Midlands Partnership University NHS Foundation Trust

4. Mrs Q complains on behalf of her daughter, Miss V, about aspects of the care and treatment she received in November 2024 from Midlands Partnership University NHS Foundation Trust (the Trust) under its Child and Adolescent Mental Health Services (CAMHS). She specifically complains the Trust:

• did not transfer Miss V to a different clinician in a timely manner after their request in November 2024 • ignored letters from Miss V’s GP and an expert Consultant which contained information about her issue and recommended treatment.

5. Mrs Q says the Trust ignoring letters from the GP and an expert Consultant meant Miss V’s mental health deteriorated further as she did not receive the appropriate treatment.

6. Mrs Q states Miss V did not receive treatment for 30 weeks because of the delay in transferring her to a different clinician. She explains Miss V has functional neurological disorder (FND), which causes motor and vocal tics, limb locking, neurological pain, and functional seizures. She adds these symptoms worsen with anxiety. Mrs Q believes CAMHS’ failure to provide treatment during this period led to a steady increase in Miss V’s symptoms. As a result, Miss V sustained injuries during seizures and was unable to perform to her full ability in her GCSE examinations. Mrs Q reports Miss V did not pass English GCSE and she has since paid for additional tuition to support Miss V in resitting English while attending college.

7. Mrs Q explains Miss V’s low mood and anxiety impacted her social life. Mrs Q says Miss V was unable to socialise with others, join family activities and required extra support to get out of bed and dress up in the morning.

8. Mrs Q stated that repeatedly having to follow up with CAMHS (Service A) regarding the transfer negatively affected her mental health, as she experiences anxiety. She explained this situation also impacted her high blood pressure. Additionally, Mrs Q had to take time off work to provide additional support to Miss V.

9. By bringing this complaint to us Mrs Q seeks an apology from the Trust and financial remedy.

10. Miss V was referred by her GP to CAMHS (Service A) in October 2024 for anxiety and depression.

11. Miss Q says she requested Miss V be transferred to a different clinician in November 2024 as she no longer wished for the doctor at CAMHS (Service A) to be involved in her care and treatment.

12. Miss V was transferred and did not receive treatment for over 30 weeks.

13. CAMHS (Service A) offered to transfer Miss V to CAMHS (Service B), Miss Q declined this because it is 25 miles from their home.

Transfer to a different clinician

17. Before deciding whether to conduct a detailed investigation, we assess whether there are indications the organisation acted incorrectly. We do this by comparing what should have happened with what actually occurred. Our review found no evidence of any wrongdoing.

18. Mrs Q says in November 2024 she requested a change in clinician for Miss V. She explains it took over 30 weeks for Miss V to be assigned to a different clinician, and CAMHS (Service A) did not provide any further appointments apart from one check in with a nurse practitioner in December 2024.

19. The records show Mrs Q requested a change of clinician on 2 December 2024 and did not want the involvement of the doctor at CAMHS (Service A) in the care and treatment of Miss V whilst they were arranging the Transfer.

20. On 30 January 2025, the Trust emailed Mrs Q and offered for Miss V to see a doctor based at CAMHS (Service B), who would provide a medication review in early April 2025. The Trust explained it offered the April 2025 review date because Miss V was stable on her current medication. In the same email, the Trust stated CAMHS (Service A) would need to carry out any urgent reviews for Miss V. The records also show Mrs Q declined this offer and instead asked the Trust to arrange a transfer to either CAMHS Service C or D.

21. The records show CAMHS (Service A) offered medication (Fluoxetine 10mg capsules) to Miss V on the following dates:

• 18 December 2025 • 31 January 2025 • 21 March 2025 • 09 June 2025

22. In an email dated 30 January 2025, the Trust responded to Mrs Q saying it had offered CAMHS (Service B) because a consultant at CAMHS (Service C) had recently retired, making it inappropriate to transfer Miss V there at that time. The Trust also stated the consultant at CAMHS (Service D) works part-time, limiting the service’s capacity to take on additional young people.

23. In its response dated 16 April 2025; the Trust explained it offered to transfer Miss V to CAMHS ( Service B). It acknowledged the difference in distance of 4 miles between travelling to CAMHS (Service B) compared to CAMHS ( Service D) (Mrs Q’s preferred hospital). The Trust explained CAMHS (Service B) was the available resource that would enable Miss V to have her needs met in a timely manner.

24. The Trust’s Admission, Discharge and Transfer Policy does not set out any specific timescales for transferring a patient to a different clinician.

25. General Medical Council (GMC) Good practice guide states that in confirming responsibility, a clinician must be confident that information has been shared and that a named clinician or team has accepted responsibility, particularly before going off duty or delegating.

26. The Consultant to Consultant Referrals Good Practice Guide does not set specific timescales for transferring a patient to a different clinician.

27. Our Principles of Good Administration require public bodies to make reasonable decisions based on all relevant factors.

28. Given there are no set guidelines that tell clinicians how quickly they should transfer a patient to another clinician our adviser said the efforts made by CAMHS ( Service A) to arrange a different clinician for Miss V meant it provided the appropriate level of support for her during the transfer process.

29. Our adviser says the doctor remaining involved in the care and treatment of Miss V was in line with GMC’s Good medical practice, as the guidance states the clinician must stay involved in a patient’s care until another clinician has formally taken over.

30. We consider the Trust’s decision to initially transfer Miss V to CAMHS ( Service B) is in line with our Principles of Good Administration. We found the Trust decision not to transfer Miss V to CAMHS Service C or D was reasonable because it was based on relevant factors such as their limited resources.

31. We acknowledge Mrs Q preferred Miss V to be seen at CAMHS Service C or D. However, the Trust explained it did not have sufficient resources to accommodate her at these hospitals. Offering CAMHS (Service B) as an alternative ensured Miss V could be seen promptly and this aligns with Our Principles of Good Administration.

32. We acknowledge it took some time for Miss V to be transferred. We cannot conclude the referral was untimely considering the Trust’s Admission, Discharge and Transfer Policy does not set out any specific timescales for transferring a patient to a different clinician. We found the Trust provided the appropriate support in line with guidance during this period.

33. We appreciate the impact the experience has had on Mrs Q and Miss V and we hope we can bring them some reassurance there are no indications of failings during the process of transferring Miss V to a different clinician.

Letters from GP and expert consultant.

34. In October 2024, Miss V’s GP referred her to CAMHS ( Service A) to help her manage her anxiety and low mood and to access suitable therapies. A CAMHS psychiatrist reviewed her on 26 November 2024.

35. Miss V’s GP referred her to a neurologist at a mental health centre within another Trust (the Centre) for specialist advice on the assessment and further management of her intermittent movements and sounds.

36. The specialist consultant saw Miss V on 27 January 2025 and recommended gradually increasing her Fluoxetine in steps of 10 mg every two weeks, up to a maximum of 60 mg a day if her anxiety or other mood symptoms continued. The Centre sent the neurologist’s recommendation to CAMHS ( Service A). Miss Q says the psychiatrist at CAMHS ( Service A) ignored this advice.

37. The records show CAMHS ( Service A) reviewed Miss V’s medication in December 2024 and issued a further prescription in January 2025. An entry in the medical records in December 2024 indicated Miss Q found the medication helpful.

38. We have seen evidence CAMHS ( Service A) received and reviewed the evidence.

39. Miss V was 16 years at the time of these events.

40. In its complaint response dated 16 April 2025, the Trust states CAMHS ( Service A) considered the information provided in the GP referral. However, as a specialist mental health service, it does not rely solely on the GP’s information when making decisions about a young person’s care.

41. GMP states clinicians ‘must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide, or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options’.

42. The BNFC guidance on Fluoxetine states for children aged 5 to 17 years, the initial dose of Fluoxetine should be 10mg once per day. The dose can be increased up to 20mg per day after one to two weeks of the initial dose. The daily dose may be administered in divided doses.

43. NICE guidelines NG134 covers identifying and managing depression in children and young people aged 5 to 18 years. Based on the stepped-care model, it aims to improve recognition and assessment and promote effective treatments for mild and moderate to severe depression.

44. We have seen the advice from the Centre was from a neurologist. It was a psychiatrist at CAMHS ( Service A( which assessed Miss Q. Given their different roles, we consider it was reasonable, and in line with GMC guidance, for the CAMHS doctor to carry out their own assessment and not solely rely on the information from the the Centre. We have not found any indications of failings.

45. Our adviser points out the specialist consultant’s recommendation to increase the dose of Fluoxetine by 10mg every two weeks, up to a maximum of 60 mg daily is not an appropriate dosage for a child and is not in line with the BNFC guidance on Fluoxetine.

46. Our adviser says, in normal practice, clinicians prescribe medication for 28 or 30 days, depending on the pack size, and review it each month. We have seen CAMHS ( Service A) reviewed Miss V’s medication in December 2024 and issued a further prescription in January 2025 and reviewed its effectiveness.

47. We consider that CAMHS followed NICE guidance by keeping Miss V’s medication unchanged, as a review in December 2024 showed it was helping her. We also consider that CAMHS (Service A) followed BNFC guidance by not increasing the dose, because Miss V was 16 at the time and a higher dose would have been an adult dose.

48. We have seen the CAMHS (Service A) team was treating Miss V for anxiety and depression. It was not commissioned to treat FND. We found CAMHS (Service A) treatment of Miss V was in line with guidance.

49. We hope we have clearly explained our view of what happened and why we saw the Trust acted in line with guidelines.

1. We have carefully considered Mrs Q’s complaint about the Trust. We are sorry to hear the delay in transferring Mrs Q to a different clinician affected the mental wellbeing of both Miss V and Mrs Q. We appreciate the impact the experience has had on Miss Q and Miss V.

2. Having looked at Mrs Q’s complaint, we have decided not to consider it any further. This is because we have not seen any indications things went wrong. This means from the evidence we have considered it appears the Trust provided appropriate care and treatment to Miss V.

3. We understand why this complaint is important to Mrs Q and we will explain our decision in more detail below. We hope our explanation provides her with reassurance about how carefully we have considered her complaint before reaching our decision.