Upheld, recommendations

Summary

C complained that the practice refused to provide their late parent (A) with an in-person GP appointment. A had a history of lung cancer which had been treated with radiotherapy (a treatment of disease, especially cancer, using high-energy radiation) previously. A contacted the practice by phone to report pain in their right leg and buttock. A was not seen in-person due to COVID-19 guidance, however a telephone consultation was arranged. The consulting GP considered that A’s symptoms likely resulted from sciatica (back and leg pain caused by irritation or compression of the sciatic nerve) and prescribed treatment for this. Further phone consultations followed with the GP and others at the practice on four other occasions. The consultations consisted of a mixture of planned contacts by the GP and unplanned contacts by A. C later contacted the practice and expressed concern that A’s condition had not improved. C asked for A to be seen in person. A was seen by a GP that day. A’s case was discussed with an oncology (cancer) nurse specialist. It was agreed that A’s condition required further investigation. A was subsequently referred to an oncology clinic and was diagnosed with metastatic lung cancer. A died the following year.

We took independent advice from a GP. We found insufficient evidence to suggest that the practice had refused any request from A for an in-person appointment. However, we did find that there had been a unreasonable delay in providing A with an in-person appointment. On consideration of relevant guidance, the clinical record and specialist advice we found that A should have been seen in-person on the third contact they had with the practice. We considered that the delay in providing A with an in-person appointment was brief and were unable to conclude that the delay had a material impact on A’s prognosis.

In the circumstances, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C that there was an unreasonable delay in providing A with a face-to-face appointment. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The findings of this investigation should be fed back to the staff involved, in a supportive manner, for reflection and learning.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the care and treatment provided to their late spouse (A) who had a history of superficial bladder cancer (early bladder cancer when the cancer cells are only in the inner lining of the bladder and has not spread beyond it) and prostate cancer. C complained about the care and treatment provided during two short admissions to Borders General Hospital. A was passing blood in their urine and had unexplained pain. C specifically complained that A was not thoroughly assessed and that further investigations should have been carried out. A chest x-ray was later performed which identified a shadow on A’s lung. A’s condition deteriorated and they died a few weeks later.

The board confirmed that they considered the care and treatment provided to be reasonable and that there was no suggestion at the time to indicate that further tests were necessary.

We took independent advice from a consultant uro-oncologist (a specialist in diagnosing and treating cancers of the male and female urinary tract and the male reproductive organs) with a speciality in dealing with bladder and prostate cancer. We found that there was a failure to take the appropriate action in response to the findings of a previous cystoscopy (bladder examination using a narrow tube-like telescopic camera) which showed a thickened bladder, and that during the first admission it was incorrect to state that the findings of this procedure were normal. We also considered that the board failed to fully investigate the cause of A’s bleeding, nor the thickened bladder, and that not enough regard was given of A’s deterioration. We upheld the complaints, concluding that these failings led to a delayed diagnosis of A’s cancer. However, we acknowledged that these failings did not impact on A’s ultimate prognosis.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the identified failings. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Staff should fully understand the importance of taking into account the patient’s medical history, accurately report on previous test results and ensure that symptoms are fully investigated.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of their client (A) that the council had unreasonably failed to handle a request for kinship care assistance. A assumed care of their grandchildren and applied for and was granted a residence order. A one-off payment along with weekly payments were paid by the council. While a kinship assessment was commenced, it was approximately three years later before A was told that they were not an approved kinship carer and that the weekly payments would be stopped.

C complained to the council that the decision to stop the weekly payments was unreasonable and that A had been treated poorly by the council. In addition, C complained that the kinship assessment had restarted three times with three different social workers which had made this a distressing process for A. Also, the grandchildren were incorrectly not being recognised as being ‘at risk of becoming looked after’.

We took independent advice from an adviser with a background in social work and children and family services. We found that there were significant delays in concluding the kinship assessment which had not adhered to the timescales set out in the Guidance on the Looked After Children (Scotland) Regulations and the Adoption and Children (Scotland) Act 2007. We also found that the outcome had not been communicated to A as per this guidance. While it is for the council to determine whether or not a child is at risk of becoming looked after, we accepted the advice we received that, in this case, the council had failed to evidence that they carried out a sufficient level of assessment to conclude whether or not A’s grandchildren were at risk of becoming ‘looked after’. In addition, we found that the council had failed to carry out an in-depth assessment of the family’s circumstances, particularly the six months before the residence order was granted, under the terms of the National Guidance. Finally, we found that the council’s communication with A was unreasonable.

For the reasons detailed above, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for the failings identified by the investigation. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The council should reconsider the situation at the time it was first presented to them, with respect to whether the children were at risk of being accommodated (as outlined by Section 71 (5) (a) of the Children and Young People (Scotland Act 2014) given there was no legislative security in place for them against a father who was alleged to be a risk to the children and who had parental rights and responsibilities that A did not have. Depending on the outcome of the above reconsideration the council should reassess whether there is a requirement to now carry out a kinship assessment. A should be notified of the outcome. The council should consider revisiting the robustness of assessment and risk assessment and how this is quality assured to ensure that the right questions are being asked at the outset and that ongoing assessments are addressing the issues such as those highlighted by the Kinship Panel.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the care and treatment provided to their late parent (A). A, who had a history of cancer, attended a medical practice, for which the partnership was responsible, with various non-specific symptoms. The practice made a working diagnosis of polymyalgia rheumatica (a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips) and a trial of steroids was commenced. Around five weeks later, A was referred by the practice for an ultrasound scan with a query of malignancy, which found metastatic (spread of cancer from the primary tumour) disease in the liver and a bladder mass. The practice referred A to the urology department (a specialty in medicine that deals with problems of the urinary system and the male reproductive system) at a local hospital. However, A’s cancer had progressed and no further treatment could be provided. A died a short time later.

C said that the practice should have considered the possibility of a cancer recurrence much sooner before trialling steroids to treat possible polymyalgia rheumatica. C also complained that the practice had not informed A of the results of the ultrasound scan and disputed the practice’s claim that C’s sibling had been informed. C further complained that the practice should have been aware of delays in A’s treatment following referral to secondary care and taken steps to expedite the treatment.

In response, the partnership stated that there had been no delay in requesting appropriate scans and said that A had received the best possible care the practice could offer during A’s illness. The partnership also stated that the records showed the practice had discussed A’s care with C’s sibling in their capacity as power of attorney.

We took independent advice from a GP adviser. We found that, while it was reasonable for the practice to commence a trial of prednisolone (medication used to treat a wide range of health problems including allergies, blood disorders, skin diseases, infections and certain cancers) to treat the working diagnosis of polymyalgia rheumatica, the lack of immediate improvement should have made the practice consider another diagnosis. Given A’s history of cancer, we considered that referral for ultrasound should have happened sooner. We also could not find any record confirming that A had been informed of the results of the ultrasound scan nor that C’s sibling had been informed. However, we did not consider that there was any responsibility on the practice to send any reminders to secondary care about A’s treatment, given no specific concerns had been raised about this.

For these reasons, we upheld C’s complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to inform A that the ultrasound scan performed showed possible liver metastatic disease and failing to refer A for an urgent ultrasound or CT scan to investigate the possible recurrence of cancer.
• Apologise to C for the unreasonable delay in responding to their complaint, for not providing updates or an explanation for the delay or when a response could be expected, and for not responding to their additional correspondence. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The practice should give consideration as to where improvements could be made to their practice to ensure that cases of possible recurrent cancer are investigated as soon as possible.
• The relevant clinicians should be reminded of the need to ensure that patients should be kept fully informed about their diagnosis and involved in decisions about their treatment and that patients are presumed to have capacity to make decisions about their treatment. If it is considered that a patient is unable to understand and/or retain information given to them, an assessment of capacity should be carried out.

In relation to complaints handling, we recommended:

• The partnership's complaint handling governance system should ensure that responses to complaints are in line with the NHS Scotland Model Complaints Handling Procedure.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained to the board about surgery they received on a semi-urgent basis. C complained that the surgery had been inadequate and that they had been unable to fully consent to it due to time pressure and a lack of information. C also complained that the board’s subsequent management of their pain medication was unreasonable. In particular, C complained that they had not been informed of the potential for opiate pain relief to become habit-forming. The board responded that the surgery had been performed correctly and that a lengthy consultation had been held with C prior to surgery by the operating consultant neurosurgeon (a surgeon who specialises in surgery on the nervous system, especially the brain and spinal cord).

We took independent advice from a consultant neurosurgeon. We found that the surgery had been performed to a reasonable standard and that the board’s management of C’s pain medication was also reasonable.

However, we identified a lack of records illustrating any discussion with C about the potential benefits, risks or complications of surgery prior to the operation. We also identified a lack of records illustrating any discussion with C regarding the potential for opiates to become habit-forming.

In the absence of such records we were unable to say whether C received appropriate information. Therefore, on balance, we upheld both complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C that there was no contemporaneous evidence that C was reasonably informed of the potential risks and complications of surgery or of the potential for morphine to become habit-forming. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• There should be complete records of discussions with patients about the potential risks and complications of surgery prior to surgery.
• There should be records of discussions with patients regarding the potential for morphine to become habit-forming.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the care and treatment provided to their late brother (A). A’s consultations with the practice took place when COVID-19 restrictions were in place and as such, a number of their appointments were held via phone.

A had been complaining of a persistent sore throat and tongue. A also said that they had been reporting a lump in their neck. A was referred to the Ear, Nose and Throat (ENT) department and was diagnosed with oropharyngeal cancer (a type of cancer that begins in the cells of the tonsils). C complained that there was a delay in referring A to ENT for further investigation.

We took independent advice from a GP. We found that there was a poor standard of record keeping by the practice. The records did not always demonstrate that an adequate medical history was obtained or that adequate safety netting and follow-up advice was provided. We also identified that the wrong antibiotics were prescribed on one occasion and that the wrong test for glandular fever was performed. We were concerned that the practice’s own investigation of the complaint did not identify any of these failings.

We considered that there was likely a delay of 15 days in referring A for further investigation. While this was not significant, in light of the other failings identified, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings identified. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The medical centre should ensure that staff are confident and knowledgeable in carrying out physical examinations.
• The medical centre should ensure that the Significant Event Analysis addresses both clinical care and treatment and internal processes.
• The medical centre should ensure the standard of record-keeping meets General Medical Council Good Medical Practice standards.
• The medical centre should have a policy to review their cases or seek medical advice, especially when several consultations occur and the case is non-responsive or atypical.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the council's social work involvement with their child (A). A had a range of conditions that affected their development and behaviour. A was placed in residential care and was made subject to a legal order via the children's hearing system.

A was transitioning out of children's services and into adult services. C raised a number of concerns with the council about the support provided by the council when arranging A's transition. Whilst the council upheld aspects of C's complaint, C remained dissatisfied with the council's response and brought their complaint to us.

C felt that some aspects of the council's response were unclear, that they had not taken responsibility for what had gone wrong, and that they misunderstood some of the family's concerns.

We took independent advice from a social worker. We found that the council could have done more to facilitate clear communication with C and to involve C in A's care planning and assessments. We also found that the council unreasonably excluded C from certain aspects of the decision-making process for A. We upheld all of C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings identified. The apology should meet the standards set out in the SPSO guidelines on apology available at: www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Social work staff should allow enough time to carry out the appropriate planning and assessment work, consider if a capacity assessment should be sought at an early stage, and take a holistic view of the needs of the young person and their wider support networks.
• Social work staff should take into account the young person's wishes about their family's involvement in the decision-making process. Social work staff should meet with families to discuss and address any issues prior to children's hearing/review meetings and try to agree a course of action to present to the Children's Panel/review officer.
• Social work staff should endeavour to use emails to contact clients/their families, when that is their preference, as it is more effective and efficient than corresponding by post.
• Unless there is good reason not to, social work staff should arrange a face-to-face meeting or a phone call to discuss sensitive matters, rather than communicating the information in writing.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C is the owner of nurseries which provide childcare. During normal operation, C receives funding to provide an amount of childcare hours to parents without charge as these are funded by the Scottish Government. During the COVID-19 pandemic, the advice was for childcare providers to close their businesses unless they were providing critical childcare for keyworkers. C closed their businesses during this time.

When arranging to reopen their business, C sought advice from the council on whether or not C can or should charge parents for critical childcare. The council told C that critical childcare should be free at the point of delivery and that C should not charge parents, however, they also advised that C could charge in certain circumstances. The council told C that they should use funding they received during the lockdown to cover costs when the nurseries reopened. C felt that the advice they received was in contradiction to advice that they received from the Scottish Government.

C had previously raised a complaint with the council about funded hours (prior to the impact of the pandemic) and, in light of this, when C complained about the advice they were given, the council decided that the complaint should not be investigated via their complaints handling procedure. This office took an early view and asked the council to investigate the complaint and provide a further response. After a further response was issued, C remained dissatisfied and brought their complaint to us.

We found that the advice given by the council was, at times, contradictory and did not appear to be in line with the guidance issued by the Scottish Government. We also found that the council did not appropriately investigate C's complaint at the time it was raised, or when this office asked them to undertake further work.

In light of this, we upheld C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for providing unclear and conflicting information about the right to charge parents fees, and for the failure to investigate C's complaint appropriately when it was initially submitted and when asked to do so by this office. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The council should ensure that advice given is clear, consistent, and in line with the relevant guidance, policy or procedure.

In relation to complaints handling, we recommended:

• The council should ensure that complaints are recognised, logged, and responded to in line with the Model Complaints Handling Procedure (MCHP). When this office asks the council to carry out further work on a complaint, they should ensure that they respond in line with our request. When required to carry out further investigation, the council should ensure that the complaint is logged and responded to in line with the MCHP. If the council is unclear what this office is asking them to do, they should engage with us to clarify prior to beginning any further work. When the council receives complaints about specific members of staff, they should ensure these are investigated in line with the MCHP, paying particular notice to the guidance on investigation and who should investigate/respond to a complaint (i.e. someone not involved in the complaint).

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C, a support and advice worker, complained on behalf of their client (A) that the council had unreasonably failed to provide A with kinship care assistance, including financial support. A became the carer to their family member (B) when B's parent was unable to care for them.

We took independent advice from a social work adviser. We found that a number of contemporaneous records were missing. The record-keeping failures in this case mean that there is no record of whether the council have met their legal and procedural obligations. In particular, there is no definitive record of whether a Section 25 order was signed and rescinded or why the decision to carry out a comprehensive assessment and refer to the Children's Reporter was not followed through.

We found that these record-keeping failures had left the family in an unreasonable position where there is difficulty corroborating what happened and therefore placing them at a disadvantage in terms of accessing a kinship care assessment and any appropriate allowances. In the absence of records, we considered that the council had unreasonably failed to take sufficient account of the evidence available from the family and the social worker involved at the time (both of whom indicated that a Section 25 order was signed). Based on the evidence available, we considered that it was likely that a Section 25 order was signed and at that point B became a looked after child which means they became an eligible child in relation to kinship care under the Children and Young People (Scotland) Act 2014. We also noted that the Kinship Care Assistance (Scotland) Order 2016 extended the definition of an eligible child to include a child who was previously looked after.

In light of the above, we considered that the council failed to provide A with reasonable kinship care assistance. As such, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for failing to maintain case records regarding A and B's involvement with social work, failing to take sufficient account of the evidence available which indicated that a Section 25 order was signed, making B a looked after child and an eligible child in in relation to kinship care. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Complete a kinship care assessment, in line with relevant guidance, in respect of A's care of B. As far as possible, consideration should be given to the evidence available indicating that a Section 25 was signed, making B a looked after child and the circumstances of the household when the assessment should have originally taken place (not just the current circumstances). If, following the assessment, the council is satisfied of eligibility, consideration should be given to the backdating of any kinship allowance to when it would have commenced had the council appropriately considered the evidence available indicating that a Section 25 was signed.

What we said should change to put things right in future:

• Where written records are not available due to a failure in record-keeping, information from families and social work staff should be appropriately taken into account.
• Written case records should be appropriately maintained and retained in accordance with relevant legislation and guidance.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C, a support and advocacy worker, complained on behalf of their client (A) in relation to the council's decision not to make payment of kinship care allowance in respect of children in A's care. C stated that A was entitled to receive kinship care allowance on the basis that both children, whom A had been caring for following the death of a parent, had initially been looked after by the council given that the children's surviving parent had agreed to transfer responsibility for their care to the council immediately following the other parent's death. A had also secured residency rights in respect of the children by obtaining an order under section 11 of the Children (Scotland) Act 1995, which C stated was to be considered as a kinship care order in terms of the Children and Young People (Scotland) Act 2014.

In response, the council stated that, while the agreement of the children's surviving parent had been sought to transfer their care to the council after the death of the other parent, it had ultimately not been necessary to proceed on this basis given that A had stepped forward to care for the children almost immediately. Accordingly, the children had never been formally looked after. In addition, the council stated that A and the children's extended family had chosen to look after the children themselves on a private basis without the need for further input from the council's social work department. For these reasons, the council considered that A was not entitled to receive kinship care support.

We took independent advice from a social worker. We found that A had stepped forward to care for the children within a matter of hours of the council seeking the children's surviving parent's agreement to transfer their care to the council. We agreed with the council's position that it had ultimately not been necessary for them to proceed further in this regard and, accordingly, the children had never been formally looked after by the council. We further agreed that A and the children's extended family had also decided to look after the children on a private basis without the need for further social work input. However, we considered that A had agreed only to care for the children on a temporary and emergency basis until the wider family had been able to decide on how the children should be cared for. Accordingly, a period of around three weeks had passed between A stepping forward to care for the children and the decision being taken by the family to care for them on a private basis, during which time it was not certain that A would agree to care for the children on a full-time basis.

We also noted that the council had remained actively involved in decisions about the children's welfare during this period. For these reasons, there was evidence to suggest that the children had been at risk of becoming formally looked after and that the council should have treated A as an informal kinship carer during the three week period, providing them with the appropriate financial support. We further noted that, as A had subsequently obtained an order under section 11 of the 1995 Act, it would be open to them to make an application to the council to be assessed as a kinship carer. We considered that the council's case records did not clearly show the justification for decisions that had been made and that there was evidence to suggest that the council had failed to carry out necessary checks prior to placing the children with A, as set out in the council's own policies. We also found that the council had failed to handle C's complaint in accordance with the relevant complaints handling processes in place at the time.

For these reasons, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for failing to assess A regarding the need to provide support and financial assistance under section 22 of the Children (Scotland) Act 1995 or section 50 of the Children Act 1975, failing to communicate reasonably with A in respect of the legal basis on which the children were residing with A and thereafter, and failing to handle the complaint made on behalf of A in accordance with the Social Work Model Complaints Handling Procedure. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Calculate the amount of financial assistance that A would have been entitled to receive for the period specified and make payment of this amount to A.
• Advise A how they can make an application to be assessed as a kinship carer. Should it be decided that A is entitled to kinship care assistance, the council should also give consideration to whether this should be backdated, in view of the fact that A was not advised that they could make such an application when C made known A's wish to be considered as a kinship carer.

What we said should change to put things right in future:

• The council should ensure that the checks set out within their Looked After Children procedures are carried out prior to agreeing to children being cared for by adults with whom they are unfamiliar, unless there is clear evidence why the checks are not required.
• When decisions are made about the long-term living arrangements for children with whom the council's social work department has been involved, the council should ensure that all parties are sufficiently clear as to the legal basis on which those arrangements have been made.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the Local Authority Model Complaints Handling Procedure, which can be found here: https://www.spso.org.uk/the-model-complaints-handling-procedures.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.