14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. Having done so, we cannot say the delay resulted in the impact Miss J has claimed. We consider the school were responsible for making sure B developed his skills in writing and pencil grip and there were resources available to the school to enable this and other interventions.
15. We acknowledge the Trust did not make a referral as it should have done and that this was the cause of much concern for Miss J. We are satisfied it took action to try and put things right – as far as it could do by apologising and backdating the referral, in line with our Principles for Remedy. We acknowledge that even though it took that action there was still a delay.
Delayed OT appointment
16. Miss J complains the Trust did not make a referral for B to see an OT. It should have made a referral in May 2021. This did not happen until July 2023 when Miss J chased it up.
17. In August 2023, the Trust explained that the consultant who saw B in May 2021 did not make the referral and has since left the Trust. It said that it would backdate the referral made in July 2023 to May 2021, meaning B would go to the front of the queue. It explained that due to the high demand for the service, it expected the OT service would see B within the next few months.
18. The Trust apologised for the missed referral. It explained it had implemented several improvements within its administrative functions to try and mitigate this happening again.
19. The OT service saw B in November 2023. As a result of the consultation Miss J further complained to the Trust that its delay in setting up a referral has had a detrimental impact on B because she believes it is now too late to change his pencil grip. This was based on something that the OT said during the assessment. She also said B had missed out on sensory interventions due to the lack of OT assessment.
20. The Trust responded and said that ‘our partners in education’ (an organisation offering support to schools) offer sensory processing training to schools enabling sensory environments to be adapted for individual children and can offer advice about pencil grip.
21. The Trust said that the OT report does not say that it is now too late for B to change his pencil grip. It said the report says it may be a challenge, and the report provides a suggestion to make a change. It said even if he had been seen within 18 weeks of referral, it would still have been a challenge to change B’s pencil grip, as the challenge is about B accepting the need to change.
22. All this considered, we think it is fair to say that there was a significant delay in the Trust referring B for an OT assessment. We looked at what the impact of that delay was.
Pencil grip
23. The Trust explained that B’s school could and should have been responsible for B’s sensory interventions and pencil grip, regardless of its delay. We looked to see whether this was a reasonable position to take.
24. To help us, we sought clinical advice from our OT adviser.
25. Our adviser looked at the available evidence. They explained that OT assessments and interventions must be taken in line with The Royal College of Occupational Therapists (RCOT) Professional Standards for OT Practice and Ethics which says an OT should help a person manage the impact of their health condition on their day-to-day activities.
26. Our adviser explained that pencil grip is not occupational performance, rather, handwriting is. Therefore, the focus of OT intervention is on the impact the difficulty with pencil grasp has on the occupational performance in handwriting. The November 2023 OT assessment indicated that B’s handwriting then was surprisingly accurate, but his output was slow and effortful.
27. In addition, the Department for Education (DfE) National Curriculum in England (English Programmes of Study) states that in terms of handwriting, there are statutory requirements for schools to teach pupils in Year 1 to sit correctly at a table, and, holding a pencil comfortably and correctly, begin to form lower-case letters in the correct direction.
28. We consider therefore, it is fair to say the teaching and development of a comfortable pencil grasp and the development of B’s letter formation and handwriting speed is the responsibility of his school in line with the UK National Curriculum. Access to earlier OT would only support his school with additional advice in improving his handwriting speed and/or letter formation through practice and other alternative or compensatory strategies (for instance using a pencil grip or different types of pencil) rather than changing B’s pencil grasp as a solution to effortful handwriting.
Interventions and recommendations
29. The OT Miss J saw in November 2023 made some recommendations in their report. Miss J is concerned that these recommendations could have been in place earlier if the Trust had not failed to make an appointment sooner.
30. Again, we sought advice from our adviser here. We wanted to know whether the Trust’s position is correct - that the school could have been providing the interventions without an OT being involved. This would help ius decide whether the Trust was responsible for the impact Miss J described, or the school was, or both.
31. The OT made a number of recommendations including:
• adult support is required to ensure B understands the tasks requested and the steps needed to complete it • support from a member of staff to check he is dressing correctly when changing for PE to prevent meltdowns and dysregulation.
• school staff to access the universal advice and information provided by the occupational therapy service regarding sensory strategies.
32. Our adviser explained that the recommendations are not specific to occupational therapy. They are strategies commonly used by both education and healthcare professionals when working with students with additional or special education needs. Therefore, B’s school could have considered putting them in place prior to the November 2023 OT appointment.
33. In addition, universal OT advice is not patient-specific, meaning B’s school would have been able to access it prior to the OT’s recommendations.
34. We consider, having weighed this up, that it is fair to conclude that B’s school could have considered putting movement breaks in place and accessed universal OT sensory strategies as part of good practice without the need for OT input.
35. We appreciate how frustrated Miss J was at the Trust for not making the referral as it should have done. As we have indicated earlier though, we are satisfied with the action it took to try and put that right. We are also satisfied that the school had access to materials in relation to sensory interventions as well as its obligation to work in line with the DfE’s national curriculum requirement. We think therefore, we cannot link that delay with the impact Miss J is claiming.
36. Miss J told us she has since sought private assessments for B and we hope this provides further ongoing support and assistance. We wish them both well going forward.
37. Our Principles for Remedy say that where things have gone wrong and have resulted in someone suffering an injustice, public organisations should offer that person a remedy. This can range from an acknowledgement that something went wrong and an apology to financial compensation. They also say that public bodies should try to put someone back in the position they’d have been in had nothing gone wrong and that they should seek continuous improvement to ensure the poor service is not repeated.
38. The Trust apologised for the missed referral and has put in place service improvements in the way it administers referrals since the complaint. In that regard, we are satisfied its apology and service improvement is in line with our Principles for Remedy.