An independent provider in the City of Derby area

4. Ms H complains about the care and treatment she received at the Hospital in 2024 and 2025. She complains the Hospital:

• did not respond appropriately when a resident assaulted her in November 2024 • threatened to take her blood and give her an electrocardiogram (ECG- a test that records the heart’s electrical activity) against her will in July 2025.

5. Ms H says she experienced anxiety, upset and distress following her treatment. She says the assault left her concerned for her safety.

6. Ms H is seeking financial remedy and service improvements.

7. Ms H resides in a low security forensic unit. She was detained under the Mental Health Act in 2017 and receives treatment for schizoaffective disorder.

8. In November 2024, Ms H was assaulted by another resident. Hospital staff made a safeguarding referral and the matter was reported to the police. The Hospital also made changes to the living arrangements of the parties involved to prevent a reoccurrence.

9. In July 2025, Ms H refused to allow the Hospital to perform a blood test and an ECG. She frequently underwent these treatments to monitor her response to her medication.

10. After several refusals, staff told Ms H they would consider carrying out the treatment under restraint if she did not give her consent. They said Ms H’s detention was supported by a T3 Certificate of Second Opinion, which authorises medical treatment for a mental disorder when a patient is incapable of consenting.

11. Several days after this meeting, Ms H consented to a blood test and ECG. She says she felt pressured into this decision and says she has capacity to make decisions about her care and treatment.

The Hospital’s response to Ms H’s assault by another resident in November 2024

15. 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 seen any indications that something has gone wrong.

16. In November 2024, Ms H was assaulted by another resident. Hospital staff made a safeguarding referral and the matter was reported to the police. The Hospital also made changes to the living arrangements of the parties involved to prevent a reoccurrence.

17. Hospital policy on violence and aggression says incidents should be recorded on the reporting system and should normally reported to the police. It says victims should be offered support and kept informed.

18. Hospital policy on safeguarding says peer to peer abuse must be taken seriously, with care plans and risk assessments updated after an incident.

19. The records show that following the incident, Hospital staff checked Ms H for injury, contacted the police and updated care plans and risk assessments. Hospital staff reviewed CCTV, completed a safeguarding referral and arranged a room change for Ms H’s peer.

20. Our adviser said the Hospital’s policies were in line with national practice and legislation. They said it responded to the incident in line with its policies, following safeguarding requirements and involving the police as needed. They said the Hospital mitigated the risk appropriately and supported Ms H in line with its policies and procedures.

21. We understand Ms H’s concern that the Hospital did not respond to the incident appropriately. We understand how distressing this incident must have been for her. Having reviewed the evidence, we are satisfied the Hospital had appropriate policies and procedures in place relating to violence, aggression and safeguarding and responded to this incident in line with policy and legislation. We will therefore not be looking at this part of the complaint further.

The Hospital threatened to give Ms H a blood test and ECG against her will in July 2025

22. In July 2025, Ms H refused to have a blood test and ECG.

23. Section 63 of the Mental Health Act 1983 (the Act), relating to treatment not requiring consent, says patient consent is not required for any medical treatment given for the mental disorder they are suffering from, if given by or under the direction of the clinician in charge of their treatment. A T3 certificate is required to administer medication in this scenario.

24. NICE guidance NG10, section 1.4.7 says restrictive interventions should be proportionate, minimally restrictive and used no longer than necessary.

25. Our adviser said treatments such as blood tests and an ECG could given without consent under section 63 of the Act, if they were considered necessary for Ms H’s core mental health treatment. They said the Hospital requested a blood test to review underlying causes of mental illness and for monitoring directly related to Ms H’s antipsychotic medication, as well as to consider future treatments. They said it was therefore necessary for the continuation of Ms H’s core treatment.

26. Our adviser said an ECG is often completed as a necessary part of psychiatric treatment with antipsychotics. This is because antipsychotics often cause changes in heart rhythm that can be dangerous without adequate monitoring and an ECG can guide safe treatment.

27. Our adviser said the Hospital encouraged Ms H to have a blood test and an ECG without success. They said the Hospital had concerns these investigations were required to safely enforce Ms H’s core mental health treatment. They said it would have been justifiable and reasonable for the Hospital to use controlled restraint if required as a least restrictive option, given that the investigations were necessary for Ms H’s core treatment and she had been given sufficient time and encouragement to comply.

28. Our adviser said the Hospital offered Ms H sufficient opportunity to give informed consent. They said the Hospital made a plan for restrictive practice in line with guidance, gave a two-week deadline and did not rashly use restraint. In the event, Ms H approached clinicians and consented to the treatment, and restraint was therefore not required.

29. In summary, the Hospital acted in line with the Mental Health Act and NICE guidance when it explained the possibility of using restraint if Mrs H refused to undergo investigations necessary for her core mental health treatment. Ms H was not required to give consent as these investigations could be authorised under the Mental Health Act.

30. We understand Ms H’s concern that the Hospital threatened to treat her under restraint and without her consent. We understand how distressing this must have been for Ms H and accept this is a complicated situation for her and the Hospital to navigate. Having reviewed the evidence, we consider the Hospital acted in line with the Mental Health Act and NICE guidance. We will therefore not be looking at this part of the complaint further.

31. We thank Ms H for bring her complaint to our attention. We understand this may have been difficult for her and our decision is not intended to cause her any additional distress. We wish Ms H the best for the future.

1. We have carefully considered Ms H’s complaint about the care and treatment she received from the Hospital in 2024 and 2025.

2. We have seen no indication that anything went wrong in the Hospital’s care and treatment of Ms H. We consider the Hospital followed appropriate guidance and policies when it responded to the incident of violence in November 2024. We consider the Hospital acted in line with relevant guidance when it advised Ms H it may restrain her to allow treatment in July 2025, in line with her T3 certificate.

3. We hope our explanation reassures Ms H and explains the care and treatment she received.