18. 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 found any indications that something has gone wrong.
Issue 1 – Extensive Waiting List
19. Miss G says there was an extensive waiting list for treatment following her referral in February 2023. She says she was not able to access local services during this time, and she says she would have been removed from the Trust’s waiting list had she accessed these.
20. The Trust explained it had an extensive waiting list for face-to-face services. This was in part due to the COVID-19 pandemic, as the service had been closed to referrals between November 2020 and December 2022. Sadly, this caused a long waiting list to develop.
21. Miss G therefore did not have her initial assessment until 23 May 2024, which was some 15 months after the Trust received the referral from her GP. We recognise this was a considerable time to wait and appreciate the distress this will have caused Miss G.
22. The NHS England guidance ‘Mental health access and waiting time standards’ notes there are not specific waiting times standards for community mental health services. Work is currently in progress to measure the time to someone starting to receive meaningful help in the form of assessments, co-produced care plans, clinical and social interventions, and baseline outcome measurements.
23. Our adviser also explains there can be a high demand for mental health services nationally, which means there can be lengthy waiting lists.
24. We would not consider the Trust’s waiting list to be an indication of failing on its own in light of the above.
Consideration of priority criteria
25. We have also considered if Miss G met any of the limited criteria which would have prioritised her referral, in line with the NICE guidance ‘Post-traumatic stress disorder’. This includes priority for maternity and military patients. Miss G did not meet these criteria and therefore was not eligible for prioritisation.
26. During the referral process a GP can give their opinion if they think a patient has urgent needs. If a patient has an urgent need for treatment, a higher level of therapy can be considered as the first step of treatment. This was not the case for Miss G, and she did not require urgent treatment during the time she was waiting for her initial appointment with the Trust.
27. Therefore, during the waiting time, Miss G’s first point of contact would be her GP, an out of hours service, or 111 services. Miss G was also provided details of other services who may help in the waiting period or if she wished to look elsewhere for support.
Local talking therapy services
28. We have next considered Miss G’s concern that she was unable to access local services. Miss G says the Trust sent her a letter which directed her to her local community mental health team or GP whilst she was on the waiting list for treatment. She says she tried to gain support from a local talking therapies service, but this was refused as she was waiting on care from the Trust.
29. We can see the talking therapies service wrote to Miss G and explained it did not feel it could meet Miss G’s needs as it did not have the appropriate expertise. The Trust also acknowledged this can be the case for patients with complex trauma in its complaint response of 12 December 2024.
30. We recognise these events will have added to Miss G’s distress at a time when she was experiencing a prolonged delay for specialist care. However, we would not consider this to be an indication of failings in the Trust’s service and note Miss G was also directed to her GP. This would be appropriate in line with the NICE guidance ‘Post-traumatic stress disorder’, as they could highlight any urgent needs to the Trust.
Removal from waiting list
31. Miss G also raises concerns that she would be removed from the Trust’s waiting list had she assessed a local service. This relates to a new traumatic stress services which had opened at a different hospital trust. The Trust’s complaint response of 12 December 2024 explained this service was open to seeing patients with complex trauma. It noted Miss G was to discuss referral to the service with her GP.
32. The Trust explained if Miss G felt this service would better suit her needs, she would be discharged from the Trust’s service. The Trust also reassured her that it would expediate a re-referral to the service in the future if needed.
33. We consider this information was appropriate and in line with the NHS Choices guidance, which says patients have the right to choose where they receive their NHS treatment and the options available to them. We can see the Trust provided reassurance about being referred back into its service if needed. We therefore do not see indications of failings in relation to this concern.
Issue 2 – Treatment
34. Miss G complains the Trust refused to provide EMDR unless the group therapy and extended assessment process were first completed. She also says the assessing clinicians did not appropriately consider her request for individual therapy, in line with her individual circumstances and previous medical history.
35. We have considered the Trust’s records and the information given to Miss G at each stage of her engagement in line with the Trust’s policies for the trauma and dissociation service and the NICE guidance ‘Post-traumatic stress disorder.’ This says:
‘For people with additional needs, including those with complex PTSD:
• build in extra time to develop trust with the person, by increasing the duration or the number of therapy sessions according to the person's needs • take into account the safety and stability of the person's personal circumstances (for example their housing situation) and how this might affect engagement with and success of treatment • help the person manage any issues that might be a barrier to engaging with trauma-focused therapies, such as substance misuse, dissociation, emotional dysregulation, interpersonal difficulties or negative self-perception • work with the person to plan any ongoing support they will need after the end of treatment, for example to manage any residual PTSD symptoms or comorbidities.’
36. We can see the Trust considered Miss G’s needs following her referral from the GP. She attended an online assessment on 21 March 2024 and a further in-person session on 11 April 2024.
37. The assessment report noted Miss G’s personal circumstances, family history and relationships. The report noted a working diagnosis of dissociative (conversion) disorder (where a patient has psychological stress manifesting as neurological symptoms, without a neurological disease) and a possible differential diagnosis of neurodivergent personality (when someone's brain processes, learns, and/or behaves differently from what is considered ‘typical.’), which was to be explored further by her GP.
38. The report noted the treatment recommendations for Miss G. This included pre-therapy stabilisation and a further extended assessment within a sensorimotor psychotherapy group (a stabilisation treatment for CPTSD), to understand the severity of her dissociative symptoms. It was also noted this would allow time to clarify if Miss G was able to take on board the strategies, with a view to considering individual therapy and/or further treatment.
39. Our adviser confirms the Trust’s assessment and conclusions were in line with the above NICE guidance. There were a number of potential barriers to Miss G engaging with trauma-focused therapies, including her diagnosis of dissociative (conversion) disorder and her stability to be able to take on this type of therapy. Therefore, the offer of a period of extended assessment and group therapy that aim to provide stabilisation was consistent with the above guidance.
40. We have next considered Miss G’s concerns about access to EMDR therapy. Miss G’s referral to the Trust did not specify that Miss G needed EMDR therapy; this instead noted Miss G presented with CPTSD and asked that she be referred to the Trust’s trauma and dissociation service. There was no mention of the type of therapy Miss G would benefit from in the referral letter.
41. We have not seen mention of EMDR in the Trust’s records, so we are unlikely to be able to say why Miss G felt she was referred for this therapy.
42. Overall, we consider Miss G was appropriately assessed and her individual circumstances and previous medical history were carefully considered. We therefore do not see indications of failings in the recommendation for group therapy before individual therapy would be considered.
Issue 3 – Complaint Handling
50.Miss G says the Trust failed to address the points she raised or provide answers to her concerns. She says this caused her further distress, as she feels the Trust was not open, honest and transparent with her about her care.
51.We recognise Miss G was left feeling disappointed after the Trust’s investigation of this complaint. We are sorry this left her feeling like she was missing important information about her care and recognise this was very important to her to get the closure she needed.
52.Our ‘Complaints standards’ say when an organisation investigates a complaint, we expect staff to ‘give a clear, balanced account of what happened based on established facts’. This would include comparing ‘what happened with what should have happened’ and give an ‘objective’ response based on facts and evidence.
53.In this case, we can see Trust staff correctly considered Miss G’s medical records as part of its investigation. This assures us it referred to relevant evidence, to reach an objective, evidence-based view about the care she received. We can see it set out a clear chronology of events, to explain each stage of Miss G’s care thoroughly. We did not see any indications it overlooked any parts of Miss G’s complaint.
54.Taking all this into account, we consider the Trust acted in line with our ‘Complaints standards’. We therefore do not see indications to suggest further action is needed in relation to this concern.
Conclusion
55.We thank Miss G for taking the time in bringing her complaint to our attention. We hope our explanation brings some reassurance that the care and treatment she received was in line with the relevant standards and guidance.