Time to respond
10. Mrs O complained in January 2022 and a final response was provided on 4 August 2023 (the letter is dated 31 July 2023 but was sent by email to Mrs O on 4 August 2023). This is roughly 19 months later, although we know an initial response was sent on 9 December 2023, with the complaint later being reopened.
11. We see in a meeting on 31 May 2022, the Trust gave an expected timeframe for a final response of 40-60 working days following this. We have not seen anything which suggests any expected timescale was shared with Mrs O before this meeting took place. As said, an initial response to the complaint was provided on 9 December 2022, roughly six months later. This was well outside of the Trust’s own estimate given at the meeting. Following this initial response, Mrs O returned with further queries on 19 February 2023, with a final response being provided on 4 August 2023.
12. The ‘Local Authority Social Services and National Health Service Complaints (England) Regulations 2009’ state complaints should be dealt with efficiently and complainants should receive timely responses. It states if a response has not been made after six months, the organisation should explain why and provide a response a soon as possible after this. In addition, ‘NHS complaint standards 2022’ and ‘Principles of good complaint handling 2009’ emphasise the importance of handling complaints promptly and ensuring they are resolved at the earliest opportunity.
13. Accordingly, we would reasonably expect most complaints to be resolved within six months but recognise this is not always possible. Where it is not possible, we would expect to see some evidence within the complaint file which would explain a delay. We see the initial response from the Trust took around 10 months and so considered whether this was reasonable.
14. At the time of the meeting in May, the complaint had been open for four months. Therefore, we would usually expect there had already been some level of investigation surrounding the complaint. Having reviewed the minutes from this meeting, it appears the purpose of this was to establish more detail about the points of complaint and explain the investigations process. It does not appear any complaint points were answered during this meeting, and so it is not clear that any consideration of the complaint had taken place by this point. Whilst we can see a significant period of time had already passed, we do also appreciate the need for the Trust to be clear on the specifics of what they were addressing.
15. We therefore considered whether this meeting taking place in May was reasonable, given no investigation had begun at this stage, and the complaint had been brought in January. We can see the complaint was acknowledged in January. We also see there was correspondence between Mrs O and the Trust throughout February, with Mrs O expressing concern there had been no updates. It was then proposed by the Trust for this meeting to take place on March 11, however Mrs O expressed this was not convenient.
16. Mrs O then suggested 15 March as a suitable time, however the Trust was not able to meet on this date and stated this was due to diary commitments and conflicts with annual leave. It appears the meeting was then arranged for 29 April. It is not clear why this could not take place sooner, as this was more than one month later than the date Mrs O suggested. We cannot see any reasons outlined within the complaint file. However, this meeting (on 29 April) was then cancelled due to the lead investigator being off work due to sickness.
17. The Trust then suggested the meeting take place on 23 May, however Mrs O’s advocate was not available to support her on that date, so the meeting was scheduled for 31 May. We see the meeting did go ahead as planned on this occasion.
18. Having considered the time frames involved and the reasons for the delays, we think it is likely this could have been arranged sooner. We understand there were occasions where Mrs O was unavailable, although we know one of these was due to her advocate’s availability, which would be out of Mrs O’s control.
19. We also considered the Trust reasons for delaying or cancelling meetings, and think these are broadly reasonable, however we are mindful these are generally related to personnel issues with staff being on leave. We think it is likely reasonable a meeting could still have taken place while some staff were on annual leave in March, with information fed back to those staff members on their return. However, we understand the Trust’s wish to have all relevant staff present and do not think this stance is particularly unreasonable.
20. We think it was appropriate to cancel the meeting in April where the lead investigator was unwell, as it would have been important for the person leading the investigation to be present. Overall, whilst we think it is clear the meeting could likely have been scheduled sooner, we are not able to say it was unreasonable on the part of the Trust and have seen no basis to suggest a failing.
21. In consideration of the timeline of the complaint process from this point, we can see there were some internal communication issues in August 2022, which Mrs O was notified of. However, she was told at the time the Trust expected to send out a complaint response by 14 September 2022. On 9 September 2022, Mrs O was notified the response had been reviewed internally, and some questions raised which would need additional work. There was no indication if this would cause any delay, or how long any delay might be.
22. On 2 November (about seven weeks after her last update), the Trust again contacted Mrs O to tell her it was still awaiting some further information from another organisation. The Trust then sent Mrs O an email on 9 December 2022 which contained an attached response letter (this letter was dated 7 December). At this point, this was roughly 10 months after the initial complaint and five months after the meeting.
23. Overall, in mind of the reasons for the delay in arranging the meeting, and the subsequent investigation taking five months, we do not think there was a failing in the time the Trust took to respond to the complaint initially. We accept the response came outside of the Trust’s own expected timeframe, and was a significant period overall, and so it is understandable Mrs O would be frustrated by this. We understand this and agree this would have been disappointing. We see the Trust notified Mrs O of delays and the reasons for these where relevant. We think the time the investigation further to the meeting took overall was reasonable, and so we cannot point to this as a failing.
24. Following this, Mrs O returned with some further queries on 19 February 2023. The Trust emailed Mrs O on 2 March 2023 to let her know that an investigator was on leave, on 21 April 2023 to explain another staff member was on leave, and on 24 April 2023 to apologise for the delay and to explain an investigation into the new raised issues would be taking place.
25. The Trust issued a final response to the complaint on 4 August 2023, however on reviewing this letter, it does not go on to answer any of the further issues raised. This response states the Trust felt it had nothing further to add to its original investigation and response. We note this response was sent roughly six months following the additional issues being raised.
26. While we generally consider six months to be an appropriate time frame, in this case the Trust took this long to tell Mrs O it had nothing to add, and we do not think this is reasonable. The Trust told Mrs O it would investigate these issues, and she would therefore have been expecting further answers. We acknowledge it is not always possible for organisations to provide further answers to a complaint which has already been looked into, however where this is the case, we would expect the complainant to be told this quickly to manage expectations.
27. We do think a short delay of one to two months would have been reasonable, as the Trust would have needed time to review the issues raised and determine whether it could add anything more, but it is unlikely for this to take six months. During this time, we see Mrs O contacted the Trust on several occasions for updates. The Trust did respond in March 2023 to say a staff member was on leave, however we cannot see any further occasions where Mrs O was provided with an update.
28. As such, we find the Trust failed to provide a response to this further complaint in a timely manner, and this was aggravated by a lack of communication from the Trust. Mrs O told us that her faith in public bodies has been shattered, and although we cannot say this experience would necessarily be reflective of how any other public body would handle a complaint, we do think it is reasonable that she was left feeling ignored and not taken seriously.
29. This is because Mrs O chased the Trust several times for responses, and these messages were not always answered. She was also initially told a further investigation would take place, but was later informed the Trust would not answer anything further. We recognise the frustration she would have felt surrounding this issue.
30. We recognise there can be unexpected delays while investigating a complaint, but we would expect the Trust to be proactive in providing updates about this, particularly where a complainant has contacted the Trust to ask about this. In this case, we cannot see any clear reason as to why it took so long to respond to Mrs O, and there were no updates regarding this. Overall, we think this issue did at least affect Mrs O’s faith in the service provided by the Trust.
31. As an outcome to this complaint, Mrs O has told us she would like the Trust to answer her outstanding concerns and pay a financial remedy. We recognise Mrs O’s desire for further answers about what has happened to her and how the complaint has been answered. We are also mindful the Trust has said it does not have any further information it could provide in response to the complaint. Having thought about this, we do not think it would be helpful or beneficial to recommend the Trust take an action it has already outlined it would not be able to do. We do, however, think it is appropriate to recommend a financial remedy to the complaint, and we will outline this in further detail later.
Independent investigation
32. Mrs O raised concerns about a specific staff member (SR) being assigned to look into part of the complaint. She is concerned because she says this staff member was directly involved in the previous related safeguarding investigation, and she felt they would not be independent because of this. Mrs O expressed at the time she would like the complaint to be looked at by an external investigator.
33. SR was a nurse consultant for safeguarding. We see SR was involved in the meeting with Mrs O on 31 May 2022. The original complaint had been about a serious safeguarding concern. The minutes from this meeting show that the Trust explained its safeguarding process, and outlined that the initial safeguarding investigation was conducted by human resources. It also says the concerns were sent to the Local Authority safeguarding.
34. Our understanding is that the safeguarding concerns raised related to the investigation were sent to the local authority rather than the Trust’s own safeguarding team, and that the Trust’s safeguarding team was not responsible for investigating. We therefore think it is likely that any involvement in the initial investigation by SR, if indeed there was any, would have been minimal.
35. Mrs O later says in an email ‘it is clear that the aspects of the complaint which (SR) is responsible for are those areas where I am complaining about her handling of the investigation. I find it difficult to understand how this cannot be seen as a conflict of interest’. It is therefore clear Mrs O remained concerned about the independence of the Trust in looking at her complaint, and despite the level of involvement SR had in any other investigation, her understanding at the time was that SR had been involved.
36. Principles of Good Complaint Handling 2009 say Trusts should ‘ask a member of staff who was not involved in the events leading to the complaint to review the case’. In addition, NHS complaint standards 2022 say ‘Where possible, staff who have not been involved in the issues complained about should look at the complaint. If this is not possible, the person looking into the complaint should openly demonstrate they are acting fairly when they consider all the issues.’ We do appreciate the NHS complaint standards were published during the course of these events but note they build on the principles previously outlined in the Principles of Good Complaint Handling referred to above.
37. As SR was a nurse consultant for safeguarding at the time of the investigation and the original complaint had been about a serious safeguarding concern, we think it is broadly reasonable SR would have been asked to be involved in the investigation. However, once concerns were raised we would expect to see this considered by the Trust.
38. As mentioned, we cannot say with certainty whether or not SR was involved in the previous safeguarding investigation. However, Mrs O has told us she was, and we have no reason to disbelieve her view. In any case, it is her understanding SR was involved, and so it is reasonable she would have been concerned about any further involvement of SR in the complaints process. It is important to note that raising a concern does not necessarily mean the decision to include SR in the complaint process was wrong. Therefore, we considered SR’s role in this and how her involvement likely affected the consideration of Mrs O’s complaint.
39. We appreciate Mrs O is clear the elements of the safeguarding investigation she believes SR was involved with previously are the basis of her complaint. As such we have considered whether including SR in the complaints process was appropriate. There is limited information regarding this. We do see in the meeting on 31 May 2022, SR explained the role of safeguarding, and agreed to follow up with the local authority to obtain some information for Mrs O. Similarly, we are aware the initial safeguarding investigation was conducted by human resources as it related to an employee of the Trust, and after consideration these concerns were passed to Local Authority safeguarding for further consideration. Accordingly, whilst SR may have had a role it appears the focus and substance of Mrs O’s safeguarding concerns were carried out by other areas of business.
40. Following this meeting, the next piece of information we have regarding SR’s involvement is on a complaint response dated 7 December 2022, where the Trust lists the people who had assisted in facilitating the response. SR is not included in this list. It additionally says the complaint was overseen by a quality and patient safety lead, as per Mrs O’s request to have an independent person involved. There are no further indications of any involvement from SR.
41. Overall, having considered the information available, we do not think it is likely SR contributed significantly to the investigation of Mrs O’s complaint. The evidence we do have shows SR committed to tasks which were not directly involved in the consideration of the complaint (gathering information from the local authority to pass onto Mrs O). In addition, she was not included in the Trust’s list of those who did contribute directly to the complaint handling.
42. We do recognise Mrs O’s concerns here, as involvement in looking at a complaint by someone involved in a previous safeguarding investigation might reasonably cause worry about a potential bias. We thought about this, and we think involving a nurse consultant for safeguarding, at least to some extent, on a complaint about safeguarding is likely reasonable. We also see some information indicating her involvement, if any, on the related safeguarding investigation would have been very limited. As such, we are not persuaded this fell below the expected standard for someone uninvolved in the case to lead on it or review it. We overall do not see any failings in the Trust’s handling of the complaint in this regard.
Responding to points
43. We see in a letter in dated 31 July 2023 the Trust acknowledges there were further outstanding issues Mrs O had raised, but after further discussion it had nothing more to add. Situations such as these are not outlined specifically in complaint handling guidance, but there is a clear emphasis on honesty and transparency. Where additional issues have been raised, we would expect to see these addressed where it is reasonable to do so.
44. We therefore went on to consider the additional points which were raised, to see if we think it reasonable for the Trust to have responded further or not. We see from Mrs O’s communications, she raised a series of very specific concerns related to both her original complaint and the Trust’s response to it. For example, who was involved in the complaint and what was their role, why certain staff did not return her calls, the use of word processing software to make clinical notes, and outlining parts of the complaint response she disagreed with. Please note, this is not a complete overview of the further concerns raised, we are simply sharing examples of some of these.
45. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 state the responsible body must investigate complaints in a manner to resolve it efficiently. It also says the body is not required to investigate a complaint where the subject matter has already been investigated. In addition, Principles of Good Complaint Handling 2009 state that there is often a balance between responding appropriately and acting proportionately within available resources. Finally, the NHS complaint standards 2022 state that effective complaint handling involves taking a thorough, proportionate and balanced look into the issues raised.
46. Having looked at the overall complaint, including the additional issues raised, we think the Trust had responded to the main parts of the complaint. We know there were some very specific questions asked after the initial response, but we are mindful the Trust was not required to investigate further and that investigations should be balanced and proportionate.
47. We recognise Mrs O’s desire for further explanations. She had been through a very difficult time and she wanted as much information as possible to help her to understand what had happened. We recognise the frustration surrounding this. Given the nature of the outstanding concerns, we think these had largely been answered by the Trust (although we recognise Mrs O did not agree with these answers) or were so specific it would have been disproportionate to investigate in order to provide answers. We do not see the Trust not providing further answers in this case is a failing.
Withdrawing care
48. Mrs O has told us that when she brought her formal complaint to the Trust, all ongoing care was stopped, and she was told she should contact the crisis team if her mental health worsened. The Trust has maintained her care was stepped down as she did not meet the remit for further care. It tells her the treatment pathway from that point forward would be to access independent psychological therapy.
49. Having reviewed the evidence available, we are not convinced that on the balance of probabilities, the decision was based on clinical need. This is because we see in letters sent to Mrs O and her GP on 3 August 2022 the Trust discharged her from its service and specifically refer to her complaint as the reason explaining this decision. In these letters, it states she should ‘wait for a response regarding the formal complaint she has made, where a proposed plan of care, to meet her needs shall be provided’. This implies the Trust’s plan was to discontinue her care and would only plan for continued care once the complaint is resolved.
50. In addition, the letter to her GP says ‘telephone call made to (Mrs O)… regarding her complaint made for treatment and support. (Mrs O) will receive a reply in due course, which will include an ongoing plan’. This suggests that the decision to discharge her is related directly to her complaint and that any future care would be dependent on the outcome of the complaint. Both the letters to Mrs O and her GP outline that if she needs support, she should contact the crisis team. There are no other reasons given in these letters which would explain why she had been discharged.
51. NHS complaint standards 2022 make it clear people should be reassured their care will not be compromised when bringing a complaint. In addition, Principles of good complaint handling 2009 outlines that customers should have fair access to services and staff should not treat the complainant any differently during a complaint. Finally, the Trust’s own complaint policy, ‘your right to complain – the health and social care complaints procedure (2021)’, says patients will not be treated any differently because they have made a complaint. Therefore, we would not expect an organisation to withdraw care and only intervene in emergency circumstances, and we are persuaded the Trust’s actions fell below the standards expected and those it outlined in its own policy.
52. We recognise it is possible this was a clinical decision, and that the actual reasons were not clearly explained to Mrs O or her GP. However, we still see that the impression given to Mrs O was that her care was withdrawn due to her complaint, and she would not be able to access further care until it was resolved. Regardless of the reason for her discharge, Mrs O understandably felt her care was paused due only to her complaint based on the information shared with her, and there were no other options for her to access the care she needed.
53. Overall, we think this is a failing. We would not expect to see care stopped due to a complaint being made or a complainant being given that impression, and we see here that Mrs O could not access any ongoing care while the complaint was ongoing. We therefore turned to consider the impact.
54. Mrs O says this has shattered her trust for public bodies, and she remains without mental healthcare. We know this would have been a very worrying and uncertain time for Mrs O. While we do see she was discharged on 3 August 2022, we see in a Trust response dated 7 December 2022 that a referral for psychological therapy from an independent provider was at the time being actioned by another Trust.
55. Mrs O has told us that this care ultimately did not go ahead, and so she did not have access to this. As this plan was in place with another organisation, we cannot say the Trust is responsible for this not going forward. Our recommendations therefore relate to the time between discharge and the point at which we know there was a plan for Mrs O’s care to be picked up by another organisation, despite this later falling through.
56. As such, we consider that there was a period of four months where Mrs O was left without any ongoing plan for future care. We also think it is reasonable that this would cause her to feel a lack of trust, further to her understanding that care had been removed as she had raised a complaint.