An independent provider in the West Berkshire area

4. Ms X complains PPG failed to appropriately identify, monitor and treat her eating disorder from her detention on 4 April 2024 until her release on 2 May 2024.

5. Ms X believes significant harm was caused by not providing appropriate assessment, treatment or intervention plan for her. As PPG only monitored her food refusal and conducted routine tests, she believes her chances of recovering from her eating disorder or accepting food were minimal. Ms X says these failings caused her health to deteriorate, risking serious harm or death.

6. Ms X is seeking to ensure appropriate treatment plans and interventions are in place for treatment of prisoners with eating disorders and financial compensation for her experience.

7. Ms X has a history of eating disorders, which is reflected in her medical records. Despite this, she says her risk was not appropriately identified during the initial assessment on admission to prison on 4 April 2024.

8. Ms X states she did not eat at all during her detention and although her parents’ raised concerns, it was not until 15 April 2024 that PPG identified her low fasting blood glucose levels. Low fasting blood glucose levels, known as hypoglycaemia, occur when the body does not have enough sugar in the blood to function properly. This is particularly dangerous in anorexia nervosa because the body has very limited energy reserves and cannot correct the imbalance. As a result, the brain is deprived of its main source of fuel, which can lead to confusion, fainting, seizures, or even coma, and the strain on the heart increases the risk of life-threatening rhythm disturbances.

9. Following the recognition of the low fasting blood glucose levels, Ms X says the care and treatment plan put in place by PPG was inadequate. Ms X says her monitoring was limited to recording her ongoing refusal of food (which was consistent throughout her time in custody) and conducting occasional blood and urine tests. She says no positive support plan was implemented to address her eating disorder.

10. On 22 April 2024, Ms X was hospitalised due to concerning observations and test results while in prison. Her parents continued to raise concerns and requested feedback from PPG, but none was provided. Ms X says this resulted in a communication barrier between the clinicians and nurses providing care and those most familiar with Ms X’s mental health history.

11. PPG has since accepted that, at the time of Ms X’s detention, it did not have an internal Eating Disorder Guideline in place. Following Ms X’s experience, it has established a task and finish group to develop such a guideline to improve future care for individuals with eating disorders. However, Ms X feels the lack of a guideline during her detention has not been adequately explained.

14. The Health Service Commissioners Act says we cannot investigate a complaint if there is, or was, a legal remedy that the aggrieved could or could have pursued, unless it is (or was) not reasonable to do so. We do not consider whether legal action would succeed, but whether it would be a reasonable option to look in to.

15. In each case, we consider whether a court could provide a complete remedy for the matter complained about and achieve the outcomes the complaint is seeking.

16. In considering whether there is an alternative legal remedy, we need to first consider whether there is a legal cause of action. It appears there is a potential clinical negligence action open to Ms X. This is because Ms X says her care and treatment was incorrect and this had a significant effect on her physical and mental health.

17. As a legal remedy appears to be open to Ms X, we then need to consider whether it is reasonable for her to pursue the matter in that way. In doing this we have considered the outcomes sought by Ms X. This includes the amount of compensation she wants, and whether we are likely to recommend it, in relation to the injustice claimed.

18. Ms X confirmed she is seeking a financial remedy to remedy the significant impact these events have had on her physically and mentally. We discussed how we consider financial remedy and our levels in line with our ‘Severity of injustice’ scale. Ms X is unsure what figure would be relevant to her complaint and would like to speak to a solicitor about what would be reasonable in her situation. She explained the lack of care and treatment she received directly caused a severe health deterioration resulting in hospital admissions.

19. Considering the outcomes Ms X seeks and the type of impact claimed, we therefore consider there may be a potential clinical negligence claim open to her. Ms X confirmed she would continue seeking legal advice to consider this further.

20. Ms X understands that she may need to contact several solicitors if an outcome of one solicitor is to decline her claim. Just because one legal firm declines a claim does not mean there is no claim and the outcome of an enquiry does not rule out other solicitors taking a different view. Ms X also confirmed she has no barriers preventing her from pursuing a legal claim.

Aspects likely outside of a legal claim

21. We have also considered if any of Ms X’s concerns or sought outcomes would likely fall outside of a legal claim. We consider Ms X’s sought outcome of service improvements, to ensure appropriate treatment plans and interventions are in place for treatment of prisoners with eating disorders, may fall outside of this.

22. We have therefore considered whether to look this outcome now. We consider it would be more appropriate to look at this after the concerns have been explored through the legal process. This is because whilst service improvements may not be directly achievable via the courts, these may still happen as a result of a successful legal claim.

Next steps

23. If Ms X is unable to secure legal representation and receives written confirmation explaining why, then she is welcome to return to us with the evidence so that we can further consider her complaint. Ms X can also return to us if following legal action, she has outstanding outcomes that the court was unable to order (such as service improvements), or if the court was unable to consider parts of her complaint.

24. We would ask that Ms X to come back to us promptly if she is unable to proceed with legal action or if there are outstanding outcomes. This is because we are unable to investigate complaints brought to us 12 months after someone has become aware of the problem. We can put this time limit to one side if we think there is a good reason to do so and would consider any legal advice or action sought.

25. Overall, we consider it is reasonable for Ms X to explore a potential legal claim. Ms X is open to exploring this route, intends to take legal action, and has confirmed she has no barriers preventing her looking into this. We will therefore close Ms X’s complaint at this time.

Conclusion

26. We thank Ms X for bringing her complaint to us. We appreciate how difficult it is for her to relay the distressing experiences she has been through and the significant impact these had and continue to have on her. We hope we have provided reassurance as to the next steps should Ms X wish to return to us following the exploring of potential legal routes.

1. We have carefully considered Ms X’s complaint about the care and treatment Practice Plus Group (PPG) provided during her period of relapse of anorexia nervosa (an eating disorder and serious mental health condition) whilst she was detained in prison.

2. We appreciate this was an incredibly stressful and upsetting time for Ms X and we would like to take the opportunity to thank her for bringing her complaint to our attention.

3. Ms X has told us she wishes to continue to obtain legal advice with a solicitor to consider her complaint against PPG. As Ms X could take legal action on the matter she has brought to us, and we will take no action on the complaint at this time. We explain this further below and also outline the next steps should Ms X wish to bring her complaint back to us after exploring a potential legal claim.