19. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen. If what happen fell far short of what should have happened, we call this a failing. When we see indications of a failing, we next look at whether that failing had a negative impact on the person in question. If we think it did, we will go on to consider what, if anything, the organisation has done to try to put things right.
20. Having done this, we see no indication, in the main, that these bodies fell short of providing a good service to Miss M and Y. We have identified one area where Midlands Psychology appears to have fallen short; however, the actions it has already taken to put this right appear sufficient.
21. We were very sorry to learn of the difficulties experienced by Miss M and her family. We hope this explanation reassures her how seriously we have taken her concerns.
Midlands Psychology Support provided
22. Miss M complains Midlands Psychology did not contact her or offer any support following her son’s diagnosis of autism in May 2018.
23. NICE guidance CG128 explains that the following support should be offered following a diagnosis/working diagnosis of autism:
· in person discussion of findings with parents/caregivers
· share information about what autism is and how it will likely affect the child’s development
· a written report of the diagnostic assessment should be shared with GP
· share information with key professionals, including education
· offer follow-up appointment within 6 weeks of the end of the assessment for further discussion
· provide contact details for local and national support organisations
· offer information for organisations that can offer support with welfare benefits and educational support.
24. The service undertook psychological assessments of Y between March and April 2018, with a working diagnosis of autism reached in May. There is no indication the service arranged a face-to-face discussion; however, it did offer the family the opportunity to have a feedback session, which our Adviser says was a reasonable alternative to this.
25. The service issued a written report of the assessment to Y’s parents, GP, school and the local Autism Outreach team. This included a comprehensive explanation of the assessment’s findings and a care plan for Y.
26. There is no indication the service offered a follow-up appointment for Y within six weeks, which should have happened. However, the clinical notes indicate the review should take place within 12 to 18 months, to allow Y to progress developmentally. Therefore, the reason a review at six weeks was not undertaken was because the psychologist felt a longer time period was needed, which seems reasonable. The family also had open access to the service and had been offered a feedback session, which it seems they did not arrange.
27. The letter to Y’s parents in May 2018 outlined that they should contact the service’s administration team to book onto an Autism Course in order to better understand autism and Y’s difficulties. It also provided a leaflet on autism and signposted to support organisations, such as the National Autistic Youth Group and the local Autism Outreach team. The records indicate Y’s parents attended an Introduction to Autism Course on 12 June.
28. In June, Midlands Psychology also provided a letter which offered support for Y to bypass the queuing systems in crowded or public places. In October, the family received an EHCP application support letter from a Counselling Psychologist at the service. This is a legally binding document that outlines a child’s special needs and the support they need in school. Y’s family were also formally invited to one of the service’s Launch Events in 2018, which gives families an opportunity to meet others that have shared experiences with autism.
29. Overall, it appears the service met NICE guidance on the support it should have offered following Y’s working diagnosis of autism, even when acknowledging there was not a follow-up appointment at six weeks.
30. Miss M also is also unhappy about a lack of contact from Midlands Psychology during this time. However, the letter she received is quite clear she needs to reach out to the service in order to book onto the courses and access the support on offer. We can see she did book onto a course, and we can also see the service contacted her to invite her to events and provided the support she requested. There was no requirement for the service to provide further contact.
Intervention in July 2019
31. Miss M also complains Midlands Psychology did not review Y’s diagnosis within the required time frame or when she gave it new information. She adds that it did not arrange the intervention Y required, after agreeing to do so in July 2019. The records do not support Miss M’s recollection of being promised intervention. However, we can see that Miss M was requesting counselling for Y, which was something the service could not offer.
32. Y’s diagnosis should have been reviewed within 12 to 18 months, as per the clinical notes from the psychologist. In line with our Principles of Good Administration, we would expect the service to have communicated this to the family and kept this commitment. If it could not keep to the commitment, it should have explained why.
33. The evidence shows that Midlands Psychology omitted the review date from its letter to the family and Midlands Psychology has acknowledged this should have happened. This seems to have led to Miss M expecting that Y’s diagnosis would be reviewed sooner. Midlands Psychology recognised this error and apologised to Miss M. It also took steps to prevent this happening again, which included creating an updated template that prompts staff to put the review date into the letter when writing to families. We consider this is enough to put right the impact of what appears to have gone wrong.
34. The notes provided by Midlands Psychology indicate that when Miss M contacted it regarding Y’s review in July 2019, the CCG had instructed the service not to offer interventions unless it was an urgent case. This was due to the fact the CCG had only funded the service to provide urgent support between April and September 2019. The notes state Miss M did not wish to engage with the service via telephone, and so they were unable to establish whether the case was urgent.
35. The evidence also shows an Assistant Psychologist (AP) offered support to Miss M via email and attempted to gauge the urgency of the situation but could not do so. From the emails we have seen, the AP was empathetic and attempted the arrange a telephone call to better understand what was happening. However, Miss M said she would prefer to ‘keep a log’ of the support offered by email and so declined telephone support.
36. We requested evidence of the CCG’s communications with Midlands Psychology, which it provided, to establish whether it had been instructed not to provide interventions during this time. The communications reveal that between July and August 2019 Midlands Psychology had been drafting a letter to parents regarding interventions and the tender for the autism service.
37. On balance, it looks like the CCG did tell the service to provide only urgent interventions. An email from Midlands Psychology to the CCG states: ‘we are under considerable pressure to let our families know what is happening with regards to interventions’ and asks the CCG to suggest wording for the letter so they can agree it and send to parents as soon as possible.
38. A letter agreed between the CCG and Midlands Psychology in September indicates that the service was supposed to be advertised for tender (where the CCG chooses which organisation will provide a service) in January 2019 but this did not happen. From April, it agreed limited funding for interventions with Midlands Psychology, which included the introduction to autism course and ‘to provide support to a small number of families who are in urgent need’.
39. Overall, the evidence indicates that Midlands Psychology, between April and September 2019, had been given limited funding to provide services for autism. Specifically, this meant it could only offer the Introduction to Autism Course, which Miss M had already attended, and interventions for families in urgent need. As Miss M did not engage with the AP to enable Midlands Psychology to ascertain whether the need was urgent, it appears there was little it could do to offer support during that time.
40. In addition, whilst Y’s working diagnosis should have been reviewed, it appears Midlands Psychology was unable to do so due to factors beyond its control. Further, the timescale for review was 12 to 18 months and so this was not overdue until after Midlands Psychology was no longer commissioned by the CCG.
41. Regarding communicating the reasons for being unable to offer a review between April and September, the evidence indicates that Midlands Psychology had to agree the wording of this communication with the CCG. The CCG took some time to meet with Midlands Psychology to agree this wording and the communication was eventually sent.
42. As Midlands Psychology was an independent service commissioned by the CCG, it had to act in accordance with the CCG’s direction and so we cannot criticise it for a delay in communicating why it was unable to review Y. If he was in urgent need of support, Miss M needed to engage with the service so it could assess whether he could be seen as an urgent case, for which it had some limited funding.
43. We see no indication the service fell short of our Principles of Good Administration as the reasons it could not review Y were beyond its control. In addition, it needed to agree the wording of its communication with the CCG, which took some time. Midlands Psychology was proactive in chasing the CCG for this agreement and pressed the urgency of the situation.
44. Overall, we saw no indications of failings in the support Midlands Psychology offered and provided, with the exception of communicating the review date to Miss M. Our view is that it has done enough to put this right. Therefore, we are taking no further action on these issues.
Communication in September 2019
45. There is no formal guidance on the advice and support which should be offered during a transition between service providers. However, we would expect Midlands Psychology to have informed Miss M about what to expect. We would also expect it to have dealt with her helpfully and promptly. This would be in line with our Principles of Good Administration.
46. We know Midlands Psychology delayed in telling Miss M about the transfer of service. It says this was due to the CCG instructing it not to inform patients about this change. As already noted, it appears Midlands Psychology may have been unable to communicate these reasons sooner. It did attempt to offer telephone support and to tried to assess whether the case may be urgent, but Miss M said she did not want to engage with this.
47. The letter it sent to service users on 5 September 2019 adequately advised on the transfer of service. It is understandable that it would be unable to offer further support after being notified it needed to be ready to hand the service over from 30 September. Miss M was hoping Y could access counselling; however, this was not something it could offer at this stage. It appears appropriate that it could not offer more practical support due to the transfer of service. However, the letter could have done more to signpost Miss M to other support services that could help. In this sense, it could have done more to be helpful, in line with our Principles of Good Administration.
48. On balance, given the short notice Midlands Psychology says it was given to complete ongoing interventions and prepare the service for handover, its advice or support does not appear to have fallen so far short of our Principles of Good Administration that it could amount to service failure. Whilst its letter could have offered more advice on where to access support during the transition, it did explain why it could not offer interventions and did attempt to offer telephone support. Overall, this does not appear to amount to a failing in the service provided and so we are taking no further action on this aspect of her complaint.
Transfer of records
49. There is no specific guidance relating to the transfer of records during a transfer of service; however, we would expect Midlands Psychology to provide a prompt and helpful service, in line with our Principles of Good Administration. This should include transferring patient records to the new service provider promptly to facilitate continuation of care.
50. Having reviewed the records, there is no indication that Midlands Psychology delayed in sending Y’s records, specifically. In the Trust’s analysis of Miss M’s complaint it simply says there were delays in obtaining records from the provider. However, this is not specific to Y’s case; rather it appears to be a statement relating to the overall transfer of records. Midlands Psychology’s records indicate Y’s records were transferred on 30 September 2019, when the contract ended, and the records provided appear to be complete, based on the clinical file we have seen. Therefore, there is no indication Midland Psychology’s actions could amount to service failure or maladministration and we are taking no further action on this aspect of her complaint.
Failure to put things right
51. We would expect Midlands Psychology to acknowledge its mistakes and apologise where appropriate, in line with our Principles of Good Administration.
52. We have seen evidence, in its responses to Miss M and its own internal documents regarding the mistakes it may have made, that it acknowledged and apologised for what it felt went wrong. So there is no indication its service fell short here. Therefore, we are taking no further action on this aspect of her complaint.
Midlands Partnership NHS Foundation Trust
53. Miss M complains the Trust did not offer the correct interventions to support Y whilst his care was transferred from Midlands Psychology from October until November 2019.
54. We would expect the Trust to provide a prompt service to Miss M and Y, in line with our Principles of Good Administration.
55. We can see from the Trust’s response to Miss M that during this time it was having to co-ordinate a large volume of records from the previous service provider. It was also having to check which of these were complete, which individuals needed urgent interventions and arrange a large number of appointments with different families. Given the finite resources available to the Trust, and the volume of work it needed to undertake, we do not consider that four to six weeks is an unacceptable delay. It appears quite prompt, given the circumstances. We see no indication of service failure here and so we are taking no further action on this issue.
Staffordshire and Surrounds CCG Delay in responding to her complaint
56. Miss M says the CCG failed to respond to her complaint for five months and she received no updates during this time. She also says it did not respond to her emails chasing a response to her complaint.
57. In line with The Local Authority Social Service and National Health Service Complaints (England) Regulations 2009 (the Complaints Regulations), the CCG should have:
· acknowledged the complaint within three working days – either in writing or over the telephone
· provided a timeframe for completion of the investigation into her complaint.
58. We would also expect the CCG to have dealt with Miss M’s complaint helpfully and promptly, which should include updating her on the progress of her complaint and providing prompt responses to her contacts. This would be in line with our Principles of Good Complaint Handling.
59. Miss M raised her complaint on 25 September 2019. The CCG received this and sent her an acknowledgement letter on 27 September, explaining it needed her consent to share her concerns with two other bodies and asking her to provide this consent. This appears in line with the Complaints Regulations as the complaint was acknowledged within three working days. The letter also explained the timeframe for responding was 40 working days, in line with the Complaints Regulations.
60. On 12 November the CCG sent Miss M an interim holding letter, which provided an explanation for the delay and details for accessing support during the transition. This appears in line with providing prompt and helpful support to her, as per our Principles of Good Complaint Handling.
61. On 3 January 2020 Miss M emailed the CCG to say she had not heard from it since its letter of 27 September 2019. It replied the same day and apologised for the delay in completing work on her case. It reassured her it was chasing a response from Midlands Psychology.
62. On 16 January, Miss M emailed the CCG again to say she still had not received a response. She emailed it again on 24 January asking for a response to her previous email.
63. The CCG responded the same day. It explained it had chased Midlands Psychology for a response on a number of occasions but had not received a reply. It explained it would issue the response as soon as it was able. The CCG issued an update on 5 February and issued its response to Miss M on 7 February.
64. Overall, there is no indication the CCG fell short of the Complaints Regulations or our Principles of Good Complaint Handling. With the exception of one email, it acknowledged all Miss M’s correspondence promptly and helpfully, in line with our Principles. This one oversight does not indicate service failure or maladministration overall. It sent her an update in November 2019, explaining the delay, and further emails in January and February 2020, and so we cannot agree it provided her with no updates during this time. Further, it acknowledged the complaint and provided a timeframe, in line with the Complaints Regulations.
65. With regards to whether the complaint was delayed, whilst the time taken to progress the complaint did extend far beyond the 40 working day target, it appears there was a good reason for this. It needed a further response from Midlands Psychology as there were outstanding issues. Midlands Psychology’s emails indicate it was resistant to providing this as it was no longer commissioned by the NHS. This delayed the complaint and was beyond the CCG’s control. It updated Miss M about this, which was appropriate. As there is no indication anything went seriously wrong, we are taking no further action on this issue.
The CCG did not ensure the provider followed NICE Guidelines
66. The NHS Oversight Framework 2019/20 (Appendix 1) sets out what CCGs have a responsibility to provide oversight to. There are 60 indicators that apply to CCGs, including 3 which relate to responsibilities for autism and learning disability care. This does not include taking an active role in ensuring independent providers follow clinical guidelines.
67. The Care Quality Commission (CQC) is the independent regulator of health and social care in England, and is responsible for ensuring the service provided is in line, overall, with the relevant standards. The CCG does have the responsibility to review the quality of the services it commissions, but this does not mean it needs to undertake a comprehensive review of compliance with NICE guidance in every complaint it considers. If there are individual concerns about the service provided, the CCG should follow its complaints policy.
68. The CCG’s complaints policy states that it is responsible for co-ordinating a response and drafting a response to the complainant. It appears to have acted in line with its policy in doing this, which we would expect to see in line with our Principles of Good Complaint Handling.
69. There is no indication the CCG’s service fell short of the relevant guidance. Its complaints process is not intended to undertake an in-depth investigation into compliance with clinical guidance; rather, its role is co-ordinate a response from the commissioned service and assess whether the response itself is adequate. It appears to have done this, acting in line with its complaints policy, and so there are no indications of maladministration regarding this point. Therefore, we are taking no further action on this issue.
Transfer of service from Midlands Psychology to the Trust
70. Miss M says the CCG did not ensure a timely transfer of service from Midlands Psychology to the Trust.
71. Whilst there is no guidance on the transfer of commissioned services, we would expect the CGG to ensure its change in commissioning did not impact on its responsibility, set out in the NHS constitution, to provide convenient and easy to access services. This would be in line with our Principles of Good Administration.
72. Having looked at the time it took the new provider to contact Miss M, four to six weeks, following the transfer of service, there is no indication the transfer of service was unduly delayed. With any transfer of service, there will be some delay as the new service must review and arrange treatment for a number of individuals. Four to six weeks appears quite prompt, given that context. Given this, we cannot say the CCG failed to ensure the transfer was timely as it appears to have been a prompt transition.
73. Further, in its letter of 12 November 2019 the CCG provided Miss M with a lot of information about how to access support during the transition, including which services to contact during this time and the support available to her and Y. Therefore, there is no indication that during the transfer it failed to ensure a service provision, and it appears the services offered were convenient and easy to access.
74. As there is no indication of undue delay in the transfer of the service, and support was offered during this time, there is no indication of service failure. Therefore, we are taking no further action on this issue.
Failure to put things right
75. Miss M says the CCG would not accept responsibility for what it did wrong.
76. We would expect the CCG to accept where it made mistakes and apologise where appropriate. We can see it apologised where there had been delays, and there appears to be no indication of a shortfall in its service overall. Therefore, there was little requirement for it to take responsibility for errors or put things right. There is no indication anything went wrong here, and we are taking no further action.