Referral 14. Mr N complains the Trust failed to provide him with an ECS course for his mental health despite being referred for this by the Trust in 2018. He says during the period from August 2018 to March 2022, he and his partner were told on several occasions that he was on the waiting list for ECS but that nothing ever came of it.
15. NICE guidance on service user experience in adult mental health services say people should be able to access mental health services when they need them, should be supported in shared decision making and that a care plan should be agreed with social care and health professionals.
16. We have seen evidence in the progress notes that the ECS course was first recommended for Mr N alongside other courses by the Trust in August 2017 with the view that further work was needed with his care co-ordinator on his agoraphobia and panic attacks before he would be ready for the ECS course which was in line with NICE guidance. We can see this course was recommended again in August 2018 and that by May 2019, Mr N had completed an assertiveness and wellness recovery action plan and was ready for the ECS course.
17. In February 2020, Mr N had been ready for the course for nine months but had not been given a start date. We consider this was not which was not in line with NICE guidance as no alternative had been offered while he was waiting.
18. It was at this point he was told he was next on the waiting list for the course but in March 2020, Covid 19 restrictions came into place, and he was told it would be autumn before the course would be accessible again. However, this did not happen, and it was not until April 2021 that course was offered to him again but sadly in May he was given a cancer diagnosis and taken off the ECS waiting list and referred for Cognitive Analytical Therapy (CAT) pending the status of his physical health.
19. At this point, we can see Mr N had been on a waiting list for this course almost four years of which two of those years he was considered ready. He was also told he was on a waiting list for the CAT course in July 2021 but then there is no further mention of any courses until March 2022 when he was told he was now on the waiting list for ECS again. We consider this was not in line with NICE guidance.
20. Our clinical adviser has explained that there should have been a written care plan of what support could be provided while Mr N was waiting for ECS and that he should have been offered an alternative when the Trust became aware the course was not available. They go on to say there was a lack of communication in relation to this and at times during the five years he was on the waiting list there also seems to be a gap in him having a care co-ordinator which would have added to the confusion. We consider this was not in line with NICE guidance.
21. Therefore, we consider the Trust did not follow NICE guidance in relation to the length of time Mr N was on the waiting list for ECS without an alternative being given and the lack of communication around this. We did see that although he was on the waiting list for ECS from August 2017, he was not actually ready for the course itself until May 2019 which means the length of time, he was waiting is three years.
22. We have considered what the impact of this was on Mr N and Mr A. They both have told us the lack of support from the Trust has impacted Mr N’s already fragile mental health and his social phobia and PTSD is worse. He says the lack of information to his partner’s GP has also made receiving ongoing care difficult and due to this he never leaves the house, and he feels like his partner has been left to support him alone.
23. Due the nature of the impact described we sought further advice from our clinical adviser who explained that no effective mental health support or clear plan for the course recommended, appears to have contributed to Mr N’s mental health deterioration as described. We have also seen evidence of Mr N’s GP’s contact with the Trust to find out the status of the care plan and support offered. We can see how the failings identified caused the impact described and we were sorry to hear how this has impacted both Mr N and Mr A as his carer.
24. The Trust apologised for delay Mr N experienced, it does not appear to have recognised fully the impact this has had on him and his partner. Therefore, we consider the Trust has not addressed the failings we have found or put things right. We will therefore uphold this part of the complaint and make recommendations in our final report.
Complaint handling 25. Mr A as Mr N’s representative is unhappy about how his complaint to the Trust was managed as he says it changed his upheld complaint following an investigation to partly upheld without an explanation and no further action was taken.
26. The Trust’s complaint policy says in handling complaints the Trust endeavours to listen to the complainant to understand their concerns and the outcomes they are seeking, to be open and accountable, to act fairly and proportionately, to put things right and to seek continuous improvement. It also says it should aim to send the complainant a response within 25 working days of the complaint being received and where this is not possible the complainant will be kept informed.
27. We have seen evidence in records, Mr A made a complaint to the Trust on 19 March 2022 and that this was allocated to one of the Trust’s investigators to complete a report. The Trust then contacted Mr A by email on 31 October to advise the report was complete and that he would receive a response from CEO in due course. When there was no further contact from the Trust after this date, Mr A completed a subject access request for his partner’s records in November and then contacted the Trust after three months on 31 January 2024 as he had not received a copy of the report or a response.
28. Mr A then received a copy of his partners progress notes and a draft version of the report which upheld his complaint.
29. On 13 February, a new complaint manager wrote to Mr A to advise he had taken over the complaint, and that the report had not been completed and needed more work. From this date Mr A continued to chase his complaint on multiple occasions and the Trust responded to each contact. The Trust then sent final response to Mr A on 8 June, 15 months after the original complaint, with a partly upheld decision.
30. Based on the evidence we have seen; we consider the Trust did not follow its complaints policy when managing Mr A’s complaint as it took significantly longer than the 25 working days in the policy with the onus appearing to be on Mr A to follow up on his complaint. Although, communication improved when a new complaints manager took over the complaint in February, and we acknowledge the Trust would have been dealing with a backlog at this time due to covid. However, at this point the complaint was almost a year old.
31. We also consider the Trust missed a chance to explain in its final response to Mr A why the overall decision was different to that of the draft investigation report which upheld the complaint. We consider this would have been beneficial to Mr A as he had received the draft report through a subject access request and had also been sent an email by the investigator to advise report was complete and had been passed to the chief executive officer.
32. We have considered what the impact of this was on Mr A who has told us that the lack of clear communication during the complaint process has added to the upset and anxiety both him and Mr N were experiencing leaving them both feeling not listened to and unsupported. We can see how the failings in the Trust’s management of Mr A’s complaint caused the impact described.
33. The Trust partly upheld Mr A’s complaint and offered an apology for the delays he experienced. It has not however recognised fully the impact this had on Mr A and Mr N.
34. Therefore, we consider the Trust has not addressed the failings we have found or put things right. We will therefore uphold this part of the complaint and make recommendations in our final report.