SPSO Individual Decisions

C's elderly parent (A) was admitted to a care home to recuperate following surgery. C complained to Aberdeen City HSCP (ACHSCP) that the care home discharged A to their family home without knowing the result of their COVID-19 test and that they were not wearing a mask. The family were informed that A had tested positive for COVID-19 the day after they returned home. C also complained that the care home failed to communicate reasonably with the family about A during their admission. In their response to C's complaint, ACHSCP acknowledged that it was best practice to have the result of the COVID-19 test prior to discharge. They explained that there was no national guidance regarding COVID-19 testing of residents being transferred from a care home to their domestic home. However, Health Protection Scotland guidance was that the risks should be discussed with the resident's family, specifically when there is an ongoing outbreak as there is a risk that the service user may be incubating the virus and could transmit to other household members. ACHSCP acknowledged communication with the family could have been better and that A was not supported to communicate with the family. We found that there was no national guidance regarding COVID-19 testing of residents being discharged from a care home to their domestic home. However, we also found that it was evident that there was some ambiguity about what the discharge procedures should be and that there was a missed opportunity for ACHSCP and the care home to firm up their policy on safe discharging residents to their domestic home. As a result, A was discharged home having unknowingly tested positive for COVID-19 and the family were prevented from having a discussion to consider the risks. We noted that it was accepted by all parties that A was not wearing a mask when they were discharged and that this was in breaching of COVID-19 hygiene protocols. In addition to this, we found that the standard of communication with

C complained on behalf of A (an adult who lives as a tenant in supported accommodation provided by the partnership) about the partnership’s communication with A’s welfare guardian (B). A, B and C are siblings. Following incidents between A and other individuals, B emailed A’s carers to make a suggestion about A’s care. A’s carers responded by email and copied their manager into the email for their information. The care manager subsequently emailed the carers to remark on comments they had made to B but accidently sent a copy to B. B emailed the care manager shortly after to complain. B considered that the care manager’s email instructed A’s carers to withhold information about A’s care. Neither the care manager, nor the partnership responded to B’s email. C subsequently emailed the partnership to complain on B’s behalf. C reiterated B’s initial complaint. C also complained about the failure to reply to B’s email. In the partnership’s response, they did not uphold C’s complaint about the contents of the care manager’s email. However, they upheld C’s complaint about the failure to respond to B’s email. We took independent advice from a social work adviser. We found that the content of the care manager’s email was inappropriate. We considered that the email encouraged A’s carers to reduce the amount of information provided to B specifically to reduce their feedback about A’s care. We also considered that the partnership had failed to adequately investigate B’s and C’s complaint. Therefore, we upheld these complaints.

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,

Miss C and another member of her family applied for welfare powers for an adult relative. As part of that process, a Mental Health Officer (MHO) interviewed Miss  C over the phone. When Miss C saw the MHO's report, she felt what she said during the interview had not been reflected accurately. Miss C complained that the partnership refused to change the report. We found that the partnership concentrated on the issue of what was actually said or not said during the phone interview. We were critical of this approach, as it meant the central issue of what was the correct position in relation to Miss C's adult relative was overlooked. We looked at the MHO's handwritten note of the phone interview, which we found supported Miss C's view of the phone interview. The partnership did not consider the handwritten note as being the best available record of the call, which we found to be a failure on their part. We accepted that the opportunity to review a draft of the report was not possible in the circumstances. However, as a matter of good practice, we expected that an interview would start with an explanation of what would happen with the information provided at the interview, and would end with the interviewer reflecting back to the interviewee their understanding of the points made, and seeking confirmation of that understanding. This is standard interviewing procedure, and one we expect all staff conducting interviews to be aware of. We upheld Miss C's complaint.