Upheld, recommendations

Summary

Mrs C's husband (Mr C) was referred to hospital by his medical practice because he was suffering from fatigue and shortness of breath on exertion. He had some tests, but it was not until almost five months later that he was diagnosed with lung cancer. Mr C died shortly after the cancer was diagnosed. Mrs C said that her husband had a complicated medical history, but she was concerned that there appeared to be a lack of urgency by the hospital in establishing the cause of his symptoms.

To investigate the complaint, we carefully considered all the relevant documentation, including the complaints correspondence and Mr C's medical records. We also took advice from one of our medical advisers, who is a consultant in respiratory medicine.

We upheld Mrs C's complaint. Our investigation found that there was a three week delay before Mr C was seen at the respiratory clinic and, later, it took four weeks for the GP specialist's urgent referral request to be seen by the hospital's consultant respiratory consultant, although the reasons for this could not be established. After Mr C was seen, there was then little urgency in dealing with him. Our adviser confirmed that although an earlier appointment would have led to an earlier diagnosis, the outcome for Mr C would not have been different. However, Mr C would have had more time for palliative care (care to prevent or relieve suffering), which would have alleviated his pain and discomfort.

Recommendations

We recommended that the board:

• make a formal apology to Mrs C for the delay and lack of urgency; and
• ensure that, where cancer is suspected, there is a robust cancer pathway in place in accordance with the Scottish referral guidelines for suspected cancers.

Summary

Ms C complained about her care and treatment during the birth of her son. In particular, she was concerned about the attitude of the midwife - she said that the midwife had snapped at her, had not listened to her and had not explained what was happening. She was concerned that the actions of the midwife had almost cost her son's life.

Our investigation took into account all the available information, including the complaints correspondence and the relevant clinical records. We also obtained independent advice from a medical adviser. We found that the board had already accepted that there had been a failure in communication and had taken action to address this and had apologised to Ms C.

Overall we found that the level of care provided was adequate and safe and that there was nothing in the clinical records to suggest that a different course of action should have been taken. However, we were concerned that Ms C's blood pressure or pulse were not taken as required. We were also concerned that record-keeping was not to an acceptable standard, and that the failure in communication, in particular the failure to explain what was happening, had added to Ms C's concern that her baby was at risk. We upheld Ms C's complaint and made relevant recommendations.

Recommendations

We recommended that the board:

• bring the failures identified in this investigation to the attention of the relevant midwife; and
• undertake an audit of record-keeping at the maternity unit to ensure that their record-keeping is in line with Nursing and Midwifery Council guidance.

Summary

Miss C complained to us on behalf of her son (Mr A) about the way his college treated him. Mr A has a developmental disorder and behavioural symptoms, and Miss C was concerned that the college had put in place additional requirements before accepting him on to a course, after he had withdrawn from previous courses.

Mr A withdrew from his first two courses without completing them. When he withdrew from the first course, he was assessed to identify any learning support needs. The assessment found that he would benefit from support and he was encouraged to seek this with his next course. However, Mr A did not do so, and again withdrew before completing the course. Shortly after he enrolled for a third course, he had to withdraw on medical grounds. However, he applied for the same course the following year. At this point he was told he had to complete an additional module before he could gain a place on this course, to show he could commit to a full course.

We took independent advice on this case from our equalities adviser, who said that the college needed to put in reasonable adjustments relating to Mr A's support needs during his college courses. Given Mr A's disabilities, the adviser considered that the college had not done enough to support him during his first two courses. She also noted that the level of support was less than that indicated by the college's policies.

In reviewing the evidence available, we found that Mr A had withdrawn from the third course on medical grounds, and that he had done so early enough for his place to be allocated to another student. We also noted that he and his mother had moved house to facilitate his access to the college. However, the college had no evidence relating to any discussions with Mr A at the time, either in relation to why he was withdrawing, his circumstances or what this might mean for any new application for the course. There was also no evidence that they provided appropriate guidance at this time, as required by their policies.

We upheld Miss C's complaint as we found that the college did not provide sufficient support to Mr A during his courses, and we were critical of the lack of evidence of discussions at that time or of any proactive offer of support. We also found that the college failed to take account of Mr A's full circumstances in their decision on his later application, and concluded that they had inappropriately put in place an additional requirement for him to achieve before he could access the course.

Recommendations

We recommended that the college:

• review their policies and procedures to ensure that it is clear to staff when reasonable adjustments should be considered for students with disabilities;
• consider Mr A's current application for a place on the course in light of this decision;
• ensure that significant interactions between students and staff relating to withdrawals from courses are suitably documented; and
• apologise to Mr A for the failures identified in our investigation, and to Miss C for the time and inconvenience caused in bringing this complaint.

Summary

Mr C complained that for three years Business Stream had failed to read the meter for a village hall run by a committee of volunteers. As a result Mr C had been unaware that the hall had two meters and that there had been a significant increase in consumption. Once the committee were made aware of the increased consumption they took steps to reduce it.

During our investigation we discovered that, during the three year period, Business Stream had taken meter readings for the hall but in the year before the high consumption occurred they had not taken two actual readings. In addition they had only issued invoices for one meter and had incorrectly identified its location.

As a result Business Stream had addressed the accuracy of the location of the meter and had decided not to backdate the second meter charges to when it was installed. However, we considered that had the invoices accurately described the location of the meter Mr C would have been able to identify that there were two meters instead of one and would have had the opportunity to monitor them. Because Business Stream had not read the meters in line with their policy we were unable to identify when the increase in usage occurred, and we made a recommendation about this.

Recommendations

We recommended that Business Stream:

• apologise for the failings identified in our decision letter; and
• consider crediting the account with an amount equivalent to 50 percent of the increased water usage during a specified period.

Summary

Mr C, who is a prisoner, complained there was an unreasonable delay in the prison finalising his report after he completed a treatment programme. Mr C said the delay in completing the report meant he was prevented from undertaking any further work required before the parole board review his case.

The Scottish Prison Service (SPS) told us that Mr C's report should have been finalised 16 weeks after he completed the programme. However, it had still not been completed four months after that. They explained that the facilitators were new to delivering the programme, and writing reports, and that this had impacted on timescales. In addition, before a decision could be reached on whether Mr C was required to undertake further programme work, his completed report needed to be considered by the prison's programmes case management board (PCMB).

As Mr C's case is due to be considered by the parole board in early 2014, we agreed the delay in completing his report was unreasonable. We upheld his complaint and made recommendations.

Recommendations

We recommended that the SPS:

• complete Mr C's report as a matter of urgency and ensure it is ready to be considered by the PCMB without further delay; and
• prioritise Mr C's access to any further programme work that may be identified by the PCMB.

Summary

Mr C complained to the council about a statutory notice that had been served on his property, and for which the council had told him he was now liable. He was unhappy at having to pay as he said he and his solicitors had tried to find out more from the council about this, both before he bought the property and since, without success. He had a lot of communication with the council about this, and was also unhappy with the advice they gave to solicitors acting on his behalf and how they handled his complaint. He was dissatisfied with the council's responses and complained to us.

We found that the council's responses did not reasonably address his complaints, that their responses to his enquiries about the matter had been unreasonable, and they did not make clear what an apology they provided was related to. Given this, we upheld the complaint.

Recommendations

We recommended that the council:

• apologise unambiguously to Mr C for the poor standard of their communication with him;
• reflect on how the situation came about that Mr C was advised that a manager would be made aware of his contacts and would return calls as a matter of urgency at a time when he had been on holiday, and whether action requires to be taken to ensure this cannot be repeated; and
• remind all staff to ensure that all matters raised by complainants are clearly acknowledged and responded to at all stages of the process.

Summary

Ms C had complained to the council about antisocial noise in her building. This had been a problem for some time and she felt that the council had failed to address the underlying issue. A flat that was the source of some of the noise was owned privately with a high turnover of tenants, and Ms C said that this contributed to the ineffectiveness of the council's approach as she felt that it had been addressed on a 'tenant-by-tenant' basis, rather than as a continuing issue. She was also dissatisfied with the way that the council handled her complaint and their responses, and she raised her complaints with us. We explained that we did not have the legal power to address the alleged antisocial behaviour on her behalf. However, we did consider the way that the council had handled her complaints.

Although Ms C questioned the council's reasons for handling matters in a certain way, this in itself, does not automatically mean that they mishandled her complaint. For example, the council had provided explanations and, although Ms C did not agree with them, these had explained the council's position. When we reviewed the correspondence, however, we felt that it indicated that the long-term problems had had a significant and distressing effect on Ms C. We took the view that the council's responses did not appear to have taken this into account, and we noted that there were delays in replying. We found they had also failed to keep Ms C updated about how matters were being progressed and so, on balance, we agreed that the council failed to deal with her complaint appropriately.

Recommendations

We recommended that the council:

• reflect on their complaints handling at stages one and three, and advise the Ombudsman of any action taken (over and above their new complaints process) to ensure that in future complaints will be handled more appropriately; and
• apologise to Ms C for not keeping her informed of what was happening about her complaint.

Summary

Mr C made an application to the Scottish Welfare Fund for a crisis grant but the council refused this because he was not in receipt of a qualifying benefit. Mr C asked for the decision to be reviewed, because he was waiting for his benefit application to be processed. After the review, the council told Mr C the original decision would not change and no award would be made. Mr C complained to us about the council's handling of his application. In particular, he said the council's communication was poor; there was an unreasonable delay in processing his second tier review (a further review by a panel who are not part of the Fund team); and the guidance was not followed properly.

We examined what happened in Mr C's case against the relevant guidance from the Scottish Government, and upheld his complaints. Our investigation found that the council did not explain the evidence that Mr C should put forward when requesting a review, and had not responded to the concerns he raised in his request for a review. The guidance says the applicant should understand why a decision has been made. Mr C was also not told when the panel would consider his second tier review or about his right to see the documents that would be considered. The council also accepted there was a delay in processing that review. They said his letter requesting this was misfiled into his housing benefit file. Finally, the council told Mr C his application was refused because he was not in receipt of a qualifying benefit. However, the guidance clearly states the key test of eligibility for a crisis grant is the severity of the applicant's situation.

Recommendations

We recommended that the council:

• apologise to Mr C for the additional failings identified.

Summary

Mrs C complained that a school had unreasonably excluded her child. She also complained that they offered a mediation session to allow her to discuss this but, when she went to it staff refused to listen to her side of the story or to allow her child to attend. She was also unhappy about the way the council dealt with her complaint about this.

The council said that they had offered the mediation session to ensure that appropriate support was in place to allow her child to return to school and that they had made clear to Mrs C that the meeting was not held to discuss the exclusion. They also said that they had dealt with her subsequent complaint in line with their complaints procedure.

We found that, although the council offered the mediation meeting in order to try and ensure that Mrs C's child returned to school as quickly as possible and were trying to help resolve this, they incorrectly told Mrs C that the mediation meeting and complaint were an alternative to the appeals process. This was not the case, and there is a separate statutory process that considers appeals against school exclusions. We concluded that the council provided Mrs C with misleading information. In terms of her complaint, we found no evidence to suggest that the school failed to take her concerns seriously or failed to investigate every allegation she made. We did, however, conclude that they failed to address all her complaints as they had said that they could not look at new issues she raised with them after concluding her original complaints. As a result of these failings, we upheld her complaints.

Recommendations

We recommended that the council:

• apologise to Mrs C for the misleading advice;
• ensure that they respond to all points of complaint and that any new and separate issues are duly investigated; and
• inform Mrs C of the steps she should take if she still wishes to formally appeal against her child's exclusion, making sure they fully explain what this process will involve.

Summary

Mrs C's child had suffered verbal abuse, physical assault and bullying on social media. Mrs C complained that the school did not follow anti-bullying policies, and that the council's policy did not provide adequate protection. She said that the school and the council had not taken enough steps to protect her child. The council responded that they were reviewing their policy, but that was a year after Mrs C had first raised her concerns.

We upheld Mrs C's complaint and made a number of recommendations, as our investigation found that policy and procedures were not followed, no action had been taken in relation to evidence of bullying on social media, and evidence of a serious incident had not been kept. We also found that the council had not taken reasonable steps to ensure the adequacy of their anti-bullying policy.

Recommendations

We recommended that the council:

• apologise for not ensuring that anti-bullying policy and procedures were followed;
• review anti-bullying staff training in light of the potential abuse of social media and actions that staff should take in such cases to ensure all staff are clear about their responsibilities when bullying is reported;
• consider how they could encourage schools to use specific incidents of bullying as learning opportunities for pupils within the curriculum;
• share the findings of our investigation with relevant staff; and
• consider the adequacy of their anti-bullying policy and their advice to schools.