Dorset Healthcare University NHS Foundation Trust

6. Ms T complains Dorset Healthcare University NHS Foundation Trust (the Trust) did not provide access to an autism lead or specialist knowledge staff to support her care and treatment between February to October 2025.

7. Ms T says the Trust did not respond appropriately to her request for support to complete her autism passport, despite her autism, dyslexia and communication needs.

8. Ms T says the Community Mental Health Team (CMHT) did not provide support to help her manage and live with autism and did not provide appropriate care planning to meet her needs.

9. She says she feels she has lost choice in her care and treatment options and that Trust has not responded to her repeated requests for help. She says she has self-funded for a private carer to support her, but the Trust has not provided a care plan to meet her needs.

10. She also tells us she sought support from online autism specialists, but they declined to help because her needs were to complex. She says the lack of support has caused her significant distress and led to episodes of self-harm and overdose.

11. As an outcome, Ms T wants an apology, service improvements, and financial remedy.

12. Ms T has a long-standing diagnosis of autism. Autism is a lifelong developmental condition that can affects how people communicate, interact with others and experience the world. Autistic people have different strengths and support needs, so care should be based on their individual circumstances.

13. Ms T was receiving treatment for several of mental health difficulties. This included difficulty managing intense emotions, hearing voices, self-harming behaviours (cutting and burning), and taking overdosing of medication. She also had diagnoses of Emotionally Unstable Personality Disorder (EUPD), this is a mental health condition marked by intense emotions, unstable relationships and impulsive behaviour.

14. Furthermore, she also experienced physical health problems, including complications following surgery.

15. The records show Ms T had a wellbeing plan since April 2019. The wellbeing plan outlines a comprehensive approach to Ms T’s care, addressing her mental health, physical health, personal goals, safety plans, and support systems. It aims to support her recovery through detailed plans for interventions, monitoring, and collaboration between Ms T, clinicians, and supporters.

16. The plan highlights key areas such as crisis management, distress tolerance, physical health monitoring, communication preferences, engagement with support services, and mental health review appointments. It also incorporates Ms T's views, strengths, interests, coping strategies, and long-term goals, such as returning to work and engaging in social activities.

17. Between February and October 2025, Ms T received care from the Trust’s CMHT. The CMHT provided ongoing mental health assessment, care planning and review involving consultant psychiatrist, mental health nurses and psychological therapy staff.

18. During this period Ms T asked to see a specialist autism practitioner and requested help completing her autism passport because she has dyslexia, a learning disorder that affects reading and language related skills and found it difficult to complete independently. An autism passport is a document designed to help autistic individuals communicate their needs to healthcare professionals.

Request for an autism lead

22. Ms T says the Community Mental Health Team (CMHT) did not provide support to help her manage and live with autism and did not provide appropriate care planning to meet her needs.

23. We recognise Ms T believes the Trust should have provided access to an autism specialist practitioner or an autism lead. She says this would have better met her needs.

24. In response to the complaint, the Trust said that whilst it does not have a designated lead for autism within the Trust, it does have colleagues who have specialist knowledge who can be contacted for advice and guidance.

25. The Trust explained that it would not be usual for these colleagues to make direct contact unless they received a specific referral. The Trust explained it had reviewed The Autism Act (2009) and the statutory guidance in 2015, and undertook a benchmarking exercise when it was launched. The requirement is to ensure that the Trust have suitably trained staff, which it has, and it has not identified a mandated requirement for a lead or a policy.

26. NICE guideline CG142 says care for autistic adults should be based on a comprehensive assessment of the person’s individual needs, with care planned and coordinated accordingly. The guidance does not require every NHS trust to provide access to a designated autism lead or specialist autism practitioner on request.

27. Our adviser explained that whether someone should be referred to specialist autism services is a matter of clinical judgement. This decision should be based on the person’s individual assessed needs.

28. The records show the CMHT assessed Ms T’s needs on several occasions, reviewed her presentation over time and discussed her care through multidisciplinary meetings.

29. The records show her care involved consultant psychiatrist, community mental health nurses and psychological therapy staff. Treatment plans and clinic letters were regularly reviewed and shared with both Ms T and her GP.

30. The Trust also explained in its complaint response that staff completed mandatory autism training, including the Oliver McGowan Mandatory Training on Learning Disability and Autism.

31. We have considered if the assessments and treatment provided reflected the principles set out in NICE guidelines. Ms T’s needs were assessed holistically throughout the period of care and the Trust was not required to provide a specialist autism practitioner simply because one had been requested.

32. We are satisfied that the Trust’s assessment and treatment were consistent with the principles set out in NICE guidance CG142.

33. Although the Trust did not have a designated autism lead, we have not seen evidence it failed to consider whether specialist autism support was clinically necessary.

34. For these reasons we have not identified evidence the Trust failed to provide appropriate autism-related care.

Support and care planning

35. Ms T says the support she received did not meet her autism-related needs. We recognise Ms T believes staff mainly cleaned her home and spoke to her rather than helping her manage her autism.

36. In the Trust response it says it is sorry that Ms T feels this way regarding the steps being taken in her care however it is the role of the CMHT to support her presenting symptoms. It has been notified that Adult Psychology Service are to complete an assessment with Ms T’s to gain their own formulation and diagnosis and form a care plan moving forward.

37. GMC guidance says healthcare professionals should assess people’s individual needs, work collaboratively with colleagues and use professional judgement when planning and delivering care.

38. The records show Ms T received ongoing care from a multidisciplinary team including mental health nurses, consultant psychiatrists and psychological therapy staff.

39. The records include multidisciplinary discussions, clinic letters and documented treatment planning throughout the period.

40. Although we have not seen a separate stand-alone care plan, the records demonstrate continuing assessment, care planning and regular review throughout the period of care. This is consistent with community mental health practice and shows the Trust kept Ms T’s care under review.

41. The records show it involved appropriately skilled professionals, considered Ms T’s requests for specialist autism support and assistance with completing her autism passport, and continued to provide care based on its assessment of her needs.

42. The records show Ms T was also provided information on how the psychological assessment was being offered to consider appropriate psychological care planning. The psychological assessment was described as having an aim to ‘gain a better understanding of your mental health difficulties from a psychological perspective and explore what psychological interventions may be most helpful for you at this stage’. Ms T declined this assessment.

43. Our adviser explained supporting activities of daily living while building rapport is a recognised therapeutic intervention within community mental health services. This approach can help staff assess needs and plan future care.

44. Having carefully considered all the available evidence, we have not seen indications the Trust failed to assess Ms T’s needs appropriately or that the care provided fell below the relevant clinical standards. We have therefore not identified evidence of maladministration or service failure.

45. We recognise Ms T may remain dissatisfied with the support she received and understand why this has been upsetting. However, disagreement with the clinical judgment exercised, or with the type of support offered, does not by itself demonstrate maladministration or service failure. For these reasons, we will not investigate this complaint further.

Assistance with the autism passport

46. Ms T says the Trust did not respond appropriately to her request for support to complete her autism passport, despite her autism, dyslexia and communication needs.

47. The Trust says staff discussed Ms T’s request during contacts on 5 February 2025. It explained it could not complete the autism passport on her behalf but discussed her request with her, documented this in the clinical records and advised where appropriate support could be obtained.

48. The Trust also acknowledged Ms T’s concerns about information shared with her in an accessible format. They are happy to support her as best as they can and look forward to working with her openly regarding any specific requests she has regarding accessible information.

49. GMC guidance says doctors should take reasonable steps to meet patients’ communication needs and provide information in a way they can understand and make reasonable adjustments to meet communications needs so people can participate in decisions about their care.

50. We recognise Ms T found completing the autism passport difficult because of her autism, dyslexia and communication needs. We understand why she believed she required more direct support.

51. However, the available evidence shows the Trust considered her request, explained why it could not complete the passport on her behalf and advised her where appropriate support could be obtained.

52. Although we have considered her concerns carefully, we have not seen evidence the Trust responded inappropriately or failed to take account of her communication needs when explaining its position.

53. We are satisfied the Trust responded appropriately to Ms T’s request. We have not seen evidence that it failed to consider her communication needs or that its response amounted to maladministration or service failure.

1. We are sorry to learn Ms T remains dissatisfied with the care and treatment she received from the Trust. We acknowledge the impact this has had on her mental health and wellbeing.

2. We have carefully considered Ms T’s complaint, the Trust’s complaint responses, the relevant clinical records and independent advice from our clinical adviser.

3. We have looked at whether the Trust appropriately assessed Ms T’s autism-related needs, provided care and support in line with relevant guidance and responded appropriately when she requested additional autism support and help completing her autism passport.

4. Having considered all the available evidence, we have not found that the Trust’s care fell below the standard we would expect. We recognise Ms T wanted support from a specialist autism service and believes this would have better met her needs. The evidence shows the Trust assessed her needs appropriately and provided care in line with relevant guidance.

5. For these reasons, we have not identified indications of maladministration or service failure. We have explained the reasons for our decision below and hope this provides Ms T with reassurance about the care and treatment she received.