11. Firstly, within the complaint, there are outcomes we cannot achieve. In our role, as defined by the Law, it is beyond our remit to instruct or tell health practitioners where or when to refer patients and what for. Our role is to consider whether failings happened, and what an organisation has done to put matters right where failings are present and have not been remedied. Secondly, we cannot instruct a GP what checks to do. Though we can recommend a range of outcomes, instructing practitioners how to practise is outside our remit.
The Practice
12. The Law states a person needs to make their complaint to us within a year of becoming aware of the problem they wish to complain about. As set out within the Law, we cannot investigate complaints brought to us after one year, unless we consider there is an exceptional or justifiable reason for the delay in bringing a complaint to us.
13. There is no exhaustive list of reasons we refer to, and in conducting our work we consider each complaint and delay on a case-by-case basis. It is for us to decide whether we can put our time limit aside.
14. We have discussed this with Miss Z to understand the reasons why she could not raise a complaint to us within the time limit. We have also considered the time the organisation has taken to respond to Miss Z.
15. Miss Z says she was not offered a face-to-face appointment with her GP even after she made several requests for help with her son’s cough, weight loss, aggressive and unpredictable behaviour, swearing and bed-wetting. Miss Z also complains the Practice wrongly told her she had not received a referral for her son from HCRG. Miss Z also complains she requested a referral to paediatrics via her GP, but her requests for help were ignored.
16. The Practice is sorry Miss Z felt it necessary to make a complaint. Its response says it did not receive a referral letter from HCRG and it hoped this would clarify the situation for her.
17. We spoke with Miss Z on the telephone to discuss the timescale of her complaint. She said she initially spoke with her son’s GP in March 2020 and raised concerns about his physical and mental health and the need for a referral to paediatrics. We thus take this as the date Miss Z knew she had a reason to complain (her date of knowledge). The date by which we would have expected to receive her complaint would therefore be March 2021.
18. Miss Z had various interactions with the Practice between March 2020 and August 2021, but she made no complaints or enquiries for 17 months, which is a substantial period of time.
19. On 31 August 2021 Miss Z contacted the Local Government and Social Care Ombudsman (LGSCO) as her complaint spanned several agencies, including the local council and two health organisations.
20. Miss Z was advised by the LGSCO her complaint was premature. She then complained to the Practice on 16 November 2021, some eight months after her date of knowledge, and received a final response from them three months later on 28 February 2022.
21. Miss Z submitted her complaint to the LGSCO on 17 March 2022.
22. During this six-month period Miss Z’s complaint went into the LGSCO queue and was then assessed to see whether the Joint Working Team would take it on, as there were interlinked matters about health and social care services.
23. The LGSCO contacted Miss Z on 4 October 2022 to confirm that her complaint would no longer be considered as a joint investigation as the matters were not so closely linked, and the health elements would be looked at by us. This six-month period is out of Miss Z’s control as her complaint was being assessed by the LGSCO, so we would not consider this in the time taken for her to bring her complaint to us.
24. Miss Z brought her complaint to us on 4 November 2022. By the time we received her complaint 31 months had passed from her date of knowledge - 19 months over the 12-month time limit to complain to us.
25. Even if we consider the six-month assessment time by the LGSCO, Miss Z’s complaint would still be 13 months over the time limit for a complaint. We identified the following delays in the complaints process:
COVID-19
26. We spoke with Miss Z to establish why she did not complain to us sooner. Miss Z stated Covid-19 was a factor and the UK being in lockdown prevented her from making her complaint sooner. Miss Z also stated her health was a barrier to her making her complaint on time, as she has several health issues including complex post-traumatic stress disorder (PTSD), fibromyalgia (a condition that causes pain and fatigue) and heart problems, and the stress of managing her son’s health issues.
27. We paused complaints between 26 March 2020 and 1 July 2020 so as not to place additional burdens on the NHS, which was responding to the COVID-19 pandemic. It would be reasonable to consider this pause when assessing our time limit for Miss Z’s complaint. Miss Z did not complain to the Practice until November 2021 which is 17 months after she became aware she needed to complain.
28. Our expectation is the complainant is responsible for ensuring the complaint is brought to us quickly, and if the complainant is responsible for delays in the complaints process (for example, by not bringing their initial complaint to the organisation quickly or by delaying bringing the complaint to us after complaint handling was complete), then we would need to consider whether those delays were justified.
Health issues and caring responsibilities
29. Miss Z states her family are all ill and they have PTSD. Miss Z also says she has complex PTSD, fibromyalgia, chronic fatigue syndrome, sarcoidosis (an inflammatory disease), asthma and long Covid, heart problems and high blood pressure. Miss Z says she is exhausted from being her son’s carer and not getting support, and she struggles to manage her own care along with the needs of her son.
30. We recognise the impact of Miss Z’s health issues, but we do not consider high blood pressure or asthma to be so exceptional as to justify a delay. We accept a combination of PTSD, fatigue, long COVID, sarcoidosis and care responsibilities would paint a complicated picture of wellness and home life.
31. Miss Z became aware she needed to complain in March 2020, but she did not make her complaint to the LGSCO until 31 August 2021, which is 19 months after her date of awareness.
32. When faced with a combination of challenging health matters, we have not seen that Miss Z made any attempt to complain or any activity to support making a complaint, such as approaching an advocacy service, Patient Advice and Liaison Service, Healthwatch or the community and voluntary sector (including Citizen’s Advice), or seeking the help of a friend, family member or colleague. We have not been made aware of any such attempts.
33. Although we do recognise complicated factors may have contributed to some delay, we are not persuaded these fully justify the whole period of inactivity. By this we mean there likely would have been times when delays happened due to flare-ups or different presenting combinations of Miss Z’s conditions, but we are not persuaded these would have prevented her from complaint activity every day for 17 months.
34. Miss Z first contacted the LGSCO on 31 August 2021, which is 17 months from when she first became aware she needed to complain – a delay of five months. Miss Z complained to the Practice on 16 November 2021 – a further two and a half months later. Miss Z received her final response on 28 February 2022 and submitted her complaint to the LGSCO on 17 March 2022, which was referred to us in October 2022.
35. We recognise Miss Z has been through a difficult time with her caring responsibilities for her son and her own ongoing health issues. It is our view Miss Z could have brought her complaint to us sooner, and the reasoning she has provided is not enough for us to overlook this delay. Therefore, we will take no further action.
HCRG
36. Miss Z complains about the care and treatment her son received at HCRG in January 2020. She says the consultant in paediatrics refused to listen to her concerns and inappropriately cancelled her son’s ASD assessment within weeks of his appointment.
37. The Law says a person should bring their complaint to us within a year of when they first become aware they need to complain.
38. Miss Z complains the consultant paediatrician refused to listen to her concerns about her son and inappropriately cancelled an ASD appointment for him on the basis his problems related to poor parenting and attachment issues. Miss Z says he had already been on the waiting list for around three years and the consultant agreed to reinstate his position, but this did not happen. Miss Z says this has caused distress to her son and the whole family.
39. Miss Z complained about this matter on 31 August 2021 when she contacted the LGSCO, which is 19 months after she became aware she needed to complain. The LGSCO advised her the complaint was premature and she needed a final response from HCRG. HCRG received Miss Z’s complaint on 21 February 2022 and sent a detailed response to her on 29 June 2022.
40. In their response HCRG confirmed Miss Z’s son was assessed by the consultant on 3 February 2020 to get a clear picture of his strengths and needs, and they felt he was showing good developmental progress. The response also says the consultant felt Miss Z’s son was progressing well and he did not meet the diagnostic criteria at that time for autism. Miss Z was then invited to meet face to face with the consultant involved in her son’s care and the clinical lead on 18 May 2022.
41. From our telephone call with Miss Z, she confirmed she was aware she needed to complain from the appointment in January 2020. Taking into account the 12-month time limit to make a complaint to us, we would have needed Miss Z’s complaint by January 2021 at the latest.
42. Miss Z says Covid-19 and the subsequent lockdown were the reasons she did not complain sooner, and her health issues and caring responsibilities for her son were also a barrier.
43. It is the complainant’s responsibility to ensure they get their complaint to us within a year of when they first become aware they need to complain. We have carefully considered Miss Z’s multiple health issues and caring responsibilities for her son, but we are not persuaded these justify a 19-month total period of inactivity.
44. We consider Miss Z could have brought her complaint to us sooner and we take into account the reasons she has provided, but these are not enough for us to set aside our time limit. Therefore, we will take no further action.
Summary
45. In reaching our decision, we have explained how we consider the time limit for making a complaint and considered Miss Z’s reasons for the delay. We have also explained that we would not be able to achieve some of the outcomes Miss Z seeks from this complaint. We would like to thank Miss Z for bringing her complaint to us for consideration.