An independent provider in the Wakefield area

4. Mr D complains about the treatment received by the provider in 2023 and 2024.

5. Mr D says: • the provider reduced his pain medication, gabapentin and pregabalin, without any consultation • the provider then reduced his medication further, with a view to stopping it completely, despite assurances this would not happen until after a nerve conduction study.

Mr [name redacted] says this decision has left him in ongoing pain.

As a resolution to his complaint, Mr [name redacted] would like: • an appropriate consultation on his pain medication and some financial remedy, and; • service improvements to prevent the same thing happening to another vulnerable person.

6. Mr D has been diagnosed with multiple chronic conditions in his shoulders, back, legs and hips. These cause him a lot of discomfort. He also has nerve damage from previous injuries in his hands and right arm.

7. As a result of his ailments, Mr D was prescribed gabapentin. He took 12 tablets, at 300mg each, a day. This is the maximum dose. He was on this dose for a number of years.

8. Mr D was moved between prisons in November 2023.

9. Between December 2023 and April 2024, his gabapentin prescription was decreased.

10. In April 2024, the provider switched his medication from gabapentin to pregabalin. They explained this was because Mr D was struggling with the number of tablets he had to take, and pregabalin can be ingested as a liquid.

11. Between 14 and 29 May 2024, the provider decreased his daily dosage of pregabalin from 15ml daily to 7.5ml daily.

Dosage

15. Mr D complains that the provider reduced his gabapentin and changed over to pregabalin. He says this left him in significant pain and affected his mental health.

16. The provider said the medication was changed was because Mr D was taking too many tablets. Pregabalins can be taken in a liquid form.

17. Our adviser explained that from Mr D’s medical records, it appears the reason for the switch in medications was done to facilitate reduction, as it followed on from a conversation in February 2024 in which reducing his gabapentin was discussed

18. NICE drug treatment guidance highlights the dangers of gabapentin. It is a highly addictive substance, with several undesirable side effects.

19. Our adviser stated gabapentin should be prescribed with caution to people who have a history of substance misuse, due to its addictive qualities. The risk of harm in custodial settings is exacerbated through inappropriate use. Therefore, where medication poses a risk of harm, it should be reduced or stopped entirely.

20. Mr D’s medical history shows he has struggled with opioid dependency for a number of years, dating back to 2009. Therefore, we consider it was reasonable for the provider, once they learned of Mr D’s difficulties, to move towards reducing his dosage. Given the dangers of both drugs prescribed, it is reasonable to believe the provider made this decision for Mr D’s benefit.

21. Mr D was prescribed pregabalin to aid reduction, which was also then reduced over a number of weeks from 15ml to 7.5ml.

22. Mr D stated that the lower dosage caused him significant pain. We are sorry to hear of his ongoing struggles.

23. Our adviser stated that, unfortunately, Mr D will suffer long term pain regardless of his medication. Medication only plays a small part in the overall management of chronic pain.

24. The RCGP states persistent pain is difficult to treat, and medication should be used as part of a wider treatment plan including advice on activity, and support in improving quality of life.

Communication

25. Mr D complains that the provider made these changes without consulting him.

The provider acknowledged reducing Mr D’s medication without consulting him was regrettable and changes to care plans should always be communicated with the patient.

26. In April 2024, the provider changed Mr D’s prescription of gabapentin to pregabalin. The provider tried to engage with Mr D at several points throughout this process, as noted in their complaint response. This is in line with NICE chronic pain guidance.

27. NICE chronic pain guidance states that patients have the right to be involved in discussions regarding their healthcare, and efforts should be made to agree on a support plan.

28. However, when Mr D was approached by the provider regarding a reduction or a change, he was unhappy and didn’t want his medication to be altered. NICE chronic pain guidance states that the guidance doesn’t override the responsibility to make decisions appropriate to an individual, and it is not mandatory to follow them if a conclusion can’t be met.

29. While we think the reduction to his our advmedication was appropriate, we do believe his transition would have been easier if the provider had communicated better. While we can see attempts were made, we don’t think Mr D was involved enough in the process.

30. Mr D’s medical records show that efforts were made to actively engage him with his care and hear his voice throughout. Mr D was not interested in reduction. However, despite his difficult relationship with the provider, our adviser explains he still should have been made aware of the plan to reduce his medication prior to this taking effect.

31. If Mr D was unwilling to engage in meetings, our adviser explained the provider should have written to him with the details of the reduction instead.

32. However, we don’t think stronger communication would have changed the outcome of his medication being reduced, as this was in line with NICE chronic pain guidance. That said, we think it was the source of frustration for him, as he was left feeling uninvolved in his own care.

33. Our Principles for Remedy say that when something has gone wrong, organisations should apologise and acknowledge what went wrong.

34. The provider apologised to Mr D for the shortcomings in its communication with him and acknowledged how he was left feeling. We think this was an open and transparent response. We think that an apology and acknowledgement was the right thing to do to put things right for him. That was in line with our Principles for Remedy.

35. We therefore do not consider that the provider needs to take any further action. We are sorry this is not the outcome Mr D was looking for, and we would like to thank him for bringing this issue to our attention.

1. We have carefully considered Mr D’s complaint about the provider. We understand he has concerns about the provider reducing his neuropathic pain medication without consulting him or explaining the decision to him first. We appreciate the situation must be very frustrating for Mr D and empathise with the pain he is currently feeling.

2. Having considered Mr D’s complaint, we see no indication of failings from the provider in regard to the reduction of his medication. This is because they have followed appropriate guidelines when deciding on the appropriate dosage of medication. There seems to have been some poor communication on the part of the provider, but we think the impact of that has been put right. This is because the provider has acknowledged and apologised for the lack of effective communication.

3. This report outlines the reasons for our decision in more detail.