West of Scotland

The complainant (Mr C) received treatment and regular check-ups from his Dentist (Dentist 1) over a four year period from the end of 1996 until March 2001. He returned to the Dental Practice in November 2001 and was told by a different Dentist that he had bad gum disease. Mr C was shocked by this as he said Dentist 1 never told him that he had a problem with gum disease. Mr C complained via the local Primary Care NHS Trust but he was dissatisfied with the response. An Independent Review Panel considered his complaint and concluded that he had experienced an acute episode of his periodontal condition (gum disease) towards the end of 2001 which caused a rapid deterioration of his oral condition. The Panel also concluded that this could not be attributed to any lack of care provided by Dentist 1.

This complaint concerned the removal of a patient from the GPs' list. The complainant was of the view that the GPs concerned acted unreasonably in removing him from the Practice's list of patients.

The complainants, Mr and Mrs E, felt they had been removed from their GPs' list with insufficient justification after Mr E had complained to the practice manager about the treatment Mrs E had received from the reception staff.

General Practitioner Lothian Area

Lothian NHS Board

West Lothian Healthcare NHS Trust

Summary
Mrs C complained about the delay in arranging an endoscopy procedure for her late husband (Mr C).  She said that although Mr C's GP requested an urgent referral for him, the required procedure was not undertaken until more than three months' later.  At this time, a malignant tumour was found in his oesophagus which was later determined to be inoperable.  Mr C died seven months after this.

Mrs C complained to the board who said that as Mr C's review was not marked 'urgent suspicion of cancer', it was not upgraded to be seen with the highest priority at a time when there were substantial waiting time delays for endoscopy procedures to be carried out.  The board accepted that there had been a delay and said that they were planning to put procedures in place to increase their capacity to meet endoscopy waiting time targets.

We obtained independent clinical advice and found that the board's approach had not been a reasonable one in that there were too many priority streams for grading the urgency of endoscopies.  There was already sufficient clinical information available for Mr C's case to have been triaged as a suspected cancer case and, from the available guidance, it appeared that Mr C's GP had followed the instructions given.  We upheld the complaint.

Redress and Recommendations
The Ombudsman's recommendations are set out below:

What we are asking the Board to do for Mrs C:

We are asking the Board to improve the way they do things:

Evidence of action already taken
The Board told us they had already taken action to fix the problem.  We will ask them for evidence that this has happened:

Summary
Mr C is the landlord for his brother (Mr A), who receives housing benefit.  Mr A has an injury which means he needs support to manage his affairs.  Because of this, the housing benefit is paid directly to Mr C as landlord, (and Mr C is authorised to communicate directly with the council about this).  Mr A's housing benefit payment was delayed on three occasions without notice, with the longest delay being about five weeks.

When Mr C complained after the second delay, the council agreed to monitor Mr A's account so they could notify Mr C of any future delays.  However, this monitoring was stopped after three months, and Mr A's payment was again delayed without notice.  Mr C complained to the council, who apologised that he was not told that the monitoring of Mr A's account had stopped.  The council said they had found a more efficient way to monitor Mr A's account, for a further six months.  However, Mr C was not satisfied with the council's response and brought his complaint to SPSO.

In response to SPSO's enquiries, the council explained that the Department of Work and Pensions (DWP) use a system of automated notifications to notify the council electronically of any changes to a benefit claimant's records (such as contact details or income details).  Where a notification is received that could result in a change in benefit entitlement, the council's system automatically suspends the claimant's benefit payment (to stop any payments being made until the change has been reviewed).  Council officers then review these notifications and either lift the suspension (if the change does not affect the claimant's entitlements) or contact the claimant to request further information or make changes, if necessary.   The council said Mr A's benefit was automatically suspended on three occasions (each time due to one benefit being stopped, with a different benefit starting in its place).  As these changes did not affect Mr A's payment, the council unsuspended the payment each time (once they had an opportunity to review it).  The council said the delay was due to the workload they had at the time, with each automated suspension being dealt with in turn.

We asked why the council did not notify claimants when their benefits were suspended in this way.  The council said this was because, in most cases, the automated suspensions are removed without any impact on benefit claimants, so it is not necessary to warn people about a possible delay in payment.  The council said they receive thousands of automated notifications every month, and notifying every claimant of a suspension that may be lifted before the payment is due would create unnecessary confusion and contact with the council, which would divert resources from dealing with the suspensions as quickly as possible.  The council also said their system would not allow them to send a letter that would fully explain the situation in appropriate circumstances, so they would need to do this manually (which would impact on resources).  The council said that, since this complaint, they had improved their processes to minimise the chance of a payment being delayed.

After investigating these matters, we upheld Mr C's complaint.  We found that the council was not complying with guidance from the DWP that requires decision makers to notify claimants in writing when a decision is made to suspend their benefit.  We did not consider the council had a reasonable explanation for not complying with this guidance, as the numbers they gave us about the average number and length of automated suspensions did not support their claim that the risk of a payment being delayed was small.  The council was not able to provide information on the actual numbers of people whose benefits are delayed, or for how long, as they do not monitor this.  We were particularly concerned that the council's system of automated suspensions did not include mechanisms for protecting vulnerable people or considering hardship at the time the suspension is made.  It was also not clear that the council is giving appropriate consideration to the individual circumstances of each case when they make a decision to suspend a payment under the automated system.

Redress and Recommendations
The Ombudsman's recommendations the Council:

• apologise to Mr C for the failings our investigation found; and
• amend their processes to ensure that individuals are notified at the time a suspension is applied to their benefit (as required by the DWP Guidance).

Summary
Mr C complained about the City of Edinburgh Council (the council's) handling of a series of complaints about their management of projects to control small poster advertising within the city.  Mr C also complained about the tendering process for an advertising contract.

Mr C said multi-sided drums for sticking posters to had been put in place as a trial project in 2003.  Although the project had meant to be reviewed after a year, this had not happened.  Over the following twelve years, more drums had been added throughout the city.  Mr C had complained the project was not properly managed and that the council had no control over it.  He said the council had taken an unreasonable length of time to respond to his complaint and had provided an inaccurate response.

Mr C said the council had not responded at all to his complaint about tendering for advertising contracts.  He considered this unreasonable given the length of time the council had taken.

Mr C said he had complained about a specific site where advertising was being placed without the appropriate permission being given by the council.  When permission was requested, it was denied, but the council failed to take enforcement action.

Mr C also complained the council had provided inaccurate responses to his complaints.  He said he had proved this using information he had obtained from the council.

Mr C said none of his complaints had been handled reasonably by the council.  He also suggested the council's responses had been inaccurate and confusing.

The council accepted they had taken too long to respond to Mr C's complaints and that in one case, they had not responded at all.  They said they had received a significant amount of correspondence from Mr C about the same issues.  The council did not accept their complaint responses were inaccurate, confusing or misleading.

We found the council's handling of Mr C's complaints was unreasonable and failed to follow their own complaints procedure.  The council had not responded at all to one of Mr C's complaints.  Although the council had accepted there were delays in responding, we did not find evidence they recognised the length of these delays, and they had not provided an explanation for the failure to respond at all to one of Mr C's complaints.

We found the council's response to Mr C's complaint about advertising drums was inaccurate and that they had failed to keep appropriate records about the project.  The council were unable to provide evidence of any project management or assessment and it was unclear how the project could have been assessed for success or failure.  Although the council's internal correspondence accepted Mr C's complaint had identified areas of risk to the council they did not indicate to Mr C whether his complaints had been upheld.

We found the council had generally failed to handle Mr C's complaints reasonably.  He had been able to demonstrate that their responses were inaccurate with information he had obtained from them following their responses to his complaints.  We found the council had failed to follow their complaints handling procedures when dealing with any of his complaints and that staff appeared unaware of their responsibilities in this regard.

We found there were significant concerns about the failure to keep proper records about the advertising projects and the continual postponement by the council of a full assessment of them.  This was despite repeated statements by the council to Mr C that the projects had been reviewed.

Redress and recommendations
The Ombudsman recommends that the Council:

• provide a full response to Mr C's complaint 201508737 addressing each of the points raised by him;
• carry out a full review of the complaints handling in these cases to establish the lessons to be learnt for handling future complex complaints;
• provide evidence that all the officers involved in responding to these complaints have undergone complaints handling training;
• conduct a full review of their management of all the various advertising projects from their inception as proposed in 2012 and provide their findings to the Ombudsman;
• provide evidence of the actions taken to improve internal communication in view of the acknowledged failings in this case; and
• apologise to Mr C for the failings identified in this report.

Summary
Mr A was admitted to A&E at the Royal Infirmary of Edinburgh after being found at the bottom of a flight of stairs with a suspected head injury.  He was assessed as having a reduced level of consciousness but this was attributed to intoxication.  It was therefore decided that he would be observed in A&E overnight to ensure his symptoms improved.

Mr A was discharged the following morning and collected by his mother, who found him to be confused and disorientated.  However, after discussion with reception staff, she was assured that he was medically fit to leave.  On their return home, Mr A's mother remained concerned about his condition, so they attended A&E at Wishaw General Hospital, where a CT scan was carried out. This indicated that Mr A had suffered a brain haemorrhage.  He was then transferred to the Southern General Hospital for emergency surgery.

Mr A's sister (Mrs C) complained that Mr A had failed to receive appropriate treatment for his head injury at the Royal Infirmary of Edinburgh.  Mrs C felt that Mr A should not have been discharged, given his condition.  The board apologised for failing to provide a correct diagnosis and accepted that they had wrongly attributed signs of disorientation and incoherence to intoxication rather than a developing bleed on the brain.  The board stressed that assessing patients who have head injuries but are also intoxicated can be very difficult.

During the investigation, my complaints reviewer took independent medical advice on Mr A's treatment from consultants in both emergency medicine and neurosurgery.  The advice received was that, under Scottish Intercollegiate Guidelines Network (SIGN) guidance, Mr A should have received a CT scan on admission to the Royal Infirmary of Edinburgh based on his recorded symptoms and that it was not reasonable to attribute those symptoms to intoxication in the circumstances.

My investigation also highlighted a poor level of record-keeping for Mr A's admission.  According to records, Mr A appeared to have undergone significantly fewer neurological observations than were required by the board's internal procedure for managing patients with head injuries.  We also found that this procedure was not in line with SIGN guidance and that there was no record made of any assessment prior to Mr A's discharge.

Redress and recommendations
The Ombudsman recommends that the board:

• apologise to Mr A and Mrs C for the failings identified in this report;
• review their procedure for the management of patients with a head injury to bring it in line with SIGN guidance;
• carry out an audit of a sample of recent cases of this kind, to ensure they are being dealt with appropriately; and
• carry out a root cause analysis to identify why the medical and nursing staff on duty did not follow the systems in place.