16. Before we decide if we should investigate 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 we have not seen a sign that something has gone wrong.
Failure to complete pre-assessment
17. Mr A was referred to the Trust by his GP to help with his PTSD and depression. Mr A complains a pre-assessment on his background should have been completed and it was not.
18. We have seen the Trust assessed Mr A before it put him on the waiting list for CBT. This assessment was completed during a phone call on 27 July 2020.
19. The IAPT Manual sets out what is an effective assessment. This says a trained clinician should do a ‘person-centred assessment’ which covers seven key elements - the client’s presenting problem, eligibility for the service, a risk assessment, psychometric measures for the IAPT data set, mental health cluster, problem formulation, and treatment plan.
20. We understand it seemed to Mr A the therapist did not do a pre-assessment of his needs. The records show this was completed by another member of staff so he could be assigned to the correct therapist.
21. Our adviser says the Trust identified Mr A needed to see a high intensity therapist trained in trauma focused work, which is in line with NICE guidelines for PTSD.
22. We have seen no signs of failings in the way the Trust assessed Mr A’s needs.
Therapist was late and rushed appointments
23. Mr A says the therapist was often late and in a rush. He says the sessions were less than an hour.
24. The Trust says, ‘Clinicians are often working in busy clinics that unfortunately sometimes run a little late. Whilst sessions may be up to one hour, we do not expect that all sessions will take the full hour and sessions will sometimes end before the one-hour time limit, when the additional time is not required.’
25. Our adviser says this was a reasonable response from the Trust as there is no guidance on length of sessions in the IAPT manual. Our adviser says sessions are not usually the full one hour with a patient as the session includes time for note writing.
26. Only the start times were recorded in the medical records. There is no information about starting late or finishing early. Only in the third session, where Mr A ended the call, is an end time recorded.
27. We cannot say the sessions were late or rushed, or that the length of the appointments was not appropriate.
28. We have seen nothing to show the therapist did not give enough time to the appointments as there is no guidance to say how long an appointment should be.
29. It is not possible to say what the cause of the lateness was or how it was managed. That means we cannot know whether the lateness showed failings in the management of the appointment.
Therapist did not understand how to help a traumatised person
30. Mr A complains the therapist did not understand relational dynamics with traumatised people.
31. The Trust responses and medical records show the therapist assigned to Mr A was qualified to work in a service treating adults with PTSD.
32. Although we do not know whether the therapist understood relational dynamics, we are satisfied they were trained to work with traumatised people in line with NICE guidelines and the IAPT manual.
33. Mr A says the therapist did not understand traumatised people as they suggested a different type of therapy may be more suitable for him. He says this made him feel the therapist was unwilling to support him.
34. Mr A was assigned to a high intensity therapist trained in trauma focussed work, in line with relevant guidance. In the first session the therapist discussed Mr A’s main symptoms. Mr A replied he wanted to ‘learn to manage memories connected with his past experiences’.
35. In the final session the notes say Mr A was asked about the focus for the appointment. He talked about his past week and current stresses. The therapist noted she empathised with his situation before discussing the support he needed.
36. The therapist wrote in the notes that ‘apart from being a listening ear’ she was not sure what the ‘goal of the appointments was’. The therapist asked Mr A to think about ‘whether this was the right time for therapy’. The notes for this session say Mr A became angry and asked for a different therapist.
37. Our adviser says there is no evidence in the medical records that the therapist suggested a different type of therapy. The therapist did say that it may not be the right time for therapy.
38. This advice is in line with the IAPT manual that says, ‘to ensure treatment is effective and recovery is promoted, it is an essential and core principle of the IAPT model that NICE-recommended treatment is provided at the appropriate dose, in line with the identified problem descriptors, and that a choice of therapy is offered where appropriate.’
39. Our adviser says it shows there was a difference between what Mr A expected and the service offered.
40. We can see the therapist was working in line with relevant guidance in that she was trying to focus Mr A on his goals.
41. Based on the available evidence, including our discussion with our clinical adviser, we can see no sign Mr A did not receive the right level of care during his sessions with the therapist.
Complaint handling
42. Mr A complains that:
• the Trust did not acknowledge his concerns or try to understand the treatment he received • the Trust lied in its response to him and says he felt the apology was not genuine.
43. The Trust’s complaint policy sets out the way in which a complaint should be handled It says all formal written or serious, verbal complaints should be:
• acknowledged within 3 working days and a letter/email sent to the complainant • managed in accordance with risk assessment of the concern or complaint • investigated and fully responded to as soon as possible. Which can range from an immediate response to a maximum period of 60 working days, although this will depend on the nature and complexity of the issues that have been raised.
44. Our ‘Principles of Good Complaint Handling’ say organisations should be customer focused, open and accountable when responding to complaints, and should act fairly and proportionately.
45. Mr A made a complaint via email to the Trust on 8 December 2021. When it received it the Trust tried to call Mr A on 10 December, but was unsuccessful. After Mr A requested a response by email, the Trust replied on 15 December.
46. The email from the Trust apologised to Mr A before explaining the limits of the service, acknowledging the therapist’s training and offering an assessment with a different psychologist in the new year.
47. The actions show the Trust took a customer focused and positive approach to the complaint, in line with their complaint policy and our Principles.
48. The Trust showed customer focus by inviting Mr A for a new referral with a different therapist. Although Mr A declined this offer, it is in line with our Principles and shows an understanding of Mr A’s issues with the therapy sessions.
49. In the medical records it says Mr A told the therapist he was not competent. Mr A is unable to explain why he believes this.
50. When we asked Mr A why he declined a further assessment, he said he has a short-term memory issue and struggled to remember events. He said the clinician who contacted him on the phone to arrange an initial appointment was not very nice to him and so he declined the therapist’s help. As there were no other suitable clinicians available, Mr A was discharged from the service.
51. We can see Mr A had a representative raise a further complaint with the Trust on 1 February 2022.
52. The Trust replied to Mr A on 23 May after an investigation into the complaint and a further reply to his concerns on 15 July.
53. Both responses are professional and polite and provide a full explanation about the treatment provided. The Trust also apologised for any offence caused to him during the complaints process. There is no sign the Trust made any untrue statements in its replies to Mr A.
54. The Trust provided honest and evidence-based explanations in its replies to Mr A during the complaints process.
55. We have not seen any signs that something went wrong and we will not be investigating this matter further.