Upheld, recommendations

Summary

Mr C complained about a bill he had received from Business Stream, and about their handling of his complaint. Mr C had disputed a meter reading, claiming that it was impossible for the amount of water billed to have been used. He had been told that his account would be put on hold. Despite this, Business Stream took full payment of the invoice. Business Stream then failed to investigate the matter, despite repeated requests from Mr C over two years. Neither did they investigate the complaint properly until we prompted them to do so.

We found that the passage of time meant that it was impossible for us to establish whether or not the disputed amount of water had been used. There were, however, significant failings by Business Stream in the way that they handled the complaint. Our recommendation for financial redress was calculated as a percentage of the bill, to reflect the poor service they had provided.

Recommendations

We recommended that Business Stream:

• apologise to Mr and Mrs C for the failings identified in our investigation; and
• pay Mr and Mrs C £450 by way of financial redress for the failings we identified.

Summary

Mr C, who is a prisoner, declared to the prison that he was Jewish and asked to be provided with a kosher diet. The prison told Mr C that he would only be provided with this after he met with a rabbi. Mr C refused to do so and because of that, the prison did not agree to provide him with the kosher diet. In bringing his complaint to us, Mr C said the prison were not allowed to insist that he meet with a rabbi and their refusal was inappropriate.

The prison rules confirm that a prisoner must be treated as having a particular religion, belief or non-belief if they declare so at any time. In addition, the prison rules say that the prisoner is not obliged to give any information about having a particular religion, belief or non-belief. The prison rules also confirm the governor should, as far as practicable, provide a prisoner with food which takes into account their age, health and religious, cultural, dietary or other requirements. We asked the Scottish Prison Service (SPS) to confirm whether any rule or other policy existed that gave prison staff the authority or discretion to assess and test whether a prisoner had shown or was showing evidence of their declared religion. The SPS confirmed that no such rule or policy existed. In light of this information, we concluded that the prison had breached prison rules by insisting that Mr C had to meet with a rabbi before his dietary needs would be met. The prison were not entitled to do so and because of that, we upheld Mr C's complaint.

Recommendations

We recommended that the SPS:

• issue guidance to all prison staff reminding them of the requirements of prison rule 13 and its practical implementation; and
• apologise to Mr C for the failings identified by his complaint.

Summary

Mr C, who is a prisoner, submitted a complaint to the prison prior to his transfer to another establishment. He had escalated the complaint to the internal complaints committee (ICC) but they did not convene until the day after Mr C's transfer, so he was not given the opportunity to attend. He felt that the prison had adequate opportunity to convene the ICC before he left and, failing that, he complained that they did not explore the use of video link facilities to allow him to take part remotely. He said that his requested witnesses were not called to the ICC, but that the chairperson had not recorded that he had considered these requests and deemed the witnesses to be of no relevance or value, as he was required to do under the prison rules. Mr C also noted that the ICC appeared to have had only two members rather than the required three and that the governor did not countersign the complaint form within the 20 day target timeframe.

In responding to our investigation, the prison explained that, although they had been aware of Mr C's transfer several days before the ICC, the chairperson had not been personally aware and the need to prioritise the hearing had been overlooked. They confirmed that the video link facilities at the prison were not operational at that time. They also confirmed that the ICC had three members but the third member left before signing the form. The prison acknowledged that they had not adhered to the rules in considering Mr C's witness requests and accepted that the governor did not sign the complaint form in the required timeframe. They told us that they had emailed managers reminding them to ensure that ICCs have three members. They also confirmed that, since Mr C complained, they had begun logging when complaints are passed back for the governor to sign. They said they would apologise to Mr C for these failings.

We considered it reasonable that a member of staff not directly involved in a prisoner's transfer ie the ICC chairperson, might not have been aware of the impending transfer. We, therefore, understood why this might have been overlooked in the context of the complaints process. We also accepted that video link facilities were not available at that time. However, we were critical of the handling of Mr C's request to call witnesses, of the failure to have the complaint signed off by three ICC members and of the delay in the governor signing off the complaint. We upheld his complaint and asked the prison to provide evidence of the actions that had been taken to address these failings.

Recommendations

We recommended that the Scottish Prison Service:

• apologise to Mr C for the identified failings in the handling of his complaint.

Summary

Mrs C complained that the council had not adequately investigated her complaint about how school and council staff dealt with her concerns about a meeting she attended to discuss the welfare of her son.

Our investigation found that the council had not clarified what her complaint was, and had not appointed an independent objective investigating officer. There was little evidence of how the council had investigated her concerns and they had not clearly signposted the stages of their complaints handling procedure.

Recommendations

We recommended that the council:

• apologise for not carrying out a reasonable investigation and for not following their complaints handling procedure.

Summary

Mr C had wanted to build a house and garage. He attended two pre-application meetings with the council's planning officer and was advised that his proposals might be viewed favourably in accordance with a rule in the local development plan (LDP), which favoured development for organic growth within 400 metres of certain settlements in the local area. Encouraged by this information, Mr C arranged for his architect to draw up plans and submit a full planning application. However, the planning officer then told Mr C that he had been given incorrect information about the 400 metre rule, that the place where he wanted to build was not included in the list of places to which the rule applied and his proposed development could not, therefore, be approved. The council explained that this error had occurred due to a new LDP coming into effect around the time of Mr C's pre-application meeting and full details of the 400 metre rule not being known at that time. Mr C was dissatisfied with the council's handling of his proposed development and sought reimbursement of the cost of preparing and submitting his planning application.

Although there was never any suggestion that Mr C had been told his planning application would be approved, we acknowledged that the information provided at the pre-application meetings gave him the confidence to prepare and submit a full application. We found that the new LDP had come into effect several weeks prior to Mr C's first pre-application meeting. Although its content would still have been open to legal challenge at that stage, we considered that there was enough information available to the planning officer at that time to advise Mr C that his proposed development would not be approved under the 400 metre rule. We considered that Mr C and his architect also had a responsibility to familiarise themselves with the LDP, but under the circumstances did not find it reasonable for the council to charge him for the planning application or advertising fees.

Recommendations

We recommended that the council:

• pay Mr C a sum of money to reimburse his planning application and advertising fees.

Summary

Mrs C complained about the way the housing partnership handled complaints about antisocial behaviour. Mrs C complained on numerous occasions about the behaviour of her upstairs neighbours. The partnership investigated all the complaints that were reported directly to them, based on their antisocial behaviour policy. They twice took action against Mrs C's neighbour, and monitored the situation over a prolonged period. During this time Mrs C made further complaints about antisocial behaviour, but the partnership did not think there was enough evidence to take further action.

Our investigation reviewed the evidence from the partnership, and found that there were occasions when staff could have investigated reported antisocial behaviour more promptly, when it was not reported directly to them. There were also occasions when there was some evidence of antisocial behaviour of a minor nature that was not addressed. In particular, we found that the partnership lacked an antisocial behaviour procedure for staff dealing with ongoing issues such as those reported by Mrs C. They also failed to provide Mrs C with enough information about what they had done about some of her complaints, and did not explain sufficiently what other action she could take.

Recommendations

We recommended that the partnership:

• develop a clear procedure to assist staff in handling persistent antisocial behaviour and for addressing situations where information is not corroborated, and share this procedure with SPSO; and
• apologise to Mrs C for the failings identified in this complaint.

Summary

Mr C, an advocate, complained on behalf of Mrs A that there was avoidable delay in her medical practice diagnosing that she had unknowingly contracted a sexually transmitted disease (STD). She had been attending her medical practice for more than two years with the symptoms but it was not until she was referred to an STD clinic that this was diagnosed. When Mr C complained to us, Mrs A was still undergoing treatment for the condition.

After taking independent advice from one of our medical advisers, we upheld this complaint. Our investigation found that an opportunity to diagnose the STD in August 2009 was missed. The adviser was critical of a lack of detail in the clinical notes, which made it difficult to assess whether or not the condition could have been diagnosed even earlier than that. They said that delay in diagnosing STDs can have serious consequences, as the presence of one can indicate the presence of others, some of which can have serious health effects. Undiagnosed STDs can also be passed on to new or different partners. The adviser also said that the delayed diagnosis probably contributed to the length of Mrs A's treatment.

Recommendations

We recommended that the practice:

• apologise for the failings identified during our investigation;
• conduct a significant event audit of this matter and share the outcome with Mrs A and Mr C; and
• conduct an audit of a selection of medical notes across the practice to ensure that the standards set by the General Medical Council are being met, and if any failings are identified ensure that appropriate training and discussion at annual appraisal(s) takes place.

Summary

Ms C complained about the standard of nursing care that her late mother (Mrs A) received after she was admitted as an emergency to hospital with shortness of breath, unexplained weight loss and dehydration. Mrs A was diagnosed with cancer of the oesophagus (gullet) and died four days later after a cardiac arrest. Ms C complained about 16 incidents in the hospital and about aspects of her mother's care.

We took independent advice on this case from one of our medical advisers. She noted 13 areas where the board had acknowledged failings on their part, apologised and said that they had taken or would take appropriate remedial action. In the remaining three areas, the adviser said that when a patient was admitted with dehydration, a five hour wait for intravenous fluids was unacceptable and she would have expected these to have been started in the emergency department. She also noted Ms C's concern about her mother's white blood cell count being low and that information from hospital staff suggested there was a delay in a blood transfusion. The adviser said the records showed that the transfusion started on the day of Mrs A's admission to hospital and was not delayed. On the final point, the adviser was critical that when Ms C was called to the hospital during the night because of her mother's deteriorating condition, no-one was asked to meet her at the hospital entrance and take her to her mother's ward.

The adviser said there was evidence of significant failings that led to a traumatic experience for Mrs A in her last hours of life and to her immediate family. We noted that the board had investigated and addressed Ms C's complaint and that statements from staff members appeared to contain important reflections about their care and treatment of her mother and suggested that they were truly sorry for their failings. As the board had already taken action in a number of areas, we made recommendations to reflect this.

Recommendations

We recommended that the board:

• provide Ms C with a written apology for failing to start her mother's intravenous fluids in the emergency department;
• feed back our adviser's views on this failing to relevant staff;
• consider what local arrangements are in place to ensure that distressed relatives arriving at night are welcomed/orientated to the ward areas;
• provide us with full documentary evidence of each of the remedial actions identified in our investigation (with the exception of the apologies); and
• provide us with an update to improvements in the ward in question in the areas set out in the quality improvement plan, and demonstrate that the issues have been addressed and that learning has taken place.

Summary

Ms C was a Business Stream customer. She complained that they gave her poor advice when she moved premises about the difference it would make going from metered to unmetered property. She said that this resulted in her paying almost twice as much for their services. Ms C said that when she realised this, she arranged to have a meter installed, and a repayment plan, and discussed a reduction of the payments. Despite this arrangement, a collection agency contacted her about the debt. When she complained to Business Stream, Ms C was told that the sum agreed for repayment was too small, and that she could not have the bill reduced through reassessment. Ms C complained to us that she did not receive clear advice from Business Stream about having a meter fitted, and that they failed to address her complaint about changing the payment agreement.

In our investigation we were unable to verify what Ms C said she had been told during a phone call with Business Stream, because there was no record of the call. We noted that she had phoned, and had requested a call back. She had received an email with advice to check their website for information if she wished to apply for a meter, which accorded with our understanding of the standard of service required of them. However, we took the view that if, as she claimed, she was told that it was not to her benefit to have a meter installed for her current premises, it was understandable if she did not check this out with any urgency. We upheld her complaints because of the failure to record the phone conversation, and subsequent failure to respond fully to her complaints. We took into consideration that Business Stream did not respond to this when we asked them to comment.

Recommendations

We recommended that Business Stream:

• issue a formal apology to Ms C for the failings identified in our investigation;
• implement improvements to their record-keeping;
• pay Ms C £100 for their failure to respond fully to her complaint;
• fully investigate Ms C's complaint and apologise for not having done so before; and
• depending on the outcome of the investigation, consider making Ms C a further, ex-gratia, payment.

Summary

Mr C’s wife runs a business. He said that she suddenly received an invoice from Business Stream for three years' water services, amounting to over £3000. Mr C said that neither he nor his wife had been approached by Business Stream or anyone acting on their behalf, despite the business being open for long hours every day, but a third party company had, inappropriately, approached their neighbours. Mr C said that it was unreasonable for Business Stream to issue an invoice without any prior communication by phone or letter explaining their charges.

Our investigation found that Business Stream have no procedure or policy document setting out what is expected of those whose job it is to trace the customer responsible for a property recorded as vacant, but which appeared to be occupied. They told us, however, that the initial contact would always be direct with the customer. Business Stream confirmed that a third party had spoken to one of Mr C’s neighbours. We found no evidence that there had been any difficulty in contacting Mr C or his wife, and found that Business Stream’s expectation of how a third party company would operate was not met. We found also that it was unreasonable to issue an invoice without any prior contact with Mr C or his wife.

Recommendations

We recommended that Business Stream:

• apologise to Mr and Mrs C for the failings identified in our investigation;
• deduct £100 from Mrs C's account;
• implement a procedure for the companies acting for them to follow when making enquiries about commercial premises that appear to be operating without a water service provider;
• ensure that any queries Mr C made about the charges have been addressed before re-issuing their invoice; and
• implement a procedure where letters of introduction and explanation are issued to new customers with the issue of the first invoice.