The Trust wrongly declined Mr J’s CMHT referral
18. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. Having done so we have found the Trust has already done enough to put right the impact of these events.
19. Mr J complains the Trust wrongly declined his CMHT referral in 2023. In its final response, the Trust said the decision on whether to accept a referral is dependent on the individual’s needs and the extent to which those needs can be met by CMHT. It said CMHT decided Mr J did not meet this criteria.
20. The records show Mr J was referred to CMHT in September 2023. CMHT declined the referral a week later. The records say that following MDT discussion, the CMHT team did not identify any needs requiring CMHT intervention. The Trust’s complaint response says Mr J’s referring clinician requested he be allocated a support worker, which was not something provided by CMHT. It said a Care Act assessment by the local authority may have been more appropriate.
21. Our adviser said the contemporaneous clinical notes are not clear about the clinical rationale for rejecting the referral. They said additional information was given in the Trust’s complaint responses, which said the referring clinician had requested Mr J be allocated a support worker and this was not something CMHT would provide.
22. In its complaint responses, the Trust said because there was no request for active care coordination, the criteria for CMHT was not made. Our adviser said this information was not in the contemporaneous notes and did not explain the clinical rationale for declining the referral.
23. The Trust’s CMHT Operational Policy 2023 does not list active care coordination as the only criteria for accepting a referral. It lists several additional clinical criteria for accepting a referral, including that the individual cannot be managed through primary care.
24. Our adviser said Mr J appeared to fulfil some, although not all, of these criteria. They said these criteria are not exhaustive and clinical discretion is often crucial when deciding whether to accept a referral. However, if discretion was used, the rationale is not documented in Mr J’s records or any MDT records.
25. Our adviser said Mr J had a complex clinical presentation and explanations for the rejection of his referral should have been more clearly made. They said there may have been nuanced reasons for declining Mr J’s referral but the reasons were not made explicit. They said neither the contemporaneous documentation nor subsequent justification of the declined referral allows a judgement on whether the referral decision was correct.
26. We consider the Trust did not adequately explain the reasons for rejecting Mr J’s referral in its contemporaneous clinical notes or subsequent complaint responses. This meant we could not evaluate whether the Trust decision to decline the referral was appropriate. In addition, we consider the Trust’s subsequent explanations for declining the referral were not wholly supported by the Trust’s CMHT policy.
27. The Trust had three opportunities to explain the clinical rationale for declining Mr J’s referral in its communications with Mr J regarding his complaint. It had not done so, which caused Mr J considerable frustration and distress.
28. Given the amount of time since Mr J’s original referral in 2023, we approached the Trust and requested it reassess Mr J for a referral to CMHT. In its response, the Trust advised Mr J had been re-referred to CMHT in 2025 and had undergone a reassessment then. It said Mr J had been receiving support since, from the CMHT and Structured Clinical Management (SCM) pathways.
29. Given this information, we consider the Trust has already done enough to put right the impact on Mr J. We will therefore not be looking at this part of the complaint further.
The Trust did not properly communicate the referral decision to Mr J or his clinician
30. Mr J complains the Trust did not properly communicate its decision to decline his referral to him, his referring clinician or his GP.
31. In its responses to Mr J’s complaint, the Trust initially said the referral was dealt with appropriately by CMHT, but the outcome was not communicated to Mr J. It partly upheld his complaint and recommended CMHT should communicate the outcome of referrals to patients going forward.
32. Following internal discussion, the Trust said some of Mr J’s records had not been taken into account during the original investigation. Following further investigation, in its final response it said CMHT Operational Policy indicated it was the referrer’s responsibility to inform the patient of referral outcomes. It said it would not be appropriate for a patient’s GP or the patient themselves to be informed directly of the outcome of referrals, as CMHT would need to liaise with the referring clinician to discuss any next steps. It said it would remain the referrer’s responsibility to inform the patient of the outcome of the referral.
33. The records show Mr J was referred to CMHT in September 2023. CMHT informed Mr J’s referring clinician his referral had been declined one week later. The records do not show that Mr J was informed by his referring clinician. Mr J contacted the Trust in early October 2023 and was advised his referral had been declined.
34. Our adviser said the Trust’s CMHT policy on this issue was slightly contradictory. Section 2 of the policy says referrers would be advised of the referral outcome. Section 4 says CMHT staff should liaise with the referrer and service user to explain why the referral was rejected.
35. Our adviser said the standard approach taken across the NHS is for the service provider to advise the referrer of the outcome of a referral, and suggest any suitable alternatives. It is then the referrer’s responsibility to advise the service user accordingly.
36. Although the Trust’s communication of Mr J’s referral outcome was generally in line with NHS practice, the referring clinician did not inform Mr J of the outcome of his referral. This caused a delay in Mr J becoming aware his referral had been declined. He did not become aware his referral had been declined 19 days after his referring clinician was informed.
37. We use PHSO’s ‘guidance on financial remedy’ to consider what the remedy for impacts of any potential injustice should be. We think this part of Mr J’s complaint falls in level one, in that it represented a one-off administrative failure which caused Mr J minor worry or annoyance. We generally consider an apology to be an appropriate remedy for a level one injustice.
38. Our ‘NHS Complaint Standards’ say organisations should provide meaningful apologies and transparent explanations. The records show the Trust apologised to Mr J in its first complaint response and apologised again for its errors in its complaints process in its final response.
39. Given the impact of this interaction on Mr J, we consider this apology sufficient and in line with NHS Complaint Standards. We will therefore not be considering this part of the complaint further.
The Trust mishandled Mr J’s complaint
40. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. Having done so we have found the Trust has already done enough to put right the impact of these events.
41. Mr J complains the Trust mishandled his complaint and did not respond in a timely manner.
42. In its final response, the Trust apologised for the significant delay and gave an explanation. It acknowledged it should have communicated more with Mr J throughout the process and apologised for the upset and frustration caused.
43. The records show Mr J complained to the Trust in February 2024. The Trust acknowledged receipt of the complaint the following day. It gave its initial response three months later in May 2024, which partly upheld Mr J’s complaint.
44. Mr J emailed the Trust with his outstanding concerns at the end of May 2024. Several days later, internal emails show the Trust had identified errors in its initial response. In July, the Trust told Mr J it would respond to his outstanding concerns and aimed to respond by September.
45. Following several chases from Mr J, the Trust’s response was delayed until mid-November 2024 and again to January 2025. The Trust gave its final response in mid-January 2025, almost one year after the complaint was first brought to them. It reversed its decision of partly upheld and did not uphold Mr J’s complaint.
46. Mr J began to discuss his case with an advocate and wrote a letter to the Trust in April 2025. When he did not receive a response, he brought the case to PHSO in April 2025.
47. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 says organisations should respond to complaints within 6 months. Mr J brought his complaint in mid-February 2024 and received the first response in mid-May. This is a period of three months and falls within the timescales laid out in the legislation.
48. Mr J made the Trust aware of his outstanding concerns at the end of May 2024. The Trust provided its final response in mid-January 2025. This is a period of nearly eight months from the date of Mr J’s outstanding concerns, and almost a year from the date of Mr J’s original complaint.
49. The regulations says where organisations do not respond to a complaint within six months, they should notify the complainant in writing, explain the reason why, and provide a response as soon as is reasonably practicable. The records show the Trust responded to Mr J’s requests for updates when received, but did not proactively inform Mr J of the delays or the reasons for them.
50. The Trust’s final response apologised for the delay and explained it had been undertaking a review of Mr J’s first complaint response, which had caused a significant delay. The Trust did not explain this to Mr J at any earlier juncture. It apologised for not doing so and acknowledged it should have given Mr J the opportunity to decide whether he wanted a combined response. It also apologised for the upset and frustration caused.
51. Our ‘NHS Complaint Standards’ say organisations should deliver fair and robust complaint investigations and provide meaningful apologies and transparent explanations.
52. The Trust’s complaint handling was not initially in line with the relevant legislation or our ‘NHS Complaint Standards.’ It did not provide a response in a timely manner and did not keep Mr J suitably informed and updated on the progress of his complaint. This would have caused Mr J considerable frustration as he was seeking to understand the rationale for his declined referral and track the progress of his complaint.
53. Our Severity of Injustice (SOI) scale identifies a level one injustice as annoyance, frustration, worry or inconvenience typically arising from a single (one-off) incidence, where the effect is of short duration. We usually consider an apology to be an appropriate remedy for these cases. We consider the inconvenience to Mr J falls at level one of our SOI.
54. Although the Trust’s handling of Mr J’s complaint was not in line with regulations, it did provide a thorough and transparent explanation and apology in its final response. We consider this sufficient to resolve this part of the complaint.
55. We thank Mr J for taking the time and effort to bring his complaint to our attention. We recognise this was a frustrating and distressing experience for him. We hope our explanation provides some reassurance about the care and treatment he received. We wish Mr J the best for the future.