Not upheld, no recommendations

Summary

C, an advocacy worker, complained on behalf of A about the care and treatment they received from the board. A had been referred to the Ear, Nose and Throat (ENT) department when they noticed a growth on their neck. A was diagnosed with a positive squamous cell cancer (type of cancer that starts as a growth of cells on the skin) in their left tonsil which had spread to their neck lymph nodes. C complained about the standard of communication from the ENT department and a failure to provide appropriate treatment which they considered led to A's terminal diagnosis.

The board provided an overview of the care and treatment provided and were satisfied that appropriate care was provided. Due to the metastatic nature (spread) of A's cancer, the only treatment available was palliative. The board also noted there was regular communication with A and they were copied into letters that were sent to A's GP.

We took independent advice from a consultant ENT surgeon. We found that the clinical decision making with regards to treatment for A's cancer was appropriate and clearly set out in the records. While we recognised that A may have been under the impression that their cancer had been successfully treated, we were satisfied that the records documented detailed discussions which took place between clinical staff and A on multiple occasions regarding their diagnosis and treatment plan. We acknowledged it was possible that A may not have understood the complex and technical terminology used, however overall, we did not find that the clinical team failed to communicate with A. As such, we did not uphold C's complaints.

Summary

C complained about the care and treatment provided to their late partner (A) by the board. A had been diagnosed with anorectal cancer which had spread to their liver and was treated over several admissions to hospital. A died while receiving in-patient care. C complained that the board had failed to provide A with reasonable care and treatment while they were an in-patient. C also complained that the board had failed to communicate adequately with them.

The board did not identify any failings in A's care and treatment. However, they apologised for an aspect of their communication with C regarding A's diagnosis. C remained unhappy and asked us to investigate. C complained that clinician's had failed to take adequate action in the face of A's condition and that there had been a failure to provide adequate nursing care for A's stoma. C also complained about aspects of the board's communication regarding A's condition and death certificate.

We took independent advice from a consultant physician in acute internal medicine and a nurse. We found that the clinical and nursing care provided to A was reasonable. We found that the board's communication with A regarding their condition was also reasonable. Due to conflicting evidence we were unable to make findings about other aspects of the board's communication. Therefore, we did not uphold C's complaints but fed back to the board about keeping clear and accurate records of communication.

Summary

C complained that the council failed to undertake a proper assessment of them as a prospective adoptive parent for a foster child placed in their care (A). C also complained that the transition of A from foster care to their adoptive family was unreasonable.

The council said that it was decided that C would not be considered further as a prospective adoptive parent for A based on C's responses to enquiries made of them at the early screening stage and their circumstances at the time. C did not agree with the council's response and brought their complaint to the SPSO.

We took independent advice from a social worker. We noted that the council had acknowledged their failure to ensure sufficient visits with C had taken place. However, we found that the council's decision not to consider C further as an adoptive parent was reasonable and did not uphold this part of C's complaint.

In relation to the transition of A to their adoptive family, we found that this was reasonable and decisions were made with the best interests of A in mind. Therefore, we did not uphold this part of C's complaint.

Summary

C complained on behalf of their parent (A) about the council's investigation of incidents of anti-social behaviour from A's neighbour. C said the council failed to carry out a reasonable investigation which had an adverse effect on A's mental and physical health.

The council's initial response was very brief and simply stated that they had looked over the case notes and spoken with the staff involved. The council did not uphold C's complaint and C brought their complaint to this office. We sent the complaint back to the council and asked them to provide a more full response. The council's second response was more detailed, gave a chronology of events and summarised the action they took each time C, A (or their neighbour) reported an incident. However, it still only gave brief details of the actions taken by the council after each report and failed to evidence that this was in line with their anti-social behaviour policies.

After further enquiries the council provided evidence of the policy and procedure they followed. We found that there were a series of administrative errors on the part of the council and that council records contained inappropriate speculation about A's health and its possible impact on their complaint. Although these administrative failings undermined C's confidence in the council's actions, we found that the council did respond to the complaints of anti-social behaviour in line with their own procedures. Therefore, we did not uphold C's complaint but provided the council with feedback.

Summary

C complained that the social work service unreasonably failed to carry out an appropriate assessment of their grandchild (A)'s parents. They also complained about the level of support provided to the parents. In particular, C complained that there was too much focus on the past behaviours of the parents, and that social work had unreasonably planned for A to be adopted prior to their birth. C also said a social worker showing bias towards the parents, and that social work had interfered with a housing transfer application.

We took independent advice from a social worker. We found that the assessment of the parents undertaken by social work had been reasonable, noting that the relevant guidance required for the past behaviours of parents to be considered as part of a wider comprehensive assessment to determine future risks to a child. We also found the plan to move A to the adoption register had occurred over a period of time, and we did not find evidence to support C's view that it had been planned prior to A's birth. We considered the overall level of support provided to the parents had been reasonable, including in relation to the housing transfer application. In relation to C's complaint about the social worker, we did not find evidence to support that a full investigation of this point had taken place, and we provided feedback to the council on this matter. Overall, we considered that the assessment and support provided to the parents by social work had been reasonable. We did not uphold C's complaints.

Summary

C complained about the care and treatment provided by the practice. C was diagnosed with polycystic ovary syndrome (PCOS, a condition that affects the function of the ovaries) a number of years ago and had previously had an ovarian cyst removed. Over the following years, C experienced a number of symptoms, including abdominal pain which the practice attributed to irritable bowel syndrome (IBS, a common condition that affects the digestive system). C complained that the practice did not explore a potential link to their PCOS. C attended A&E with severe pain. It was identified that C had a large ovarian cyst which required surgery. C complained that the practice's failure to diagnose the cyst exacerbated their symptoms and led to prolonged pain and discomfort. C also complained about poor postoperative care by the practice.

The practice confirmed they were satisfied that their treatment of C's symptoms was appropriate in the circumstances and explained that the NHS does not offer routine surveillance scans for patients with PCOS or to patients who have a history of cysts.

We took independent advice from a GP. We found that prior to C's attendance at A&E, there was no significant evidence of a cyst and in the absence of any other clinical indication it was reasonable to attribute C's symptoms to IBS. With regard to C's concern about the postoperative care provided, we noted that the practice diagnosed an incisional hernia and referred C to the Surgical Admissions Unit where an ultrasound was carried out but failed to show anything. A subsequent CT scan identified three hernias. We concluded that the GP's presumed diagnosis of a hernia was reasonable and therefore C was appropriately referred to the Surgical Admissions Unit. Overall, we were satisfied that the care and treatment provided to C was reasonable and we did not uphold C's complaints.

Summary

C complained about the care and treatment provided to their spouse (A) by the out-of-hours (OOH) service. A had a headache, temperature and dizziness and collapsed twice. The OOH GP spoke with A and A's family and prescribed painkillers for their headache. A later started hallucinating and the OOH service sent an advanced nurse practitioner who diagnosed A with a urine infection. A was later taken to hospital where they died from organ failure a few weeks later.

We took independent advice from a GP. We found that it was reasonable for the GP have carried out a telephone consultation instead of a home visit and that the telephone assessment conducted appears to have been reasonable. We also considered that it was reasonable for the OOH GP to have obtained a medical history from A and A's family and that given the symptoms described and the results of the urine test, the diagnosis of a urine infection was reasonable, as was treatment with antibiotics rather than admission to hospital. We also found it reasonable that a Significant Adverse Event Review was not considered given that there were no direct issues raised with the OOH service at the time of events.

We did not uphold C's complaint but provided feedback to the board that the notes of the telephone consultation were inadequate given that reasonable record keeping is an integral part of patient care.

Summary

C complained about the council’s Community Care Assessment (CCA) of their young adult child's (A) care and support needs. The CCA recommended that A continue to work with Social Work to meet the family’s desired outcome of A working towards independent living and becoming less reliant on their parents. C complained that the CCA did not take into account all of the information that they had submitted for consideration. In particular, they were concerned that the CCA failed to take account of the family’s home situation and allow for periods of respite for both A and their parents.

The council concluded that the CCA had taken account of, and referred to, all relevant information, including from other relevant council departments and outside organisations. The council were also of the view that the CCA had taken into consideration A’s outcomes, including time that would be neither spent by A at home nor with their parents.

We took independent advice from a social work adviser. We found that the council’s decisions following the CCA regarding respite for A were reasonable, and that they reasonably took account of the family’s home situation.

We found that the CCA was completed following the principles of the relevant legislation and reached a reasonable conclusion. We found nothing to suggest that the council failed to take account of relevant information, or minimised any potential risks to A or others. We did not uphold C’s complaint.

Summary

C complained on behalf of their relative (A) who is an elderly adult with profound learning difficulties and other support needs. C complained regarding the Partnership's assessment of A’s care and support package. The assessment resulted in A’s budget being reduced. The Partnership confirmed that they considered the budget was sufficient to meet A’s identified care needs. They explained that since A’s last assessment, the council had introduced an eligibility criteria and that the recent assessment was undertaken in accordance with the new criteria.

C complained that the Partnership failed to demonstrate how the budget met A’s needs and that the Partnership failed to produce a final support plan.

We took independent advice from a social worker. We found that the assessment was carried out to a high standard and while C and the Partnership were not able to reach an agreement and finalise the support plan, we did not consider the Partnership had failed to demonstrate how the budget proposed would meet A’s needs. We did not consider the Partnership contributed in a significant way to the failure to produce a final support plan and that they made reasonable attempts to work with C and A's guardian in order to produce the final support plan. As such, we did not uphold the complaints.

Summary

C complained about the standard of medical care and treatment provided to their spouse (A). A was diagnosed with, and treated for, advanced breast cancer. A’s condition deteriorated and they later died. C complained that clinicians failed to, amongst other things, act upon A's worsening symptoms or their concerns that their cancer may be spreading. C also raised concerns about the end of life care A had received from the board.

The board, in responding to C’s concerns, did not consider that there had been a failure to act on A’s worsening symptoms. However, they acknowledged incidences where A had not been given the opportunity to bring support to out-patient appointments where clinicians reported a deterioration in their symptoms. They apologised to C for A's poor experiences and agreed to take a number of improvement actions in response. They acknowledged A’s end of life care had been highly distressing for C and their family but did not consider that this had fallen below a reasonable standard.

We took independent advice from a consultation clinical oncologist. We found that the communication surrounding A’s diagnosis and progressive disease could have been better. We also noted a lack of documented Clinical Nurse Specialist support, but overall felt A’s treatment following metastatic (when cancer cells spread to other parts of the body) diagnosis had been appropriate. We did not uphold this aspect of the complaint.

With regards to A’s end of life care, we found that although the board’s handling of A’s DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) and discussions around their deterioration were appropriately documented, the communication around this did not meet C’s own expectations or needs. However, we found no evidence to support that decisions taken in respect of A’s end of life treatment, including their nursing care, had been unreasonable. For these reasons, we did not uphold this aspect of the complaint.

We did, however, provide feedback to the board on complaint handling matters, specifically in relation to adhering to response timescales and updates to the complainant during a complaint investigation.