Upheld, recommendations

Summary

C, an advocacy worker, complained to us on behalf of their client (A). A and their partner agreed to care for their partner's two younger siblings, after their parent became seriously unwell. The children were on the child protection register (a list of children who are considered to be at risk of significant harm and who are subject to a child protection plan) and they had additional support needs. During our investigation, we took independent advice from a social worker.

C complained that the council delayed in contacting A, after the children went to live with them. We found there was an unreasonable delay in the council contacting A to provide them with advice and to discuss plans for the children's immediate and longer term care.

C complained that the council failed to visit the children weekly. We found that the council should have ensured the children received weekly visits from social workers while they were on the child protection register and that did not happen. We found there was a failure to properly seek the children's views and include them in the child protection case conferences and associated paperwork. We noted that the council considered that the children were no longer at risk when they went to live with A. We found that the council failed to appropriately gather information to assess the risk to the children before they decided to remove them from the child protection register. We also found that, if the council considered that the children were no longer at risk, the council should have held a review child protection case conference within the timescales set out in the national child protection guidance.

C also complained that the council failed to help support the children with their special education needs. We found that the council's social worker, as the lead professional, should have taken steps to co-ordinate the education aspects of the children's care and ensure this aspect of the child's plan was progressing.

Finally, C complained that the council failed to carry out a kinship care assessment and A was not given financial support for the children. We noted that the council had made payments to A that were the equivalent sum to a kinship care payment. However, we found that the council's timescales for completing the kinship care assessment was considerably outwith the timescales in the statutory guidance. We also found that the council's record-keeping was unreasonable, as the information was blended and it was not in chronological order.

We upheld all aspects of C's complaint and while we recognised that the council had acknowledged some of the failings and reflected on this, we made a number of recommendations to address the failings we found. We also made recommendations in relation to the council's complaint handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for the failings identified. 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:

• Child protection should be delivered within the context of the Getting It Right For Every Child (GIRFEC) framework so the views of the children should be listened to, considered and recorded.
• If the council concluded the risk to the children had been removed, they should have held a review child protection case conference within 21 days, with the involvement of local social work services.
• In child protection matters, it is important that social work records are clear, transparent and easily understood.
• In making decisions regarding the care and wellbeing of children, appropriate steps should be taken to gather information that is relevant to the assessment of risk.
• Kinship care assessments should be completed within an appropriate timescale, in line with relevant guidance and legislation.
• When children are on the child protection register, it is the lead professional's responsibility to co-ordinate action to meet their education needs and ensure the child's plan is progressing.
• When children are on the child protection register, their carers should be visited promptly in order to safeguard the children's wellbeing, health and development.
• When children are on the child protection register, they should receive weekly visits from social workers.

In relation to complaints handling, we recommended:

• Complaint responses should include an apology where things have gone wrong. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• The council should ensure that accurate responses are issued to our enquiries, which are based on the records as well as the evidence gathered during their complaint investigation.

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 was on a Compulsory Supervision Order (CSO) and in the care of their grandparents. When C became a care leaver, C complained to the council that they failed to provide the appropriate Throughcare and Aftercare. C said that the council wrongly advised that C was not entitled to any financial support and that they failed to implement a support system.

The council said that C did not always respond to social work contact, and following C’s complaint, they identified they had misunderstood the changes to their responsibilities with regards to financial assistance for care leavers.

We took independent social work advice. We found that the council incorrectly identified C’s status as not being an eligible young person in terms of Section 29 of the Children (Scotland) Act 1995 from the outset. This resulted in C not being provided with access to certain services. We also found there was a delay in putting in place a Pathway Plan. While the council did take steps to backdate a financial payment to C, we considered that they should have backdated the payment further to the point when C first contacted the service to ask for assistance. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to correctly assess the care leaver’s legal status and for failing to provide the appropriate Throughcare and Aftercare. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• The council should make the additional payment of Basic Living Allowance they proposed.

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

• Staff should be familiar with the relevant guidance and regulations and care leavers should receive clear information about the supports that are available to them.

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 a health centre complaining of chest pain. A doctor attended to C and an ambulance was called. The ambulance attended around an hour later and C was taken to hospital and diagnosed with Type B aortic dissection (a tear in the inner layer of the aorta, the large blood vessel of the heart) and admitted to the coronary care unit (a specialised hospital ward dedicated to caring for people with serious or acute heart problems).

C complained about the urgency of the care provided at the health centre and that the incorrect priority level of ambulance was requested initially. In response to the complaint, the partnership said that the doctor conducted all basic examinations and recordings required; they explained the circumstances with respect to doctor cover during lunch and confirmed a yellow priority ambulance was initially requested, but this was upgraded in response to C’s condition.

We took independent clinical advice. We concluded that the care and treatment provided to C in response to the chest pain was reasonable. However, following communications with the partnership, it was established that there was an error in arranging the correct priority of ambulance initially; when this was discovered the correct priority of ambulance was requested. We concluded that this error was unreasonable and we upheld the complaint on this basis only.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for initially requesting the incorrect priority of ambulance to attend for treatment. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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 care and treatment they had received from the board and that the board failed to communicate reasonably with them. C was diagnosed with breast cancer and felt they were not able to have a full discussion of the treatment options for their condition and that they were not being given the opportunity to make informed decisions about their care.

C sought a second opinion from a different health board and said they were offered a much fuller discussion of their treatment options, including some tests which were not offered by Tayside NHS board. C complained to the board about the differences in the treatments offered. C noted that the board appeared to be alone in not using a specific test and that their approach was outdated and not patient centred. C did not feel the board’s justification, that the test might cause anxiety amongst its patients, was in line with patient centred medicine. C also pointed to a Healthcare Improvement Scotland (HIS) report into practices within the board’s oncology (study and treatment of tumours) department. This had found areas for improvement, including communication with patients and the use of the test in question.

The board said they did not agree that the tests offered to C when they received their second opinion were necessary or required by clinical guidance. The board had accepted the findings of the HIS report, but did not agree that the test should have been offered in C’s case.

We took independent medical advice from a consultant oncologist. We found that the majority of oncologists would have offered the test in dispute, as it would have helped to guide discussions with C. In addition, the medical records did not record whether a detailed discussion was held with C about their treatment options. We found that C’s care and treatment had fallen below a reasonable standard as they were not able to have a full discussion of all the treatment options available to them and because they were not offered testing, which they could reasonably have expected to receive had they been patients of another health board in Scotland. We also found the standard of communication with C was not of a reasonable standard. We upheld both aspects of C's complaint. However, as communication with patients had been addressed by the HIS report, we did not make any recommendations in this regard.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to offer particular testing, or to discuss fully the treatment options available to them. 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 board should provide patients with copies of the letters from their clinics.

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 had been referred to the blood pressure clinic at the hospital by their previous GP practice, and when they did not hear from the clinic, they called their current practice to enquire about this. The practice told C that they had failed to attend an appointment at the clinic and that C was to contact the hospital in the first instance. C made enquiries with the clinic to be informed that they had indeed missed an appointment and that they should ask the GP for a further referral. C said they had not received the appointment letter.

We took independent clinical advice. We found that the practice had received notification by letter from the clinic that C had failed to attend an appointment and that should the practice deem C still required to be seen at the clinic, then they should initiate a further GP referral. We found that the practice should not have told C to contact the clinic as they were already aware that a further referral was required or that the practice could have decided to undertake more investigations locally to monitor C’s blood pressure levels. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure to communicate to C whether their blood pressure issues could have been monitored by the practice or rerefer them to the blood pressure clinic. 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 be mindful of the need to fully communicate to patients about whether further investigations are required before a hospital referral is deemed necessary.

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 practice to collect prescriptions and had a brief discussion with a member of staff. Subsequently, C received a letter from the practice informing them their registration with the practice had been terminated due to inappropriate behaviour. C considered the practice’s actions to be unreasonable.

We found that the practice failed to follow the relevant process prior to removing C’s registration. The practice did not give a prior warning or keep reasonable records of the actions they took. We also found that the practice did not provide an accurate response to C’s complaint. As such, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to investigate C’s complaint appropriately, failing to issue an accurate response letter and for unreasonably removing C from the list of patients. The apologies should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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 board's communications with them regarding the treatment of their children. C’s children have a congenital condition which requires steroid replacement treatment and regular monitoring. C was dissatisfied with the treatment provided by the board and initiated the process to have the children transferred to another provider for treatment. The board gave inconsistent messages about the referral process and C was left unclear about the steps being taken to transfer the children’s treatment. Some months elapsed during which the children did not receive treatment.

During our investigation, we found that the board’s position regarding the referral had been inconsistent and confusing. Had they been clearer with C about the referral process, C's children could have accessed treatment much sooner. Given their need for regular monitoring, this was a significant failing. We found that the board’s communication had been unreasonable and, therefore, upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings in communication, with a recognition of the impact this had on their family.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 communicate clearly about who is responsible for doing what in this type of situation. In particular they must ensure the relevant information is clearly conveyed to the patient.

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 child (A), who was admitted to the Royal Hospital for Children with multiple bruises. Medical staff initiated child protection procedures to investigate if A's bruising had been caused by physical abuse. C raised various concerns about A's care and treatment. In particular, that the decision to initiate child protections was disproportionate; that unnecessary and distressing medical investigations were carried out on A; and there was a lack of communication with C.

We took independent advice from a consultant paediatrician. We found that it was reasonable child protection procedures were initiated and that no unnecessary medical investigations were carried out. However, we found that there was a failure to communicate clearly with C about what was happening at the outset so we upheld their complaint.

C also raised concerns about how the child protection process was concluded. We found that there was an unreasonable delay in the board concluding their part of the child protection process. We also found that the outcome should have been recorded in A's medical records. We upheld their complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings identified in the communication with them and in relation to how the child protection process was concluded. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• As it could be relevant to future care and treatment, A's medical record should contain information about the final outcome of the child protection process.

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

• Families should be given prompt and clear information about the child protection process. It should then be documented in sufficient detail.
• When child protection concerns have been raised, medical reports should be provided within a reasonable timeframe, taking into account relevant clinical guidance.
• When child protection concerns have been raised, the child's x-rays should be reported in a timely manner, taking into account relevant clinical guidance.
• When child protection procedures are initiated in hospital, the child's medical record should contain information about the final outcome so it is available to hospital based medical staff if the child is readmitted.

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 worker, complained to us on behalf of their client (A) about the care and treatment they received at Aberdeen Royal Infirmary. A had an autologous fascia sling procedure (where a strip of tissue from the abdomen is used to create a sling under the urethra) to treat stress urinary incontinence (where urine leaks out of the bladder when it is under pressure). A suffered two complications from the surgery; including a bladder injury and overactive bladder (needing to get to the toilet in a hurry or leaking urine before reaching the toilet). C complained that A was not properly informed about the risks during the consent process.

We took independent gynaecology (specialists in the female reproductive system) advice. We found that at A's clinic appointments, they were given appropriate information about the risks involved in the surgical options available. However, a significant period of time passed until A had the surgery. Moreover, surgery had not been A's first choice of treatment, and there was a change to the planned procedure. In the circumstances, we found that it was particularly important to have reiterated all the significant risks of surgery when A signed the consent form. However, we found no evidence that A was advised about the risk of overactive bladder, even though it is a common complication. We upheld C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for failing to appropriately inform them of the risk of overactive bladder. 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 consent process should follow national guidelines. As part of the consent process, information about the common and serious complications of surgery should be reiterated to the patient as close as possible to their surgery; and that information should then be clearly documented.

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 care and treatment they received regarding a fractured collarbone. C was scheduled to have surgery but on the day of the surgery a decision was made to cancel on the basis that C’s collarbone had healed. C complained about the decision to cancel the surgery and that a decision was not made to proceed with surgery at an earlier date.

We took independent advice from an orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that it was reasonable for the board to allow for six months of conservative (non-operative) management and to cancel the surgery following an x-ray which showed the fracture had joined together.

However, we found that it was unreasonable not to mention or discuss operative intervention and its associated risks at earlier clinic appointments. This is because patients should be informed of all treatment options including that of no treatment in accordance with the General Medical Council’s guidance on consent. We also found that it was unreasonable for one of the clinic letters to state that the x-rays showed hypertrophic (healing tissue has formed but the bone fractures have not joined) non-union. We noted that the x-rays actually showed a delayed union (when a fracture takes longer than usual to heal) because approximately four months had passed since C’s injury at that point. We also found that the decision to proceed with surgical intervention was unreasonable given that the x-rays showed delayed union, rather than hypertrophic non-union and there was no evidence that the clinician had discussed C’s case with the consultant. In light of the above, we upheld C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for not discussing operative intervention and its associated risks at their clinic appointments, and that the decision to proceed with surgical intervention was made when the x-rays showed delayed union rather than hypertrophic non-union, and while the clinician had not discussed C’s case with the consultant. 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:

• Decisions to proceed with surgery for clavicle fractures should be based on an accurate assessment of the patient including any available radiograph. Changes in a patient’s management plan from a consultant’s decision should be discussed with the consultant and documented.
• Patients should be informed of all treatment options, including that of no treatment and these discussions should be documented.

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.