Not upheld, no recommendations

Summary

C complained on behalf of their late parent (A) that the board unreasonably failed to diagnose A’s cancer, from which they later died.

We took independent advice from a respiratory consultant adviser. We found that clinical management from the respiratory team carried out appropriate investigations.

We found that there was a failure in communication of the CT results to A and their family and that there was also a delay in intervention following the abnormal CT report, that a biopsy could have been carried out earlier, and that there was no need to await review at an MDT.

On balance, we found that there was no evidence of an unreasonable delay in diagnosing cancer, therefore we did not uphold this complaint.

Summary

C complained on behalf of their parent (A) that the board did not provide a reasonable standard of nursing care. A was admitted to hospital with COVID-19 and had to be nursed in isolation due to their COVID-19 positive status.

We took independent advice from a nursing adviser. We found that the majority of the events described by C and A would not necessarily be documented. That in itself was not evidence of a failing, merely that events documented in the notes would be largely clinical in nature rather than communication. Due to the time that had passed since the events complained about, staff did not recall the specific period of care. We found that there was no evidence of unreasonable nursing care or treatment in the medical notes. As such, we did not uphold the complaint.

Summary

C spent time in hospital for their mental health. C complained about how the board had managed their prescriptions and about the lack of treatment for their physical symptoms of migraines and hand/arm injuries.

We took independent advice from a consultant psychiatrist adviser. We found that C’s perspective was recorded in contemporaneous notes, that they had requested a change of medication and that their doctor agreed to the trial of an alternative. C’s consent was regularly sought and this was good practice. The evidence suggested that C’s reports of physical symptoms were also properly investigated and that C was offered appropriate pain relief for their migraines. As such, we did not uphold the complaints.

Summary

C is an adult who requires support with various daily living tasks. C is in receipt of Self-Directed-Support (SDS) payments to enable them to employ personal assistants to help with these tasks. C complained that they were not permitted to employ their family member as a personal assistant. C told us that the partnership did not fully consider C's circumstances or explain the reasons for their decisions.

The partnership said that family members of the supported person may be employed as a personal assistant where this is deemed appropriate, under exceptional circumstances. Ultimately the decision to permit such an agreement is at the discretion of the local authority. The partnership acknowledged the difficult circumstances faced by C, however, they considered that ultimately they did not agree with the request to employ a family member, particularly in light of the dynamics involved with someone being both an employee and a family member.

In response to our enquiries, the partnership further explained that a social worker spoke with C and a family member to explain the reasons for their decision. They said that they considered C's circumstances, but also, that they considered the aims identified in C's support plan and it was their view that the employment of a family member would not be in keeping with C's assessed needs.

We took independent professional advice from a social work adviser with particular experience in Adult Services. We found that decisions like these are discretionary decisions that the partnership is entitled to make. Each of the factors identified by C were considered by the partnership when making their decision.

We found that the partnership made their decision in line with the regulations and reasonably explained their reasoning to C. As such, we did not uphold the complaint.

However, our investigation highlighted a small error whereby the partnership referenced legislation rather than the related regulations. This did not impact the reasonableness of the partnership's position or response, therefore, we provided feedback to the partnership on this point.

Summary

C complained on behalf of their sibling (A) about the care and treatment that they received during a hospital admission. A had a cannula (a thin tube inserted into a vein or body cavity to administer medication, drain off fluid, or insert a surgical instrument) fitted which then became infected and caused them to develop sepsis (an infection of the blood stream). C complained that A had requested the cannula be removed sooner and that this was declined. C also complained that A had advised staff that they felt unwell and that this was not taken seriously, and also that their medication had not been properly managed.

We took independent advice from a consultant in acute internal medicine. We found evidence in the medical records that A declined to have the cannula removed. There is no other documentary evidence from the time about A either refusing, or requesting, to have the cannula removed. We found that the care and treatment provided was reasonable.

We also found that A's medication had been properly managed and that they did not note any failings in the communication with A and their family. We did not uphold this complaint.

Summary

C complained about the care and treatment that their child (A) received from the board. A had an autistic spectrum disorder (ASD) diagnosis and a history of treatment through the board's Child and Adolescent Mental Health Service (CAMHS). A was placed on an urgent waiting list for further assessment and treatment. A was assessed and was assigned medication and individual therapeutic work. Following a number of appointments, A was discharged from the individual appointments, was seeking support in the community and was supported with accommodation.

C reported concerns about A's behaviour, including an incident where they set a mattress on fire. A subsequently attended another appointment thereafter.

C complained that professionals failed to respond adequately to an escalation in A's behaviour which should have prompted an urgent appointment. C also complained that a later appointment did not result in a reassessment of A and the support that they required. In response to the complaint, the board said that there was no evidence of any new psychiatric symptoms that required urgent assessment, and that the later appointment was appropriate with a plan for A agreed at the time.

We took independent advice from a mental health services specialist. We found that appropriate assessments were completed following C's reports of concerns about A's behaviour. We found that the decision not to carry out an urgent psychological review was reasonable and that the records showed a thorough and detailed assessment was carried out at the later appointment. We found that the conclusions reached were reasonable. As such, we did not uphold the complaints.

Summary

C complained about the care and treatment provided to their partner (A). A had been suffering from an extended period of constipation which the District Nursing Team had attempted to treat at home. A's GP referred them to hospital for further treatment. A died following a fall in hospital.

C raised a number of concerns about the GP's assessment of A's condition and the decision to refer them to hospital. C said that the GP should have visited A at home, should have considered alternative treatments at home, and that the GP made assumptions about A's wishes and condition. C believed that there were no grounds for admitting A to hospital and that the GP's actions led directly to A's death.

We took independent advice from a general practitioner adviser. We found that the care and treatment provided to A was of a reasonable standard. It was not a requirement for the GP to visit A at home prior to referring them for admission. The admission had been discussed with C, and the decision to refer A for hospital admission was a reasonable clinical judgement for the GP to make in the circumstances. The GP's referral had acknowledged C and A's wishes for resuscitation to be attempted and the advice did not consider that there was an unreasonable focus on this in the admission.

We found that the care and treatment provided to A was reasonable and that the practice had acted appropriately when considering and responding to C's concerns. We did not uphold C's complaints.

Summary

C complained to the board about several aspects of the care and treatment provided to their parent (A) during their time in hospital and also about the discharge planning on each occasion.

A was diagnosed with terminal cancer and was in hospital for treatment before being discharged home. A was later readmitted to hospital with illness. A was discharged home again and later died.

The board's position was that the discharge planning for A on each occasion was appropriate. There was discussions about what supports could be offered, and it was frequently documented that A's wish was to be at home. Discharge plans were discussed on a daily basis.

With respect to the care and treatment provided to A during the second admission, the board commented that A was being treated for a chest infection and apologised if C was not aware of A's chest infection. The board said that there was no indication to replace the nasogastric tube (tube used to deliver food or medicine to the stomach for people who have difficulty eating or swallowing).

We took independent advice from a consultant geriatrician (doctor who specialises in treating older patients) and from a registered nurse. We found that the care and treatment provided to A during their admission was reasonable. We also found that given A's condition and prognosis, the decision that A was suitable to be discharged was also reasonable. We did not uphold the complaint about care and treatment.

With respect to the planning made for A's discharge home, we found that the planning on each occasion was reasonable. On A's first discharge from hospital, appropriate assessments were carried out and discussions documented about supports which could be put in place for A's return home. It was documented that these were declined by A.

With respect to the second discharge, whilst there was no formal discharge plan, given A's prognosis and assessment that they were independent and requesting to go home, it was reasonable to discharge A.

Whilst we determined that the arrangements for A's discharge were reasonable, and did not uphold these complaints, we provided feedback to the board with respect to the absence of some records which we would have expected to see and/or be updated more regularly.

Summary

C made a complaint to the practice regarding the care and treatment provided to their late spouse (A). A attended the practice with pain and a family history of cancer. C said that the practice caused unnecessary suffering and stress to A and their family through misdiagnosis of A's condition. They also said that there was an unreasonable delay in progressing the ultrasound and that this led to poor management of A's pain. A was later diagnosed with lung cancer.

We took independent advice from a general practitioner adviser. We found that overall the practice did provide reasonable care to A. We found that the practice took reasonable steps to investigate A's symptoms and their actions were reasonable based on the information known at the time. As such we did not uphold the complaint.

Summary

C cares for their spouse (A) who has Alzheimer's disease. C complained about the council's social work department, after they took action under their Adult Support and Protection (ASP) procedures, including obtaining a warrant to remove A from home. C complained that false allegations about them resulted in the warrant being issued and served. They complained that social work staff had presented unsubstantiated claims of neglect and abuse during the ASP proceedings.

We took independent social work advice. We noted that there was evidence that C was experiencing stress in their caring role and that there was a difficult relationship with social work. We noted that there were periods during which A was locked in the house alone and C had mentioned that A may have bruising on them and would not allow access for a GP to assess A at that moment in time. We found that there was sufficient evidence to indicate that the council had a statutory duty to investigate the circumstances and put in place an action to safeguard A's welfare.

We found that the council followed the ASP process reasonably, seeking input from C and relevant professionals. A number of actions were agreed to ensure that both C and A had the support they needed in place and once it was established that the appropriate support was in place the ASP process was ended. We were also satisfied that it was reasonable for certain meetings to take place without C and A's involvement. Therefore, we did not uphold this part of C's complaint.

C also complained about the council's communication in respect of these matters. We found that the council had attempted to communicate clearly and openly with C. We considered that the circumstances themselves and the stress and anxiety involved likely contributed to a breakdown in communication. Therefore, we did not uphold this part of C's complaint.