Upheld, recommendations

Summary

C complained to the board about the treatment which they received when they attended the out of hours service (OOHS) at Aberdeen Royal Infirmary. C said that they had already reported problems with back pain and loss of feeling to their GP practice. However, the OOHS doctor who attended to C did not conduct examinations or arrange investigations such as a scan, and told C to see their GP the following day. C was taken by ambulance to hospital the following day and, after a CT scan, they were diagnosed as having cauda equina syndrome. C felt that the doctor at the OOHS should have completed a more thorough examination and that the correct diagnosis would have been reached sooner and would not have had such a drastic effect on their health.

We took independent advice from a GP. We found that that although the OOHS doctor obtained a good history from C and conducted a reasonable examination, they failed to action C's progressive neurological symptoms and new onset bladder problems. These required referral for an orthopaedic (conditions involving the musculoskeletal system) opinion or further investigations that day. Therefore, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure of the OOHS GP to fully consider the red flag symptoms presented which indicated the possibility of developing cauda equina syndrome. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The OOHS GP should ensure that when red flag signs are evident when a patient presents that they conduct a full examination and consider whether an urgent referral to a hospital specialist is appropriate. In addition, the OOHS GP should discuss this complaint at their annual appraisal.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the medical and nursing care that their late parent (A) received at Forth Valley Royal Hospital. Regarding A's medical care and treatment, we took independent advice from a general and colorectal (bowel) surgeon. We found that reasonable action was taken to assess A's cardiac murmur (unusual sounds made by turbulent blood in or near the heart). However, following the exclusion of malignancy or an acute surgical issue, it would have been reasonable to involve a more specialised team involved in the care of the aged. It was reasonable that the board made a referral to the Aging and Health department in the circumstances. However, we found that it was unreasonable that this specialist review did not take place (which may have provided a different perspective on A's symptoms). We noted that the board had already acknowledged and apologised for this failure and had described that the board took reasonable action to address this. We upheld this aspect of C's complaint and requested evidence of the action the board had taken.

Regarding A's nursing care, we took independent advice from a nursing adviser. We found that the assessment and control of A's pain was reasonable and that there was evidence that A's pain level was regularly assessed and that a review of their nursing notes did not indicate that A was in pain for most of their in-patient stay. However, we also found that it was unreasonable that A's fluid intake and output were not monitored using a food balance monitoring chart given their overall condition, cognitive issues, feeling of nausea, low blood pressure, swollen legs and that they had been receiving IV fluids. Therefore, we upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for not monitoring A's fluid intake and output appropriately using a fluid balance monitoring chart. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Fluid balance monitoring charts should be used to monitor fluid intake and output, particularly where the patient has cognitive issues, feelings of nausea, low blood pressure, swollen legs or have been receiving IV fluids.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C has Crohn's disease (a condition where parts of the digestive system become inflamed) and had received various treatments, including two previous surgical procedures to remove lengths of small bowel. C attended Forth Valley Royal Hospital with abdominal pain. A CT scan showed inflammation of the ileum (a portion of the small intestine) at the site of the joint that had been created by the previous bowel resection (partial surgical removal of an organ). The decision was made to operate as an elective procedure (surgery that is scheduled in advance because it does not involve a medical emergency). The operating surgeon considered the length of small bowel identified on previous imaging was not causing an obstruction, and decided not to remove it. C continued to experience difficulties following the surgery, including a number of further hospital admissions.

C complained that the care and treatment they received from the board was unreasonable. We took independent advice from a general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that, while the level of investigations carried out were reasonable, a midline incision (a vertical cut made in the abdomen to allow access for a medical procedure) should have been performed in C's case. We noted that if a midline incision was employed, then it is likely that the resection would have been carried out as planned. We were also critical of the level of documentation provided by the board. As a result, we upheld this element of the complaint.

C further complained that the communication they received from the board was unreasonable. We found that there was no evidence to show that appropriate explanations were given to C following the surgery, and no evidence to demonstrate the board's clinicians effectively communicated with C about their condition. As a result, we upheld this element of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings this investigation has identified. The apology should meet the standards set out in the SPSO guidelines on apology available at HYPERLINK "http://www.spso.org.uk/information-leaflets" www.spso.org.uk/information-leaflets .

What we said should change to put things right in future:

• Clinicians must communicate effectively with patients, and make adequate records of these communications.
• The board should have appropriate pathways in place for the management of Crohn's disease, to ensure surgery to address this condition is carried out appropriately.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the length of time they waited for gallbladder surgery. They had two emergency admissions to hospital without surgery being carried out and had been placed on the waiting list for surgery after their second admission. C said that they were left in chronic and excruciating pain and considered the surgery should have been carried out on an emergency basis. They considered the length of time that they were waiting was unreasonable. As a result, C had the surgery carried out privately.

The board said that it was reasonable to postpone surgery each time C was admitted to hospital because their gallbladder had been inflamed. C was seen and allocated to the surgery waiting list. C's surgery would have been carried out within current NHS waiting times.

We took independent advice from a colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that C should have been regarded as a high priority case given their symptoms had led to two emergency admissions and, after each admission, they should have been offered an early appointment for surgery once the inflammation settled. Instead, due to an administrative error, an initial follow-up appointment was not offered after the first admission. After the second admission, C was added to the waiting list with no indication as to when their surgery would take place.

We found that the board had failed to arrange C's gallbladder surgery within a reasonable timeframe and, therefore, we upheld C's complaint. We took into account that the cost of the private treatment was partly due to the board's failings and also partly due to a private decision by C. In the specific circumstances, we recommended that C be reimbursed to the extent which the surgery would have cost the board.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the unreasonable delay in the time that they waited for gallbladder surgery and not communicating more clearly with them about this. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Reimburse C for the amount that the operation would have cost the board. The payment should be made by the date indicated; if payment is not made by that date, interest should be paid at the standard interest rate applied by the courts from that date to the date of payment.

What we said should change to put things right in future:

• Management of emergency admissions for patients with cholecystitis should be reviewed so that treatment for the diagnosis and management of gallstone disease is based on National Institute for Health and Care Excellence (NICE) guidance, in particular, when an early cholecystectomy should be considered. A clear treatment path should be in place for patients whose surgery must be delayed because of acute clinical factors (such as a chest infection). For patients whose surgery must be delayed because of acute clinical factors, there should be clear communication with the patient as to when they can expect to have their surgery.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C complained about the university regarding the handling of two complaints she had made, both of which were about the management of her course and the university's handling of reasonable adjustments to take account of her needs as a disabled student. On investigation, we found that there had been lengthy delays in the handling of both complaints, requiring considerable prompting from Ms C in order to be updated and eventually receive a response. We also found that the content of the second complaint response was unreasonable, as it had failed to respond to all of the complaints made, including some about sensitive disability issues. On this basis we considered that both complaints were unreasonably handled and upheld the complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to handle her complaints in line with the complaints procedure and failing to fully respond to her second complaint. The apology should met the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• All relevant staff should be aware of their equality responsibilities and make the reasonable adjustments agreed in students' Personal Learning Support Plans.

In relation to complaints handling, we recommended:

• All complaints should be handled in line with the complaints procedure and responded to in full.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of a family member (A), who was a disabled student at the University of Glasgow.

C was unhappy with the university's assessment of A's IT and assistive technology needs. C considered that the equipment and software recommended following the assessment were unsuitable and ineffective. We found that the documentation from the assessment included insufficient detail about how the equipment and software recommended for A was suitable for their needs. We also found that the university did not act appropriately once concerns were raised about one of the devices. We upheld the complaint and made recommendations.

C also complained that the university failed to make appropriate provision for A to attend an employability event. A was unable to attend the event as they did not have support in place in time. C felt the university were responsible for this. The university upheld C's complaint in part and acknowledged that someone should have approached A about whether they would like to attend the event. We were satisfied that the university had taken steps to prevent a similar issue. We upheld C's complaint and recommended an apology.

C had concerns that the university failed to treat C and A with an appropriate level of dignity and respect. The university partly upheld C's complaints in relation to this matter and made a number of recommendations. We noted that the complaint related to challenging and sensitive issues for both C and A, as well as the members of university staff involved. We were satisfied that the matter was investigated robustly by the university. We found an apology had been provided and that appropriate action had been taken in relation to the issues identified. We upheld the complaint, but did not make recommendations.

C also had concerns about the arrangements made in anticipation of A's exam diet and in relation to the way the exams were conducted (including provision of breaks and access to water). We found that, in the weeks leading up to the exams, there was a failure to respond to C and A's correspondence which led to a missed opportunity to fully explore exam arrangements within good time of the exam diet commencing. We noted that there was limited evidence in relation to the way the exams were managed. We considered that it would have been appropriate for clearer instructions about breaks and water to have been provided to C. We upheld the complaint and made a recommendation.

Finally, we considered the university's handling of C's complaints. We found that the university had inappropriately responded to some complaints at stage 1, as the complexity of the complaints meant that direct investigation at stage 2 was more appropriate. We also found instances where the university did not manage the timescales at stage 2 appropriately and we noted in one case that there was a substantial delay in the university accepting a complaint for investigation. We made a recommendation in view of our findings.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A that the documentation from the needs assessment included insufficient detail about the IT recommendations; the university did not act appropriately once concerns were raised about the equipment recommended; the university failed to make appropriate provision for A to attend the employability event the university failed to respond to C and A's correspondence which led to a missed opportunity to fully explore with them the exam arrangements within good time of the exam diet commencing; and there were inappropriate delays in complaint handling. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Documentation of a needs assessment should provide a clear rationale for the recommendations. Where the recommendations involve substantial expenditure, the university should seek assurance of the suitability of any equipment once delivered and support a student to return it if needed.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the Model Complaints Handling Procedure for Higher Education.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C submitted an application for an escorted day absence (EDA) to visit their parent who is unable to leave home or travel because of poor mental health. The prison refused C's application on the basis that there were no exceptional circumstances in which to support the visit. C was offered the option of being transferred to another prison for the purpose of receiving a visit from their parent.

In complaining to this office, C said that the prison had not given clear reasons why their request had been refused, or why they considered there were no exceptional circumstances to support the application.

According to the relevant legislation prison governors and directors have the discretion to grant an EDA application if satisfied that the purpose of the application is genuine and appropriate; this office cannot challenge this discretion. However, even where there is discretion, such decisions must be based on the available evidence, and decisions should be clear and well explained.

We found that the prison failed to properly consider the facts presented in C's application. We also found that there was a failure to properly and fully explain the reasons for the decision taken to refuse C's application. As such, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to appropriately consider their application for escorted day absence. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Review C's application again and communicate the outcome clearly and properly explaining the reasons for the decision reached.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C made an application for escorted day absence (EDA) to visit their father at home on the grounds that he was dangerously ill and had been deemed medically unfit to travel to the prison. The prison refused C's application. They said that due to C's prison status they had been unable to risk assess the potential of a home visit and offered C a contact session with their father at another prison. C said that the prison had failed to give proper consideration to their father's circumstance and raised a formal complaint through the prison complaints process. In response to the complaint, the prison explained that due to reasons pertaining to C's prison status, and also that C's father was not considered dangerously ill, the application could not be approved at that time. C complained the prison had not given clear reasons why their request had been refused or why they did not consider their father to be dangerously ill when they had provided a letter from their father's GP in support of their application.

We found that the prison had followed the correct EDA procedure, criteria and prison rules in exercising their discretion to refuse C's application (Rule 101 The Prisoner and Young Offender Institutions (Scotland) Rules 2011). However, they had failed to clarify on what grounds C's application was being considered and had inaccurately considered C's prison status as an exceptional circumstance. We found the reasons that had been provided to C in both the EDA decision form and the complaint response were confusing and not relevant, and the prison had failed to properly explain or provide evidence in support of their decision. We also found there had been an unreasonable delay in the prison communicating the refusal of the EDA application to C.

Our investigation concluded that the Scottish Prison Service failed to appropriately consider C's EDA application, therefore, we upheld the complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide a clear explanation as to the reasons C's application for escorted day absence was refused. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• In considering applications for escorted day absence, steps should be taken to clearly establish the legislative grounds/criteriaon which the request is being considered.
• In making decisions for escorted day absence, reasons should be clearly explained and well evidenced.

In relation to complaints handling, we recommended:

• In making decisions on prisoner complaints, reasons should be clearly explained and well evidenced.
• Exceptionally sensitive or complaints of a serious nature should be considered and responded to by the Governor. Where this is not possible, clear reasons/explanation should be provided.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the council's social work department's handling of child protection concerns that were raised about their children and their subsequent removal from the family home. C was not at home at the time and said that they objected to the decision. C complained that their spouse also did not give consent to the children being removed and, therefore, the appropriate powers were not used to remove the children.

The council said that they understood that C's spouse had given their verbal consent to the children's removal; however, they acknowledged there was a failure to prepare the necessary paperwork prior to visiting the children's home.

As part of our investigation, we reviewed the relevant case records and took independent social work advice. We found that there were failings to properly obtain consent, that there was confusion over the legislation being used to remove the children and that there was a failure to explain to either C or their spouse what the legislative framework was. We found that the council failed to follow their child protection procedures and, therefore, upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to correctly follow their child protection procedures. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The council should undertake further reflection on the findings of this investigation, taking into account in particular the summary of points we provided and implement relevant learning and improvement. This could involve a review of internal procedures and/or additional training for staff.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained that the partnership had unreasonably failed to provide C with kinship care support in line with their obligations. C became the carer for their family member (A) when A's parent was no longer able to care for them.

We took independent advice from a social work adviser. We found that the partnership had not published information about their application process for kinship care assistance in accordance with the relevant legislation and guidance and had failed to advise C how they or A could apply for a kinship care allowance. We upheld C's complaint that the partnership had unreasonably failed to provide C with kinship care support in line with their obligations.

C also complained that the partnership had failed to provide A with transition support. Following independent social work advice, we found that a referral to an appropriate support scheme should have been made. We also upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and A for failing to publish information about the local authority's application process for kinship care assistance, failing to advise C or A how they could apply for a kinship care allowance, and failing to refer A to the 16-25 Young People in Transition Scheme. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Advise C and A how they can apply for a kinship care allowance.
• Check if A would still like to be referred for an assessment with a view to providing support under the relevant legislation and if so, make this referral.

What we said should change to put things right in future:

• Information about the local authority's application process for kinship care assistance should be published in accordance with Section 9 of the Kinship Care Assistance (Scotland) Order 2016.
• Information about the local authority's kinship care allowance application process should be provided to kinship carers or children in kinship care placements.
• Referrals to the 16-25 Young people in Transition Scheme should be considered for eligible vulnerable young people in need of support.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.