Not upheld, no recommendations

Summary

C underwent a septoplasty (procedure to straighten bone and cartilage in nose). Around nine years later, C was referred to neurology (the science of the nerves and the nervoussystem, especially of the diseases affecting them) with symptoms of migraine. C believed that their pain and symptoms were related to physical issues with their nasal passages, rather than being neurological in origin.

C underwent an MRI scan to investigate their history of recurring pain and headaches. The board's conclusion was that there was no abnormal findings and ruled out issues with C's septum and nasal passages being the cause of their symptoms. C complained to the health board that the findings from the MRI scan were incorrect and that the board refused to offer C a second opinion.

The health board responded to C's complaint advising that the results of the MRI were reported accurately and that there was no evidence of failures with respect to the assessment of the imaging. Repeat imaging was arranged but C cancelled the appointment and advised that they did not want this to go ahead.

C brought the complaint to us that the health board had failed to appropriately assess the MRI scan and take appropriate action to resolve their symptoms. We sought advice from an independent adviser and we found that the board appropriately assessed the MRI scan and took appropriate action for follow-up imaging to be arranged. We identified that it may have been beneficial had the health board clarified the deviated septum identified in the imaging was considered incidental and therefore not included in the imaging report. This was fed back to the board. Given that the assessment and treatment was reasonable, we did not uphold the complaint.

Summary

C complained about surgery carried out by the board. C underwent abdominal surgery and immediately after the procedure, experienced issues and severe abdominal pain.

C was made aware by the surgical staff that there had been complications during the operation, but was advised that this would not have caused the issues. C underwent a second procedure and a diagnosis was made during this surgery.

C complained about the board's handling of the first operation and the surgeon's failure to make a diagnosis during the first procedure. We found that, whilst there were complications during the first procedure, these occurred despite the board's staff taking all reasonable precautions. We accepted advice that, due to the nature of C's condition, it was not unreasonable that no diagnosis was confirmed during the first procedure. We could find no clear link between events during the first surgery and the problems C later experienced. We did not uphold C's complaints.

Summary

C complained that the care and treatment provided to their partner (A) was unreasonable. During a routine scan around 20 weeks into A's pregnancy, their cervix was found to be short, putting them at risk of miscarriage. A suture (a stitch or row of stitches holding together the edges of a wound or surgical incision) was inserted in their cervix that day. In hospital the following day, it appeared that A's membranes had ruptured and that the decision was taken to remove the suture. A and C were advised their baby was unlikely to survive. They were offered medication to abort the foetus and condolences were given. They chose to continue with the pregnancy and as time passed it appeared that the initial diagnosis had been incorrect. A was monitored for a few days on the ward and was discharged with follow-up arrangements when their condition was deemed to be stable.

At a follow-up appointment a few days after discharge from hospital, the consultant advised that a further suture was required to protect the pregnancy. The procedure was carried out that day. A few weeks after the second suture was inserted, A went into labour and their baby was born three months prematurely.

C complained that the decision to remove the first suture was unreasonable. They also complained that they had been told their unborn baby was dead.

We took independent clinical advice from a consultant obstetrician and gynaecologist (specialist in pregnancy, childbirth and the female reproductive system). We found that in deciding to remove the suture the clinicians were acting in good faith with the information available and in the best interests of the mother, at a stage when the foetus could not survive if delivered. Appropriate discussion took place with the on-call consultant who was in agreement with the instruction that the suture should be removed if there was any sign of ruptured membranes. This is a recognised indication for removal of a cervical suture as it increases the risk of maternal sepsis (blood infection).

Given the likelihood that the patient would go on to miscarry, we found that it was appropriate to offer condolences. We found no evidence in the notes that staff told the patient their baby was dead. The adviser noted that the foetal heart was heard using sonic aid and that the patient reported feeling foetal movements.

Therefore, we did not uphold either complaint.

Summary

C complained that the practice had unfairly accused them of being threatening and aggressive, resulting in their removal from the practice list and that C had been unreasonably placed on an opiate reduction programme. C said that they had been targeted because they had successfully complained about the services provided by the practice in the past. C said that the practice had misrepresented the opiate reduction as mandatory, when in fact they were only required to review opiate use. C said that the practice had not taken into account the impact of the opiate reduction on them.

The practice said that they had a zero tolerance for aggressive or inappropriate behaviour. C had abused the prescription request service and had entered the practice and refused to leave unless they were provided with an additional prescription. The practice had, after review, reinstated C to the practice, but C had continued to request medication early, breaching their agreements with the practice. This had resulted in their removal from the practice lists. The practice had reviewed and reduced C's medication in line with best practice and health board guidance. C had previously sought medication early and was considered by the practice to meet the criteria for opiate reduction.

We took advice from an independent medical adviser. We found that the practice had acted reasonably in seeking to reduce C's opiate use. We also found that arguably the practice should have provided C with a written warning prior to the first decision to remove them from the practice list. When C had appealed against this decision, however, the practice had reviewed it and agreed to reinstate C subject to commitments about their behaviour. C's second removal had been due to the practice's view that the agreements reached with C had been breached. The practice were entitled to reach this decision and had acted reasonably. Therefore, we did not uphold the complaint.

Summary

C complained that the council failed to provide kinship care allowance after they had moved into the area from England, despite them having custody of their grandchild through a Residence Order (a court order which determines where a child should live) from an English court. The council had refused on the basis that they considered the English council should be responsible for the cost of the allowance, unless and until the Residence Order was confirmed by a Scottish court. C was also concerned that the council had failed to provide appropriate support to them and their grandchild.

We took independent advice from a social worker. We found that, apart from a delay of a couple of months when C first applied for assistance, the council had acted appropriately, and that the order in question was not one that was transferrable between England and Scotland. As such, we did not uphold C's complaints.

Summary

C lived in a property managed by the association. C complained that the property's heating system was inadequate, resulting in high bills despite not heating rooms to an acceptable temperature. C also complained that the property was poorly insulated, suffered from damp, and had a shower that was dangerous to use.

Although the association sent engineers to the property to investigate C's complaints, C remained dissatisfied with the action taken and did not feel able to continue living in the property until the maintenance issues were resolved.

We found that the association responded to each of C's concerns reasonably. Engineers attended the property to investigate any maintenance issues raised, and repairs or upgrades were made where problems were identified. Whilst C remained dissatisfied with a number of amenities within the property, we were satisfied that the association had acted reasonably and appropriately informed C if they were unable to meet C's requests for upgraded facilities. We did not uphold C's complaints.

Summary

C, an advocate, submitted a complaint on behalf of B, parent of A. C complained that A and their family had not received sufficient, timely or ongoing support from the social work department of the partnership. In the year prior to the referral to the intensive family support service (IFSS), A exhibited behaviours which B considered should have qualified them for intensive intervention at that time, however, input from the IFSS was not agreed to until a year later. B considered that A's escalating behaviours could have been avoided if intensive support had been provided sooner. Having complained to the partnership, and being dissatisfied with their response, C brought the complaint to our office.

We took independent advice from a social work adviser. We found that it was reasonable that other supports were tried prior to A being referred to IFSS. We found that the response and involvement of specific agencies was reasonable, with regular and frequent contact and involvement in assisting A and the family to manage A's behaviour. While there were issues with record-keeping, we found that, overall, the support provided by the partnership in the period prior to referral to IFSS was reasonable. Therefore, we did not uphold the complaint.

Summary

C complained on behalf of A in relation to A's child (B). B, along with their siblings, were placed on the Child Protection Register (CPR, a confidential list of all children in the local area who have been identified as being at risk of significant harm).

B was taken to A&E with a broken arm. The medical staff felt the explanation provided by B's parents did not fit with the injury found. It was determined that the type of injury sustained by B was highly indicative of a non-accidental injury. A cause for concern was submitted to the partnership. The partnership took initial action to allow a relative to act as a protective factor and be present at all times to supervise any contact with the children and parents. The partnership then conducted a child protection investigation.

C raised concerns on behalf of A that the partnership stepped in unnecessarily, whilst refusing to consider further medical evidence and the partnership did not allow C or B's parents to have a voice at the meetings. They also felt that the partnership placed all the children on the CPR when this was not needed.

We took independent social work advice. We found that it was reasonable for the partnership to carry out a child protection investigation in the circumstances and that it was reasonable for all children to be placed on the CPR whilst an assessment of the overall situation was carried out. We found that the meetings held were conducted appropriately, although, there appeared to have been a mixed response to allowing one parent to contribute to the meetings (i.e. at times they were allowed to contribute and at times they were told their contributions were not appropriate – without being provided with an explanation why).

Summary

C attended a clinic a number of times where it was found that they had non-specific urethritis (inflammation of the tube that carries urine from the bladder to outside the body). On one occasion C was diagnosed with chlamydia (a common sexually transmitted disease). C was prescribed antibiotics to treat these conditions.

C raised concern that the partnership provided incorrect treatment. C told us that they were given multiple types of antibiotics and these had significant side effects. They were concerned that the antibiotics had impacted on their liver.

The partnership said that C was prescribed the correct antibiotics for their diagnoses. They noted that liver damage is a rare side effect of the antibiotics prescribed and blood results from the time period in question showed normal liver results and suggested that there was not severe liver damage following the antibiotics.

We took independent clinical advice from an adviser experienced in general practice, and an adviser experienced in hepatology and gastroenterology (a specialist in diagnosing and treatment disorders of the liver, stomach and intestines). We found that the treatments provided by the clinic were reasonable and that it was reasonable to treat C on the basis of the symptoms they presented with. We noted that the choice of antibiotics was reasonable, and that the partnership's position on liver damage (being a rare side effect) was reasonable.

As such, we did not uphold the complaint.

Summary

C, a support and advocacy worker, complained to us on behalf of their client (A) about the care and treatment that the partnership provided to A. In particular, C complained that A was not given appropriate support during and after their transfer to adult mental health services.

We took independent advice from an adviser in mental health nursing. We found that A's transition to adult mental health services was reasonably planned and carried out. We also found that A was given reasonable care and treatment after their transfer to adult services. We did not uphold the complaint.