Surrey and Sussex Healthcare NHS Trust

4. Mr T complains about the care and treatment he received from Surrey and Sussex Healthcare NHS Trust following his diagnosis of coeliac disease in April 2025. Specifically, Mr T says:

• the Trust did not provide psychological screening following his diagnosis • the Trust did not consider the psychological impact of his diagnosis as they did not provide anticipatory guidance and tailored support • the Trust’s investigation into his complaint was not impartial or thorough, and did not meet NHS complaints standards.

5. Mr T says the claimed failings have caused him to be left without the tools to manage a lifelong condition leading to deterioration in his mental health. He says he has also experienced issues with his living situation due to the failings, and he felt dismissed, invalidated and further distressed by the complaint response.

6. Mr T wants a full written apology acknowledging the failings and the distress caused, service improvements relating to the psychological support for newly diagnosed coeliac patients and in the Trust’s complaints handling. He also wants a financial remedy.

7. Mr T is in his thirties and has coeliac disease (a condition where a person’s immune system reacts to them eating gluten by attacking the lining of their small bowel). Mr T has pre-existing mental health conditions of anxiety and depression which he says were stable and well-managed with medication prior to his coeliac disease diagnosis.

8. The Trust diagnosed Mr T with coeliac disease in April 2025. Following this, Mr T attended a face-to-face appointment with a dietician in June 2025.

Psychological screening

12. 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.

13. Mr T says the Trust did not psychologically screen him following his diagnosis of coeliac disease.

14. Psychological screening is a brief, standardised check used to identify potential mental health concerns. It is the first step to determine if a person needs further assessment.

15. During a phone call on 16 April 2026, Mr T told us he did not specifically ask the Trust for support for his mental health following his coeliac disease diagnosis. He thinks the Trust should have recognised his pre-existing diagnosis of depression and anxiety and psychologically screened him because of this.

16. The Trust says Mr T’s general practitioner (GP) can provide mental health support, and if he had raised mental health concerns with the dietetics team, they would have advised him to contact his GP.

17. To consider this part of the complaint, we reviewed the relevant guidance and evidence with our clinical adviser.

18. NICE guideline 20, 1.6.4 says healthcare professionals (HCPs) should be aware people with coeliac disease may experience anxiety and depression.

19. NICE clinical guideline 91, 1.3.1 states HCPs should be aware of the possibility of depression occurring in adults with a chronic health condition, especially in those with an existing diagnosis, and consider asking patients who may have depression the following two questions:

• ‘during the last month, have you often been bothered by feeling down, depressed or hopeless?

• during the last month, have you often been bothered by having little interest or pleasure in doing things?’

20. We have seen evidence Mr T had a face-to-face appointment with a dietician on 17 June 2025. The clinical notes state during this appointment, Mr T reported he was ‘finding it all mentally draining’, and the new diagnosis of coeliac disease was affecting him socially as he was not eating out as much.

21. The dietician documented they provided extra time for Mr T to discuss his concerns, which were mainly psychological and he may need time to get used to these strict changes. The dietician discussed eating out tips with Mr T.

22. It is not clear in the notes exactly what Mr T’s psychological concerns were. The notes suggest it was related to the new diagnosis and implementing the strict changes, rather than depression, but we cannot say for sure.

23. We asked our adviser if there is any indication the dietician should have screened Mr T for depression. Our advisor says a dietician would only ask the questions set out in NICE clinical guideline 91 if there was a clear indication of possible depression.

24. We have not seen evidence in the notes to suggest Mr T displayed symptoms of an acute mental health crisis or that he specifically described feelings of depression. Due to the lack of detail, we cannot say for sure.

25. NICE clinical guideline 91, 1.3.1.2 says ‘If a patient with a chronic physical health problem answers ‘yes’ to either of the depression identification questions but the practitioner is not competent to perform a mental health assessment, they should refer the patient to an appropriate professional. If this professional is not the patient’s GP, inform the GP of the referral.’

26. Our adviser says if the dietician had asked Mr T the screening questions during this appointment, and identified signs of depression, they would have referred Mr T to his GP as the appropriate professional.

27. We have seen evidence of the Trust contacting Mr T’s GP on 13 August 2025 requesting them to address his psychological concerns, after the Patient and Liaison Service (PALS) informed the gastroenterology department of his complaint.

28. In its complaint response on 20 August 2025, the Trust advised Mr T that his GP can provide appropriate mental health support services.

29. Mr T told us he did not contact his GP for mental health support as he felt it was a reactive response from the Trust. He decided to seek private therapy instead.

30. Due to lack of detail in the evidence, we cannot reach a decision as to whether the dietician should have asked Mr T the screening questions for depression during the appointment on 17 June 2025.

31. We are satisfied the Trust has acted in line with NICE clinical guideline 91 in referring Mr T to the appropriate professional after becoming aware of his psychological concerns in August 2025.

32. For these reasons, we have not identified the Trust has done anything wrong in addressing Mr T’s psychological concerns, and we will not be taking any further action on this part of the complaint.

33. We acknowledge the distress Mr T experienced after receiving his coeliac disease diagnosis and do not wish to dismiss this.

Guidance and support

34. Mr T says the Trust did not consider the psychological impact of the diagnosis on him as it did not provide anticipatory guidance or tailored support.

35. The Trust says it sent Mr T a standard letter for people with newly diagnosed coeliac disease which includes written advice about gluten free living, cross-contamination and food labelling. It says the letter also recommends patients to join Coeliac UK (a national charity for people who need to live gluten free).

36. The Trust explains the letter offers patients an appointment with a dietician if they would like. As explained in paragraph 20, we have seen evidence Mr T took up this offer.

37. NICE guideline 20, 1.6 ‘Information and Support’ explains the information an HCP should provide patients with after a diagnosis of coeliac disease. This includes telling them about the importance of a gluten free diet, gluten free foods, suitable alternatives, food labelling, managing social situations and avoiding cross contamination. It also says HCPs should signpost patients to national and local coeliac groups.

38. We have seen evidence the dietician provided Mr T with the relevant information as set out in NICE clinical guideline 20 during the appointment on 17 June 2025.

39. During this appointment, the dietician also signposted Mr T to Coeliac UK.

40. We are sorry to hear Mr T has found it difficult adapting to his new lifestyle required to manage his coeliac disease. We have no doubt it has been a difficult adjustment for him.

41. After considering all available evidence, we are satisfied the Trust provided relevant information and support in line with NICE guideline 20.

42. For these reasons, we have not identified any indications the Trust has done anything wrong in the information and support it provided Mr T following his coeliac disease diagnosis, and we will not be taking any further action on this part of the complaint.

Complaint handling

43. Mr T complains about the Trust’s complaint handling. He says its investigation into his complaint was not impartial, thorough, and did not meet complaints standards.

44. Mr T says the investigation was not impartial as the Trust allowed the clinician involved in the complaint to investigate his complaint and it did not consult a senior gastroenterologist as part of the investigation.

45. Mr T refers to NHS Complaints Regulations, specifically regulation 14.

46. NHS Complaints Regulations, regulation 14 says an organisation must explain how it has considered the complaint, the conclusions it has reached in relation to the complaint, what actions it will take in response to a complaint, and an apology where appropriate. It also should advise a complainant of their right to take their complaint to the Health Service Ombudsman.

47. We have seen evidence the Trust explained how it considered Mr T’s complaint, including which staff it consulted to investigate and what records it looked at to inform its investigation.

48. It says a dietetic clinical lead and an associate specialist in gastroenterology investigated the complaint. The Chief Nurse for the Trust issued the final response.

49. An associate specialist is a senior grade doctor who often work independently without supervision within their speciality.

50. There is no specific guidance about what grade a doctor should be to investigate a complaint. We understand an associate specialist is a senior within their speciality, therefore would be an appropriate grade doctor to investigate the complaint.

51. We have seen evidence the Trust’s response addressed each point of the complaint, explaining what the records show and what guidelines the department has followed when providing care.

52. The Trust’s response directed Mr T to the Parliamentary and Health Service Ombudsman if he remained unhappy with its final response.

53. We acknowledge the associate specialist in gastroenterology is the doctor who provided care to Mr T in relation to his coeliac disease diagnosis. Our ‘NHS Complaint Standards’ say organisations should be thorough and fair and give fair and accountable responses. The standards say where possible a member of staff not involved in the complaint should look at it, but this is not mandatory. If a member of staff involved in the complaint is looking at it, they should demonstrate they are acting fairly when they consider all the issues.

54. We have seen evidence the associate specialist advised Mr T to contact his GP, and they wrote to his GP on his behalf to request psychological services.

55. We consider this to be a fair and transparent approach in line with our ‘NHS Complaint Standards’. They considered the issues Mr T raised, acknowledged his psychological concerns and took appropriate action by advising Mr T to contact his GP, as well as writing to his GP on his behalf to request psychological services.

56. We consider the Trust’s response adheres to regulation 14 of NHS Complaints Regulations for the reasons explained above.

57. For these reasons, we have not identified any indications the Trust has done anything wrong in the way it investigated and responded to Mr T’s complaint, and we will not be taking any further action on this part of the complaint.

58. In conclusion, while our decision has been made based on the evidence available, we do not intend for this to minimise or dismiss the experience Mr T had or the impact it caused. We appreciate the time and effort Mr T has taken to bring the complaint to us, and we hope the information provided within this statement provides him with some reassurance about the care and treatment he received.

1. We have carefully considered Mr T’s complaint about Surrey and Sussex Healthcare NHS Trust (the Trust).

2. Mr T raised concerns about the care and treatment he received from the Trust after his diagnosis of coeliac disease. We have reviewed the information provided by Mr T and the Trust, as well as seeking clinical advice from a dietician and considering the relevant guidance and standards relevant to the care provided. After doing so, we have seen no indication that anything went seriously wrong.

3. We fully acknowledge Mr T’s experience and do not wish to minimise this. We hope our explanation below reassures Mr T the Trust provided him with appropriate care in line with guidance.