During her admission at the hospital her care co-ordinator did not visit
13. Miss E told us that during her admission in the hospital, she rang her RCO to come visit her. She also had ward staff, and her GP contact her RCO.
14. The NICE guidance CG136, paragraph 1.1.1 defines that the role of a RCO is to be the central, trusted point of contact who manages the principles of person-centred care. This involves building a collaborative and empathic relationship that prioritises the service user’s own goals and expertise in their recovery journey.
15. This role is fundamentally reinformed and expanded by the Community Mental Health Framework for Adults and Older Adults, Specifically. Section 3.2.3 says the RCO does not just manage a single care plan but actively ‘co-ordinates and personalises care, support and treatment’ across the entire system. This means proactively navigating health, social care, and voluntary sector partners to build a cohesive support network around the individual.
16. In summary, the RCO’s role is to coordinate the person’s day-to-day care primarily in the community. Miss E was receiving inpatient care for an acute mental health issue during the time we are looking at.
17. The records show a doctor spoke to Miss E’s RCO on 7 June, and the RCO planned to visit her in the hospital. On 9 June this was arranged for the following day and the RCO attended with student. The RCO also texted Miss E on at the end of June, and twice in early July, and Miss E replied to the last of these.
18. On review of the records, we have found no documentary evidence to support the assertion that Miss E had to ask staff and her GP to contact her RCO. But we have looked at the RCO’s involvement overall.
19. During Miss E’s inpatient admission, her care was the primary responsibility of the hospital multi-disciplinary team. The records indicate that the RCO did maintain contact through a visit, calls and messages to assist with the discharge back to community services. Therefore, in line with the guidance, there is no indication of a failing in the RCO’s involvement in Miss E’s care during her hospital admission.
20. We do understand Miss E expected her RCO to be more involved with her care while she was in hospital and that she was distressed when this did not happen. We hope our decision is clear about why we could not have expected the RCO to do more.
Miss E did not receive emotional support from her RCO
21. Miss E complained that there was a lack of constructive emotional support from her RCO after her discharge from the hospital. She was under the impression they would discuss options with her on psychological therapy to address her emotional needs. Miss E says the RCO instead referred her to Workways to support her in finding a job. Miss E says she did not receive emotional support from her RCO by way of kindness and understanding.
22. The Mental Health Act 1983: Code of Practice, sets out how organisations should plan section 117 aftercare. We reviewed Miss E’s s117 aftercare plan for counselling and personal support. It is documented that the consultant psychiatrist was to review the types of psychological therapies Miss E had accessed previously and to draw up a treatment plan. The consultant psychiatrist was then to speak to the RCO to see what options there were via psychology and psychological therapy team within Trust. It noted that compassionate focussed therapy would be a good starting point for Miss E to start when she was ready. The aftercare plan makes no specific mention of the RCO themselves providing Miss E with emotional support.
23. From the evidence we have seen, the aftercare plan shows the consultant psychiatrist was responsibility for making decisions on counselling and personal support, rather than the RCO. In the Trust’s complaint response, it said the RCO believed she acted in both a professional and compassionate way in all her interactions with Miss E. The evidence in the records indicates this was the case. We can see the RCO prioritised Miss E’s needs in line with their role.
24. Again, we can see Miss E hoped for more support from her RCO after her discharge from hospital. And again, we hope she can see why we do not think they should have done more here.
The RCO’s attitude and behaviour
25. In her complaint to the Trust, Miss E said after her discharge from the hospital during her visits with the RCO would be rude to her, hang up calls and would blame her and put it down to her emotionally unstable personality disorder (EUPD) and eating disorder. Miss E says the RCO’s attitude and behaviour made her feel intimidated and made her feel verbally abusive.
26. We are sorry to learn of Miss E’s distressing experience.
27. In the complaint response, the Trust said it expects its staff to treat all patients and their families with respect and compassion. If they do not, the Trust would take appropriate action.
28. In response to Miss E’s specific concerns about the RCO, it said it discussed her concerns with the RCO. The RCO commented she was unable to recall a time where she had acted in a way that might have appeared to be rude. The RCO recalled one call where the conversation had reached an impasse, and no progress was being made, so she advised that she would be ending the call, before doing so. The RCO apologised to Miss E that she came across this way and for the upset this caused her.
29. Our role is to make independent final decisions about NHS complaints in England. We made decisions weighing up all the available evidence. We then consider the likelihood that something has gone wrong with the service provided. As we are impartial, we must make robust decisions based on facts and evidence.
30. Here we have two different accounts of what happened, and we are unable to prove or disprove this. We have thought about whether there is any other, impartial evidence that might show us how the conversations between Miss E and the RCO went, but there is not. Regrettably without further evidence we are unable to reach a view on whether something likely went wrong during Miss E’s interaction with the RCO. For this reason, we have decided not to consider this part of her complaint further.
During a hospital visit, the RCO brought a student without obtaining her consent first
31. Miss E complains the RCO did not obtain her consent before bringing a student along to the appointment.
32. In the complaint response, the Trust explained it expects that all practice mentors will introduce their learners to the people in receipt of services and seek their permission for students to take part in that particular clinical intervention or meeting.
33. The Trust explained that the RCO is a senior member of staff and there are times when they will have students and learners accompanying them, as part of their training and development. When it spoke to the RCO they recalled they introduced the student and advised Miss E that the student could be asked to wait outside the room if she preferred. However, this is not reflected in the medical records.
34. The NHS Complaint Standards say we expect organisations to ‘support and encourage staff to be open and honest when things have gone wrong.’ It is also important ‘staff recognise the need to be accountable for their actions.’ Finally, our standards say when an organisation investigates a complaint it should ‘explain why things went wrong and identify suitable ways to put things right for people. Staff should give meaningful and sincere apologies and explanations that openly reflect the impact on the people concerned.’
35. Miss E told us she wants an apology from the Trust as she felt pressured and uncomfortable with the student’s presence. We can understand why Miss E feels strongly about her complaint. This must have been a very distressing experience for her, and we are sorry to hear of how this made her feel.
36. In its response, the Trust apologised to Miss E that the RCO did not get her consent and made her think she did not have a choice. It has reminded all staff of the importance of ensuing that patients are asked whether they are comfortable with trainees being present in appointments, and that they have a right to decline this and to ask the question without the presence of the trainee to avoid any undue pressure to agree.
37. We consider the Trust has acted in line with the NHS Complaint Standards. It has apologised to Miss E and recognised the impact on her. It has made wider service improvements, to change its process and support its staff to minimise the risk of similar mistakes happening in the future. There is nothing more we would achieve if we looked into that part of the complaint further.
Complaint handling
38. Miss E states that the Trust’s handling of her complaint caused significant delays, which she feels exacerbated her mental health conditions, including depression and flashbacks, and led to physical symptoms such as functional seizures.
39. Our ‘Principles of Good Administration’ say organisations should acknowledge a complaint and deal with it promptly, avoiding unnecessary delays and in line with published service standards where appropriate.
40. The Regulations states organisations should respond to complaints within six months.
41. The Trust’s complaint policy states it should acknowledge a complaint within three working days of receipt and the complaints investigation officer will contact the complainant to discuss how long it is likely to take to investigate and respond to issues (complex issues may take up to six months).
42. In November 2021 Miss E complained to the community team but this was not taken further because the Trust could not contact Miss E. The Regulations state organisations must investigate whether further contact can be made with the complainant or not. There is indication of a failing here as the action of the Trust was not in line with the Regulations.
43. In March 2022, Miss E approached an advocacy service and with their support she submitted a complaint to the Trust at the end of April 2022. The Trust completed a ‘complaint resolution plan’ in late May and set a date for the complaint response of the end of March 2023. But we have seen no evidence that the Trust told Miss E and her advocate about the proposed date to receive a complaint response.
44. Miss E’s advocate received a complaint response in late May 2023. It took the Trust 12 months to respond and two months beyond the planned timescale. We recognise this is an excessive length of time to wait. The Trust acknowledged it took an unacceptably long time to respond. It explained the delays were due to the effects of COVID pandemic and there was a national issue in accessing the electronic medical records from August until November 2022.
45. Miss E sent a further complaint to the Trust in late July 2023. This included one new complaint point and the remainder questions from her original complaint. The Trust sent a second complaint response at the end of December 2023. It took the Trust a further five months to respond. The combined time in issuing the first and second complaint response falls significantly short of the expectations for a prompt and efficient service, and not in line with the Ombudsman’s principles.
46. Miss E told us the delays in complaint handling exacerbated her mental health conditions, including depression and flashbacks, and led to physical symptoms such as functional seizures. She wanted an acknowledgement of failings, an apology and service improvement.
47. We recognise that the Trust’s failure to handle her complaints in a timely manner, over a prolonged period, caused her distress, frustration and impacted her mental health. Our Principles for Remedy states that where maladministration or poor service has caused an injustice, the public organisations should try to take action to put things right. An appropriate remedy can typically include an apology, a clear explanation, acceptance of responsibility and service improvement to prevent a recurrence.
48. We have considered the actions the Trust has taken to remedy its failings. It has give Miss E an explanation for the delays and a formal apology. Furthermore, it has implemented service improvements by reviewing its procedures to ensure it handles all complaints in line with Regulations and providing additional training to staff. These actions align with the outcomes Miss E stated she wanted.
49. We think the Trust has already done enough to put things right here. There is nothing further we would ask it to do.