Humber Teaching Hospitals NHS Foundation Trust

5. Mrs H says the Trust referred her son, Mr H, to a service who diagnosed him with ADHD, autism, and suspected learning difficulties. She complains the Trust:

• significantly delayed in offering him any treatment, intervention or support following his ADHD diagnosis in June 2023, despite his ADHD report stating the importance of medicating him straight away to keep him safe in the community • delayed in arranging a specialist psychiatrist to assess him following his diagnosis in June 2023.

6. Due to this, she says:

• her son is not receiving the care to meet his individual needs. She says his symptoms remain and he is struggling to keep him safe because there is no intervention or support available to him • she feels frustrated and let down by the service and says it has also affected her psychologically.

7. As a result of complaining to us, she is seeking:

• a written apology • financial remedy in the sum of £2000 • service improvements to ensure the same thing does not happen again.

8. This brief background is only intended to place the key events in context, not to provide a full account of everything that happened.

9. On 13 January 2023, the Trust accepted Mr H’s ADHD referral and placed him onto the ADHD diagnostic pathway.

10. On 2 March 2023, a commissioned service for the Trust completed an assessment of autism spectrum condition summary report, following assessing Mr H. The report confirmed Mr H met the criteria for an Autism Diagnostic Observation Schedule (ADOS, a standardized, observational assessment tool used to help clinicians diagnose autism) classification of autism.

11. On 14 June 2023, the commissioned service wrote an assessment summary report explaining Mr H met the diagnostic criteria for Combined Type ADHD (a subtype of ADHD where individuals experience symptoms of both inattention and hyperactivity/impulsivity). Mrs H during the assessment, reported she would like the Trust to consider ADHD medication for Mr H. It was confirmed he will be transferred to the NHS service’s waiting list for titration (a process used to find the right dosage of a medication), and she will be contacted once an appointment becomes available. It said it will leave the timing of the medication with the Trust and if they wish to delay until he is six years old, they should medicate at this point (he was five years old at this time). They also discussed useful services to approach to learn more about ADHD and useful strategies for some of the areas in which she reported difficulties. The Trust shortly after put Mr H on its waiting list for Child and Adolescent Mental Health Services (CAMHS, specialist NHS mental health services for children and young people up to the age of 18) for consideration of medication for ADHD.

12. Mrs H expressed concerns to the Trust about the waiting times for an appointment for Mr H’s medication following his diagnosis. On 2 May 2024 Mrs H discussed with the neurodevelopmental team at the Trust her concerns that Mr H was not on ADHD medication and should be. The Trust involved a paediatrician and a consultant psychiatrist before concluding that Mr H did not appear suitable for an urgent ADHD medication assessment.

13. On 26 June 2024, Mrs H expressed concerns about the waiting times. The Trust explained to her there were no new appointments available and suggested a referral to the learning disability service. Mrs H declined this. The Trust discussed ‘Right to Choose (allows consideration of alternative options to avoid waiting so long for a diagnosis and post-diagnosis support)’ which was also declined. The Trust said the appointment will be offered as soon as it becomes available.

14. On 21 October 2024, the Trust arranged for a psychiatrist to review Mr H on 11 November for a Medication Initiation appointment (a consultation to discuss the potential use of medication for a child or young person’s mental health condition).

15. On 11 November 2024, a psychiatrist assessed Mr H to review his ADHD and to discuss further management. They agreed, after a discussion about the possible treatment options for ADHD, to have a trial of treatment with Equasym XL (medication used to treat ADHD, which typically helps improve the activity of central parts of the brain, which are under-active in ADHD).

19. Before we decide if we should conduct a detailed investigation of a complaint, 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 have not found any indications that something has gone wrong.

Treatment

20. Mrs H says the Trust delayed in offering her son any treatment, intervention or support following his autism diagnosis in March 2023 and ADHD diagnosis in June 2023. Specifically, she has concerns that the ADHD report stated the importance of medicating him straight away and the Trust did not do this.

21. The diagnostic report said the Trust should consider medication for Mr H (as he is younger than would usually be the case for considering medication), but that it would leave timings with the Trust. The report did not say it was important to medicate him straight away.

22. We think the Trust then acted appropriately by adding Mr H to their waiting list for an assessment for ADHD medication.

23. In terms of waiting times, our adviser explained that services consider risk when assessing whether to expedite such requests. We saw no evidence to indicate that the Trust failed to appropriately consider the risk here. The risks the Trust identified were Mr H accidentally cut himself with a razor and some issue with road safety, but our adviser’s view, which we share, is that this would not reach the usual thresholds for expediting a referral.

24. The relevant guidance, NICE guidance [NG87], does not specify when to expedite requests. We consider the Trust acted appropriately by adding Mr H to the waiting list for ADHD medication following receiving the report from the commissioned service and by considering risk in the context of the timing.

25. We understand Mr H waited a significant period before he was given medication, and can see how this was difficult for Mr and Mrs H. We note that the Trust informed the ICB that there had been a surge in referrals and requested an increase in funding, which will hopefully lead to an improvement in this regard.

26. We do not consider the Trust did anything wrong, or could have done anything further, and will therefore not take any further action on this.

Psychiatrist assessment

27. Mrs H says there were significant delays in a specialist psychiatrist assessing Mr H. She says she has concerns as he is struggling a lot with his behaviour.

28. She explained there have been several near misses when he has broken free of his reins in the community. She said he also cut his finger badly on a razor mistakenly left in the bathroom.

29. The Trust in its response said each child is assessed on an individual basis. It said it hopes support offered from other services it directed them to, will help with advice to keep Mr H safe. It confirmed Mr H’s case has been discussed with the consultant psychiatrist.

30. The Trust booked an appointment for a psychiatrist to assess Mr H on 11 November 2024. Our adviser indicated the Trust acted reasonably in arranging for a specialist psychiatrist to review him following his diagnosis. We saw nothing to indicate that Mr H’s referral should have been expedited.

31. Our adviser explained that typically there would be a more cautious approach to medication given Mr H’s young age. Our adviser’s view, which we agree with, is that the Trust acted reasonably in arranging for a specialist psychiatrist to review him after he had been added to the waiting list and there is nothing to suggest he should have been seen earlier. We have no evidence to suggest it was dangerous for a psychiatrist not to assess Mr H sooner.

32. We nevertheless understand the delay would have caused concern and can see why this would have been frustrating and distressing and sympathise with Mrs H for that.

33. We wish Mr and Mrs H all the best for the future.

1. We have carefully considered Mrs H’s complaint about the care and treatment Humber Teaching Hospitals NHS Foundation Trust (the Trust) provided to her son, Mr H.

2. We were sorry to hear from Mrs H how significantly she believes the lack of treatment and support following Mr H’s ADHD and autism diagnosis has affected him. We can see how distressing this has been for both Mr and Mrs H.

3. We have carefully reviewed the complaint and have seen no indications that anything went wrong in the Trust offering him treatment or in arranging for a psychiatrist to assess him.

4. The reasoning behind our decision will be explained below.