Derbyshire Healthcare NHS Foundation Trust

4. Miss R complains about aspects of the care and treatment provided by the Trust between July and August 2024. Specifically, she complains the Trust’s communication regarding her reassessment appointment on 29 July was unclear, potentially misleading, and communicated at last minute. Additionally, Miss R complains the Trust abruptly stopped her long-term prescription of methadone.

5. Miss R says these events have significantly affected both her physical and mental health. As the primary carer for her partner, Miss R says she was unable to fulfil her caregiving responsibilities during this period.

6. By bringing this complaint to us, Miss R seeks evidence of service improvements and a financial remedy to recognise her experience.

7. The Trust has prescribed 70mg of methadone to Miss R for the past seven years.

8. On 29 July, the Trust arranged a re-assessment appointment to review her prescription. Miss R did not attend the appointment, so the Trust instructed her to collect her prescription from another service (Service B) within the Trust. Miss R did not attend Service B to collect her prescription.

9. On 8 August, the Trust withdrew her prescription and she remained without the medication until 23 August when she attended another reassessment appointment.

13. Before deciding if we should conduct a detailed investigation, we assess whether there are indications the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have carefully considered this below.

Communication

14. Miss R was scheduled for a re-assessment appointment with the Trust on 29 July. She explains the Trust first told her the appointment would be with her keyworker, but later sent her a text saying it would be with a prescriber. She also says the appointment was due to take place in the afternoon, but the Trust called her twice in the morning.

15. Miss R says she tried to contact the Trust after she noticed she had a missed call, but no one answered her call. She says later that afternoon she received a text message stating she had missed her appointment and the Trust would send her prescription to Service B for collection. Miss R explains she did not have a direct number to contact Trust.

16. The Trust explain it sent Miss R a text message on 25 July to inform her that her appointment would be on 29 July. It also tried to call Miss R twice on the morning of the scheduled appointment to let her know a prescriber would be conducting the appointment, but she did not answer.

17. Because of this, it also sent Miss R a text message explaining the call in the afternoon would take place over the telephone with a prescriber and if she misses this appointment it could affect her prescriptions. The Trust further explained it sent a second text message to confirm the prescriber’s identity prior to the call.

18. The Trust say it called Miss R at 1pm as agreed but she did not answer. After the missed appointment, the Trust explained it sent Miss R a third text message advising her that she had missed her appointment and needed to collect the prescription covering a 2 week period from Service B the following day.

19. The Trust explained there are no records showing Miss R contacted the service after missing her appointment on 29 July. It says it did not receive any voice message from Miss R on the day of the appointment but it received a voice message from Miss R on 30 July explaining she will pick the prescription up on 31 July. Miss R did not collect the prescription on the 31 July either.

20. Our principles says public bodies should communicate effectively, using clear language that people can understand and that is appropriate to them and their circumstances. It also says public bodies should provide services that are easily accessible to their customers.

21. The call records show on 25 July the Trust sent Miss R a text message to notify her that her appointment will be in the afternoon on 29 July. The message advised that a keyworker would conduct the appointment.

22. On the morning of 29 July, the Trust made two telephone calls to Miss R but she did not answer. Later that day, it sent a text message advising the appointment would take place by telephone with a prescriber. The Trust then sent a second text message confirming the identity of the prescriber.

23. As Miss R missed her appointment, the Trust sent a third text message advising her to collect the prescription from Service B within the Trust on 30 July.

24. We have not seen evidence in the Trust’s call log that the Trust called Miss R at 1pm, which was the scheduled appointment time. However, the Trust told us medical notes entered at 1pm stated Miss R did not attend the appointment. The Trust said this indicated staff called her at 1pm, but she did not answer. Although this was not recorded on the call notes, her medical records do suggest this occurred.

25. In line with our principles, we reviewed how the Trust arranged the reassessment appointment for 29 July. We found the Trust gave Miss R clear and accurate information about the appointment, and we do not consider that it communicated the arrangements at the last minute.

26. The records show the Trust notified Miss R of the appointment on 25 July, three days before it took place. The Trust also confirmed the appointment would take place by telephone and identified the prescriber who would conduct it.

27. It gave Miss R sufficient notice and information about the appointment through text messages sent before and on the day of the appointment. It also made the service accessible by offering the appointment by telephone. We consider that the Trust acted in line with our principles here and we found no indication of failings by the Trust.

28. We can also see the Trust had a direct contact number which Miss R used on 30 July to confirm she could not attend Service B that day, but would collect her prescription from on 31 July. We have not found indication of failings in relation to the Trust not having a direct contact number. As a result, we will not investigate this matter any further.

29. We appreciate the impact the experience has had on Miss R and hope we can bring her some reassurance that there are no indications of failings in the communication between her and the Trust during the period she complains about.

Withdrawal of prescription

30. Miss R was scheduled for an appointment on 29 July for an assessment regarding her prescription of methadone. Miss R explains her prescription was abruptly withdrawn the next day by a prescriber who she says was unfamiliar with her case, following her missed appointment on 29 July.

31. Miss R says she was unable to collect her prescription from Service B on 30 and 31 July. Miss R explains it took approximately one month for her prescription to be reissued.

32. The records indicate, after Miss R missed her appointment on 29 July, the Trust sent a text message advising her to collect her prescription from Service B on 30 July. When Miss R was unable to pick it up that day, she made arrangements with the Trust to collect her prescription from Service B on 31 July.

33. Sadly, Miss R did not pick up her prescription on 31 July either. The records show the Trust offered Miss R a re-assessment appointment on the 6 August, but she did not attend this too. As a result, she had not received her methadone for more than five days by this point.

34. The Trust explained it was no longer safe to dispense from the prescription following the missed appointments and as a result it stopped the prescription on 8 August.

35. The UK guidelines on clinical management says a prescription for opioid substitute medication should normally only be considered if the clinician is satisfied that the patient may be able to comply with the prescribing regimen.

36. It explains says for suitably safe prescribing, as a minimum, agreement is needed from the patient to ongoing attendance for prescribing reviews and therapeutic monitoring by a clinician. This will normally involve the need to agree to engage at least in a minimum level of key working and care planned treatment.

37. Our adviser explained that in the community setting the patient is not as closely managed as they would be within an in-patient setting. This means there is a risk of the patient not complying with how the medication is prescribed. Our adviser explained that if a patient misses 3 consecutive doses of methadone, there is a risk of the patient overdosing when restarting the prescription.

38. The UK guidelines on clinical management says it is unsafe to restart a prescription above 20mg without the prescriber reviewing the patient. The guidelines explains that, when five days’ supply has been missed, pharmacists would not normally be asked to dispense on the current prescription.

39. NICE guidelines on opioid dependence says prescribers should not be pressured into prescribing opioids in an unplanned manner in order to abolish withdrawal symptoms. The guidelines say everybody requires an adequate assessment to allow for the necessary information to be obtained efficiently without adding delay or placing the person at risk.

40. We can see Miss R had not taken her methadone for over five days after her missed appointments. In line with the UK guidelines on clinical management, we consider the Trust acted in line with the guidelines when it withdrew the prescription on 8 August.

41. Also, in line with NICE guidelines, it was appropriate to carry out a further assessment to ensure the prescription was still safe for Miss R before dispensing.

42. The records show the Trust gave Miss R sufficient notice that her prescription will be withdrawn if she does not engage for an assessment. We consider the Trust did not abruptly withdraw the prescription after the missed appointment on 29 July.

43. We hope we have clearly explained our view of what happened and why we saw the Trust acted in line with guidelines. We appreciate the impact of this experience and wish Miss R the best of health for the future.

1. We have carefully considered Miss R’s complaint about the Trust. We are sorry to hear how not having access to her prescription affected her mental wellbeing. We appreciate the impact and the experience this has had on Miss R.

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

3. We understand why this complaint is important to Miss R 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.