A medical practice in the Westminster area

3. Ms H complains that she was discriminated against by reception staff at the Practice, as a transgender female. This incident occurred on 19 November, when Ms H attended the Practice for a routine appointment. She says that a staff member referred to her as ‘sir and ‘he’ on several occasions, despite her repeated requests for them not to do this.

4. Ms H says that the situation left her very distressed and suicidal. Ms H lost trust in the Practice and was left feeling that she was no longer welcome there as a patient.

5. By bringing this complaint, Ms H seeks changes in procedures, better training for staff and a financial remedy.

6. Ms H attended the Practice on 19 November for a routine appointment. She attempted to check-in using the self-service system. Unfortunately, it was out of order on this particular day.

7. Ms H says she was standing in the waiting area, listening to a voicemail on her mobile phone, when she says a member of reception staff loudly shouted, ‘no phones are allowed sir’. She says the member of staff shouted this at her three times, despite Ms H confronting her and explaining that she identifies as female and requesting that the staff member stop calling her ‘sir’. Ms H says she became uncomfortable speaking to the staff member and asked to speak to a different member of staff.

8. Ms H completed her consultation with her GP and mentioned the incident to them, expressing her distress and discomfort. The GP arranged for Ms H to be immediately spoken to by the reception manager and they offered an apology.

9. Feeling that this response was insufficient, Ms H wrote a letter of complaint to the Practice. In its response, the Practice advised Ms H that it cannot guarantee that staff will have undertaken equality and diversity training before interacting with patients over the phone and face-to-face. Ms H feels that this is unacceptable.

10. Ms H has now moved Practice but wants to ensure that this situation does not happen again with another patient.

13. Appendix 2(a) of the Practice’s dignity policy states:

‘Reception

· The Practice will not stereotype patients based on perceived characteristics.

· Patients will be addressed by their preferred method and titles. Mr, Mrs etc. Will be used as a first preference by staff’

14. The Practice have said that Ms H was speaking loudly on her mobile phone at the time of the incident, making it difficult for the receptionist to communicate with the patient she was dealing with. This conflicts with Ms H’s claim that she was listening to voicemails. We have not found independent evidence to support either account. In the circumstances, it is unlikely we could make a robust decision about what is more likely to have happened, but we acknowledge the differing opinions on this point.

15. The Practice acknowledge that the member of staff referred to Ms H as ‘sir’ and has explained to us that the staff member called out ‘sir’ because Ms H initially had her back to the reception area, while using her mobile phone. The Practice accepts that the staff member used the term on three occasions, at which point Ms H approached the desk and explained that she was not a ‘sir’ and requested that she not be referred to as such.

16. Despite this request, the staff member continued to refer to Ms H as ‘sir’ twice more when offering an apology for the error. Ms H became distressed and asked to be dealt with by a different member of staff. The staff member then approached another receptionist and said ‘he would like to speak to you.’ Both the Practice’s investigation notes into the incident (undated) and Ms H’s recollection of events confirm this is what happened.

17. The Practice has said that Ms H was aggressive and intimidating towards the receptionist when she confronted her about referring to her as ‘sir.’ It says that this caused the receptionist to become flustered and visibly distressed, and this is the reason she continued to refer to Ms H as ‘sir.’

18. We can see that Ms H’s evidence and the Practice’s evidence conflicts. We have asked the Practice whether Ms H was spoken to, or warned, about her behaviour by practice staff in line with its zero tolerance policy. The Practice said that it considered whether warning Ms H about her behaviour would be appropriate but decided against this. As we do not have evidence to show that Ms H was acting inappropriately and causing distress to the staff member, we are unable to conclude that this was the case.

19. While we understand the reason for the initial error, as the staff member was talking to Ms H’s back, we consider that the Practice did not act in line with its policy. This is because the staff member continued to refer to Ms H as ‘sir’ and ‘he’ after she made them aware she did not identify as a man, and after she asked them to stop. We acknowledge that the Practice says the staff member was distressed by the events, but this does not alter the fact that she continued to refer to Ms H as ‘sir’ and ‘he’ after repeatedly being asked not to. We understand that this would have been an upsetting and difficult experience for Ms H.

20. The Practice explained that the member of staff was new and had not undergone equality and diversity training prior to being placed in direct contact with the public. This was because the Practice had changed learning providers.

21. The Practice states that all new employees shadow existing members of staff for the first month of employment. However, the Practice has told us that this staff member was not shadowing anybody at the time, which is not in line with Practice policy. Ms H had to request that she be dealt with by a different member of staff.

22. Whether or not the member of staff had been trained, or was shadowing another staff member, the Practice has an obligation for staff to comply with its own policies. It did not do that in this situation, and as such we consider the Practice’s actions amount to service failure.

23. When we find a failing, we consider what impact this has had on the person affected and whether the organisation has done enough to put that right, in line with our Principles for Remedy.

24. Ms H says that she has been left extremely distressed, humiliated, and upset by these events, and this led to her feeling that she was not welcome at the Practice as a patient.

25. We can understand why Ms H would feel like this and we accept this must have been a very upsetting experience for her.

26. She has told us that her irritable bowel syndrome (IBS – a condition that affects the digestive system) symptoms were worsened, and she felt suicidal because of the distress she suffered. We have considered whether there is a link between this and the Practice’s failing.

27. Ms H has told us that, at the time of these events, there was a family issue which was causing her stress and upset. Clearly, this was already a really difficult time for Ms H and the events we have investigated did not help her cope with the difficulties she was facing in her personal life.

28. We have asked Ms H to provide any clinical evidence of her worsening IBS symptoms or her suicidal feelings. She has told us that she does not have any, and so we have not seen a direct link between those worsening symptoms and the actions of the Practice. It is possible that the challenging personal circumstances Ms H faced during this time contributed to the impact she has described to us, in relation to her IBS and suicidal feelings, and without any further evidence of what caused these clinical symptoms we cannot say how far the Practice’s actions contributed.

29. Ms H has also alleged that the Practice discriminated against her. It is not our role to decide whether someone has been discriminated against. We have looked at whether the staff member concerned correctly followed Practice guidance when speaking with Ms H and have concluded that it did not. This constitutes a service failure. We accept that the Practice’s actions caused her upset, distress, and to feel like she was not welcome as a patient.

30. We are aware Ms H brought a similar complaint to us about the Practice in 2016. This was in relation to a member of Practice staff referring to her as a male.

31. The information about the previous complaint Ms H brought to us is limited, in relation to our decision, as this has been destroyed in line with our data retention policy, but it was closed with no evidence of unremedied injustice. This indicates that we found a failing but were satisfied that the Practice had done enough to resolve the matter, and it had taken steps to avoid the situation from recurring.

32. We have taken into consideration that this is the second time Ms H has experienced these issues with the Practice, which will have added to the feelings she experienced.

33. The Practice has confirmed that an earlier incident did occur where a member of staff referred to Ms H as a male and said that it did apologise at the time of these events, which is in line with our Principles for Remedy. However, given that a similar situation has happened before, and considering the severity of the impact caused to Ms H this time, we do not consider an apology is enough to put things right, as set out in our Principles for Remedy.

1. We have found that staff at a medical practice (the Practice) in the Westminster area did not follow the Practice’s dignity policy when speaking with Ms H on 19 November and we consider this a failing. This failing has led to an injustice to Ms H which has not yet been remedied. We therefore uphold Ms H’s complaint.

2. We have recommended the Practice write to Ms H to acknowledge and apologise for its error, as well as the impact this has had on her. We have also recommended that the Practice explain how similar failings will be prevented in future. We have recommended that the Practice pay Ms H £450 as a financial remedy.

34. In considering our recommendations, we have referred to our ‘Principles for Remedy’. These state that where poor service or maladministration has led to injustice or hardship, the organisation responsible should take steps to provide an appropriate and proportionate remedy.

35. They also say that public organisations should look for continuous improvement and should use the lessons learned from complaints to make sure they do not repeat maladministration or poor service.

36. The Practice should therefore write to Ms H within one month of the date of our final report apologising for the distress and upset caused to her by it not following its own dignity policy.

37. It should also complete an action plan evidencing that its staff have been further trained on its dignity policy, and any other steps it has taken to ensure compliance with this policy going forward.

38. This action plan should be completed within one month of the date of our final report, with a copy sent to us and Ms H.

39. Our principles state that public organisations should put things right and, if possible, return the person affected to the position they would have been in if the poor service had not occurred. If that is not possible, they should compensate them appropriately.

40. To decide on a level of financial remedy we have considered our Guidance on Financial Remedy, which sets out six different levels of injustice and a recommended financial remedy for each. We have decided that the impact caused to Ms H by these events fits into level two.

41. Level two injustices cover distress, worry, annoyance and similar injustice of the sort which a healthy adult would be expected to deal with, without external support, and which does not impact on the affected person’s day to day functioning, or their ability to live a normal life. We have also compared the impact in this case with other similar cases we have upheld and have decided that the Practice should pay Ms H £450 in recognition of the injustice she suffered. This should be paid within eight weeks of the date of our final report, with proof of payment sent to us.