Upheld, recommendations

Summary

Mrs C, who is an advice worker, complained on behalf of her clients (Mr and Mrs A) that there was a delay in diagnosing Mr A's cancer.

During our investigation, we took independent advice from one of our medical advisers, following which we upheld Mrs C's complaint. The adviser said that there was an unreasonable delay in the diagnosis of Mr A's cancer. Two abnormal chest x-rays should have been reported to the clinicians caring for Mr A, which would have prompted them to consider further investigations. This did not happen and was a failure in care. We noted that the board had accepted that the diagnosis of cancer should have been reached sooner, which might have enabled treatment to have started earlier and afforded Mr A an improved outcome. We noted that the matter was to be discussed by the appropriate clinical staff to increase staff awareness of this type of situation and to take more appropriate action in the future.

Recommendations

We recommended that the board:

• report back to us on the outcome of the discrepancy meeting attended by the Head of Radiology to discuss this case.

Summary

Mr C was diagnosed with alopecia (hair loss) as a child. It became progressively worse and he now suffers from alopecia universalis (a condition where a patient has no body hair). Mr C's GP referred him to Aberdeen Royal Infirmary where he saw a consultant dermatologist. Mr C complained about the care and treatment he was given which he believed was neither reasonable nor appropriate. He said that he had been forced to take medication that was ineffective and possibly had long-term side effects. He questioned his treatment plan and said that he had not been properly reviewed. Mr C was unhappy that he had not been prescribed an experimental treatment and said that the board did not provide him with appropriate support.

We took independent medical advice on the complaint from a dermatology specialist. Our adviser said that alopecia universalis has a very poor prognosis and that there is little or nothing that is effective in its treatment. The treatment given to Mr C was reasonable and appropriate and in accordance with his symptoms but, given the devastating consequences of this condition, we upheld his complaints as our adviser said that the board did not go as far as could have been reasonably expected to treat him. They did not seek support from neighbouring health board services or try to establish whether there were medical trials that might assist him. Their follow-up was poor, as a consequence of which he was effectively discharged and lost his wig entitlement, and had to visit his GP again for a further referral. Our adviser said that the board were, however, correct to refuse him the unlicensed treatment that he sought.

Recommendations

We recommended that the board:

• make a formal apology for their oversights in this matter;
• bring our findings to the consultant dermatologist's attention for him to reflect upon;
• make a formal apology in recognition of these failures; and
• emphasise to staff the importance of responding to complaints in a full and timely manner.

Summary

Mrs C told us that she suffers from fibromyalgia (a long-term condition that causes pain all over the body) and attends a pain clinic. In 2012, she began to experience further pain, which she did not believe was as a result of fibromyalgia. She said that she was virtually suicidal but that clinicians failed to investigate alternative sources for her pain and continued to treat her for fibromyalgia. She said that she should have been x-rayed or scanned and that the board's failure to do so meant that the true nature of the problems with her spine were not identified.

We took independent medical advice from consultants in rheumatology and orthopaedics. We found that while it was more than likely that Mrs C had fibromyalgia, her diagnosis had not been confirmed by a specialist. When Mrs C began to suffer further pain, advice was taken from another practitioner who admitted that this was not his area of expertise. Our advisers said that while the subsequent advice given to Mrs C was mostly correct, it may have been misleading and advice should have been sought from a specialist. Doctors did not carry out further investigations into her pain to exclude either another diagnosis or a further illness.

Although our advisers did not agree that Mrs C needed an x-ray or scan, we upheld her complaint, as we found that the board had failed to carry out an appropriate investigation into her pain.

Recommendations

We recommended that the board:

• make a formal apology for their shortcomings;
• review their system for diagnosing fibromyalgia and confirm to us that they are satisfied that it is fit for purpose and sufficiently robust;
• ensure that details of the complaint are brought to the attention of the speciality doctor and the associate specialist concerned; and
• consider our adviser's comments about including reference to cervical spondylosis (neck pain caused by age related wear and tear) in the diagnosis.

Summary

Mr C is elderly and has dementia. His wife (Mrs C) complained to us about failings in her husband's nursing care during a stay at Cameron House Hospital. These included delays in taking Mr C to the toilet, delay in receiving medication for constipation; lack of stimulation; failure to supervise Mr C, which led to him falling several times; and poor nutrition, which caused him to lose weight. Mrs C said that her husband had suffered a urine infection and that nursing staff did not ask a doctor to test him for this and that he contracted MRSA (a bacterial infection resistant to a number of widely used antibiotics). She was unhappy with the attitude of nursing staff, both towards her and Mr C, and said that they failed to communicate with her about Mr C's care.

We took independent advice from a nursing adviser who said, after considering Mr C's medical records, that his care was reasonable. However, the adviser said that it was clear that staff failed to appropriately communicate with Mrs C about her husband's care and treatment. In addition, there was a failure to ensure Mrs C's views were listened to and acted on. The board had accepted there were some failings in how members of staff communicated with Mrs C, and in record-keeping. They had apologised to Mrs C and put an action plan into place to deal with this.

We took the view that this failure in communication understandably led to a breakdown in the relationship between Mrs C and nursing staff, causing Mrs C to lose confidence in the staff caring for her husband. We accepted that Mrs C had a genuine belief that there was a failure to meet Mr C's care needs. In addition, we also found that there was a lack of support and reassurance from nursing staff to help Mrs C cope with the distressing and worsening nature of Mr C's dementia. We were critical of the apparent lack of empathy by staff, given that caring for relatives is a key part of the healthcare professionals' role. We upheld Mrs C's complaint and made two recommendations for further action.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings identified; and
• provide a copy of the action plan and an updated report on the implementation of the plan.

Summary

Mr C had concerns that, when his late mother-in-law (Mrs A) was discharged from hospital to a nursing home, staff failed to inform the family about the existence of the NHS continuing healthcare procedure and that as a result there were financial implications for Mrs A. The board maintained that Mrs A's medical records contained details about communication with Mrs A's family about her discharge from hospital and that the family were satisfied that placement in a nursing home was appropriate. We upheld the complaint as we found that, although the records showed that there were frequent discussions with Mrs A's family about the plans for her discharge, there was no specific mention of the NHS continuing healthcare procedure.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the failure to advise the family that there was an appeals procedure where there is a disagreement about the decision to provide NHS continuing healthcare;
• issue a written apology to Mr C for the failure to specifically record at discharge that consideration had been given to NHS continuing healthcare; and
• remind staff of the requirement to communicate with patients and carers about the procedure for NHS continuing healthcare and ensure that decisions are recorded in the medical records.

Summary

Miss C complained to us on behalf of her son (Mr A). She said that the board had failed to provide reasonable care and treatment to him after he injured his nose. Mr A had several appointments in the board's ear, nose and throat (ENT) and maxillofacial (the specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) departments after he sustained the injury.

We took independent advice on the complaint from one of our medical advisers, who is an experienced ENT surgeon. We found that the board had initially taken reasonable action to investigate Mr A's problems. However, we found that staff in the ENT department had failed to identify that an x-ray that had been carried out suggested a disease in one of his sinuses. They had then not taken action to investigate this further, and in view of this, we upheld this aspect of Miss C's complaint.

Miss C also complained about the way in which the board handled a complaint from Mr A's representative about the matter. We found that they had delayed in issuing a response, and had failed to keep Mr A's representative updated when the response was delayed.

Recommendations

We recommended that the board:

• apologise to Mr A for the failure to adequately investigate the condition affecting his sinus;
• take steps to arrange an urgent ENT appointment for Mr A in order that the matter can be investigated;
• review the reporting of images in the ENT department to ensure these are appropriately reported;
• make the staff involved in Mr A's care in the ENT department aware of our finding on this matter;
• remind the staff involved in handling the complaint that they should keep complainants updated when there is a delay in a response being issued; and
• apologise to Mr A for the complaints handling failures.

Summary

Mr C complained that because the Scottish Prison Service (SPS) failed to appropriately process his property, he lost two items. Mr C said that they failed to record or itemise his belongings correctly, failed to place them in sealed bags and mixed them up with those of another prisoner.

The evidence showed that at several stages the SPS failed to follow their procedures and appropriately process Mr C's property, and it was clear from their own investigation of his complaint that they had found failings. However, the SPS did not appear to have taken any action to remedy these, despite repeated prompts from us to do so, and we criticised them for this.

Recommendations

We recommended that the SPS:

• feed back our decision on Mr C's complaint to the staff involved to ensure that such failings do not occur in future;
• reconsider Mr C's claim for lost property, taking into account the failings identified in this case; and
• provide Mr C with a written apology for the failings identified.

Summary

Miss C complained about the way COPFS handled her complaint, which concerned the death of a relative. Miss C said the handling of her complaint was very poor and took an unreasonably long time, and there was a lack of respect and compassion towards her as a bereaved relative in the written response to her complaint by COPFS. Our jurisdiction in complaints about COPFS is very limited, and we could look only at whether they acted in line with their complaints procedure.

We found that Miss C raised a number of issues in her complaint to COPFS and, in their letter, COPFS provided a response to those issues. From an administrative point of view this showed there was a reasonable level of investigation into, and response to, Miss C's complaint. We were in no doubt that their response would have been difficult to read, given the distressing subject matter dealt with in the letter. However, we concluded that the letter was not lacking in respect or compassion; rather, it was empathetic and tried to deal with a difficult subject sensitively.

In terms of the time taken to deal with Miss C's complaint, it took considerably longer than the 20 working days allowed for in the COPFS complaints procedure; it was in the region of 85 working days. COPFS explained why it took this length of time, and the explanation appeared to be reasonable. However, COPFS failed to update Miss C every 20 working days, as required by their complaints procedure. Miss C should have had at least three, if not four updates. This was particularly important given the impact on Miss C of her relative's death and subsequent events. Therefore, on this specific point, we upheld Miss C's complaint.

Recommendations

We recommended that COPFS:

• confirm to us what measures they have in place to ensure that complainants are given progress updates in line with their complaints and feedback policy.

Summary

Mrs C, a tenant of the council, complained about difficulties arranging repairs to her home. Mrs C said there were delays in carrying out several repairs, and the council failed to return her calls or communicate with her, except when she made formal complaints. Mrs C was also concerned that her energy costs for the year were very high, which she thought could be due to the delays in repairs to windows and doors, or to a fault in her boiler (which was not inspected by the council for two months after she reported it).

The council accepted that their communication was poor, and apologised to Mrs C for this. However, the council said that the energy costs could not have been affected by the faulty boiler, as this would have used less, not more, electricity.

After investigating these issues, we upheld Mrs C's complaints. There was no evidence that the faulty boiler increased Mrs C's energy costs and, while the delays in repairing the doors and windows might have affected her heating costs, it was not possible to determine this for certain. However, we found that there was unreasonable delay in the council inspecting Mrs C's faulty boiler, as well as in carrying out several repairs to her house. We also found that the council did not respond reasonably to Mrs C's attempts to contact them, except when she made formal complaints.

Recommendations

We recommended that the council:

• consider inspecting boiler and heating systems (to ensure they are functioning properly, in addition to electrical safety) as part of the preparation of a void property for a new tenancy;
• apologise to Mrs C for the failings our investigation found;
• review their processes to ensure that repair requests are promptly recorded and carried out, including where requests are made verbally, or as a result of a property visit; and
• take steps to ensure there is a robust process for logging and following up calls relating to housing repairs.

Summary

Ms C applied to the council on behalf of her son for a Young Scot card and education maintenance allowance. There were delays in processing her applications and because of that, Ms C complained to the council. She then complained to us because she said the council failed to address her complaint appropriately.

Having reviewed the council's complaint file and related documents, we found that the council could have taken steps to outline what the relevant procedures and likely timescales were in relation to each application. We also considered that they could have explained in more detail what had happened to the Young Scot card application. In addition, the council failed to address Ms C's concerns about her application for education maintenance allowance.

Recommendations

We recommended that the council:

• make a time and trouble payment in recognition of the failings identified with the handling of the application for a Young Scot card; and
• apologise for failing to address Ms C's complaint about the handling of the application for education maintenance allowance.