North West Boroughs Healthcare NHS Foundation Trust

4. Miss Y complains about aspects of care and treatment provided by North West Boroughs Healthcare NHS Foundation Trust (the Trust). Miss Y says the Trust referred her incorrectly to outreach services when she should have been referred to a psychiatrist. She says the staff member completing her assessment was unsympathetic and did not explain the reasons for the referral.

5. Miss Y says she suffered emotional distress at a very difficult time when she needed help for her mental health condition. She felt let down by the NHS and she has suffered anxiety and panic attacks following the assessment.

6. Miss Y seeks financial compensation for the private psychiatrist appointment she had to attend as she was not offered an NHS one. Miss Y would also like service improvements.

7. Miss Y has a history of mental health issues. Miss Y has previously accessed Cognitive Behavioural Therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR), and talking therapies.

8. She underwent two assessments by the mental health triage team on 14 September 2020, and again 8 December 2020, following self-referrals.

9. In the second assessment, Miss Y explained that she had recently been diagnosed with Post Traumatic Stress Disorder (PTSD), Generalised Anxiety Disorder (GAD), agoraphobia, and panic disorder by a private psychiatrist. The private psychiatrist prescribed prazosin.

10. She has since been diagnosed with borderline personality disorder (BPD).

Referral to outreach services

14. When we carry out a primary investigation, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and, we have not found any indications that something has gone wrong.

15. We took independent clinical advice and considered the assessments completed by the Trust on 14 September 2020, and 8 December 2020. We found that the assessments were robust and comprehensive.

16. The assessments considered Miss Y’s mental health history, personal history, presenting complaint, a mental state examination, and took into account Miss Y’s views. The assessments were in line with the Trust’s standard assessment template for assessment, and in line with the NMC’s guidance on ‘Assessing needs and planning care’. This guidance states that registered nurses should:

‘prioritise the needs of people when assessing and reviewing their mental, physical, cognitive, behavioural, social and spiritual needs. They use information obtained during assessments to identify the priorities and requirements for person-centred and evidence-based nursing interventions and support. They work in partnership with people to develop person-centred care plans that take into account their circumstances, characteristics and preferences.’

17. The records show the Trust followed the above guidance and took into account Miss Y’s history, presenting concerns, and her views.

18. We recognise that Miss Y has since been diagnosed with BPD, however, we can only consider the information provided to the assessor at the time of the assessment, and whether this was considered appropriately. As a result, we do not consider that there are indications of failings in the Trust’s assessments of Miss Y.

19. Additionally, we consider that the Trust acted correctly in providing details of the crisis service and in its referral to outreach services. We found no indications that the Trust should have referred Miss Y to a psychiatrist. Guidance on NHS patients who wish to pay for additional private care says that ‘Private care should be carried out at a different time to the NHS care that a patient is receiving.’

20. The notes show that Miss Y had recently seen a private psychiatrist and was already being prescribed medication by them. Therefore, we do not consider that it would be appropriate for the Trust to involve a further psychiatrist in Miss Y’s’ care.

21. We recognise that Miss Y has advised us that she was unable to afford further private appointments, however, we can see no evidence of that in the information provided to the Trust. We can also see that Miss Y paid for additional private treatment following the assessments. It is also noted, in the Trust’s final signed response, that a review of Miss Y’s medication with the pharmacist took place, and it was confirmed that the treatment was in line with NICE guidelines for PTSD. The Trust also signposted Miss Y to ‘Think Wellbeing’ which provides CBT, as is recommended by NICE for PTSD. Therefore, we consider that the Trust acted in line with relevant guidelines for Miss Y’s diagnosis.

22. Miss Y also says the Trust did not explain the reasons for the referral. The notes show that Miss Y agreed to a referral to outreach services, to self-refer to ‘Think Wellbeing’ and that a safety plan was posted to her. The notes also show that Miss Y agreed to contact the crisis line should she need immediate help. Therefore, there are indications that Miss Y was aware of the plan by the Trust and had agreed to this.

Tone of the assessment

23. Miss Y says the staff member assessing her was unsympathetic. In this instance we have been unable to access recordings of the assessment, and as such, we cannot fully consider the actions of the Trust. We do not consider that the Trust should have recorded the calls as this is not part of its own policy. However, based upon Miss Y’s account of the assessment, and the impact she describes, we have considered what actions the Trust took following the complaint. We recognise that Miss Y did not feel listened to at a difficult time, and that this was very difficult for her.

24. Before we decide if we should investigate a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. We have done this, and we have found the Trust has already done enough to put right the impact of these events. In Miss Y’s complaint, we can see that the Trust has asked the staff member concerned to reflect on their own practice. Therefore, were we to investigate the complaint further, and to find failings in the actions of the Trust, we consider that the Trust has already done enough to put this right and to prevent this from happening again.

1. We have carefully considered Miss Y’s complaint about the Trust. We have seen no indication that anything went seriously wrong.

2. Miss Y says the Trust referred her incorrectly to outreach services when she should have been referred to a psychiatrist. She says the staff member completing her assessment was unsympathetic and did not explain the reasons for the referral.

3. We have decided not to investigate the complaint further. We do not consider that there are indications of failings in the Trust’s assessment of Miss Y. Additionally, we consider that the Trust acted correctly in its referral to outreach services. We are unable to listen to the phone call to determine whether the staff member assessing Miss Y was sympathetic, but we can see that the Trust took learning from Miss Y’s complaint. The Trust asked the staff member to reflect on their phone manner, which would put things right if something went wrong. We recognise that Miss Y felt unsupported and unable to access treatment and we understand that this was extremely difficult for her.