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 link the events complained about with the negative impact Mr A has claimed.
Delays in care
12. Mr A says there have been excessive delays in his care from the NHS Trust between July 2021 and August 2022.
13. Having reviewed Mr A’s records during this episode of care, our adviser says there is no indication of excessive delays in his care. Mr A was informed at times that the waiting list at the NHS Trust was between 7 and 8 weeks. It is noted that Mr A had support from other agencies if needed while he waited.
14. The NHS Trust’s Mental Health Liaison Team Operational Policy states on pages 8 and 9:
‘The MHLT, acting in accordance with their service level agreement, will accept referrals for individuals with mental health need from the age of 17 and upwards at hospital.
Referrals can be made by a nurse, doctor, or any other health professional working within the hospital for individuals felt to be in mental health crisis who are within the ED or are an inpatient on one of the hospital wards.
The patient must be triaged by the medical or nursing team prior to the referral being made to MHLT. Examples of referrals:
-Any individual, either in the ED or on an inpatient ward, who are over the age of 17 and who are felt to be experiencing a mental health crisis or presenting to services with self-harm.
-The MHLT assists with formulating discharge plans for in-patients whose social care and/or placement issues are felt to be due to mental health problems, alongside the hospital’s discharge team, to ensure patient flow is maintained in the acute hospital.
-The MHLT will assist acute hospital multidisciplinary teams with capacity assessments in patients with particularly complex needs and where senior medical staff require a second opinion.
-The MHLT can provide mental health assessments, guide discharge discussions and planning for patients with long term chronic issues e.g. somatisation and/or conversion disorders.’
15. The NHS Trust’s Crisis Resolution Home Treatment Team Policy states at 5.0:
‘Some referrals will be (where deemed appropriate) and following a screening discussion either by telephone or face to face between the referrer and CRHTT, determine that intensive support is not required. In these instances, CRHTT will signpost the referrer to an alternative service.’
16. In summary, Mr A’s records show the NHS Trust acted in accordance with its own policies and as above, there is no indication of excessive delays in his care between July 2021 and August 2022.
Misdiagnosis
17.Mr A says his mental health issues such as Attention Deficit Hyperactive Disorder (ADHD) and bipolar disorder were originally misdiagnosed by the NHS Trust as other illnesses.
18.Having reviewed Mr A’s clinical records between July 2021 and August 2022, our adviser says there is no indication that Mr A was diagnosed with ADHD or bipolar disorder. There is a reference made on 11 April 2022 which states that ADHD ‘might be considered’ but there is no further action or there was never a diagnosis made. Bipolar disorder is not a diagnosis in Mr A’s clinical records.
19.During an assessment by the Mental Health liaison team at the NHS Trust, Mr A reported that he suffered from anxiety and depression diagnosed by his GP in accordance with the NICE guidance on generalised anxiety disorder and panic disorder in adults and treated in primary care. It is noted that Mr A had stopped antidepressant medication because of side effects.
20.As such, there is no indication that Mr A was diagnosed with ADHD or bipolar disorder by the NHS Trust during this episode of care. We appreciate that Mr A may disagree with this, but we cannot reconcile these diagnosis with the records at the time.
Assessment and treatment plans
21.Mr A says there is an ongoing absence of assessment and treatment plans by the NHS Trust including failure to supervise him when he was a suicide risk, and a risk to others.
22.Our adviser says that Mrs A’s records show he had comprehensive assessments from the mental health liaison teams between July 2021 and August 2022. The NHS Trust’s Mental Health Liaison Team Operational Policy states on page 8:
‘The MHLT can provide mental health assessments, guide discharge discussions and planning for patients with long term chronic issues e.g. somatisation and/or conversion disorders.’
23.We note that the Rapid Response Team at the NHS Trust developed a safety plan with Mr A while he was waiting for an assessment. The NHS Trust’s Crisis Resolution Home Treatment Team Policy states at 5.0:
‘Some referrals will be (where deemed appropriate) and following a screening discussion either by telephone or face to face between the referrer and CRHTT, determine that intensive support is not required. In these instances, CRHTT will signpost the referrer to an alternative service.’
24.Given this, there is no indication of inappropriate psychiatric assessments, treatment plans or supervision of Mr A by the NHS Trust.
Medication mismanagement
25.Mr A says the NHS Trust mismanaged his medication during this episode of care including dosage errors and delays in medication review.
26.Having considered the relevant information in Mr A’s records, our adviser says there is no indication that the NHS Trust mismanaged his medication. As such, there is no indication of this from the records we have seen.
Premature discharge
27.Mr A says the NHS Trust prematurely discharged him from their services. Specifically, Mr A says he was discharged by the NHS Trust in July 2022 without it informing his GP, despite his ongoing mental health issues.
28.The NHS Trust’s Mental Health Liaison Team Operational Policy states on page 14:
‘The Mental Health Team Liaison can refer mental health patients for follow up to mental health care in the community by either specialist secondary care or by primary care/third sector providers.’
And
‘The Wellbeing service provide counselling and therapy for people suffering from depression and anxiety disorders. The individuals themselves can self-refer or the MHLT can refer by secure email with the patient’s agreement. The response is up to 20 days. GP’s can make a direct referral to the Wellbeing Service and can request a 5-day priority response. Wellbeing service will accept referrals for those presenting with low risks and who feel willing and able to engage in talking therapies.’
29.Our adviser says Mr A was discharged on 25 July 2022 and had support from a key worker. Mr A was not requiring secondary mental health services and was discharged from the service.
30.Nevertheless, our adviser says that appropriate discharge information including medication needs should have been provided to Mr A’s GP, as well as any other agencies that may be providing any ongoing care. A final care plan should have been produced in that correspondence with agreement from Mr A, circulated appropriately indicating that discharge has taken place ensuring that any further care is effectively transferred to the appropriate agency.
31.While we acknowledge that this indicates potential failings by the NHS Trust contrary to its own policies, we note that it has already identified this and apologised to Mr A in its complaint response. The NHS Trust also outlined what we consider to be appropriate remedial action by reminding all relevant staff of the need to communicate effectively with service users and GPs especially in relation to matters concerning discharge from services. Therefore, we consider there is no further action for us to take.
32.Overall, we recognise that the NHS Trust did not manage Mr A’s discharge from its service ideally. It was not in keeping with its stated policy and we acknowledge there was an inconvenience impact for Mr A after he was discharged as his GP was unaware of the situation. Having said that, based on the records, our adviser has made it clear that Mr A was not discharged prematurely from secondary mental health services at the NHS Trust during this episode of care. We hope that this and the information contained in the complaint response will provide Mr A with reassurance about the discharge process at the NHS Trust.