Upheld, recommendations

Summary

Ms C inherited a property from her mother, who had died unexpectedly. Unable to sell it, Ms C decided to rent the property out. She complained that the council had unreasonably held her liable for council tax during periods for which exemptions should have been granted. She said the council had pursued her relentlessly and had taken recovery action unreasonably when she had already provided all the information they had asked for.

We upheld all Ms C's complaints, as we agreed that the council took too long to resolve this. They missed the opportunity to reply to letters from Ms C in which they could have clarified that information, which Ms C clearly believed had been sent, had not in fact been received. We concluded that the council were also responsible for creating unreasonable confusion. Not only had they failed to clearly explain that information had not been received when Ms C repeatedly said it had been sent, they requested information which had already been provided, and did not send the correct exemption form. We concluded that the council should not have pursued debt recovery action when they had missed an opportunity to explain clearly to Ms C what information they still needed from her.

Recommendations

We recommended that the council:

• apologise for the distress caused by their administrative shortcomings;
• review arrangements in the council tax and revenues team for reviewing and responding to correspondence to ensure that customers receive a high quality and responsive service; and
• review any costs to Ms C arising from the recovery action taken by the council for the period in question and consider whether any reimbursement is warranted.

Summary

Mrs C attended the board's dental service, as her dentures were loose and uncomfortable. She had a new lower denture fitted and her top denture relined. However, she found the new dentures uncomfortable from the outset and returned to the service. The dentist made her a new lower denture based on her original dentures. Mrs C was unable to eat with these dentures and they caused her pain. She went back to the dental service again and was referred to the dental hospital. She was told to wear her old dentures in the meantime, as they fitted better.

Mrs C saw a consultant at the hospital. He suggested replicating her old dentures, and adding a permanent soft lining material. He placed her on the waiting list for treatment by postgraduates at the hospital. However, at that time, they were reaching the end of their placements and were unable to offer treatment to new patients. Mrs C told us that due to the delay, she decided to get private treatment. She said that the dentist she saw privately was able to make her dentures without any difficulty.

Our investigation found that the board had failed to let Mrs C know that there would be a delay in her treatment because the postgraduates were unable to offer treatment to new patients at that time. Due to the delay that occurred as a result of this, the board failed to meet the 18 weeks referral to treatment target. Although the board's view was that the dentures made by the dental service were not defective, we found that they had accepted that the dentures were not fit for purpose by agreeing to make new ones.

Recommendations

We recommended that the board:

• consider how they can prevent delays for patients referred to postgraduates at the dental hospital for treatment; and
• refund the money Mrs C paid for dentures that she was unable to wear.

Summary

Mrs C complained that she experienced an unreasonable delay in receiving appointment notification letters from the board. After she was referred to a respiratory clinic by her GP, the board wrote inviting her to an appointment at the clinic. Mrs C did not receive this letter until after the time of the appointment on the day it was due to be held. The letter was dated seven days earlier. It had been sent via a private delivery firm and had not been stamped with the date it had been posted. Mrs C went to her medical practice and a receptionist phoned the hospital to rearrange the appointment.

The board wrote to Mrs C the next day to confirm the rearranged appointment time and date. Mrs C received the letter two days later. The envelope was marked first class and had two Royal Mail first class stamps on it. She attended the appointment four days later, but returned home to find another letter inviting her to the appointment. The letter had been dated six days earlier. It had been sent via the private firm and had not been stamped with the date it had been posted. The letter said that if she failed to keep the appointment without notifying them in advance, she would not necessarily be given another one.

Mrs C did not receive the two appointment letters posted via the private firm until after the appointments were due to be held. In view of this, we upheld the complaint. In addition, we found that Mrs C had told the board that she was deaf. However, in their response to her complaint, they said that she should phone them if she had any questions.

Recommendations

We recommended that the board:

• carry out a further audit of the time taken for letters posted via the private delivery firm to arrive and take appropriate action on the results of this audit;
• provide clarification to staff on when first class Royal Mail/private delivery postage should be used; and
• issue a written apology for stating that Mrs C should contact the complaints team on the phone number provided if she had any questions, despite the fact she had told them she was deaf.

Summary

Mr C complained on behalf of his father (Mr A) about the care and treatment he received when he was admitted to hospital three times over a period of about eleven days. Mr A had a history of high blood pressure and arthritis, as well as a history of heavy drinking, for which he was being treated by his GP with Antabuse (a drug that causes an unpleasant reaction when taken with alcohol). Mr A was taken to hospital after suffering a seizure. He was complaining of shaking in his right arm and leg, speech disturbance and confusion, and had a three-day history of headache. He was admitted overnight for observation and investigation and was discharged the next day. Mr A's wife (Mrs A) and daughter went to collect him and felt that the attitude of the staff on the ward changed towards him when Mrs A mentioned that he was taking Antabuse. Despite Mrs A and her daughter telling staff that they thought Mr A was still confused and unwell, he was discharged.

Mr A was re-admitted to hospital later that night suffering from confusion and hallucinations. He was again kept in overnight and discharged the next day. Mrs A was told that his condition had been brought on by his previous lifestyle. The family said that Mr A remained confused and disorientated over the next week. He then suffered four or five fits at home and was taken by ambulance to the hospital, where he was again admitted. Mrs A phoned the hospital the next morning to ask if she could bring in some personal items for her husband at lunchtime, and was told that she could do so. However, when she phoned again at 11:45 she was told that Mr A had been discharged some ten or 15 minutes previously.

Mrs A and a friend went to the hospital and also reported to the police that Mr A was missing. He was later found sitting at the main entrance to the hospital dressed only in a vest, cardigan, jogging bottoms and slippers. He had a supply of medication with him that he had been given on discharge from the ward. He had no money with which to phone home or pay for a taxi. His family say he was generally confused and did not know what the supply of medicines he had were or when he had last had his regular medication. It was only after Mr C made a verbal complaint to the hospital that someone phoned and spoke to Mr A's daughter and explained the medication. The caller did not phone Mr C or respond to his verbal complaint as he had been expecting them to do. Mr C, therefore, made a written complaint but was dissatisfied with the response he received.

We upheld Mr C's complaints. Our investigation, which included taking independent advice from two of our medical advisers, found that while in general the investigations of Mr A's condition were reasonable, there were some deficiencies in the care and treatment provided. In particular, the discharge planning and documentation were inadequate. There were also insufficient arrangements made for Mr A to be followed up in the community after his discharge from hospital.

Recommendations

We recommended that the board:

• apologise to Mr A and his family for the failings identified;
• consider the introduction of structured pathways for patients presenting with complications of alcohol consumption to standardise appropriate treatment, discharge and follow-up; and
• ensure that all relevant staff are aware of and properly trained to apply the board's admissions and discharge planning guidelines.

Summary

Mr C said that when he consulted his dentist for the first time, she carried out an initial examination and told him he required six fillings. Three of these were carried out nine days later, but when Mr C returned to to have the remainder of the work done, he said that the fillings she had completed earlier were sensitive. The dentist replaced the filling in the tooth that she decided was the problem, and arranged a date for the rest of the work to be done. However, before returning, Mr C obtained a second opinion. He said he was told, after examination, that the teeth remaining to be filled did not require work. Mr C complained that dental work was carried out unreasonably when none had been required.

As part of our investigation we took independent advice from a dental adviser, who reviewed Mr C's dental records and relevant x-rays. We also looked carefully at the complaints correspondence. We upheld Mr C's complaint, as the adviser agreed that there was no evidence to suggest that Mr C required the number of fillings that had been suggested.

Recommendations

We recommended that the dentist:

• apologise to Mr C; and
• provide the Ombudsman with an undertaking that she will address the concerns raised in this complaint through her continuing professional development.

Summary

Mrs C's daughter (Miss A) has a rare disorder affecting her joints. Since 2010, Miss A has had the support of iCare (a subsidiary of the health board) a respite service for children and young people with complex needs. The care is delivered at home and, to qualify, clients need to meet six health indicators. Mrs C complained that, despite her daughter's condition being unchanged, she was told that Miss A would no longer qualify as her points score had reduced to five from six.

In investigating this complaint, we looked at all the available information, including the complaints correspondence and Miss A's relevant medical records. We also asked the board to provide more information about what had happened. The board in their comments said that they no longer provided Miss C with any health intervention and that she was continent. They added that she could move independently in her electric wheelchair. The board said that Miss C's points had reduced to reflect the change in her mobility.

Our investigation confirmed that Miss C's condition was unchanged and that it would not improve. We found that she was not continent although her incontinence was managed with the use of pads. The level of support from other agencies had been the same since 2010. We found that it was not clear what health intervention had ever been provided to Miss C. Furthermore, Miss C had had the use of an electric wheelchair for many years which she had been able to operate herself.

Although we agreed that it was for the board to set qualifying criteria in the face of competition for finite resources, the assessment of individuals under these should be transparent and ensure visible fairness to all. No guidelines had been provided to show how the staff concerned assessed Miss C's health needs. We upheld the complaint and made a recommendation to address this.

Recommendations

We recommended that the board:

• create appropriate guidelines for the assistance of staff when assessing care requirements and reassess Miss C accordingly.

Summary

Mrs C complained on behalf of her son (Mr A), who was admitted to hospital on a voluntary basis to try to address his obsessive-compulsive disorder (OCD - an anxiety disorder where a person has obsessive thoughts and displays compulsive behaviour). Among other things, Mr A found it very difficult to share toilet facilities with other people, including his family. He was admitted to a mixed-sex dormitory-style ward, where there were only a few single rooms with private toilets. These rooms were allocated on the basis of clinical necessity. Although at times one or more of these rooms was vacant while Mr A was on the ward he was not allocated one, despite his and his mother's requests. Mr A became dissatisfied with his care and treatment, and discharged himself against medical advice. Mrs C later complained that her son did not receive appropriate care and treatment while he was on the ward. She said that he was not allocated a single room with private facilities, so instead he used bedpans, which were not emptied frequently enough; a doctor did not listen to Mr A during a review; and, when Mr A discharged himself, he was told that he would not get his medication.

When we investigated, the board told us that they decided to place Mr A on the ward on the basis of a clinical assessment that providing him with access to private facilities would not help him address his OCD. Our investigation, which included taking independent advice from one of our medical advisers, found that this was a reasonable decision. However, the adviser considered that allowing Mr A unlimited and unsupervised access to bedpans was in fact counter-productive. We found no evidence that the disposable bedpans used were not regularly disposed of, but noted that the board also said that Mr A sometimes hid used bedpans or would only accept assistance to dispose of them from certain staff and would wait until they were on duty.

Similarly, we found no evidence that the doctor involved in the review talked over, or would not listen to, Mr A. Where versions of events differ, and without truly independent evidence to support either version, we cannot prefer one version over another. We did find evidence that Mr A was very keen to discuss certain issues, mainly to do with dissatisfaction with some staff members, but that the doctor did not pursue these. It is possible that Mr A may have perceived this as not being listened to or being talked over. On the matter of medication, a series of appointments with a psychologist had been made, the first of which was to be on the day after Mr A discharged himself. He was issued with only 24 hours worth of his regular medication, in the hope that this would encourage him to keep the appointment. Unfortunately, he did not. Our adviser considered, however, that it was reasonable to only dispense a limited amount of medication in these circumstances. There was no evidence that Mr A was refused medication or only proved with medication on condition that he signed the discharge form.

Overall, however, as we found little evidence of the type of structured, supportive and focused care plan that we would have expected to address Mr A's complex condition and behaviours, we upheld Mrs C's complaint and made recommendations to address the failings our investigation found.

Recommendations

We recommended that the board:

• provide appropriate training to enable multi-disciplinary team working to be supported by cohesive and structured care plans that are appropriately recorded in a patient's notes;
• monitor the implementation of the 'Ten essential shared capabilities for mental health practice' training to ensure that relevant rights-based and recovery-focused care is being provided; and
• apologise for the failings identifed.

Summary

Ms C complained about the treatment her daughter (Miss A) had received from the Child and Adolescent Mental Health Service (CAMHS). She said that they had not responded soon enough when she and her daughter had expressed concerns about Miss A. Miss A experienced a significant deterioration in her eating behaviour, which coincided with a planned break from treatment, and a change in treatment staff. Ms C told us that she was concerned about her daughter's behaviour and weight loss, and while the staff did respond, by the time Miss A was referred to a specialist unit, she had to be hospitalised for re-feeding before she could receive treatment for her eating disorder. She felt that this significant deterioration in her daughter's health could have been avoided.

As part of our investigation, we sought independent advice from one of our medical advisers. Having taken this advice, we upheld Ms C's complaint on the basis that, while community-based approaches to eating disorders can be effective, they require a strong working relationship between family and staff. This should be in place before the situation becomes critical. Given the absence of such a relationship, the community-based approach was unlikely to be effective in Miss A's case. The absence of a risk assessment also meant that there was less scope for staff to correctly assess the situation when it became critical, and act accordingly. The family had to wait for over a month before Miss A was referred to a specialist unit, and during this time her weight loss continued and her condition deteriorated. We agreed that this could have been avoided if an eating disorder risk assessment had been in place.

Recommendations

We recommended that the board:

• develop a clear CAMHS protocol about the risk assessment of eating disorders;
• consider developing clear CAMHS guidelines on what situations merit priority and specialist referral; and
• provide information which will assure the Ombudsman that systems are in place within the CAMHS team to ensure that handover (including risk assessment) between health professionals is robust and documented to the standards required.

Summary

Ms C has type 2 diabetes. In July and August 2012 she attended, or was admitted to, hospital five times with swollen, painful legs. Deep venous thrombosis (DVT - a blood clot in a vein) was discounted and she was ultimately diagnosed as having cellulitis with some pitting oedema (an indentation on the skin that persists for some time after the release of pressure). After her last discharge, her GP advised her to stop taking the medication she had been prescribed, as she had neither DVT or cellulitis. He prescribed diuretic tablets (drugs that enable the body to get rid of excess fluid) which, Ms C said, remedied the problem. Ms C complained that the board failed properly to diagnose her condition and that she had been wrongly treated for cellulitis. She said that if the correct diagnosis had been made earlier, she would have improved sooner and spared unnecessary pain.

As part of our investigation, we obtained independent advice from one of our medical advisers. We carefully considered all the complaints correspondence and Ms C's relevant clinical records. The adviser said that, while the treatment given to Ms C was not unreasonable, overall there appeared to be a lack of clinical awareness. He said that although, throughout, she had pitting oedema, which indicated that diuretic therapy should be tried, it was not. The adviser said that if this had been tried earlier, it would likely have resolved Ms C's problem.

Recommendations

We recommended that the board:

• apologise to Ms C for failing to appropriately assess and treat her; and
• conduct a critical incident review into the circumstances in this case.

Summary

Miss C owed the university money because she had withdrawn from her course. She complained to the university about the way that a debt agency working on their behalf handled the recovery of her debt. She also complained that the university had not dealt adequately with her complaints and that communication from them was inappropriate.

We upheld Miss C's complaints. Our investigation found that she had raised several concerns with the university about the agency's handling of the debt recovery, but the university declined to respond to these and told her to continue dealing directly with the agency. We also found that the university's handling of Miss C's complaint was poor. We found that they failed to confirm receipt of her communications, missed agreed deadlines and provided inconsistent information. In addition, they sent communications to Miss C at an incorrect address and email account, even though she had provided the correct information.

Recommendations

We recommended that the university:

• apologise to Miss C for instructing her to continue to deal with the debt recovery agency;
• take appropriate action to reach an agreement with Miss C about repayment of the outstanding fees;
• apologise to Miss C for their unreasonable handling of her complaint;
• share our decision letter with relevant staff to remind them of the importance of timely responses to complaints, and of the need to explain and apologise to complainants if exceptional circumstances create delays in response; and
• review their procedures for assuring that external agencies acting on the university's behalf meet the relevant service standards, including putting in place monitoring arrangements.