South West London and St George's Mental Health NHS Trust

3. Mr A brings the complaints about the service South West London and St George's Mental Health NHS Trust provided to Mr F in June 2024.

4. Specifically, he says:

• the Trust did not provide an appropriate interpreter.

• he made a complaint about Dr A who then assessed Mr F. He says the Trust should have arranged a different doctor as there was a conflict of interest.

5. Mr A says as a result the Trust could not have accurately assessed Mr F’s capacity.

6. Further, he complains the Trust ignored a letter from a solicitor asking if Mr F was a patient of the Trust’s. He says because of this Mr F lost his court case.

By bringing the complaint Mr F seeks an apology, service improvements and financial remedy.

7. Mr F has a schizophrenia diagnosis. He is originally from Eastern Europe and does not speak or write in English.

8. Mr F had an ongoing court case regarding his housing and immigration status.

9. In June 2024 the Trust decided Mr F had capacity for treatment.

10. Mr F is assisted in all these matters by Mr A, who has bought this complaint to us on Mr F’s behalf.

Interpreter

14. 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.

15. Mr A says Dr A could not have assessed Mr F’s capacity as there was no interpreter present at the appointment in June 2024.

16. The Trust had booked a professional interpreter however, Mr A and Mr F raised concerns about the interpreter’s dialect. As Mr A and Mr F and the interpreter could not understand each other, the interpreter left.

17. In its initial complaint response, the Trust said Mr A then acted as interpreter. It said Dr A’s view was that Mr F had capacity to enable him to understand and consent to treatment.

18. Mr A disputes this. He says no consent, assessment or decision on capacity could be properly made without a professional interpreter. Mr A says a friend is not a substitute for a qualified professional.

19. Mr A says this misrepresentation of Mr F’s capacity could potentially affect future care. We appreciate his concern as he says this could affect Mr F’s leave to remain in the UK.

20. In a follow up complaint response, the Trust apologised for any misunderstanding about Mr A’s role at the appointment. The Trust confirmed it would book a new appointment with an interpreter present.

21. GMC guidance on good medical practice says in providing clinical care you must adequately assess a patient’s condition(s), taking account of their history, including:

• symptoms • relevant psychological, spiritual, social, economic, and cultural factors • the patient’s views, needs, and values.

22. Our adviser explained Dr A would have been able to assess Mr F using various methods not just verbal interaction. This was a face to face appointment where the psychiatrist could see and hear Mr F.

23. The records show Dr A referred to examples of the patient’s speech and behaviour which our adviser says was appropriate.

24. The records show Mr A was sharing information with the psychiatrist about what Mr F was saying. He also shared information with Dr A on matters such as Mr F’s daily life and whether he was taking his medication.

25. We consider Dr A acted in line with GMC guidance.

26. We appreciate Mr A does not consider he interpreted at the appointment. Whilst he is not a professional interpreter we consider he was able to share the information Dr A needed to assess Mr F. There are no guidelines which specify the interpreter must be a professional.

27. We are pleased to see the Trust agreed to arrange another appointment with a professional interpreter. As we have not seen indications of a failing, we will not take further action on this part of the complaint.

Request for different doctor

28. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. Having done so we cannot link the events complained about with the negative impact Mr F has claimed.

29. Mr A says Mr F was unhappy with Dr A because they would not provide an assessment of his mental capacity without a court order. Mr A explained the Home Office had requested an up to date medical report in support of Mr F’s application to stay in the UK. He says Dr A refused.

30. Mr A says he told the Trust Mr F did not want to see Dr A when he called three days before the appointment. He felt the disagreement meant there was a conflict of interest and the Trust should have assigned a different doctor.

31. Mr A says Dr A’s comments on Mr F’s capacity for treatment were made with hatred and not based on fact.

32. The Trust said Mr A contacted it requesting an urgent appointment. It said as there was already an appointment booked with Dr A in three days’ time and considering the urgency, it was appropriate for this appointment to go ahead.

33. The Trust advised it had not received a written request for a change of doctor and there was nothing to indicate Dr A had not been impartial in his appointments with Mr F.

34. The Trust said if Mr F would like to see someone other than Dr A, he can request it and the team would seek to arrange.

35. In response to that Mr A said it was not true that he had requested an urgent appointment. He said he rang to request an appointment for Mr F with any other than Dr A as they were refusing to provide a mental capacity assessment. He says the request was rejected.

36. In its complaint response the Trust dispute there was a request for a change of doctor. It said as the team were under the impression there was a request to be seen urgently, the appointment with Dr A was kept.

37. Mr A concludes Dr A produced a false report in retaliation of him insisting for a medical report.

38. The records say Mr A called to request a letter from the Trust confirming Mr F was still under its care. He explained they did not have any recent letters.

39. The Trust advised as Mr F had not attended two appointments it would need to see him to provide such a letter. The Trust explained as he had an upcoming appointment the best way to obtain a letter would be to attend.

40. The records show Mr A explained Mr F did not want to see Dr A. The Trust said it may not be able to accommodate that as Mr A wanted Mr F to be seen urgently.

41. In a follow up call on the same day the Trust said it encouraged Mr A to support Mr F to attend the appointment and discuss his concerns himself.

42. There is no guideline or standard that says the Trust must have arranged a different doctor to see Mr F.

43. In the record of the appointment Dr A assessed Mr F’s presentation in detail, completed a risk assessment, care plan and crisis plan. We have not seen evidence suggesting Dr A did not complete a factual assessment.

44. As Mr F’s primary concern at the time seemed to be gathering recent evidence that he was a patient of the Trust’s it seems the best way to gather that was to attend the appointment, as he did.

45. We appreciate there is evidence to suggest Mr A did tell the Trust Mr F did not want to see Dr A. We also consider Mr F had the option not to attend and rearrange to see a different doctor at a later date if that is what he wanted.

46. It is important to note it would have been difficult if not impossible for the Trust to find a different consultant at such short notice. Mr A called on a Friday and the appointment was already booked for the upcoming Monday.

47. We are sorry for any discomfort Mr F felt during his appointment with Dr A and that he felt his quality of care was reduced due to the disagreement. We appreciate it was an extremely difficult time for Mr F who sadly made increased suicidal attempts due to stress, anxiety and depression.

48. We do not find there is a link between Dr A assessing Mr F and the claim of a false report. As we explained earlier in our report, we consider Dr A completed their assessment in line with GMC guidance. For these reasons we will not take further action.

Solicitor letter

49. Mr F’s solicitor wrote to the Trust to explain they had been asked to act as a litigation friend in court proceedings. A litigation friend is a person who can represent someone who cannot represent themselves in court. This can apply to persons who do not have capacity as an example. The solicitor’s asked the Trust to confirm Mr F was under its mental health team.

50. The Trust did not answer the letter. In its complaint response the Trust explained it had misinterpreted what the letter was asking for.

51. The Trust said any clinic letters would have sufficed for evidence he was under its care. The Trust apologised for not communicating this and advised it would speak with the administration staff.

52. Mr A explained the litigation friend could not take Mr F’s case because they had not received a response to the letter. He says because of this, Mr F lost his homelessness court case and had to sleep on the streets. Mr A explained Mr F was also liable to pay the winning party’s court costs which was thousands of pounds.

53. We do not underestimate how difficult homelessness was for Mr F. We are sorry to hear the stress and conditions of being homeless exacerbated Mr F's health problems, including physical deterioration and mental health decline.

54. The Trust’s subject access policy says it is the duty of the relevant clinician to respond to all requests for access efficiently, accurately and appropriately.

55. Under solicitor requests, it says any application for a service user’s information must be accompanied by their written consent.

56. We consider if the Trust were unclear about what the solicitor letter was asking for, the reasonable thing to do would be to contact the solicitor for further information. The Trust also could have took that opportunity to ask for Mr F’s consent.

57. It is also important to note Mr F had attended the Trust and saw Dr A earlier in June 2024. Dr A wrote a report which they sent to Mr F and his GP. From this we can see there was at least one letter available to Mr F evidencing he was a Trust patient.

58. We consider the onus was on the complainant to do more to prove they were a patient, especially if this was essential to them securing legal representation.

59. We are sorry to hear how living with the fear of deportation was an overwhelming daily burden for Mr F. We appreciate that caused significant anxiety and depression which must have been extremely difficult.

60. We do not consider the Trust’s failure to answer the solicitor letter was the sole reason Mr F lost his court case. As we cannot link the indication of a failing to claimed impact, we will not take further action on this part of the complaint.

61. It is important to acknowledge that where we have not identified indications something went wrong, it does not detract from Mr F’s experience.

62. We thank Mr A and Mr F for bringing this complaint and sharing their experiences.

1. We have carefully considered Mr F ‘s complaint about South West London and St George's Mental Health NHS Trust. We are sorry to hear about the struggles Mr F has had with his mental health. We appreciate this is even more difficult for him when also facing struggles such as homelessness and financial worries.

2. We have not seen an indication something went seriously wrong regarding his concern about an interpreter. We have decided we cannot link the Trust’s inaction on a solicitor’s letter to the claimed impact of Mr F losing his court case. We also cannot link Mr F’s request for a different doctor to the claimed impact of a false report.