Chelsea and Westminster Hospital NHS Foundation Trust

3. Ms E says the Trust had previously agreed to perform Roux-En-Y surgery, and later decided she was no longer suitable for this. The Trust stated this was due to a period of mental health instability. Ms E also believes the Trust should have done more to support her mental health instead of discharging her.

4. As a result of the Trust’s actions, Ms E says she has not been able to access the surgery she needs. She feels she was treated unfairly and is depressed, stressed and angry. She has told us delaying surgery has also had an impact on her care and treatment for neurological conditions.

5. In bringing her complaint to us, Ms E wants answers and explanations about her care and compensation for the impact on her.

6. Ms E was due to have surgery in April 2020, for which she had waited since at least 2016. In February 2020, doctors saw Ms E in clinic, where she disclosed she had been struggling with her mental health and had taken an overdose with the aim of ending her life. Due to this, doctors cancelled the surgery in April.

7. Ms E’s case was discussed during a multidisciplinary team meeting (MDT) in May 2020, where the team decided she was not suitable for surgery and should be discharged from the service. The Trust informed Ms E of this decision on 27 May 2020.

11. 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 found no evidence that something has gone wrong.

12. We have taken clinical advice on this matter. We explained to our adviser that the Trust had previously approved Ms E for surgery with its Obesity and Metabolic Surgery service, and then discharged her, without the surgery taking place. The Trust said this was due to a period of mental health instability, which included Ms E sadly trying to end her life.

13. We considered this decision in two parts. We first looked at the decision to not perform the surgery and second considered the decision to discharge Ms E from the service.

14. In the case of the decision to not perform the surgery, our adviser explained a patient’s mental health needs to have been stable and well managed for a period of time before proceeding with bariatric surgery. This is supported by referral criteria set out in national guidance (BOMSS 2014 commissioning guidelines for tier 3 specialist weight management services). This states that ‘patients must be free from self-harm and suicide attempts for 12 months to be eligible for referral for bariatric surgery’. Although this specifically concerns referral guidelines, it is relevant, as the guidelines for a surgery referral and the decision to proceed with surgery are likely to be similar.

15. This is ultimately a decision a psychologist makes following an in-depth consideration of the patient’s needs and risks. In this case, the team involved with Ms E’s care decided the risk to her mental health at the time outweighed the benefits the surgery would have offered. We do not see evidence of failings in the Trust’s decision to decline the surgery.

16. In deciding to discharge Ms E from the service, we do not consider the Trust acted unreasonably. We recognise different Trusts will make different decisions. Some will choose to discharge patients from their service, while others will choose to keep patients open to services for a period of monitoring. Neither decision is incorrect, and the Trust acted in line with the BOMSS guidelines mentioned above when it made the decision to discharge Ms E.

17. We also considered whether the Trust had any specific duty to support patients with their mental health if this becomes a barrier to treatment. It is accepted best practice that professionals involved in a patient’s care have a duty to make recommendations about the support needed, to get the patient to a place where they are suitable for surgery. However, it may be the best support at the time is from another team, such as the Community Mental Health Team (CMHT).

18. We can see from Ms E’s records she was under the care of the CMHT at the time, although it is unclear whether or not it was providing Ms E with regular treatment. The Trust had attempted to find this out, as we can see from a note made by a clinical psychologist on 6 February 2020, but it is not clear if the attempts at contact were successful at this time.

19. In a clinical note made in May 2020, there is mention of an upcoming therapy appointment with a community team. There is also evidence in the note from 6 February 2020 that the psychologist contacted Ms E’s GP to arrange an appointment for her. The GP holds knowledge about the best local services and also has responsibility for the patient’s overall care. So, we are satisfied the Trust took appropriate action to ensure Ms E had support for her mental health.

20. We are very sorry to hear about Ms E’s experience. We know this surgery was, and remains, very important to her. She told us about the impact on her life, and we understand how upsetting it would have been to be discharged from the service. We can see the Trust acted in line with relevant guidance and it made decisions in Ms E’s best interest at the time, following an assessment of her needs and the risks involved. Because of this, we have not seen any evidence of failings by the Trust and we will take no further action on this complaint.

1. The Parliamentary and Health Service Ombudsman has carefully considered Ms E’s complaint about Chelsea and Westminster Hospital NHS Foundation Trust (the Trust). Having done so, we have seen no signs that anything went seriously wrong. We will explain the reasons for our decision below. We understand how important this matter is to Ms E, and we have not made our decision without recognising her report of how the events affected her.

2. We have carefully considered the complaint Ms E brought to us. We cannot see any signs the Trust was wrong in not offering Ms E Roux-En-Y surgery (a type of gastric bypass surgery), or by discharging her from its Obesity and Metabolic Surgery service. We also cannot see any evidence the Trust failed in its duty to support Ms E’s mental health needs.