14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event complained about had a negative effect which the organisation has not put right. Having done so we have found SLaM has already done enough to put right the impact of these events.
15. Ms F complains SLaM did not investigated her complaint in line with policy or the NHS Complaints Standards. This includes it prolonging the investigation and not providing a satisfactory resolution.
16. Section 8.21 of the NHS Standards says organisations will make sure investigations clearly address all the issues raised. Furthermore, Section 8.25 states that unless an organisation has agreed a longer timescale with the person raising the complaint within the first six month, it should inform the person if it cannot conclude the investigation and issue a final response within six months.
17. As detailed in paragraphs 7 to 11 above, Ms F initially raised a complaint with SLaM in summer 2021, which it responded to just over a month later. We have seen no indication something went wrong here.
18. However, in summer 2022, Ms F sent a further complaint, raising 85 complaint points regarding the care and communication she received from SLaM between 2016 and 2022. SLaM responded further in spring 2023.
19. As Ms F was unhappy with SLaM’s response, she issued two further responses to it in spring 2024. In her first letter of complaint from spring 2024, Ms F documented that out of 85 concerns, SLaM had responded to 51. She therefore detailed which elements of her complaint needed further investigation and responding to. She also raised several additional questions regarding her care in response to comments SLaM made in its spring 2023 response.
20. Ms F’s second letter of complaint from spring 2024 was regarding the issues she had raised with one specific clinician that was involved in her care. She detailed which elements SLaM had not responded to regarding this clinician and requested it investigate and respond further.
21. It is clear from reviewing Ms F’s letters of complaint and SLaM’s response that it did not address all the issues she raised. This left her having to raise her concerns with it again, chasing a further response. We therefore consider that SLaM did not adhere to the NHS Standards when it initially investigated and responded in spring 2023. We will consider the impact of this below.
22. The email correspondence that we have sight of shows us that Ms F declined SLaM’s invitation for a local resolution meeting. SLaM acknowledged her decision and advised that it had reopened her complaint and would provide a further written response.
23. We can see SLaM emailed Ms F in early summer 2024 explaining that due to the nature and volume of her queries, it had a target date of late summer 2024 to issue a final response. SLaM advised that if it required additional time past the target date, it would contact Ms F to update her.
24. SLaM emailed Ms F again in the latter part of winter 2024/2025. In this email it apologised for the delay in providing its final response. It explained again that this was due to the voluminous amount of correspondence that it needed to review. SLaM also explained that a member of staff that was involved in the further review had unfortunately taken time off sick midway through, resulting in it being unable to meet the target date.
25. SLaM issued its final response in late summer 2025. In the response, SLaM addressed Ms F’s outstanding concerns and answered her additional questions.
26. It is clear from the evidence available that SLaM did not adhere to the NHS Standards regarding responding to Ms F’s complaint by the agreed due date and it took more than six months to issue a response. It is also clear that SLaM did not contact Ms F further until after the due date had elapsed.
27. We therefore think there is an indication of a failing here. We will consider the impact of this below.
28. Our Principles state that good practice regarding remedies includes putting things right. Where maladministration or poor service has led to injustice or hardship, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise. If they are unable to do so, the remedy should compensate them appropriately. These remedies include:
• an apology, explanation, and acknowledgement of responsibility • remedial action, which may include reviewing or changing a decision on the service given to an individual complainant; revising published material; revising procedures to prevent the same thing happening again; training or supervising staff; or any combination of these • financial compensation for direct or indirect financial loss, loss of opportunity, inconvenience, distress, or any combination of these.
29. We can see that in its final response SLaM apologised to Ms F for not adequately addressing all her concerns in its previous response from spring 2023. Furthermore, we can see it apologised to her for the length of time it had taken responding to her complaint. It reiterated the explanations previously provided for the delay and acknowledged the frustration and distress this must have caused Ms F. This is in line with Our Principles.
30. We note Ms F is seeking a financial remedy. We have considered Our Financial Remedy Guidance, and our severity of injustice scale (Our Scale) which is set out in this guidance. Our Scale allows us to ensure the recommendations we make are consistent and transparent for everyone who uses our service.
31. We do not consider that in this instance, a financial remedy is required. A case will generally be level one is we consider the person affect has experienced a low impact injustice such as annoyance, frustration, worry or inconvenience, where the effect on the person complaining is of short duration, and where we expect the person to recover from the injustice quickly once the poor service comes to an end. For cases that sit at level one on Our Scale, we consider that a financial remedy is not appropriate.
32. We acknowledge Ms F has told us the Trust’s handling of her complaint has exacerbated her physical and mental health difficulties, leading to the continuation of chronic stress and cumulative harm. Furthermore, she says she has an increased sense of mistrust in the NHS.
33. We consider this complaint to sit at level one of Our Scale. We acknowledge the annoyance and frustration caused by the Trust’s complaint handling is likely to have contributed to an impact on Ms F’s physical and mental health while it was ongoing. It is not possible for us to say whether it was the Trust’s complaint handling, or the original issues Ms F was complaining about, which caused the further impact here.
34. We consider that the apology already provided by SLaM in its final response to be a suitable remedy for Ms F’s complaint as this is fair and proportionate inline with the indications of failings we identified.
35. We recognise that Ms F has found SLaM’s handling of her spring 2024 complaint to be a difficult experience. Furthermore, we understand the experience she has had has compounded her preexisting physical and mental difficulties, and her distrust of the NHS. We do not wish to diminish this for her.
36. We thank Ms F for giving us the opportunity to review her concerns regarding SLaM.