Not upheld, no recommendations

Summary

C suffers from chronic pain and had been receiving pain management and musculoskeletal physiotherapy treatment from the board for many years. Changes were made in the board’s approach to pain management which coincided with some experienced consultants retiring. C’s care and treatment was reassessed and a number of treatments previously provided to C were said to no longer be available and an emphasis was placed on self-management. C complained that withdrawing treatments harmed their health and wellbeing, the local pain management service was now limited requiring patients to travel for certain treatments, effective interventions were removed, the board prioritised cost over patient needs, and the transition to self-management relied too heavily on online resources.

The board stated that the changes were evidence based and in line with clinical guidelines.

We took independent advice from an experienced pain management consultant. We found that the board were correct in stating that the current guidance for the management of chronic pain does not support the long-term use of massage, acupuncture or trigger point injections. We noted that the transition away from this approach towards self-management can be very challenging for patients. We considered that C had been offered a person-centred management plan. We also found that it was reasonable for the board to have explained to C that previous therapies offered in an ongoing sense were likely provided because of discretion and goodwill on the part of a now retired physiotherapist. We noted that this is not uncommon for practitioners, however, approaches to treatment change over time. We did not uphold C’s complaint. However we provided feedback about the need to reflect on cases such as this to inform how best to manage similar situations in the future.

Summary

C complained that their housing transfer application had been unreasonably handled by the housing association. In particular, C complained that they had not been offered a transfer when suitable new build housing had become available. C explained that a restriction had been placed on their transfer application without them being informed as they had declined a property with four flights of external stairs, which their partner could not manage due to their health condition. C explained that external stairs were a problem for their partner, however, they could manage one flight of internal stairs as they could control the temperature inside the property. Despite C explaining this, the restriction had remained in place as the association’s allocation policy did not distinguish between internal and external stairs. C considered this to be discriminatory.

The association confirmed that their allocation policy did not distinguish between internal and external stairs, and it remained their view that a property with stairs would not be appropriate for C’s partner, noting that they would still have difficulty managing internal stairs when their health condition flared up.

We found that the association had reasonably considered C’s transfer application request in line with their policy. While we explained to C that this office cannot determine whether equalities legislation has been breached in reference to their concerns of discrimination, we can consider whether an organisation has taken the relevant legislation into account. On review, we considered that the association had reasonably demonstrated having taken their legislative requirements into account, particularly at the point of reviewing their allocation policy. We did not uphold the complaint.

Summary

C complained about the actions taken and treatment provided by the board in respect of their pregnancy. C reported reduced fetal movements and was admitted to hospital with vaginal bleeding. The hospital discharged C as the vaginal bleeding settled and all clinical assessments undertaken were within normal parameters. However, C returned to hospital with significant vaginal bleeding and was diagnosed with placental abruption (a condition in which the placenta starts to come away from the inside of the womb wall). C’s baby was stillborn shortly after.

In C’s view, the board failed to take into account warning signs or carry out an appropriate assessment when they were admitted to hospital. C feels the outcome would had been different if their baby had been delivered at an earlier opportunity. The board acknowledged some failings in respect of delays caused by the hospital triage process, IT issues and signage. However, they concluded that these delays were unlikely to have made a difference to the outcome. The board were also satisfied that the broader treatment provided to C in respect of their pregnancy was appropriate.

We took independent advice from an adviser with an extensive background in obstetrics and gynaecology (a specialist in pregnancy, childbirth and the female reproductive system). We found that the board’s management of C’s pregnancy was reasonable and in line with relevant national guidance. There was no evidence that the board unreasonably failed to take any actions that they should have. Nor did it indicate that they unreasonably missed any warning signs pointing to this outcome. We noted that guidance prioritises the aim of prolonging the pregnancy in the absence of any signs of maternal or fetal compromise. In addition, we considered the staff’s actions to be reasonable when C presented at hospital. We agreed with the board’s conclusion that it was unlikely that the outcome would have been different had C not encountered the delays at the hospital. Therefore, we did not uphold C’s complaints.

Summary

C complained about the way that the council handled the planning process and the building warrant process for a self-build project within an existing development of houses. Planning permission had been granted, and three years later only limited progress had been made and an application was made by the developer to place a static caravan on site, where they would live whilst completing the project. There were several applications relating to the caravan, and some years later an enforcement notice was served by the council. This was appealed by the developer. Two years later, the council served a completion notice on the site, and the case was appealed to the Planning & Environmental Appeals Division (DPEA) by the developer.

C complained to the council. The Scottish Government reporter concluded planning permission had lapsed, because development had not lawfully commenced. The council took legal advice, which suggested that they reluctantly accept the reporter’s findings. The advice noted that should further evidence be submitted, then the council could take this into account if it supported a contrary position on the implementation of the initial planning permission.

C continued to correspond with the council, and brought a number of complaints to the SPSO. We took independent planning advice and we found that the council had the discretion to decide what enforcement action to pursue, if any. The council had followed the legal advice that they had received, serving a notice requiring submission of a new planning application. The developer had chosen to pursue an alternative course of action, by applying for a Certificate of Lawful Proposed Use or Development (CLPUD). This was not the same as being granted planning permission, but was an acceptable course of action by the developer. The decision of the Scottish Government reporter was only directly applicable to the completion notice, which could not be served. The council were entitled to determine whether they were satisfied the development had lawfully commenced. The advice stated that on balance, the council had acted reasonably. We found that whilst the council’s actions were not without criticism, they had exercised their lawful powers when reaching decisions on both planning and building standards matters. We did not uphold the complaint.

Summary

C complained about the care and treatment that their late parent (A) received from the board. A was admitted to hospital after a fall at home. A’s condition declined whilst in hospital. C complained that during A’s admission there were clinical errors, inappropriate treatment and insufficient diagnosis work. In C’s view, this contributed to and hastened A’s death. C stated that clinicians had fixated on alcohol as the primary cause of A’s condition. A post-mortem later confirmed this not to be the case and that A had Lewy Body dementia (a brain disorder that can lead to problems with thinking, movement, behaviour, and mood) or similar when they died. C also asserted that A’s two brain bleeds sustained in the fall were not adequately monitored or treated. C highlighted concerns that there was no intervention and no repeat computed tomography (CT) scan carried out to check the condition/size of the two brain bleeds. This was despite a decline in A’s neurological condition.

In addition to this, C complained that the board’s communication with A’s family fell below a reasonable standard. C stated that, in their view, A’s two brain bleeds were more significant than clinicians had led the family to believe at the time of admission. They also highlighted an unwitnessed fall on the ward that was not reported to the family.

We took independent advice from a neurologist adviser. We found that the treatment provided by the board was reasonable. Given A’s circumstances and presentation, we did not consider the focus on alcohol-related cognitive failure to be unreasonable or that it materially affected the treatment provided. We also found that the decision not to carry out an additional CT scan to be reasonable. However, we highlighted concerns about some of the board’s justification for not carrying out an additional CT scan. We also received a limited amount of advice from an independent nursing adviser about some additional concerns raised by C. We found that in the context of the difficult circumstances of A’s condition, the nursing care provided was reasonable. Overall, we concluded that the board provided a reasonable standard of treatment during A’s admission. Therefore, we did not uphold this aspect of the complaint.

Summary

C complained on behalf of their adult child (A) about the standard of care and treatment that they had received in relation to their mental health from their GP practice. In particular, C complained that the surgery did not provide the support recommended for A following an Adult Autism Disorder (ASD) assessment. C also complained that the surgery had prescribed medication for A without any follow-up despite knowing that they had expressed thoughts of suicide. Additionally, C complained that the surgery had failed to explain the nature and process of a mental health telephone review A had been referred for and that the surgery had failed to let them know when this had been cancelled by the receiving service.

The surgery explained that referrals had been made to mental health services on behalf of A, however, the decision to accept or decline them was made by the receiving service and not the GP surgery. Regarding the cancelled appointment, the surgery said that they had not received advanced notice and were, therefore, unable to let C know that it would not go ahead.

We took independent advice from a GP adviser. We found that the ASD assessment report did not contain any recommendations or actions for the surgery to arrange on behalf of A, that A had been regularly reviewed during the period of the complaint and referrals had been appropriately made to other services. We also found that the surgery could not influence whether a referral was accepted or declined. In relation to the cancelled telephone assessment, we found that there was no evidence to suggest the surgery received advance notice of it being cancelled. Therefore, we did not uphold the complaint.

Summary

C complained that the board had unreasonably failed to follow the care plan put in place to support them with their mental health. In particular, C complained that the board had failed to arrange their admission to hospital during an episode of crisis.

The board’s response to C’s complaint advised that they had been appropriately assessed at the time, with it being the view of the mental health service that further support in the community would help to reduce the need for an inpatient admission. The board also advised that, in keeping with the care plan, C’s request for admission had been discussed with a consultant psychiatrist, with the decision not to arrange admission on this occasion being based on clinical opinion.

We took independent advice from a consultant psychiatrist. We found that C’s care plan included provision for a five day admission to hospital when required, however, the need for this would be discussed with a consultant at the time. When C reported feeling low in mood to the mental health service during their episode of crisis, they had responded reasonably, noting that C had been supported by increased phone and face to face contacts. On receiving C’s requests to be admitted to hospital, this had been assessed by the consultant psychiatrist in keeping with the care plan. Overall, we considered that the board had reasonably followed C’s care plan. We did not uphold this complaint.

Summary

C complained about a mis-diagnosis of their parent (A) at hospital. C noted that A was diagnosed with pancreatitis (inflammation of the pancreas) during their first admission. A CT scan was taken to confirm this diagnosis. During a later second admission, blood tests and an ultrasound were taken but no CT scan was taken and pancreatitis was again confirmed. A then attended a different hospital while away. A CT scan was taken and A was diagnosed with late stage pancreatic cancer and died shortly after. C complained that the pancreatic cancer had not been diagnosed at the original hospital. The board explained that the original scans confirmed pancreatitis and showed an abnormality which increased the risk of it recurring. During A's second admission, blood tests confirmed acute pancreatitis and there were no clinical signs to indicate that a further CT scan should be arranged.

We took independent advice from a gastroenterology (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas) adviser. We found that the care and treatment was appropriate throughout the period and that there was no reason to suspect pancreatic cancer. In their second admission, A’s presentation was consistent with an attack of mild acute pancreatitis and immediate further CT scanning was not indicated at this time. As such the complaint was not upheld.

Summary

C complained that their cancer diagnosis was unreasonably delayed. They had previously suffered from cancer which had been successfully treated. C believed there was an inappropriate focus on the wrong part of their throat as a consequence, and that this combined with inadequate review of the CT imaging of their oesophagus had resulted in a delayed diagnosis, much more significant surgery and had allowed the cancer to spread to other parts of their body. C believed the extent of the cancer when diagnosed, meant it must have been visible earlier in the diagnostic process.

We took advice from a consultant ear, nose and throat surgeon. We found that C was correctly examined and there was no evidence of failings in their care. It was not possible to determine whether earlier diagnosis would have resulted in a different outcome for C. We did not uphold the complaint.

Summary

C complained on behalf of a family member (A) who was diagnosed with breast cancer and died less than two years later. C complained that during a consultation the consultant oncologist (specialist in the treatment of cancer) treating A had given the impression that despite having a condition that was treatable but not curable, A was likely to live for many more years. C noted that they had been present when this had been explained, and that it was evident that A had made important life decisions based on what C considered, in light of subsequent events, to be have been highly misleading communication. C also noted a lack of documentation relating to the initial consultation.

In response, the board stated that the oncologist treating A was clear that it had been explained that they had metastatic, stage four cancer. The consultant was also certain that they had not stated that the treatment would definitely work in an on-going sense and life-expectancy would be unchanged. The board apologised if this has been the impression formed by A.

We took independent advice from an oncologist. We found that the board’s position that it was not the oncologist’s custom to discuss life expectancy at the first meeting in order not to overwhelm a patient, and that such predictions can be very difficult to make was reasonable. Additionally, we noted that a letter had been sent to A’s GP following the initial consultation. We found it was not unreasonable for a letter to be in lieu of additional notes in a paperless system, and that it is not a requirement for a copy to also be sent to the patient. We also noted that this was one of a number of records and communications with A’s GP that were somewhat generic in nature, noting that while a further letter referenced discussions of palliative options, which implied a discussion about the seriousness of A’s condition, this letter could have been more specific in relation to what exactly was discussed.

Overall, we found that while communication and documentation could have been better and more detailed, it was reasonable. For this reason, we did not uphold C’s complaint. However, we did provide feedback for the board outlining the adviser’s criticisms of the documentation in relation to communication.