Essex Partnership University NHS Foundation Trust

3. Miss R complains about aspects of care and treatment provided by the Trust between November 2021 and December 2022. Specifically, she says the Trust:

• should not have removed her from the care coordination service in November 2021 • despite planning to see her in June following a psychiatry outpatient appointment in February 2022, the Trust did not invite her for a review until December 2022.

4. Miss R says she had suicidal thoughts and experienced a relapse of self-harm because she did not have access to a care coordinator. She says she felt abandoned by the Trust when she did not have a care coordinator to turn to for support. She says she experienced anxiety, panic attacks and poor sleep when she did not have a further psychiatry outpatient appointment.

5. By bringing her complaint to us, Miss R is seeking an apology from the Trust.

6. Miss R has with a history of Obsessive Compulsive Disorder (OCD - a mental health condition where a person has obsessive thoughts and compulsive activity) and Emotionally Unstable Personality Disorder (EUPD – a disorder characterised by instability in mood, behaviour, and functioning).

7. Miss R requested a new care coordinator (a trained healthcare professional who manages a patient's condition and oversees their treatment plan) in November 2021, after her relationship with her existing care coordinator broke down.

8. The Trust wrote to Miss R on 17 November and offered her a meeting to discuss her needs and expectations from the care coordination service.

9. Miss R explained she declined this offer to meet because at the time she had believed the Trust was inviting her to discuss her reasons for the breakdown in communication with her current care coordinator, and this made her feel anxious.

10. The Trust then discussed Miss R’s care at a Multidisciplinary Team meeting (MDT) in December 2021 and decided to discharge her from the care coordination service.

11. On 23 February Miss R attended a psychiatric outpatient appointment. The plan was for her to have a further review in four months’ time.

12. The Trust then arranged the psychiatric outpatient review appointment for 14 December.

Discharge from care coordination service

16. The Care Programme Approach (CPA) is a package of care for people with mental health problems. The Trust carries out an assessment and then allocates a person’s care to either CPA or Non-CPA care depending on their needs. Miss R was CPA until February 2022, when the Trust discharged her to non-CPA. As part of her CPA care, she had access to a care coordinator.

17. Miss R complains the Trust should not have removed her from the care coordination service in November 2021.

18. Miss R made a request for a change in care coordinator on 23 November 2021. The Trust discussed her case in an MDT meeting and decided Miss R did not need care coordination. The Trust therefore discharged her from care coordination but allocated her care to her GP instead. The Trust did not discharge her from its service.

19. The Trust’s response explained in order to be eligible for the care coordination service, a person has to have a mental health illness with some unmet needs to work on. It said at the time of discharge, Miss R’s needs were being met in the community, she was functioning well in the community, holding down a job and attending university. It therefore did not consider she had an unmet need.

20. The Trust’s CPA procedure outlines how it implements care for both CPA and Non-CPA. It explains:

• “As a service user’s needs change, or the need for co-ordination support is minimised, moving towards self-directed support will be the natural progression and the need for intensive care co-ordination support and (new) CPA will end.”

21. As Miss R had made a lot of progress, her needs had changed, the Trust discharged her from the care co-ordination service. This decision was in line with the Trust’s CPA policy. Our adviser also supported this and said the decision to discharge Miss R from the care coordination service was reasonable, as she had been under the service for over a year and had made a lot of progress. We understand Miss R disagrees with this, and do not underestimate how difficult this time was. We have seen no indications of failings in the decision itself.

22. There are indications the process in which the Trust discharged Miss R was not in line with NICE guidelines on management of personality disorder or its own CPA policy, as discussed below.

23. The Trust’s CPA policy sets out what should happen when there is a change of care coordination:

• “If a change of member care co-ordinator/lead professional is necessary, either within the existing team or to another team within the Trust or outside the Trust, the current co-ordinator must arrange to hold a formal CPA review with the patient, any carers if applicable and the new co-ordinator. The care co-ordinator will not discharge the person from their caseload until the person has been accepted fully by the receiving professional/team/service”.

24. NICE guidance on borderline personality disorder also explains:

• “1.1.7.1 Anticipate that withdrawal and ending of treatments or services, and transition from one service to another, may evoke strong emotions and reactions in people with borderline personality disorder. Ensure that: • such changes are discussed carefully beforehand with the person (and their family or carers if appropriate) and are structured and phased • the care plan supports effective collaboration with other care providers during endings and transitions, and includes the opportunity to access services in times of crisis • when referring a person for assessment in other services (including for psychological treatment), they are supported during the referral period and arrangements for support are agreed beforehand with them”

25. According to this NICE guidance and the Trust’s CPA policy, due to Miss R’s borderline personality disorder, the Trust should have given her warning about the upcoming discharge and planned this with her, so she would not see this as a rejection. Instead, it appears the Trust wrote a letter to her and her GP on 11 December 2021 confirming it had discharged Miss R from care coordination and back under the care of her GP.

26. We therefore considered whether there was a link between this, and the impact Miss R has set out. She explained she felt abandoned without a care co-ordinator. This was understandably a very difficult time. As above, we have not seen indications of failings in the decision to discharge Miss R. She was able to access care from the Trust and her GP. We cannot link the lack of a discussion in advance of Miss R’s discharge to the impact she has set out.

Delay in psychiatry review

27. Miss R had a psychiatry appointment on 23 February 2022. The plan at this time was for them to review her again in four months’ time. This would have been by the end of June. Miss R had her next appointment on 14 December, ten months later. The Trust’s response letter said this was a reasonable decision as her psychiatric outpatient appointment in February 2022 noted no acute concerns or medication changes.

28. Our adviser explained Miss R’s records show the Trust carried out a comprehensive review at Miss R’s appointment in February. The Trust removed her from CPA coordination and provided her with one worker as a lead professional under non-CPA care (this is where an individual can meet their own care needs and does not require extra support, but they have a named person as a lead professional to help with their mental health problems) which was her doctor.

29. The Trust’s CPA policy states when a patient is on non-CPA, reviews take place once a year. This applied to Miss R from February 2022 onwards. It states:

• ‘Review

You will have a review of your care plan regularly (this is usually six monthly for those under CPA and yearly for those under non-CPA but this may be sooner if things change). You will be told when the review is going to happen and will be given time to prepare for this. The purpose of reviewing your care plan is: • To discuss your care plan with everybody involved in your care. This is to make sure the care you are receiving still meets your needs. You can always ask for a review at any time especially if you think your needs have changed.

• To check that the support you are getting is helping you, and will consider if you need any other help.

• To discuss about whether you need to continue to receive support through the CPA process, and if the people present feel you no longer need the support, then CPA will end. When CPA ends, any support you need to keep you well will continue.’

30. As Miss R was under a non-CPA care plan, in line with the Trust’s CPA policy she did not need another review sooner than one year later. Therefore, there are no indications of failings in the Trust waiting until the December to see her again.

31. It is clear Miss R has been through a very difficult time. We hope our explanations go some way to reassure Miss R we have taken her concerns seriously. We hope we have explained our decision clearly.

1. We have carefully considered Miss R’s complaint about Essex Partnership University NHS Foundation Trust (the Trust). We are very sorry to hear how the events impacted Miss R’s mental health.

2. We did not see any indications of failings in the Trust’s decision to discharge Miss R from her care co-ordinator. We understand Miss R strongly disagrees with the Trust’s decision, and do not underestimate how difficult she found it. We have seen no indication that anything went wrong in relation to the Trust waiting until December 2022 to carry out her psychiatry review. We will explain our decision below.