Alder Hey Children's NHS Foundation Trust

5. Miss O, represented by her mother Mrs H, complains about aspects of the care and treatment she received from the Trust’s radiology department in 2015 and its CAMHS and EDYS in 2022.

6. In 2015 Miss O complains she had an MRI scan and was not told she had double scoliosis.

7. In May 2022 Miss O complains was discharged from CAMHS with no onward referral to adult mental health services and In September 2022 Ms O was discharged from EDYS with no onward referral to adult eating disorder services or mental health services.

8. Miss O says because of the failing she did not become aware she had double scoliosis until 2022 which meant her condition had developed resulting in pain. It also meant there was a significant delay in any treatment for scoliosis potentially causing Miss O the loss of a better outcome

9. Miss O says when she discharged in May 2022 there was no support in place and she attempted suicide. As Miss O was discharged from local services, she had no mental health support or treatment from NHS services, therefore her family paid for private treatment.

10. By bringing the complaint to us Miss O is seeking an apology and financial remedy.

11. In 2015, Miss O attended the Trust for an MRI (magnetic resonance imaging) scan of her spine.

12. Between December 2019 and September 2022, Miss O received care and treatment from the Trust’s EDYS.

13. Between 2020 and 2022, Miss O received care and treatment from the Trust’s CAMHS.

MRI Scan

19. 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.

20. Miss O complains that in 2015 the Trust failed to identify or inform her she had double scoliosis following an MRI scan.

21. Miss O says because of this she did not become aware of the condition until 2022, which delayed treatment and caused pain.

22. In its response the Trust explained there was no indication of scoliosis at the time of the scan.

23. Our radiologist adviser explained there is a clinical duty to report unexpected findings which are identified during investigation and treatment. This is in line with Radiologist Communication Standards.

24. Our radiologist adviser explained the imaging available was an MRI of the spine and was not undertaken to investigate scoliosis. However, on review of the medical records and scan our radiologist adviser explained the MRI scan from 12 August 2015 did not indicate scoliosis.

25. We understand Miss O feels there was a missed opportunity to identify scoliosis earlier. We recognise learning about the condition years later has been upsetting and has led her to question whether earlier intervention may have improved her outcome. However, based on the evidence available to us, we have not identified indications of a failing by the Trust regarding the 2015 MRI scan.

CAMHS and EDYS Discharge

26. 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.

27. Miss O complains she was discharged from CAMHS in 2022 without onward referral to adult mental health services. Miss O also complains she was discharged from EDYS in September 2022 without onward referral to adult eating disorder or adult mental health services. Miss O says this left her without appropriate NHS mental health support.

28. In its response the Trust explained Miss O was referred to CAMHS because her eating disorder symptoms had improved but she continued to report anxiety and depression symptoms. It considered CAMHS was a more suitable service for Miss O at the time.

29. It explained Miss O was discharged from its CAMHS service in May 2022 after Mrs H informed the Trust Miss O did not wish to continue with its service. The Trust said it made attempts to contact Miss O, but these were unsuccessful. It said Miss O was not left without support as she was still receiving care and service from its EDYS.

30. The Trust said it continued to provide support under EDYS until Miss O was 18 years old. It said at this stage it signposted Miss O to talking therapy or RASAC (Rape and Sexual Abuse Centre) which provides therapy for sexual trauma.

31. Our psychiatrist adviser explained there is no specific national guidance when it comes to discharging from a service. Our psychiatrist adviser says this is because it is a clinical decision.

32. Our psychiatrist adviser noted that the CAMHS discharge was a self-discharge and not a decision made by the Trust. Our psychiatrist adviser explained that in instances of selfdischarge it is standard practice to consider the mental capacity and risk of the patient. When assessing a person’s mental capacity, the standard approach is to assume they have it until evidence contradicts.

33. Our psychiatrist adviser noted there was no documented assessment for Miss O’s capacity but explains this is likely due to the Trust being unable to contact Miss O directly.

34. We have seen in appointments prior to her self-discharge the Trust’s CAMHS had assessed Miss O as a low risk following discussion at multiple appointments where Miss O reported decreased thoughts of harm and no plans for suicide.

35. We are satisfied the appointments Miss O attended with the CAMHS were comprehensive and appropriately documented Miss O’s presentation, risks, goals and care planning.

36. We have seen the Trust CAMHS discharged Miss O back to its EDYS following discussion with Mrs H who confirmed that she was happy to continue engaging with EDYS until she transferred to adult services. We have seen evidence CAMHS made attempts to confirm the self-discharge with Miss O before it issued its discharge letter.

37. We were sorry to hear Miss O experienced a deterioration in her mental health and took an overdose in February 2022. We recognise this would have been a challenging and emotionally difficult time for Miss O and her family.

38. We understand this was worsened when Miss O was later discharged from the Trust’s EDYS. We have listened when Miss O has told us this made her feel like she was left with no support from the NHS.

39. Our psychiatrist adviser says there is limited capability to provide mental health support under EDYS and its adult services. Having considered the evidence available our psychiatrist adviser explained Miss O did not meet the criteria for referral to adult eating disorder services. This is because the symptoms and concerns Miss O was reporting were related to her mental health.

40. We have seen that from mid-2022 Miss O began to disengage from the EDYS, and we consider this is likely related to the deterioration of her mental health. We understand this would have been a difficult time for her and recognise the challenges of engaging with support when experiencing low mental health.

41. Our psychiatrist adviser says when discharging a patient from young people services there is a consideration of need and willingness to engage with a service provider.

42. Our psychiatrist adviser noted the Trust’s discharge documents are comprehensive and detail Miss O’s eating disorder recovery, mood and ongoing needs.

43. We have seen in the records Miss O’s ongoing difficulties were more closely linked to mood than an active eating disorder. It is for this reason the Trust could not transfer her to adult eating disorder services as there was no indication she met the threshold for adult eating disorder services at the time.

44. We have seen in the records signposting information and details of services which Miss O could access should her needs change. This included information on a self-referral to talking therapy and RASAC. There is indication Miss O engaged with RASAC but not the talking therapy. We have also seen Miss O was referred to ‘Minds Matter’ by her GP for mental health support.

45. We recognise Miss O and her family feel she remained vulnerable and required continued specialist NHS support. We understand why the end of services felt abrupt and distressing.

46. We have seen evidence discharge planning, signposting and risk considerations were completed and comprehensive. We have not seen evidence the Trust discharged Miss O without ongoing support or without consideration of risk from either CAMHS or EDYS. As we have seen no indications of failings, we will not do further work on this complaint.

1. We have carefully considered Miss O’s complaint about Alder Hey Children’s NHS Foundation Trust (the Trust) and the care she received from its radiology department in 2015 and later through its young people mental health services.

2. We were sorry to hear of the circumstances surrounding Miss O’s complaint and the difficulties she experienced regarding her physical and mental health care. We understand this has been a distressing and challenging time for Miss O and her family. We have listened when they have told us of the lasting emotional impact of these events.

3. We have considered Miss O’s complaint that the Trust did not inform her of her scoliosis diagnosis in 2015, and we have seen no indication anything went seriously wrong.

4. We have also considered Miss O’s complaint regarding the Trust’s management of her discharge from the Eating Disorder Young People Service (EDYS) and Child and Adolescent Mental Health Services (CAMHS), and we have seen no indication anything went seriously wrong. We understand how important this complaint is to Miss O and we are sorry for any distress our decision may cause.