Not upheld, no recommendations

Summary

C, a support and advocacy worker, complained on behalf of their client (A) that the board unreasonably prescribed A with Flutiform (a type of medication to treat asthma). A presented to hospital with symptoms of severe asthma and was admitted to the high dependency unit for management of their symptoms. Following assessment, A was prescribed with Flutiform. A’s symptoms improved and they discharged themselves from hospital.

A complained that Flutiform worsened their symptoms and should not have been prescribed, as they had previously suffered adverse reactions and informed the nurse of this during their assessment at the hospital. In their response to the complaint, the board said that Flutiform was prescribed in line with relevant guidelines and that there was no record of A having indicated that they had previous adverse reactions to Flutiform.

We took independent advice from a consultant physician in respiratory medicine. We found that whilst there is some record that Flutiform had not worked well for A, there was no evidence of an allergy in the clinical records. Whilst A recalled that they raised concerns about the use of Flutiform during the assessment, the contemporaneous assessment records, clinical records available at the time, and relevant guidelines supported the conclusion that there was no evidence against prescribing Flutiform to A. Therefore, we did not uphold C's complaint.

Summary

C complained on behalf of their child (A) about the care and treatment A received prior to their surgery. They complained that some procedures had been carried out during the surgery without parental consent. They also said that A had not been examined prior to the surgery and that they had been left with unnecessary scarring. The board stated that written consent had been provided on the day of the surgery and the clinical notes recorded the procedures to be carried out and the risks of surgery had been explained at that time. The board also stated that A had been examined. However, they apologised if the verbal discussion prior to the operation had not prepared C for the outcome and also apologised if some of the scarring following the surgery was unsightly.

We took independent advice from a consultant paediatric urologist (specialist in children's urinary and genital problems). We found that the evidence suggested that the signed consent form had been read by C prior to the surgery and that no unnecessary procedures had been carried out. While there were no records to prove or disprove that A had been examined on the day of the surgery on balance we considered it was likely that A had been examined preoperatively. Although ideally it should have been explained to C during the consent process that there was a possibility that redistribution of the skin could be required during the operation, we found that it was not unreasonable that this was not mentioned. We also found that the care and treatment A had received on the day of the surgery was reasonable and that there was no evidence that the surgery carried out was inappropriate or excessive. Therefore, we did not uphold C’s complaints.

Summary

C complained about the care and treatment provided by the board during and after the birth of their child. Following the birth of their child, C received a perineal (space between the anus and vagina) repair. C complained that the stitching was incorrectly carried out and that this subsequently caused ongoing pain and tightening of the vagina. At a consultation with a gynaecologist (specialist in the female reproductive system) the following year, it was identified that C had a thick band of skin at the vaginal opening. There was also a concern about pelvic floor muscle tightness which indicted vaginismus (an involuntary tensing of the vagina when something is inserted into it). C was referred to physiotherapy. As this was not successful, an operation to remove the thick band of skin was undertaken with the explanation that it was unlikely to improve the tightness of the muscles. C was also referred for psychosexual counselling.

C complained that they did not receive a follow-up after the operation and that they had not received an appointment for psychosexual counselling. The board reassured C that their perineal repair was performed correctly. However, they explained that unfortunately vaginismus can occur after any vaginal repair procedure. They noted that it was not always standard practice to follow up patients after gynaecology surgery but C had been added to the routine waiting list which was approximately one year. The waiting time for a psychosexual counselling appointment was 91 weeks. They apologised for C’s wait.

We took independent advice from a consultant gynaecologist. We found that the perineal repair was reasonable and that the decision to offer physiotherapy, then the operation was reasonable. It was also reasonable to refer C for psychosexual counselling. Offering a follow-up review was not standard after elective gynaecological surgery. We considered that care and treatment, from the birth until the operation, was reasonable. We acknowledged that waiting times had been extended. However, we accepted the advice received. We noted that treatment time standards do not cover routine post-operative reviews or psychosexual counselling. Therefore, we did not uphold C's complaint.

Summary

C complained about the care and treatment provided to their parent (A). A was admitted to hospital (Hospital 1) following a period of delirium which was a result of a urinary tract infection (UTI). They were treated with antibiotics but their delirium continued. A was transferred to another hospital for a period of rehabilitation (Hospital 2). C said that a nurse refused to take a urine test when A was showing symptoms of a further UTI, on the basis that A had no temperature. C also complained about a delay in prescribing antibiotics. A’s condition deteriorated again during their admission. C asked for a doctor to be called but they were told that no doctors were available. A deteriorated further that night and required admission to Hospital 1, where they died the following day.

C complained that A was denied access to a doctor. They also complained about communication and a lack of compassion from staff. A’s admission was during a time when visiting was restricted because of COVID-19 guidelines. C complained that staff should have allowed more frequent access to A when A was confused and distressed.

We took independent clinical advice from a consultant geriatrician (specialist in medicine of the elderly). We found that A’s symptoms were not sufficiently clear to have merited a prescription of antibiotics sooner than they were prescribed. We noted that deterioration in older frail adults is often unpredictable and rapid, and found no failings in care and treatment provided to A. Based on the information available, we found no failings in communication, although we noted that the board had apologised to C already for certain communication failings. We found that staff were following the appropriate policies for visiting.

Therefore, we did not uphold C's complaint.

Summary

C complained about the advice received and actions taken by trading standards in relation to concerns that they had reported about a builder who had undertaken work for two of their relatives. C said that the council did not provide them with adequate information regarding the steps they could take to establish if they had cause to take further action against the builder, and the timescale in which this was required to be done.

We found that the council had reasonably explained the steps taken in reviewing C's complaint. Whilst we recognised that no information had been given in relation to issues which were time barred, we considered it could not be known until completion of the assessment which matters could be progressed. Therefore, we did not uphold this part of C’s complaint.

C complained that the council suggested they obtain an independent report of the work completed at personal cost to them. We found that C had sought advice from other sources, and we considered their decision to commission the report had been informed by their wider research and not just on the advice given by trading standards. We also did not find any evidence to support that C had been told that an independent report would be required before their case could be taken to the procurator fiscal. Therefore, we did not uphold this part of C's complaint.

C also complained that the council provided them with an inconsistent and inadequate response to their complaints. We found that the response was in keeping with the information shared with C by trading standards. Therefore, we did not uphold this part of C's complaint.

Summary

C’s spouse (A) presented to A&E with neck pain. A was discharged home as it was noted that they were on a waiting list for an MRI scan, following an urgent referral by their GP to orthopaedics (area involving the musculoskeletal system). A was admitted to hospital four days later and advised that they were terminally ill with bladder cancer which had spread to the spine. A later died. C complained to the board that A&E did not consult orthopaedics or arrange further testing when A presented with continuing pain despite prescribed medication. The board’s response indicated that A was appropriately assessed by the A&E doctors and as A was waiting on an MRI, the discharge letter to the GP advised to follow up with the hospital where the MRI was being organised. The board said that the GP was best placed to expedite further care with the relevant team.

We took independent advice from a consultant in emergency medicine. We found that A&E carried out an appropriate assessment, including consideration of any red flags which warranted further investigation or onward referral. We found that as A had already been referred to the spinal team and had an MRI ordered it was reasonable not to investigate A further. We found that the board acted in accordance with NICE guidance in how they managed A’s care and treatment, which was reasonable. Therefore, we did not uphold the complaint.

Summary

C complained that the council had unreasonably failed to follow their own enforcement process and relevant planning guidance in response to an alleged breach of planning condition/s in respect of two sites.

In responding to the complaint, the council acknowledged that breaches at the sites had occurred and highlighted the discretionary nature of planning enforcement. As such, the council considered resolution of the breaches through informal negotiation had, in the first instance, been an appropriate approach rather than formal enforcement action.

We took independent advice from a planning adviser. We found that council’s approach to securing compliance with the planning conditions was in line with their usual enforcement process and national guidance, with no evidence of undue delay or inaction on the council’s part at the time of our investigation. We also found that the council’s decision to engage in negotiations to remedy the planning breaches, rather than to pursue formal enforcement action, was a decision that they were entitled to take. For these reasons, we did not uphold C’s complaint.

However, we did draw the council’s attention to their own Enforcement Charter which sets out the principles for effective enforcement action, specifically that: negotiation to remedy a breach should be pursued provided an appropriate solution can be achieved in a timely manner. As some of the breaches had not been remedied at the time of this investigation, we suggested that the council may wish to consider setting a timescale by which formal enforcement action would be taken.

Summary

C complained about delays in ambulance response time after their elderly parent (A) had a fall at their care home. Care home staff called 999 and, following triage, the call generated an emergency but non-life-threatening response. A clinical triage call took place shortly after followed by another 999 call by care home staff. A paramedic response unit arrived at A’s location, followed by an ambulance. A arrived at hospital around 5 and a half hours after the first 999 call.

Scottish Ambulance Service (SAS) acknowledged that the wait for an ambulance was unreasonable and apologised to C for this. They explained that the delay was due to limited resource and very high demand at that time. C was unhappy with this response and brought their complaint to us. C felt that A was not prioritised fairly following the 999 and clinical triage calls. C considered this to be partly due to A’s age. Although SAS had already acknowledged that there was an unreasonable delay, we carried out an investigation to determine whether the assessment and prioritisation of the calls also contributed to that delay.

We took independent advice from a paramedic. We found that the non-clinical call handling was appropriate. We also considered that there was no indication that A was treated differently or unreasonably as a result of their age. Therefore, we did not uphold C’s complaint. However, we did provide feedback to SAS regarding an aspect of the clinical triage call which did not cause or contribute to the delay in an ambulance being provided, but was not in line with relevant national guidance.

Summary

C complained about the care and treatment provided to their parent (A) on two separate admissions to hospital. A was detained on both occasions under the Mental Health (Care and treatment) (Scotland) Act 2003. C had concerns about A being sedated and that staff had restrained A in an inappropriate manner.

In their response to the complaint, the board explained the care provided to A, the reasons for the administration of medication, how this was overseen and adjusted to address A’s levels of sedation, and the process and performance of restraints when they were required. C was dissatisfied with the board’s response and brought their complaint to us.

We took independent advice from a consultant psychiatrist and a mental health nurse. We found that on both admissions, there was appropriate oversight of A’s medication and care was taken to consider sedative effects and find a balanced approach. We found that medications were administered appropriately to manage A’s distress and aggression. Therefore, we did not uphold this part of C’s complaint.

In relation to the use of restraints, we found that these had been performed reasonably and that A’s concerns about pain to their ribs was appropriately assessed. Therefore, we did not uphold this part of C’s complaint. However, we did provide the board with some feedback on the requirements for accurate record keeping.

Summary

C complained about the care and treatment provided to their late spouse (A). A was admitted to hospital with a suspected small bowel incarcerated in the hernia (a part of the intestine that becomes trapped in the sac of a hernia). Following a CT scan and assessment by a surgeon, it was decided to treat A’s condition conservatively and transfer them to a larger hospital in the area. However, there was a delay in the transfer taking place due to a lack of ambulance resource and A’s condition deteriorated further during their admission. A died shortly after admission. C complained about the delay in transferring A to another hospital or operating on them sooner. In C’s view, A did not receive a reasonable standard of treatment or end of life care following their admission to hospital. In addition to this, C complained about the board’s communication with the family during A’s time in hospital.

We took independent advice from an emergency medicine consultant and a general and colorectal surgeon (specialist in conditions of the colon, rectum or anus). We found that the treatment provided by the board was reasonable. In light of A’s presentation, and without the benefit of hindsight, it was reasonable to treat A conservatively and arrange for a transfer to a better resourced centre. We also found that the end-of-life care provided to A was reasonable, given A’s rapid deterioration and the circumstances within the hospital at that time. Therefore, we did not uphold this part of C’s complaint.

In relation to the standard of communication with the family, taking into account A’s rapid deterioration and the circumstances within the hospital at the time, we concluded that communication was reasonable. Therefore, we did not uphold this part of C’s complaint.