Betsi Cadwaladr University Health Board

Miss C complained about whether opportunities were missed to make an earlier diagnosis of attention deficit hyperactivity disorder (“ADHD” – a condition that affects people’s behaviour, making them restless, inattentive and impulsive) and whether the prescription of antipsychotic medication was managed appropriately.

The investigation found that appropriate referrals for ADHD assessments were made. This part of Miss C’s complaint was not upheld. Whilst the prescription of antipsychotic medication was appropriate, there were failings in communication with Miss C by a Community Psychiatric Nurse (“the CPN”) regarding her treatment. A review of Miss C’s condition by a psychiatrist should also have been sought sooner. These failings are an injustice to Miss C. She was distressed by the Health Board’s communication and will be left with lasting uncertainty regarding what the outcome may have been had she undergone an earlier review by a psychiatrist. This part of Miss C’s complaint was upheld.

The Health Board agreed to the Ombudsman’s recommendations to apologise to Miss C and offer her a payment of £200 for the uncertainty and distress caused to her. The Health Board also agreed to remind the CPN of the importance of ensuring that patients understand what they can expect from primary care mental health services and communicating their right to referral to secondary care.