Upheld, recommendations

Summary

Mr C complained that the council failed to ensure that scheduled refuse and recycling collections took place at his building.

We looked at Mr C's complaints to the council, the council's responses, and the council's records of inspection of cleansing operations. We found that there had been problems with collections at times over the past three years. Mr C had to contact the council repeatedly over this time, which indicated a poor standard of service from the council, who appeared to be failing in their responsibility to deal effectively with collections at Mr C's building.

We found there was a lack of co-ordination and poor communication about the collections within the relevant council department. We noted that the department was seeking a long-term resolution to the problem. However, based on the evidence, we concluded that the problem had not been resolved. We upheld Mr C's complaint.

Recommendations

We recommended that the council:

• apologise to Mr C for their failure to ensure that scheduled refuse and recycling collections took place; and
• review the presentation and collection of refuse and recycling at Mr C's building to ensure that scheduled collections take place.

Summary

When the council created a multi-surface games court in the park close to Mr C's home they removed a number of trees. This dramatically changed the outlook from Mr C's window. Mr C complained when, in spite of repeated assurances that the council would replace foliage and would keep him informed, they did not do this. Mr C complained to us about this and the way in which the council responded to his complaint and enquiries.

Our investigation looked at all the available evidence, including the council's correspondence with Mr C, the internal council correspondence and the council's complaints handling procedures. We found that they had acted reasonably by meeting Mr C at the site and in determining that replanting outside Mr C's home was adequate. However, we found that his complaints about the assurances he had been given were not handled promptly and the investigation response he received was not detailed enough to address the issues arising from his complaint.

Recommendations

We recommended that the council:

• apologise to Mr C for not responding promptly to his complaint;
• review their practice with relevant staff to ensure that letters of complaint are correctly identified and handled; and
• consider how best to ensure that investigation responses are sufficiently detailed.

Summary

Mr C had complained to the council some time ago about the refuse collection service in his street. The council apologised and took action to improve Mr C's experience of the service. They told him that the local supervisor would monitor collections, gave him direct contact details to report any further difficulties and assured him that they would fully investigate any further service failings. After giving the council time to allow these measures to be implemented, Mr C felt that the service had not improved and complained again.

The council said that they treated this as a new complaint because more than a year had passed since he first complained. They did not, however, acknowledge or respond to it, and Mr C complained again. As well as complaining about refuse collection he also raised concerns about the council's complaints handling, but they did not pick up on this and Mr C asked us to look at his complaint.

Our investigation found that the council's complaints handling procedure (CHP), which is based on the model CHP from our Complaints Standards Authority, says that staff should use discretion when applying timescales. We found that Mr C contacted the council on an almost monthly basis when the service did not improve, which meant that his second complaint was not a new one. It was about an ongoing issue and should have been dealt with at stage two of their CHP. The CHP also says that the council will establish what a complaint is about at the start, but we saw no evidence that they did so in Mr C's case. Neither did we see evidence that the stage two response had senior executive sign-off which, again, is contrary to the CHP. We found that the council did not handle Mr C's complaint reasonably, and made two recommendations.

Recommendations

We recommended that the council:

• apologise to Mr C for the failings our investigation identified; and
• remind staff of the requirements of the model CHP, focusing in particular on the failings our investigation identified.

Summary

Mr and Mrs C complained about a bill the council issued them for rechargable repairs. A year previously the council had helped check and fit three light fittings for Mr and Mrs C. When they terminated the tenancy they had asked at the council offices if they should leave the light fittings in place. Mr and Mrs C said that the council staff phoned another member of staff who advised them to leave the lights and there would be no charge.

When Mr and Mrs C complained the council said that they had spoken to staff, who said that they would not have given that advice.

During our investigation we found that the council had not spoken to the relevant staff during their investigation. We asked them to speak to those staff members during the course of our investigation, but they did not.

As the council could not demonstrate that they had thoroughly investigated the main point of Mr and Mrs C's complaint, we upheld their complaint.

Recommendations

We recommended that the council:

• remind relevant staff of the importance of complying with the SPSO complaints handling principles;
• consider removing the outstanding charges; and
• apologise to Mr and Mrs C for the failings we identified.

Summary

Mrs C complained that part of her dental work was provided on a private basis without her prior knowledge or consent. She said that she was not given a written treatment plan or cost comparison before the treatment was carried out. The dentist said that Mrs C was given a verbal explanation of the treatment options available to her, together with details of the costs, and that fee information was also clearly displayed in the practice reception and on the practice's website. He indicated that Mrs C had provided consent, having been told that part of the treatment was not available on the NHS, and a written treatment plan was not provided as Mrs C had not yet made a firm decision on all the treatment to be carried out.

We took independent advice on this complaint from one of our advisers, who is a general dental surgeon. He said that it was not sufficient for patients to receive information relating to treatment costs verbally and through notices displayed in the practice and online. The relevant regulations and guidance require that a written treatment plan, including an estimate of costs, is provided to the patient before treatment starts, and it can be revised later if the treatment plan changes. As Mrs C was not provided with a written treatment plan, we upheld her complaint and made some recommendations.

We also found some failings in the dentist's handling of Mrs C's complaint. We were critical that he suggested to Mrs C that no further treatment would be provided until her complaint was resolved or withdrawn. Complaints handling guidance and regulations require that a practitioner's first responsibility is to ensure that the patient's immediate health care needs are being met, if relevant at the time the complaint is made. We did not consider that the dentist's actions were in keeping with the spirit of this requirement. We also identified other areas where the dental practice's complaints procedure was not compliant with regulations and guidance, particularly with regards to information that should be provided within a written acknowledgement of a complaint, and in respect of their duty to signpost complainants to us. We, therefore, made some further recommendations about this.

Recommendations

We recommended that the dentist:

• arrange for the practice's policies and procedures in respect of treatment plans to be reviewed, ensuring that such plans are provided in line with the relevant regulations and guidance;
• issue Mrs C with a refund for the private element of her treatment;
• apologise to Mrs C for failing to provide her with a written treatment plan;
• arrange for the practice’s complaints handling policy to be reviewed to ensure compliance with their statutory responsibilities, as set out in the Can I Help You? guidance: in particular, ensuring that complaints do not adversely impact on patients’ immediate health care needs; when acknowledging complaints, the practice ensures that all required information is provided to complainants; and complainants are appropriately signposted to the SPSO in the practice’s final response to complaints; and
• apologise to Mrs C for failing to respond appropriately to her complaint.

Summary

Mrs C's late mother (Mrs A) had a fall in the care home where she lived. The next morning a carer accompanied her to A&E at Monklands Hospital. A doctor examined Mrs A, but considered that she only had bruising and did not arrange an x-ray. The doctor discharged Mrs A back to the care home.

The next morning, care home staff remained very concerned about Mrs A, and she returned to A&E, accompanied by another carer, who was told to specifically ask that Mrs A be given an x-ray. Mrs C said that A&E staff were very reluctant to x-ray Mrs A and, when the carer asked them to call the care home unit manager to discuss this, they told the manager that Mrs A had already been x-rayed on the previous day. However, after checking the records A&E staff acknowledged that this had not happened. Another doctor examined Mrs A and arranged an x-ray, which showed Mrs A had a fractured collarbone.

Mrs C phoned the hospital to complain about her mother's treatment, but staff told her she had to put her complaint in writing, and that Mrs A had to give written consent to the complaint being made. Mrs C wrote and complained, but the board did not receive this until Mrs C also sent the letter to her MSP, who forwarded it to them (some three weeks later). Mrs C complained about the delay in x-raying Mrs A, the failure to give Mrs A any pain relief on her first visit to A&E and the attitude of the staff member when she phoned to complain. The board apologised for the failure to correctly diagnose Mrs A's fracture on her first visit. The board said that, given Mrs A's age and frailty, she should have been given an x-ray, and the doctor involved had accepted this as a learning point for the future. The Board also apologised for the mistaken assumption staff made during Mrs A's second visit to A&E that she had already been x-rayed, and for the attitude of the staff member when Mrs C phoned to complain.

Mrs C was not satisfied with the board's response, and complained to us about Mrs A’s care and treatment, as well as the handling of her complaint. After taking independent medical advice, we upheld Mrs C's complaints. We found that the doctor on the first visit to A&E should have arranged for an x-ray. However, we noted that the board had already acknowledged and dealt with this. We found no evidence that staff were unreasonably reluctant to x-ray Mrs A when she returned to A&E. We did not criticise staff for not providing pain relief during Mrs A’s first visit to A&E, because we found that they had checked that she had already taken pain relief. However, we found that staff had failed to follow their complaints handling policy by not accepting Mrs C's complaint verbally and by not handling it within the required time-frames.

Recommendations

We recommended that the board:

• remind A&E triage staff at Monklands Hospital of the importance of fully reassessing any patient who returns to A&E, including taking a new set of observations, to ensure that nothing has been missed or overlooked;
• apologise to Mrs C for the failings our investigation found; and
• review their processes for accepting and processing verbal complaints (including obtaining consent, where required, where a complaint is made verbally on behalf of someone else); and tracking expected complaints time-frames (including updating complainants where anticipated time-frames will not be met).

Summary

Mr C complained about the care and treatment provided to his father (Mr A) by the board.

Mr A, who had a previous medical history which included Type II Diabetes, was admitted to Wishaw General Hospital as a day-patient for a gastroscopy (internal inspection of the stomach by way of a tube fitted with a camera). On admission Mr A's blood glucose level (a measure of how the body is able to process sugars in food and drink) was very low and staff gave him medication to increase it. Two subsequent readings were also low and Mr A was given a further dose of medication, followed by insulin (a drug used by diabetics to help them process sugars) delivered intravenously (directly into the vein). His blood glucose level eventually reached a reading considered to be within an acceptable range and the procedure went ahead. Following the procedure, Mr A was discharged home.

Three days after his discharge, Mr A collapsed at home and his blood glucose level was again very low. Mr A was taken by ambulance to Monklands Hospital where he was admitted to the Emergency Receiving Unit and in the early hours of the next day, which was a Friday, transferred to a ward. He then underwent some tests and investigations and his family were told that the team caring for Mr A were considering operating on him for abdominal problems. Later that day, the family were told that the surgeon was not going to operate as he did not work weekends; they were told that the surgeon would review Mr A again on the Monday and decide if he would operate. Over the weekend Mr A's condition deteriorated and his family found it difficult to obtain information from staff about Mr A's condition and treatment. Mr A died on the Monday morning without having had surgery.

Our investigation included taking independent advice from two of our advisers, a consultant geriatrician (specialising in the care of older people), and a nurse. In relation to Mr A's first admission to hospital, we found that although the board had stated in their responses to Mr C and to us that their guidelines on diabetic patients undergoing surgical procedures had been followed, this was not evidenced in Mr A's medical notes. We also found that despite the guideline stating that a patient's blood glucose level should be checked one or two times an hour, only one reading was taken after the procedure and before Mr A was discharged.

We also found that although Mr A had been advised to speak to his GP about his low blood glucose level, no advice on how to manage his condition for the rest of the day, or who to contact for advice, was given. We also found that although the Board's guideline gave advice on how to treat patients before a surgical procedure, it did not give guidance on how to treat patients after a procedure. Mr A was also not given anything to eat or drink before he was discharged to ensure that he was able to eat and drink normally, which is recommended by the Diabetes Association (a UK-wide organisation who provide advice to patients and carers and are often involved in preparing NHS guidance). Both advisers agreed that Mr A should have been kept in hospital until his blood glucose level stabilised and he was able to eat and drink normally.

In relation to the second admission to hospital, we found no evidence to link Mr A's earlier discharge from Wishaw General Hospital directly with his subsequent collapse and death. Our geriatrician adviser said that the assessment, investigation and treatment of Mr A's condition was reasonable and that contrary to what the family were apparently told, surgical intervention, although an option considered by the team, was never thought to be realistic. This was because it had been clear to the team caring for Mr A at an early stage that he was very frail and surgery would have been likely to cause his deterioration and death. However, we found that the team failed to convey this information to the family. Our nursing adviser also agreed that communication was poor and that there was only one record in the nursing notes that a staff nurse intended to speak with Mr A's daughter when she came to visit the day before Mr A died, but there was no record of this discussion ever having taken place.

We were also critical of the Board's response to Mr C's complaint. Although the board offered apologies for failings identified during the internal investigation, it was done in such a way as to devalue the apology.

Recommendations

We recommended that the board:

• review their guideline on diabetic patients undergoing elective procedures to ensure that it provides appropriate support and guidance to staff in both pre-operative and post-operative situations;
• ensure that staff involved in this complaint are made aware of the findings of our investigation;
• ensure that staff involved in this complaint are reminded of the importance of accurate and appropriate record-keeping;
• remind staff involved in this complaint about the importance of good communication with patients and their loved ones, in particular where the prognosis is poor;
• ensure that staff involved in complaints handling are made aware of the importance of making appropriate apologies for failings identified during internal investigations; and
• issue a written apology for the failings identified during this investigation.

Summary

Mrs C complained about the care and treatment provided to her late father (Mr A) while he was in hospital. She was also unhappy with the board's response to her complaint.

During our investigation, we took independent medical advice from a geriatrician (a doctor specialising in medical care for the elderly). The advice we received was that, while several aspects of Mr A's care were good, and there was no evidence of major system failure or any actions that directly and adversely affected his physical health, in other areas his care fell below the level that he could have reasonably expected to receive. This included a failure to act on the findings of an x-ray and to provide further follow-up and monitoring, as well as a lack of communication with Mr A and his family while he was in hospital. We were concerned that these failings would have added to the distress that Mr A and his family were experiencing. We were, however, aware that the board had already taken action as a result of his case, in relation to improving communication with patients and their relatives, and were carrying out work around patient experience. The board had also apologised for the lack of communication and had carried out a debrief with staff. We were also concerned that there was a lack of communication with Mrs C while they were considering her complaint, and that the board had at first failed to fully respond to the issues she raised.

Recommendations

We recommended that the board:

• apologise for the failings identified in this investigation;
• ensure that the findings of our investigation be included in consultant appraisals in relation to the specific incidents referred to in our report;
• apologise for the failings identified in the handling of the complaint; and
• ensure that complaint responses adequately and fully address the issues raised in a complaint.

Summary

Mr C's late father (Mr A) attended the medical practice and was seen by a GP who said that he had flu. He went back two days later because he had got worse, and was prescribed antibiotics. The GP told Mr A that if he did not improve he wanted to see him again and would arrange a chest x-ray. Mr A was also told that he not to go back to work.

The following day Mr C's brother visited Mr A and, given his condition, took him to the A&E department of the local hospital. He was admitted and a significant infection or inflammation was diagnosed, the cause of which was unclear at that stage. Later test results suggested that Mr A had bacterial endocarditis (an infection affecting the tissues that line the inside of the heart chambers). Mr A was in hospital for five weeks and was diagnosed with heart valve leakage, which needed surgery. Mr A was then transferred to another hospital where he died shortly after. Mr C felt that the GP's treatment of his father was unreasonable and might have contributed to his death.

We took independent advice from one of our medical advisers, who said that bacterial endocarditis is extremely rare, and most GPs will not diagnose it during their working lives. Accordingly, our adviser would not have expected the GP to diagnose this. They said that that the role of a GP in a patient with a flu-like illness is to take sufficient history and carry out a sufficient examination to exclude the likelihood of a cause other than a viral respiratory tract infection.

We found that there were clear failings in how the GP recorded his consultations with Mr A, which made it impossible to say that the clinical history taken and the examination of Mr A were sufficient. While the GP said he had examined Mr A, the evidence from the medical records did not establish this. Our adviser said that the GP's actions did not meet the standards of good medical practice, in accordance with General Medical Council (GMC) guidance, so we upheld Mr C's complaint about the care and treatment his father received from the practice. We were, however, unable to say whether the GP's actions possibly contributed to Mr A's death.

Recommendations

We recommended that the practice:

• issue a written apology to Mr C and his family for the failings identified;
• ensure that the GP reflects on his assessment of patients presenting with flu-like illness; and
• ensure that the GP reflects on his clinical record-keeping and improves the information recorded so that it meets the standards of good medical practice in accordance with GMC guidance.

Summary

Mrs C complained about the treatment that her late mother (Mrs A) received from her medical practice between September and November 2012. Mrs A was eventually diagnosed with lung cancer and Mrs C said that the family had made repeated requests for a chest x-ray but these were ignored. The family believed that an earlier x-ray might have allowed Mrs A's cancer to be diagnosed sooner. They were also concerned that the practice failed to follow up blood test results as they should have done and which again they thought would have led to an earlier diagnosis.

We took independent advice on this case from one of our medical advisers. Our adviser said that the practice had not failed to follow up on blood tests arranged by the hospital. However, he considered that the practice did not take reasonable steps in light of the results of blood tests they themselves organised. The adviser said that there were repeated and high levels of inflammatory markers shown on blood tests in late October 2012. These should have created a higher degree of suspicion, and led to consideration of a referral rather than just arranging repeat tests. The test results should have been considered in the context of an unwell adult and consideration given to referral for other possible conditions, although he also said that it was unlikely this would have led to an earlier diagnosis. The adviser also thought that Mrs A should have been referred for an x-ray in early November, when swollen lymph glands were noted.

We concluded that, whilst Mrs A's care was reasonable up to the end of October 2012, and that earlier diagnosis was unlikely in her case, on balance there were failings by the practice from early November 2012 onwards.

Recommendations

We recommended that the practice:

• apologise to Mrs C for the failings identified; and
• review our adviser's comments on this complaint, reflect on the decision-making processes used by GPs individually and collectively in assessing Mrs A in early November, and provide us with evidence of this reflection having taken place and its outcome.