An independent provider in the Cornwall area

3. Miss N complains about the autism spectrum disorder assessment that was provided to her by the Provider under the NHS right to choose pathway on 29 May 2025.

4. She says that it made multiple failures in the way it conducted her autism assessment.

5. Miss N says that it:

• recorded that she didn’t have any issues with keeping eye contact even though the assessment was done via video call meaning this was ‘impossible’ to judge • only took 50 minutes to carry out the assessment rather than the ‘three hour NHS standard’ • failed to explore her issues with ‘masking’, ‘shut downs’ and ‘career related masking burnout’ • made multiple errors in its records of the assessment, including ‘misrepresenting’ her current mental health status • took 65 rather than the NHS recommended 20 day time frame to respond to her complaint.

6. Miss N says that as a result of this:

• she did not feel comfortable continuing her ADHD assessment that she had scheduled with the Provider due to the failings in her autism assessment. She says she is unable to access another ADHD assessment without returning to her GP • she is unable to be reassessed, as it is already recorded on her medical records that she does not have autism despite this conclusion being made through a ‘failed’ assessment • she has experienced worry, frustration, annoyance and uncertainty due to the Provider’s failure to carry out the assessment correctly and the state of confusion that this has left her in.

7. Miss N seeks the following to remedy her complaint:

• recognition that the assessment failed to meet the NHS standards • service improvements to prevent similar situations happening to future patients • a financial remedy.

8. Miss N was referred by her GP to have an autism assessment with the Provider.

9. The assessment was conducted on 29 May 2025. On 3 June 2025 the Provider sent Miss N her assessment report, which told her that the outcome of the assessment was that she does not have autism.

10. Miss N complained to the Provider on 3 June 2025. She received a response from it on 7 August 2025.

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.

Assessment of eye contact

15. Miss N told us that she did not feel that the Provider appropriately assessed her ability to keep eye contact. She explained that she does not feel that this could be done during a virtual assessment on a video call such as the assessment that she had. Miss N feels that the Provider therefore incorrectly concluded that she did not have issues with keeping eye contact.

16. Miss N’s records show that her assessment was done virtually, while she was at home, via a video call. The pre assessment letter that was sent to Miss N explains that Miss N should ensure that she can be seen ‘waist up’ on the camera, to ensure that her body language can be accurately assessed.

17. In Miss N’s self-report, she answered that she did not find it difficult to make eye contact when having conversations with people.

18. The report of Miss N’s assessment explains that the Provider felt that she showed ‘good reciprocity throughout the assessment, with appropriate eye contact, gestures, and non-verbal communication.’ It also says that her ‘eye contact was well integrated during conversations.’

19. The autism spectrum guidance says when conducting an assessment, you should enquire about core autism features such as difficulties in social interaction and communication, and the presence of stereotypic behaviour, and assess this by carrying out direct observation.

20. Our adviser explained to us that it is not a requirement for autism assessments to be carried out in a face-to-face setting to allow eye contact to be assessed. They told us that although the video call is part of the assessment, the assessors will also take information from the individuals self-report. The report of Miss N’s assessment says that her ability to make eye contact was considered.

21. Our adviser told us that an assessor may ask for a follow-up face to face meeting, if they felt that they were unable to make a conclusion on their assessment virtually. In Miss N’s case, the accessors were clear that they were of the conclusion that Miss N did not have autism, and therefore a further follow-up meeting was not required.

22. In Miss N’s case, her self-report indicated that she did not have issues with making eye contact when having conversations with people. Her assessment report shows that the clinicians did consider her ability to make eye contact in the assessment, and our adviser explained to us that there is no specific standard or guidelines which says that an assessment should be done face to face to assess a person ability to make eye contact.

23. We are sorry to hear that Miss N feels that her eye contact was not appropriately assessed in her assessment. We can understand why this will have been distressing for her.

24. After consideration, we consider that in line with the autism spectrum guidance the Provider did ask about issues with eye contact in the self-report and assessed this through direct observation during the video call. We have seen no indication that the Provider was wrong to assess Miss N’s eye contact through a video call and that this was not accurately considered in coming to an outcome in her assessment. We will therefore not consider this complaint further.

Quality of the assessment

25. Miss N told us that she feels that the Provider failed to explore her issues with ‘masking’, ‘shut downs’ and ‘career related masking burnout’. She says that it did not take these into consideration enough and that this also impacted the validity of the outcome of the assessment.

26. Miss N also told us that her assessment with the Provider only took 50 minutes for it to complete rather than the ‘NHS standard’ of 3 hours. She told us that she feels that this meant that the Provider did not have the time to accurately assess if she has autism or not, and that this has impacted the integrity of its conclusion in her assessment.

27. Miss N says that as a result of this, she has experienced worry, frustration, annoyance and uncertainty due to the Provider’s failure to carry out the assessment correctly and the state of confusion that this has left her in.

28. In its complaint response on 7 August 2026, the Provider explained that assessments are designed to be comprehensive and sensitive to the unique presentation of each individual. It explained that clinicians are trained to recognise signs of masking and base their evaluation on the information presented during the session.

29. The Provider also said in its complaint response that while its assessment with Miss N lasted 50 minutes, its clinicians dedicate additional time beforehand to review notes and pre assessment forms. It said that its assessments adhere to the relevant NHS guidelines.

30. As above, the autism spectrum guidance explains that assessments should assess the core autism features. It also says an assessment should be comprehensive and it should assess behavioural problems and functioning at home, in education or in employment.

31. Miss N’s records show that the Provider considered her history, processed her self-report information and mentioned each of these in the assessment and in the report it wrote afterwards. The assessment report shows that the Provider was aware of Miss N’s masking behaviours and ‘shut downs’, however it considered that these were likely due to ‘normal social behaviours’, rather than autism specific masking.

32. Our adviser explained that although traits such as masking can be present in autistic individuals, this does not mean that any person who shows these types of behaviours is automatically autistic. Our adviser told us that for example, masking, where an individual has to make efforts to fit in with neurotypical expectations, can be a behaviour seen in many non-autistic individuals.

33. We have seen no indications that the Provider did not appropriately consider the behaviours that Miss N reported as having when it came to its conclusion in Miss N’s assessment. In line with the guidance, and considering the information provided by our adviser, it appropriately took into account all of the information that Miss N provided to it and clearly recorded this in its assessment report. We will therefore not consider this complaint further.

34. We can see from Miss N’s records that her assessment took around 50 minutes to complete.

35. Our adviser explained to us that there is no set amount of time that an autism assessment should last for. Assessments of autism are carried out on a case-by-case basis, meaning that some may take longer or shorter than others. Our adviser said that the assessment needs to be ‘comprehensive’ and cover all of the different parts of the diagnostic process. They said that Miss N’s assessment covered all of the relevant parts of the diagnostic process.

36. The Provider’s policy says that clinicians should be able to complete the autism assessment in one hour, however, if the case is more complex, then more clinical time can be given, and/or an additional follow-up appointment can be arranged. It then says that it should be noted that these additional appointments are an exception rather than a rule.

37. Although we understand that Miss N’s assessment was shorter than she expected, we consider the Provider acted in line with the autism spectrum guidance, and its policy in completing a comprehensive assessment that considered all of the information available to it. We recognise that it will have been distressing for Miss N to feel that she was not given the right amount of time for her assessment.

38. After consideration, we have seen no indications that Miss N’s assessment was too short and did not appropriately consider her reported behaviours. Considering the autism spectrum guidance, the Provider’s policy, and the information provided by our adviser, we consider it appropriately took into account all of the information that Miss N provided to it and clearly recorded this in its assessment report. We will therefore not consider this complaint further.

Misrepresentation of Miss N’s mental health status

39. Miss N told us that the Provider ‘misrepresented’ her current mental health status in its report. Miss N told us that this was distressing and confusing for her, and she feels that this could have impacted the validity of the outcome of her autism assessment.

40. Miss N explained that she feels that the Provider put too much emphasis on her mental health history, and in its assessment report said that her difficulties are ‘more related to possible ADHD and depression’ despite her telling it that she did not currently have depression, was not undergoing therapy, and was no longer on any medication for her mental health in her assessment.

41. In its complaint response on 7 August 2025 the Provider said that it wanted to assure Miss N that her psychiatric history was only one component of a broader holistic evaluation, and all available information was considered when it reached its final outcome.

42. The records of Miss N’s pre assessment self-report shows that she told the Provider that she did not have any current mental health conditions or illnesses. Miss N then says that she has previously attempted suicide and has self-harmed in the past.

43. In Miss N’s assessment report, the Provider noted that Miss N told it that she had struggled with depression throughout her life and has previously participated in therapy. It stated it feels that Miss N’s challenges seem more related to possible ADHD and depression rather than a lack of understanding or interest in social engagement.

44. The autism spectrum guidance explains that clinicians should enquire about and assess past and current physical and mental health conditions.

45. In Miss N’s records, we can see that she told the Provider about her mental health history, and that it used this information when it concluded its assessment.

46. Our adviser explained to us that although there is a suggestion here that Miss N’s concerns could be due to a possible depression, this is not a diagnosis, and the report shows that Miss N’s mental health history was considered in the assessment.

47. We recognise that there is a suggestion in the assessment report that Miss N’s concerns could be due to a possible depression. However, this is not written as a diagnosis and the Provider mentioned Miss N’s current mental health status within its assessment report. This is in line with the autism spectrum guidance which says that mental health history needs to be considered as part of an assessment.

48. We understand why it will have been worrying for Miss N to feel that her current mental health status was inaccurately recorded and that this may have impacted on the outcome of her assessment. We have seen no indication that her current mental health status was not considered in the assessment, or that there is evidence that this was ‘misrepresented’ in the report. We will therefore not consider this complaint further.

Complaints procedure

49. Miss N told us that the Provider took 65 days rather than the NHS recommended 20 days to respond to her complaint. Miss N told us that this was frustrating.

50. Miss N initially complained to the Provider by email on 3 June 2025 following her assessment appointment on 29 May 2025. She received her assessment report shortly following this and sent a follow-up email to the Provider explaining she had ‘serious concerns about the quality and validity of the assessment process and conclusion it has reached.’ She asked to add this further information to her initial complaint of 3 June 2025.

51. On 13 June 2025 Miss N received an email from the Provider, explaining that it was aiming to respond to her complaint by 25 July 2025 and that if any further time was needed for them to resolve her complaint, it would make her aware of this.

52. On 22 July 2025 the Provider emailed Miss N to explain that it needed more time to respond to her complaint, and that it would now aim to have the finalised response to her by 8 August 2025.

53. On 24 July 2025 Miss N responded to the Provider to explain to them that although she was willing to wait until 8 August 2025 for a response, it was now past the ‘NHS recommended 20 working day response timeframe’.

54. On 5 August 2025 the Provider responded to Miss N and explained that it does aim to respond to complaints within 20 working days, however with all complaints, should they be complex, it may require more time to investigate them. It then told Miss N that the complaint handler dealing with her complaint was on annual leave until 11 August 2025, however she would receive a response as soon as possible after that.

55. On 7 August 2025, Miss N sent another email to the Provider and said that the delay has compounded the distress caused by her original clinical concerns and asked that a final complaint response be provided to her by 9 August 2025. On 7 August 2025, following Miss N’s email, the Provider provided Miss N with a complaint response.

56. Our NHS complaints standards say organisations should respond to complaints at the ‘earliest opportunity’, ‘consistently meet expected timescales’, and keep complainants ‘informed and involved’. The Regulations state that organisations should respond to complaints within six months of receipt of the complaint.

57. The Provider sent Miss N a response to her complaint in just over two months. This is within the timeframe set out in the Regulations.

58. In relation to keeping her informed, Miss N made her initial complaint to the Provider on 3 June 2025. It responded to her on 13 June 2025 with its initial timeline for response. When the Provider became aware that it was not going to make its initial response deadline, it emailed Miss N informing her that it needed more time and gave her a revised deadline for its complaint response. It then sent the complaint response to Miss N by this second deadline.

59. We can understand that it will have been frustrating for Miss N to have to wait longer than she expected to receive a complaint response. Although there was a delay in Miss N receiving her complaint response, the Provider kept her informed throughout the process and provided its final response within the time frame set out in the Regulations. This is in line with our NHS Complaint Standards. As such, we will not consider this complaint point further.

60. We would like to thank Miss N for taking the time to bring this complaint to us. After carefully reviewing all of the evidence, we have not seen any indications of failings by the Provider. We hope that our explanations have provided Miss N with some reassurance about the care she received.

1. We have carefully considered Miss N’s complaint about an independent provider in the Cornwall Area (the Provider). We would like to thank Miss N for taking the time to bring her complaint to us. We understand why it will have been distressing for her to feel that the Provider did not conduct her autism assessment correctly.

2. After consideration, we have seen no indications that the Provider made errors in the way that it conducted Miss N’s autism assessment. As such, we will not investigate this complaint further.