Upheld, recommendations

Summary

C complained about the care and treatment they received from the board when they were seen during pregnancy for symptoms of pain and bleeding. C had a colposcopic assessment (a simple procedure used to look at the cervix, the lower part of the womb at the top of the vagina), during which it was considered that there was no obvious cancer, but it was arranged for C to have a smear test (a test to check the health of the cervix) three months postnatally. C did not undergo the smear test and was later found to have cervical cancer. C complained that the board did not appropriately investigate their symptoms; that the postnatal follow-up was not appropriate or timely; and that the need for postnatal follow-up was not reasonably explained to them. C was concerned that earlier diagnosis and treatment would have resulted in a better outcome for them.

We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in pregnancy, childbirth and the female reproductive system). We found that the symptoms of pain and bleeding were appropriately investigated during C’s pregnancy; however, the board should have arranged for C to have a colposcopy three months postnatally, as opposed to being invited for a smear test. We also considered that the requirement for postnatal follow-up was not reasonably explained to C. Though it was not possible to know if the cancer was present when C was three months postnatal, we accepted the advice we received that it was likely, and that had it been diagnosed and treated at that time, C probably would have had a better outcome. We upheld this aspect of C’s complaint.

C also complained about the board’s handling of their complaint. We found that the board had not addressed all of the issues C raised in their complaint, and that the complaint response was unclear as to the need for a postnatal colposcopy. We upheld this aspect of C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide them with reasonable care and treatment, and failing to respond to their complaint reasonably. 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:

• Postnatal colposcopy should be arranged in line with NHS Cervical Screening Programme: Colposcopy and Programme Management guidance.
• Requirements for follow-up care should be discussed with the patient and these discussions should be recorded.

In relation to complaints handling, we recommended:

• Complaint responses should address all relevant issues and should clearly explain the relevant clinical issues.

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 attended the board in relation to concerns about swelling to their neck area. C was eventually diagnosed with differentiated carcinoma (type of cancer) of the left parotid (salivary gland situated just in front of the ear) with extension to regional nodes and infiltration of the skin.

C said that the board, in particular the ear, nose and throat (ENT) department, failed to provide them with reasonable care and treatment in that the board failed to take their concerns seriously and there was a delay in their diagnosis.

The board’s position was that as soon as the ENT department were presented with symptoms which raised concern, these were acted upon immediately and appropriately to ensure that C was diagnosed quickly and that a plan for further treatment could be developed with C.

We took independent advice from an ENT adviser. We found that there had been failures in the care and treatment C received which led to a delay in diagnosis and treatment, including: a delay between having an ultrasound scan and C being seen in clinic; interpretation of that ultrasound scan and a failure to appreciate the relevance of the time delay to the scan appearances; the classification of C’s referral which should have been classed as urgent; and C’s discharge from clinic and lack of follow-up appointment. We found that the board did not provide reasonable care and treatment to C and upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide reasonable care and treatment. 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:

• Consideration should be given to providing follow-up appointments for scan results if concerns are raised by the findings. If ENT patients are discharged prior to investigation results being available, there should be an audit trail to show what action has been taken.
• Patients should be diagnosed in a timely manner. In doing so, clinicians should take into consideration relevant guidance, paying particular attention to any symptoms which would be considered ‘red flag’, and triage referrals as urgent where required.
• When considering investigation findings, clinicians should ensure that they take into consideration all relevant factors. This should include the time elapsed from initial presentation/presentation at time of referral and any delays.

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 to the board about the circumstances whereby their late parent (A) was a patient at Forth Valley Royal Hospital. A had been admitted after suffering a stroke (a serious medical condition that happens when the blood supply to part of the brain is cut off). A also had delirium and a background of dementia. Whilst an in-patient, A suffered a fall. Staff were aware that A had to be supervised and to be accompanied at all times when they were out of bed. However, despite being under close observation, a contracted nurse allowed A to remain in the toilet unsupervised and they sustained a fall which resulted in a severe head injury and subsequently A’s death. C believes that A should not have been left unattended and that, had that been the case, the fall may have been prevented.

We took independent advice from an appropriately qualified adviser. We found that staff at the hospital had carried out a comprehensive falls risk assessment in regards to A and that A was not to be left unsupervised. It was felt that A had no awareness regarding the use of the call bell system (a button or cord found in hospitals that patients can use to alert hospital staff of their need for help). However, a nurse had stepped out of the toilet to afford A some privacy and A attempted to rise from the toilet unaided and suffered a fall. Although the record-keeping regarding the falls risk was completed to a good standard, there was a breakdown in communication between permanent staff and the contracted nurse about the specific level of observation required for A. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure in communication. 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:

• Staff should ensure that when passing information to others that full details of the levels of observation required are understood.

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 developed severe left arm pain and 'pins and needles' in the fingers of their left hand. Around a year later, C began to experience the same problems with their right side. Their GP was concerned their symptoms were bilateral and they urgently referred C to the board's neurosurgery service (specialists in surgery on the nervous system, especially the brain and spinal cord).

C complained that the board failed to respond to their GP referral in a reasonable manner. In particular, that the board unreasonably downgraded the urgency of the referral. During our investigation, we took independent advice from a specialist in orthopaedic medicine (the treatment of diseases and injuries of the musculoskeletal system).

We found that C did not have any red flags or signs of a serious underlying condition so they did not require to be seen urgently. We also found that C's referral was appropriately redirected to orthopaedics. However, we noted that there was an unreasonable delay (over five weeks) in telling C's GP that their referral had been vetted and redirected. In light of this delay, we upheld the complaint. We also found that the board did not adequately respond to C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the delay in responding to C's GP about their urgent referral and for not adequately addressing their complaint. 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:

• If an urgent referral has been redirected, there should be timely communication with the GP so patients can be updated.

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 their relative (A), a student at the university. A is blind and has arrangements in place to digitise course materials. A attended a law fair hosted by the university to allow students to meet prospective employers. A received a number of leaflets from law firms present and submitted these to the university for digitisation. Having not received any response to this request, C complained to the university, who informed them some months after the initial request that they did not consider responsibility to digitise the materials lay with them and that instead it was the responsibility of the law firms who provided them. They returned the leaflets around six months after initially receiving them. C complained to us that the university had mishandled the request for digitisation due to delay and refusal to accept responsibility. C said that, due to the time that had passed, A had missed out on internship opportunities detailed in the leaflets.

We concluded that the question of responsibility for providing the materials in an accessible format was a complex one, which could likely only be resolved through the courts. Regardless, we considered that there had been an unreasonable delay in handling the request and returning the leaflets. As such we upheld the complaint.

We also identified that the university had failed to reasonably handle C's complaints about the matter, as they did not adhere to the timescales for complaints and ultimately refused to investigate the matter fully.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and A for failing to respond within a reasonable timeframe and for mishandling C's complaints. 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:

• Where the university do not consider they are responsible for digitisation of materials, the student requesting this should be made aware and the materials in question should be promptly returned.

In relation to complaints handling, we recommended:

• All complaints should be processed in line with the requirements of the Model Complaints Handling Procedure.

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 to the council for a row of trees neighbouring their property to be removed or reduced in height under the High Hedge (Scotland) Act 2013. This application was refused, as the council did not consider that the trees constituted a hedge under the terms of the Act.

Following new guidance issued by the Scottish Government in 2019, C contacted the council, as they considered this guidance was relevant to their circumstances and suggested that the trees in question should be considered a hedge. The council did not signpost C into the high hedge process, responding that they did not agree and that the original decision should stand.

C then complained to us, as they considered that the council had not had due regard to the new guidance and because there was an inaccuracy in the council's ongoing position regarding the number of trees present.

We found that the council had failed to follow due process, effectively pre-judging their decision before carrying out investigations into the circumstances, and also considered that the council had failed to reasonably explain their position. The evidence also supported C's claim that the council's assessment of the number of trees present was inaccurate. We upheld C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to signpost them to their high hedge application process or sufficiently respond to the points C raised with them. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Provide C with details of how they can submit an application, should they wish to do so, along with reassurances that this will be considered on its merits, once those have been reasonably investigated and established.

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

• Access to the high hedge application process should be provided, where requested, and sufficient explanations should be provided when the council are explaining their consideration.

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, a support and advice worker, complained on behalf of their client (A) that the council had unreasonably failed to provide A with kinship care assistance, including financial support. A became the carer to their family member (B) when B's parent was unable to care for them. The council initially advised A that a kinship care assessment would take place and that A would receive a kinship care allowance. The council then changed their position. They advised that from the outset, A was clear that they would care for B should B's parent be unable to do so. As a result, their view was that B was not at risk of becoming 'looked after' (a looked after child is a child under the care of the council) and that an assessment was therefore not required and no financial assistance would be provided.

C challenged this decision, stating that B could be considered to be at risk of becoming looked after. This would mean that B could be classed as an eligible child, which would allow kinship allowances to be paid.

We took independent advice from an adviser with a background in social work and children and family services. We found that the council had not carried out an appropriate assessment to determine whether B was at risk of becoming looked after. The council had largely based their decision-making on statements made by A. We considered that these statements were not adequate evidence that B was not at risk of becoming looked after. We noted that the council's initial actions indicated that they did consider B was at risk of being looked after. In particular:

it was the council who approached A in the first instance to discuss kinship care and what was involved

the council was involved in placing B with A

there was no evidence of a clear discussion regarding the family making their own arrangements

B would have to be accommodated as a looked after child if A did not agree to care for them.

We noted that the council had apologised for indicating that A would receive kinship allowance and then changing their position on this. However, we were concerned that the council had not reflected on why these communication issues occurred or the impact that this had on A. In light of the above, we upheld C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for not carrying out a kinship care assessment which would have clearly identified whether they were eligible to receive kinship allowances in respect of B. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Complete a full kinship care assessment, in line with relevant guidance, should A still want one to be carried out. As far as possible, consideration should be given to the circumstances of the household when the assessment was originally due to take place, not just the current circumstances. If, following the assessment, B is deemed to be eligible:
• any kinship allowance should be backdated to when it would have commenced had the original assessment taken place
• an assessment should take place regarding the local authority paying a contribution towards A's legal costs in respect of obtaining the residence order
• an assessment should take place regarding the provision of a financial allowance in respect of the residence order, backdated to when the allowance would have commenced following A being granted the residence order.

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

• Assessments should be carried out in order to determine whether a child is at risk of becoming looked after.

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 their family member (A) in relation to a number of aspects of the social work service provided to A's family. A is the parent of two children who are in temporary foster care. C raised concerns about poor communication, the council continuing to use inaccurate reports (despite agreeing to amend these) and the council's handling of their complaint.

We took independent advice from a social worker. In relation to C's concerns about communication, we found that a number of aspects of the council's communication were reasonable. However, we found that the council did not provide A with adequate updates or explanation for the delay in arranging a court date for a hearing in relation to the placement of A's children. On this basis, we upheld this aspect of the complaint.

Regarding C's concerns about the accuracy of reports provided to the Children's Reporter (a person who makes decisions to help young people who need care and protection), we found that the council, as author and owner of the report, retained responsibility for the content. We noted that the council should ensure the accuracy of the reports provided and make reasonable attempts to correct the record when information previously provided is known to be inaccurate. We upheld this aspect of the complaint.

Finally, we found a number of failings in the council's handling of C's complaints. We identified investigation delays and issues with the council's communication about timeframes. We also found that some points of complaint were not addressed in the response, whilst other points had not been investigated thoroughly enough. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for not providing adequate updates or explanation for the delay in arranging a court date (and provide an explanation for the delay). Apologise for failing to take appropriate steps to ensure the accuracy of reports provided to and circulated by Scottish Children's Reporter Administration and the complaint handling failings. 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:

• Consistent with the Scottish Government's guidance, parents with parental rights and responsibilities should be given timely information and be involved in decision-making to the maximum amount consistent with the child's welfare.
• The council should ensure that information within social work reports are accurate, including reasonable attempts to correct the record if the council becomes aware of other organisations relying on outdated or inaccurate versions.

In relation to complaints handling, we recommended:

• Where possible, complaints should not be allocated to an investigating officer on annual leave. Where this cannot be avoided, the complainant should be updated and given an extended deadline for the response. The council should respond to all points of the complaint and give an apology and explanation where it is accepted things have gone wrong. Complaint investigations should take into account any relevant policies and procedures and assess whether the council's actions complied with these.

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 council did not reasonably assess their application for a Blue Badge (a badge issued to disabled drivers for display on their windscreens, indicating entitlement to specific parking privileges). C applied for a Blue Badge as they suffer from fibromyalgia, amongst other conditions, but noted that due to the variable nature of their condition, it was difficult to answer the questions in the council's application form and considered that they should have received an in-person mobility assessment. C's application for a Blue Badge was refused and the decision to refuse was upheld on review. We found that there was not sufficient evidence for the council to have reasonably assessed C's application in line with The Blue Badge Scheme (Scotland) Code of Practice, and therefore did not adequately demonstrate that a clear and robust decision was made on C's eligibility as the result of the desk-based assessment. We also found they did not explain their decision to refuse C's application in line with the Code of Practice. As a result, we upheld this aspect of C's complaint.

C also complained that they did not received a reasonable response to their complaint from the council. We found that, while the council conducted an appropriate level of investigation into C's complaints, they failed to properly identify, and therefore adequately address, the crux of C's complaints in their responses. We also found that C was not contacted when the complaint response was delayed, which was not in line with the Model Complaints Handling Procedure. We upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failures identified. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Assess a new application from C in line with the Code of Practice and provide a clear and robust decision.

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

• Assessors should fully demonstrate in desk-based assessment forms that they have made a clear and robust decision on eligibility, and considered the factors relevant to an applicant's ability to walk, in line with the Code of Practice. Applicants applying under the 'unable to walk or virtually unable to walk' eligibility criteria should be referred for an independent mobility assessment if the local authority is unable to make a clear and robust decision on eligibility using cross-checking or desk-assessment, in line with section 4.18.2 of the Code of Practice. Local authorities should clearly state in their letter to unsuccessful applicants why their application has been refused, stating why they did not meet the criteria, in line with section 6.2.7 of the Code of Practice.

In relation to complaints handling, we recommended:

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

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, an advocacy and support worker, complained on behalf of their client (A) about Self Directed Support (SDS) decisions made by the partnership. A's family had arranged for carers from an agency, which provides carers on a self-employed basis, to provide care to their family member (B). A asked for an SDS assessment to be carried out in order for contributions to the cost of carers to be made by the partnership. Several months later, the partnership told A that the request for SDS payments had been declined on the basis that the local policy advises employing personal assistants, rather than self-employed workers.

During their complaints investigation, the partnership acknowledged and apologised that there had been a delay in communicating their position. They also confirmed to us that they had updated their guidance to make their position on engaging self-employed carers more clear; and that staff training had been carried out on this matter.

We considered that the failure to notify the family of the issues regarding self-employed carers at an earlier stage was unreasonable. We also considered that the explanation provided to the family could have been clearer. On this basis, we upheld this aspect of the complaint.

In terms of actions taken by the partnership, we found that the updates made to the guidance were appropriate, but made a recommendation to ensure that all associated guidance such as practitioner's guides fully reflect the position. We also recommended that the partnership provide a further apology to the family and that they provide evidence of the staff training carried out.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for failing to communicate reasonably with them regarding SDS options and payments. 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:

• Families should be informed at the earliest opportunity of any issues or concerns which may impact on their ability to receive SDS payments.
• The guidance should be clear about the partnership's position on using SDS payments for self-employed carers.

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.