An independent provider in the Colchester area

4. Mrs O complains A received poor care and treatment from the Provider. Specifically she complains the Provider:

• decided not to support A when he stopped taking his medication • did not offer alternative treatment (other medication or non-pharmacological intervention) • did not address the concerns around A’s symptoms when on his medication.

5. She says she felt rushed into making a decision and put A back on the medication to continue to get support. She says putting A back on the medication affected his mental health as he has mood swings, low self-esteem and is extremely self-conscious. Mrs O says A has made verbal threats to himself and to others which has caused real distress to everyone in the house. Mrs O says she thinks A is depressed when medicated.

6. Mrs O says the situation has caused significant emotional strain on her as a parent. She says she has now lost trust with the care system.

7. By bringing her complaint to us, Mrs O is seeking an apology for the lack of support and for the impact it has had on herself and A. Mrs O is also looking for service improvements and a financial remedy.

8. A has been under the Provider for treatment for ADHD. Mrs O says the medication helped her son to be more focused. However, he became withdrawn. Mrs O says whilst on the medication, A experienced concerning behaviours and made threats to himself and others.

9. Mrs O made the decision to take A off his medication and contacted the Provider to discuss next steps in March 2025.

10. In April 2025, she and A attended an appointment at the Provider. Mrs O says the appointment was rushed and she says she feels other treatment options were not discussed other than lowering the dose of the medication.

11. She says staff told her they would discharge A if he was not on medication. So, she felt she did not have another option than to put him back on the medication.

12. In its response to Mrs O’s complaint, the Provider said its service is commissioned to diagnose and treat ADHD with medication. It is not commissioned to deliver behavioural strategies for ADHD.

The Provider would not support A if he was not medicated for ADHD

15. Mrs O says the Provider will not continue to provide her son with support if he was not medicated for ADHD. Mrs O found this upsetting because he was showing concerning symptoms such as making verbal threats to himself and to others when on the medication. Mrs O says the Provider did not consider alternative medication.

16. We are sorry to hear Mrs O and A have had such a distressing time when he was medicated. We are sorry she felt she had no other option than to put A back on the same medication in order to continue to receive support for his ADHD from the Provider.

17. The Provider has explained it is commissioned by the Mid and South Essex Integrated Care Board (ICB) specifically to deliver the medical management of ADHD. In its Community Contract it says where treatment is not agreed upon, patients will be discharged back to the referrer with advice.

18. Our Principles of Good Administration say organisations should act according to their statutory powers and duties governing the service they provide. It also states public bodies should behave helpfully.

19. We appreciate the frustration Mrs O feels in trying to find the right care and treatment for A’s ADHD. We do not see any indication the Provider has done anything wrong as it is acting in accordance with its contractual obligations set out by the ICB.

20. The Provider has acted in line with the services it has been commissioned to provide and acted helpfully in signposting Mrs O to the health provider best suited to supporting A with non-medicated treatments. We have seen no indication the Provider has done anything wrong and will not be considering this part of the complaint further.

The Provider did not offer alternative treatment for A

21. Mrs O says the Provider did not consider alternative treatments for A. Mrs O says she feels the Provider could have suggested alternative medication and nonpharmacological interventions (not medication).

22. In its final response the Provider says its doctor did discuss an alternative medication during the appointment. It signposted Mrs O to the clinic letter the doctor sent after the appointment. The Provider also signposted Mrs O to an alternative health provider which can provide A with non-medicated treatment.

23. In the clinic letter dated 30 April 2025, the doctor has recorded their suggestion to Mrs O of trying A on a lower dose of a short-acting preparation of methylphenidate.

24. In its final response, the Provider has suggested A attends a review appointment (which is now booked for early December 2025) to discuss alternative medications.

25. The clinic letter is a record from the time and was written and sent out prior to Mrs O raising her complaint. It is a doctor’s duty to ensure their formal records are clear, accurate and concurrent, as set out in the GMC’s Good Medical Practice guidance. As a clinical record from the time, we consider its content is compelling evidence about what happened.

26. We appreciate there is a difference in the accounts about the consultation. Considering the above, we feel on the balance of probability the Provider likely did offer alternative medication during the consultation.

27. We saw the Provider has been forthcoming with next steps to address A’s treatment and in signposting Mrs O to the right health provider to explore non-medicated treatment options. Section 28 in Good Medical Practice says staff should give patients information about different options for treating or managing their condition. We therefore see no indication the Provider did anything wrong.

28. We understand how important it is to feel informed about all available options and we are sorry to hear Mrs O did not feel this was the case. We hope we have clearly explained how we weighed the available evidence and our decision on this matter.

The Provider did not address Mrs O’s concerns about the impact of the medication on A’s wellbeing

29. Mrs O says the Provider did not address her concerns about A’s wellbeing when on the medication. She says A was withdrawn and making verbal threats about himself and others.

30. The Provider has apologised Mrs O’s concerns about the effects of the medication on A were not fully acknowledged during the appointment. The Provider has arranged a follow-up appointment with Mrs O to address her concerns about the impact of the medication on A. In its final response, it has signposted Mrs O to another health provider best suited to support A with his mental wellbeing.

31. We recognise Mrs O has had a distressing time trying to get A the right treatment and appreciate the Provider’s caused emotional strain on her as A’s mother. We feel the Provider’s apology and offer of a review appointment to discuss alternative medication is enough to put right the impact this has had on Mrs O and A.

32. Our NHS Complaints Standards say organisations should give sincere apologies when something has gone wrong. It also states staff should reflect on what has happened and consider learning from it. We are satisfied the Provider has apologised for how Mrs O felt her concerns were not addressed and shared this with staff to reflect on. Our NHS Complaints Standards also say organisations should identify suitable ways to put things right for the people involved. We are satisfied the Provider acted in line with this guidance as it has arranged to discuss Mrs O’s concerns in a follow-up appointment.

33. We considered our Guidance on Financial Remedy, which contains our severity of injustice (SOI) scale. Our SOI scale contains six levels of injustice a complaint can fall into, which increase in severity. Each level links to a range of the financial amounts we would usually recommend in those circumstances.

34. We consider the impact we described in paragraph 31 sits within level one of our SOI scale. Mrs O’s and A’s distress stems from a one-off clinical failing in which staff did not acknowledge her concerns in one appointment. Soon after, the Provider recognised she had concerns. It offered a further appointment to discuss them.

35. Our Guidance on Financial Remedy says apologies are sufficient remedies for level one impacts. This means we consider the apology from the Provider, sharing the complaint with relevant staff to learn lessons and the actions taken to discuss her concerns at a follow up appointment are enough to remedy the complaint.

36. We thank Mrs O for taking the time to bring her complaint to our attention. We hope our explanation offers reassurance that the Provider has given A care and treatment in accordance with established guidelines and its contractual obligation with the ICB.

1. We have carefully considered Mrs O’s complaint about the health provider (the Provider). We are sorry to hear Mrs O’s concerns around her son’s care and the impact this has had on them both. We appreciate her concerns are ongoing.

2. Mrs O complains the Provider decided not to support her son when she took him off his medication for attention deficit hyperactivity disorder (ADHD). She also complains the Provider did not offer an alternative treatment. We are sorry to hear Mrs O felt unsupported in the care and treatment for her son. We have seen no indication the Provider did anything wrong and will not be taking this part of her complaint further.

3. Mrs O also complains the Provider did not address the concerns around her son’s symptoms when he was taking his medication. We recognise Mrs O feels her concerns were not listened to. The Provider has apologised for not fully acknowledging Mrs O’s concerns about the effects of the medication on A. We feel the Provider has done enough to put right the impact on Mrs O and A.