17. Before we decide if we should conduct a detailed investigation of 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 have not seen any indication that something has gone wrong.
Support offered at appointment
18. Mr L tells us that during an appointment he became distressed and expressed that he was experiencing a crisis and having suicidal thoughts. He complains that the Trust offered no support to him for this crisis and did not act when he said he was suicidal. Mr L also complains the Trust did not use a safeguarding policy to keep him safe.
19. The NHS England guidance says suicidal thoughts and behaviours should be assessed based on a holistic understanding of a person’s situation. A plan should be made to manage their safety based on that understanding.
20. The guidance says the person’s experiences should be explored in a safety assessment. There should also be a shared understanding of the current issues and what may help or make things worse. Any action needed should be considered, and a plan made for future safety changes.
21. Our adviser said there are a variety of ways to implement these principles. They also said the clinician should apply these principles with the GMC guidelines in mind. The GMC guidelines say that clinicians should treat patients with kindness, courtesy and respect. It also says that this does not mean agreeing to every request. It also says doctors should refer a patient to another practitioner when this serves the patient’s needs.
22. The records show the clinician completed a detailed assessment of Mr L’s mental health concerns including his suicidal thoughts. The clinician noted Mr L had periods of depression and experienced significant distress, including suicidal thoughts. They noted Mr L had no diagnosable mental health disorders. They also noted that Mr L disagreed with this and recorded their discussion.
23. The clinician made a plan based on this assessment. This included treatment for Mr L’s depression, and that Mr L consider long term psychotherapy and support for his general wellbeing. They felt Mr L would not benefit from additional mental health services, such as the crisis team or adult mental health services.
24. Our adviser has said there was no evidence in the records of an acute risk of suicide which would require a more specific plan. They have also said there were no indications there was an implied risk or vulnerability which would require safeguarding to be included in the plan.
25. The NHS website explains safeguarding is protecting vulnerable adults from abuse or neglect, which can include sexual, physical or psychological abuse.
26. Our adviser has said there was no indication that Mr L had specific risks or vulnerabilities that would require safeguarding other than his mental health and suicidal thoughts. As such, there was no need for the Trust to put safeguarding in place.
27. We recognise Mr L has told us he was having suicidal thoughts during the appointment. We think the Trust appears to have acted in line with the NHS England guidance, as we can see the Trust assessed Mr L’s suicidal thoughts. We can also see it put a plan in place based on the assessment.
28. Mr L clearly experienced acute distress after he was told he would not be offered more support. We therefore think the Trust appears to have acted in line with the GMC guidance, as it did not think a referral to additional mental health services would serve Mr L’s needs. It planned for other treatment which it thought would better meet his needs.
29. We have seen no indication Mr L was at risk of abuse or neglect. We acknowledge he was feeling vulnerable, as he was having suicidal thoughts, but as we have explained we think the Trust appears to have put a plan in place for this. We therefore do not think Mr L met the threshold for safeguarding.
30. We understand that Mr L feels he should have received more support, specifically with his suicidal thoughts, and that not receiving this support caused him distress. It appears that the Trust’s actions are in line with the guidelines set out above. We have not seen an indication of a failing here.
Referral
31. Mr L complains the Trust refused to refer him to adult services.
32. The Trust’s policy says Adult Mental Health Services are for adults over the age of 25 who have complex mental health problems. Referrals to this service can only be made by a medical practitioner.
33. Our adviser said a patient would usually be referred if they had a mental health disorder that would benefit from further assessment and treatment, which could not be managed by a GP or primary care.
34. Mr L had a detailed psychiatric assessment through the Youth Community Mental Health Team. Our adviser has said there was no clear indication from this assessment that Mr L would benefit from another assessment by the Adult Mental Health Services. The Youth Team had a treatment plan in place for Mr L. The recommendation was for longer term psychotherapy which is not available from the Adult Mental Health Services.
35. The youth team had also treated Mr L’s depression with fluoxetine (a prescription antidepressant). Our adviser has said this is a common first line medication which Mr L’s GP would be able to manage going forward.
36. There is no indication that Mr L met the criteria for a referral to Adult Mental Health services. He does not appear to have a complex mental health problem which required a further assessment. He also does not appear to have a condition which could not be managed by his GP.
37. We appreciate that Mr L does not agree, and was distressed at what he perceived to be a lack of support. We have not seen an indication of a failing in the Trust’s actions here.
Record keeping
38. Mr L complains the record of the appointment does not include reference to his mental health crisis or his suicidal intents. Mr L received an email the next day with the doctor’s report, and he found it distressing that this was not included.
39. The Professional Record Standards Body standards set out what should be included in outpatient letters. Letters should include a history which covers the reason for the referral, a description of the presenting problems, how the problems have developed, and relevant past history and social context.
40. It should also include any risks including risk to self, to others and from others. It should include patient views, a clinical summary and a plan for treatment or support. The guidance does not specify that outpatient letters should be exhaustive in their description of the appointment.
41. Our adviser said the letter contains relevant information, and a clear and concise clinical summary. We recognise this letter does not include the events in the waiting room. Our adviser has said those would not represent new or different clinical information, and they did not change the overall management plan.
42. The records show that the information set out in the guidance is included in the letter following the appointment.
43. We understand that Mr L does not agree, and we acknowledge the distress he experienced when he read the letter. Although the clinician could have included more detail about what happened after the appointment, they were not required to. As such, the letter appears to be in line with Professional Record Standards Body standards. We have not seen an indication of a failing here.
Complaint handling
44. Mr L complains the Complaint Team ignored his concerns and did not contact him about delays in issuing a response.
45. The Trust’s complaint policy states that it will aim to complete a complaints investigation within 30 working days unless it is a particularly complex or sensitive complaint which will be responded to within 60 working days (approximately 12 weeks). It says that if circumstances change and the investigation will take more time it will notify the complainant, explain the reasons for this and provide a new target date for completion.
46. The policy says that complaint investigations should be completed within six months, unless a longer timescale has been agreed with the complainant.
47. Mr L made his complaint in mid-August. The Trust sent a response at the end of November. This is a total of 15 weeks. Mr L responded to the Trust in mid-December, and the Trust sent a further response towards the end of January.
48. We can see the Trust acknowledged this complaint in mid-August. This letter said the Trust aimed to have a response within 30 days but would contact him if this changed. The response was due in mid-September.
49. Mr L emailed the Trust on towards the end of September asking for an update. The Trust responded the next day and said that his complaint was still with an investigator, and they aimed to have a response with him by the end of October.
50. Mr L emailed again just before the end of October as he had still not received a response. The Trust replied that it was still in the process of being drafted and said it would be with him towards the end of November. The Trust apologised for the delay.
51. We can see that the complaint investigation was completed within six months. We can see the Trust did not contact Mr L to inform they would not provide a response within the initial 30 days. Mr L contacted the Trust before the next target date in October, and the Trust responded the same day.
52. The failure to contact Mr L in September does not appear to be in line with the Trust’s complaint policy. Keeping complainants updated about expected timescales is an important part of complaint handling. In this case we can see the Trust responded quickly when asked for an update.
53. We consider there to be a shortfall in communication by the Trust, but we do not consider this to be significant enough to amount to a failing.
54. Mr L also complained the complaints team dismissed his concerns. The Trust apologised if anything was said that appeared to be dismissive. It has said it understood it was frustrating for Mr L. It has provided comments from both members of staff, which indicate the concerns have been raised with them to prevent this from happening in future.
55. We are not able to know exactly what was said in the conversations Mr L had with the complaints team, or how this was said. We can see the Trust seems to have acknowledged that what was said could have been perceived as being dismissive.
56. As set out above, our Complaints Standards state that staff should give meaningful and sincere apologies and explanations that openly reflect the impact on the people concerned. It also says that complaint handling should promote a learning culture and be accountable when things go wrong.
57. We consider the Trust’s response is in line with these standards. It provided Mr L with an apology, and it took steps with staff to try and ensure something similar does not happen again.
58. We understand Mr L experienced frustration while making his complaint, and this was at an already difficult time for him. We appreciate Mr L is unlikely to agree with our thinking here. We do not intend to cause Mr L any further distress and we hope we have clearly explained our decision.