Coventry and Warwickshire Integrated Care Board

2. Mr M says his GP made a referral to the UHCW Trust’s neurology department in December 2023. He says they took too long to process his referral, and they only brought his referral forward when he complained about it.

3. Mr M says complains the ICB has not been clear about why it rejected his request for specialist funding.

4. Mr M believes the OUH Trust rejected a referral request from November 2023 unfairly.

5. Mr M says the RPH Trust did not involve him in the triage process in August 2023. He says it did not tell him the outcome of the referral until he complained, which meant the support he needed was delayed.

6. Mr M believes his condition has worsened because of delays by the organisations and that he has developed other health problems. He says he lost sensation in his body, and his appetite has reduced.

7. Mr M wants the organisations to apologise for what happened and pay him compensation. He also wants them to make changes to procedures

8. Mr M was found to have a brain injury in September 2020 when he lived overseas. This left him with a functional neurological disorder. By the end of 2023 his main concern related to sleeping difficulties.

9. Mr M’s GP made a routine referral to the neurology team at the UHCW Trust on 21 December 2023 to investigate his sleeping problems.

10. On 18 March 2024 Mr M’s GP made a routine referral to the sleep clinic at the OUH Trust. The GP noted that Mr M was sleeping less than two hours each night.

11. On 3 April 2024 the OUH Trust rejected Mr M’s referral to the non-respiratory sleep service. This was because it had changed its process for out of area referrals and was no longer accepting such patients.

12. The UHCW Trust offered Mr M a neurology appointment for 31 July 2024. He did not attend that appointment.

13. Mr M’s GP next referred him to the sleep disorder advice service at the RPH Trust. A doctor reviewed Mr M’s referral on 31 August 2024. They noted that the insomnia service available at the Trust had been reduced. It no longer provided support for people who presented with Mr M’s health problems. The doctor recommended the GP should contact a service from a different organisation which considered out of area referrals. We can see they sent an email to the GP on 2 September explaining this decision.

14. Mr M attended an appointment with a neurologist at the UHCW on 24 September 2024. The neurologist gave general sleep advice and advised his GP to consider alternative medication. They also advised Mr M to continue with a plan for a referral to a sleep centre.

15. On 18 October 2024 Mr M’s new GP made a second referral to the neurology team at the UHCW Trust. Mr M had advised his GP that an appointment scheduled for December had been cancelled without any explanation. The GP said the last appointment had not included recommendations for managing his symptoms. It seems the GP had not seen the discharge letter from the previous appointment.

16. On 9 December 2024 Mr M’s GP notified him that his referral to the sleep disorder advice service at the RPH Trust had been declined.

17. Mr M attended a neurology appointment on 27 March 2025. The neurologist confirmed the diagnosis of a functional neurological disorder. No further neurology input was required.

18. On 2 April 2025 the OUH Trust replied to a complaint from Mr M about its decision to reject the referral. It explained that the commissioning process had changed again, which meant it could now accept patient choice referrals. It said it had arranged for a neurologist to review the referral from November 2023. It said the referral had again been rejected; this time on clinical grounds, because the service does not see people whose primary issue was insomnia. The OUH Trust suggested Mr M’s GP could contact two other organisations and provided their contact details.

19. Mr M made complaints to all four organisations. He was dissatisfied with the outcome so complained to us.

UHCW Trust

22. Mr M complains the UHCW Trust delayed his GP’s referral to its neurology team. He says the UHCW Trust only brought his appointment forward when he complained.

23. The Clinical Adviser said organisations have a target to start non-urgent consultant-led treatment within eighteen weeks of a GP referral. NHS trusts should meet this target 92 per cent of the time. This is set out in the NHS Constitution and associated guidance.

24. We can see that Mr M’s GP referred him to the UHCW’s neurology department on 21 December 2023. They offered him an appointment on 31 July 2024, which was a wait of 31 weeks. When Mr M attended the appointment on 24 September, this was 39 weeks from the date of referral.

25. The second referral to the service came from a different GP on 18 October 2024. Mr M then waited 22 weeks before the appointment in March 2025.

26. The UHCW Trust told us it is currently trying to achieve a 52-week referral to treatment target within its neurology department. Its resources meant it could not meet the 18-week target. It agreed that Mr M’s wait of 39 weeks and then 22 weeks were not ideal. It said its process has now changed so that consultants review new referrals on arrival and allocate them to the most appropriate clinic. This means many patients can now be managed through advice and guidance without needing to attend a clinic.

27. It is clear the UHCW Trust took longer than it should have to arrange for Mr M to see a neurologist. But we cannot see evidence this fell below the standard in the NHS Constitution. This is because the NHS Constitution does not say that all appointments must take place within eighteen weeks. We agree with the Trust’s view that this was not ideal. We can also see the Trust is having difficulty with demand for the service.

28. It is clear that when Mr M attended his neurology appointments this did not lead to any treatment for Mr M’s sleep problems. In fact, his problems remained, and further referrals were then made to different organisations. So, an earlier appointment would not have led to any different outcome. It is unlikely the delays in neurology appointments could have had any effect on Mr M’s health. These referrals were in any case centred around sleep issues rather than any other of Mr M’s ongoing health problems.

ICB

29. Mr M complained that the reasons for the ICB rejecting his referral was unclear.

30. The ICB responded to Mr M’s complaint on 6 February 2025. It explained how several factors had led to patients having to wait longer than usual for NHS specialist care. It said it was taking steps to try and get back towards the 18-week target. It recommended that he should contact his GP or the UHCW Trust for support.

31. The ICB correctly explained that it was not its role to consider complaints relating to the experience of patients. There is no evidence the ICB rejected a referral from Mr M.

32. In this case individual decisions relating to Mr M’s referrals were not made by the ICB. This means there is nothing that we can investigate in this respect.

OUH Trust

33. Mr M complains about how the OUH Trust handled a referral from his GP to the non-respiratory sleep service in November 2023.

34. Doctors should have followed the Neurology Guidelines in relation to sleep disorders in adults. This recommends clinicians should not refer adults with insomnia. This is because these are considered common and benign and do not indicate a neurological problem.

35. We have reviewed Mr M’s GP records and can see that he first reported sleep problems in April 2023. We cannot see any records to suggest the GP referred to the OUH Trust in November 2023. The first referral was made on 18 March 2024.

36. The Clinical Adviser told us NHS trusts are expected to manage their waiting lists to optimise the use of resources. The local ICB will commission a service for the local community, and if the service is oversubscribed patients referred from outside the area are likely to be rejected. The GP would then be advised to refer to the local service which would be obliged to take the referral.

37. The Clinical Adviser said referrals may be rejected on clinical grounds if the Trust believes that the clinical problem can be managed more effectively in primary care (by a GP) or by an alternative specialist service. Out of area referrals are more likely to be rejected where there are capacity constraints.

38. We can see the OUH Trust originally rejected the referral for Mr M because he was from outside the area and there was no capacity to accept such patients. On the second occasion the criteria for acceptance had changed, but it did not accept referrals for to its non-respiratory sleep service for insomnia.

39. We cannot criticise the OUH Trust for rejecting referrals from outside its usual area if it had no capacity to provide that service. The evidence also suggests the OUH Trust did not accept referrals for insomnia, which appears to be in line with the Neurological Guidelines.

RPH Trust

40. Mr M says the RPH Trust did not involve him in the triage process. He says it did not tell him the outcome of the referral until he complained, which meant the support he needed was delayed.

41. Doctors should have followed the Neurology Guidelines as referenced earlier in this statement.

42. We have reviewed the records from Mr M’s GP and those from the RPH Trust. Mr M sent us a copy of an NHS Choose and Book referral dated 25 June 2024. This gave him the option of two centres that he could refer to. There is no documentary evidence the GP, or Mr M, made a referral to the RPH Trust in June. The RPH Trust notified the GP that his referral had been rejected on 2 September 2024. It seems it was three months later when Mr M found out about the decision.

43. The Clinical Adviser told us this referral was managed within an acceptable timescale. The service contacted his GP with a timely and appropriate response. There was no need to request further evidence from Mr M because he did not meet the criteria for the sleep disorder advice service.

44. We have seen no indications of failings on the part of RPH Trust relating to this part of Mr M’s complaint. The doctor assessing the referral appears to have followed the Neurology Guidelines. There was no requirement for the service to notify Mr M of the outcome because it provided this information to the referring GP.

45. We recognise Mr M has had distressing health difficulties for some time. We appreciate he believes failings by the NHS organisations he has complained about have contributed to those difficulties. This is not what we have seen. We hope Mr M is reassured we have seen no indication of any significant failings relating to these issues.

1. We have carefully considered Mr M’s complaint about the organisations above. We have seen no indication that anything went seriously wrong regarding the issues we have considered. We were sorry to hear that Mr M has been increasingly unwell over recent years. We have seen no evidence to indicate there were failings in care by the four organisations.