in line with the General Medical Council's good practice guidance on record-keeping.

Recommendations

We recommended that the board:

• apologise to the family for failing to arrange a timeous CT scan in line with national guidance;
• review their local protocol on the management of headaches to ensure it is in accordance with national guidance; and
• draw to the attention of the emergency doctor the importance of recording discussions about the management of patients in line with good practice.

Summary

Miss C complained that the board had failed to put in place appropriate treatment for her mental health problems when psychotherapy (a type of therapy used to treat emotional problems and mental health conditions) she had been receiving for a fixed period ended. Whilst receiving psychotherapy, Miss C had been diagnosed with autistic spectrum disorder. She was also sensitive to change and had been concerned that she would receive inadequate support when the psychotherapy ended.

We took independent advice from one of our medical advisers, who is a psychiatrist. We found that the board had tried to take active steps to liaise with relevant services to try to ensure that there was adequate support in place for Miss C. However, when the psychotherapy ended, Miss C's community psychiatric nurse was not available and her consultant in the community mental health team had changed. In addition, an autism support group said that they could not support her. We found that inadequate co-ordination and transfer of Miss C's care left her with inadequate support in place for her identified needs at that time. In view of this, we upheld her complaint.

The board had already apologised to Miss C for their failings and had said that the learning points would be fed back to clinicians, but we made one recommendation.

Recommendations

We recommended that the board:

• provide evidence that steps have been taken to try to prevent the problems that arose in Miss C's case from recurring.

Summary

Ms C was a new patient at a dental practice where she presented with a chipped tooth. She saw a dentist who examined her mouth and did an x-ray which revealed some decay. She attended the dentist six times within two months and during this time, root canal treatment was commenced, she had one extraction and four fillings.

Ms C complained about the care and treatment she received. She said that it had been unnecessary and left her with damaged teeth and in pain. However, the dentist said that she had presented with extensively damaged teeth which required attention and that although Ms C had had a difficult time, this was as a consequence of extensive decay. Despite her best efforts, the dentist said that she had been unable to save one of Ms C's teeth.

We took independent dental advice, and found that Ms C's notes were poorly recorded and that while decay was present in some of Ms C's teeth for which treatment was necessary, it appeared that one of Ms C's teeth had been treated in error while a damaged tooth received no treatment. We also found that some of the decay was minimal, not requiring the extensive drilling that was undertaken. While the dentist recorded that she had had to give Ms C extensive treatment, the condition of Ms C's mouth as recorded in her notes suggested that she only required oral hygiene advice. We upheld Ms C's complaint.

Recommendations

We recommended that the dentist:

• make a full apology; and
• undergo additional training in record-keeping and address the concerns raised by the adviser as part of her continuing professional development. She should confirm to us that she has done so.

Summary

Ms C complained about the care and treatment she received during the birth of her son. In particular, she complained that there was a delay in the decision being taken to deliver her baby by caesarean section, that midwives took too long to react to complications, and that she had been left without staff being present for long periods of time. Ms C was also unhappy with the level of information given to her during the birth of her son and complained that the board failed to communicate effectively with her.

We took independent medical advice from one of our advisers. Our investigation found that overall the care and treatment given to Ms C was unreasonable. The advice we received was that her observations should have been taken more frequently, especially following Ms C's raised temperature. We also found that there was a lack of close monitoring of her vital signs and that an obstetric early warning system chart should have been used to record Ms C's vital observations. The advice we received was that these observations are important signs that may suggest serious illness and warrant immediate medical referral. In the circumstances, we upheld the complaint that the board had failed to provide appropriate care and treatment to Ms C during labour.

Our investigation also found that, while the midwife had communicated with Ms C on some issues, there was no evidence that some of the examinations carried out were explained, or that concerns about her raised temperature or transfer to another ward was discussed with Ms C or that Ms C's ongoing treatment plan was discussed with her. We found that the board had failed to communicate effectively with Ms C and we upheld the complaint.

Recommendations

We recommended that the board:

• apologise to Ms C for the failings we identified;
• provide us with an action plan which addresses the failings identified in the assessment, monitoring and evaluation of vital signs, which should include the use of the obstetric early warning system chart and the triggers for referral to an obstetrician; and
• provide us with an action plan which addresses the communication issues identified in this investigation, which should include involving women and their partners in the ongoing plan of care and any concerns about labour and recording information /communication.

Summary

Mrs C was diagnosed with a condition where pressure is exerted on the spinal cord. She said she was told by a consultant neurosurgeon that without surgery she would become bedridden and doubly incontinent possibly within a period of three months and, therefore, she required urgent surgery which would take place within weeks.

Mrs C accepted the board's offer of having her surgery at a private hospital (paid for by the board) to meet treatment time targets. Mrs C said the private hospital then told her no decision had been made to accept her referral and gave her no indication when the surgery might take place. Mrs C paid to have her surgery carried out at a different private hospital shortly thereafter.

We took independent medical advice from a consultant neurosurgeon who said there had been a failure to give Mrs C a realistic prognosis and the board had handled her referral to the private hospital unsatisfactorily. We accepted Mrs C genuinely believed a failure to have urgent surgery would have dire consequences for her and she reasonably did not know for certain whether and when her treatment would take place at the private hospital the board had said they would refer her to. We considered the board had not clearly communicated with Mrs C and explained what was to happen with her treatment. Given the board's failings and as they had agreed to meet the cost of Mrs C's surgery we did not consider it reasonable that she, rather than the board, should be out of pocket.

We also found no evidence Mrs C was informed about her removal from the waiting list or that any clinician had approved her removal from the list.

However, we considered the board had apologised to Mrs C for delay in the handling of her complaint and had reasonably responded to correspondence.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings identified in this complaint in relation to delay and poor communication;
• reimburse Mrs C with the cost of the private surgical treatment undertaken;
• improve communication and record-keeping between them and other external care providers where patients are referred for treatment;
• provide evidence of the action taken to address the lack of availability of access to theatres; and
• apologise to Mrs C for the failure to inform her that her name was removed from the waiting list for surgery.