Within two weeks of introducing himself as the new Patient Advisory Liaison investigator, Andy Ashby ‘formally managed my concerns’, investigated the complexities of my complaints, forwarded his investigation to the CO of the Sussex Partnership NHS Foundation Trust, Dr Jane Padmore, for oversight and signature and emailed his ‘response’ to me. Andy Ashby concluded with the advice ‘This response will conclude our response to your complaint and the file will be closed.’

Andy Ashby’s ‘response’ was a farce, grossly dishonest and evidently written in haste, probably in a last ditch, desperate attempt to draw a line under proceedings. It actually provoked more questions than it answered.

I immediately wrote a rebuttal to Andy Ashby’s ‘response’. This rebuttal became the foundation of my complaints forwarded to the Parliamentary Health Service Ombudsman on the 2nd September, 2022, though my complaints expanded over the following three years as new evidence presented itself. I will publish this rebuttal, as it was forwarded to Andy Ashby, in A Murder Of Conspirators #28.

‘Our Ref: 22020

24 August 2022

In Confidence

Via Email:

********************

Dear Mr Stock

Further to our telephone conversation, I am writing to you to formally respond to your revised complaint, dated 30th July 2022.

As I said when we spoke, I am so sorry that you did not receive the Parent Work in the way in which it should have been provided, and, on behalf of Sussex Partnership NHS Foundation Trust (SPFT), I offer you a sincere apology. Further, I am truly sorry that the Parent Work transitioned, into an experience that has resulted in distress for you. I am also really sorry for the confusion that has clearly resulted from this incorrect service provision.

I can see that you refer throughout your communication with SPFT to you having received Therapy and asking for answers to how your medical records have been managed by SPFT throughout your treatment. So, I wish to clarify that, as the interventions provided to you by Hampshire Child and Adolescent Mental Health Services (CAMHS) were in the context of "Parent Work" you were never an SPFT patient, Meg was the patient. Therefore, there was no clinical file opened for you at SPFT. All documentation, where necessary was recorded on Meg's file in accordance with local and trust protocol as she was the patient in receipt of service from SPFT. I hope that this clarification will help understand the context and responses provided throughout this document. I acknowledge that in your email dated 23rd August you dispute our assertion that you were not a patient, you highlight the definition as indicating a ‘patient’ is defined as ‘a person with a specific disease or condition who receives treatment from a healthcare provider’. I would like to re-iterate that whilst we acknowledge the Parent Work transitioned to having a therapeutic impact, it was not delivered as an intervention following assessment and /or diagnosis.

I am aware that both your initial complaint correspondence and your most recent revised document relates to issues concerning both SPFT and Mental Health services at The Bridge Centre which are provided by Southern Health. This response will solely address issues relating to SPFT.

In responding to your complaint, we hope that you feel you have been listened to, your concerns taken seriously and the opportunity has been taken for Services to reflect on your feedback and lessons learnt where applicable. I appreciate that elements of our response will not provide you with the entirety of the outcome you seek and I am sorry for this. But, I re-iterate that SPFT fully acknowledge the distress you have felt and continue to feel as a consequence of your experiences with our services.

I will systematically provide responses to each of the points you have raised within your revised complaint. I will identify these in accordance with your numbering system rather than including the title of each element in order to minimise the length of this document.

Part one

1. I can assure you that Sally is a suitably qualified and experienced art therapist who is provided with appropriate supervision from the lead Art Therapist and a group peer supervision. This supervision is in line Sally's professional registration and the Trust Policies. The supervisor is suitably qualified and experienced in working with transference concepts to support Sally. A clinical supervisory relationship will only be able to reflect on the aspects of work that are raised within the supervision time and the detail of all cases held on a staff members caseload may not be able to be discussed in depth within the time given. Professional and clinical supervision is available for all clinical staff. Clinical supervision is a formal process of professional support, reflection and learning that contributes to individual development. Professional Supervision is a process that combines management, accountability, education, reflection and enabling. This occurs in the context of a professional relationship that exists between the worker and the supervisor.

2. The necessary information from your Parent Work with Sally was recorded on Meg's clinical notes, SPFT use a recording system called Carenotes. Both clinicians, Sally and Mark would have access to this information and keep themselves up to date via this platform. As previously advised you did not have a file open on Carenotes as SPFT were not providing you with care and treatment. This service was being provided to Meg. In addition to the documentation record on Carenotes, both formal and informal discussions took place between Sally and Mark where necessary.

3. We truly do acknowledge your high levels of distress that you have described very clearly and we are genuinely extremely sorry for what you have experienced. On the 30th December 2021 Sally wrote to you and this letter provided a summary of the work that she had completed with you and also offered feedback from the sessions.

4. As above

5. I note your request to be kept informed about SPFT's reflections and learning from your experience and I hope that this final response provides you with some clarification in relation to the matters raised. At the end of this response I have summarised the learning we have taken from this complaint. You have the right to contact the Parliamentary Health Service Ombudsmen (PHSO) as the 2nd stage of the NHS complaints process however this course of action does not necessitate the complaint file remaining open to SPFT, this will be closed following the sharing of this response.

6. The decision was made following discussion between the Operational Manager, Professional Lead and Clinical Lead during which they considered at length the contents of your letter. Within this process they also considered that the Parent Work was concluded and it is not usual practice for further follow up sessions to be provided. It was acknowledged at this point that this outcome could cause you further distress although this was not the intention behind the decision. The decision was made in the best interest of all involved whilst paying specific interest to the potential increased risk this may pose to yourself. Due to these concerns it was decided to convene a professionals meeting with Southern Health to consider appropriate next steps. CAMHS services, on reflection acknowledge that whilst their experiences of working with young people may not always be transferable when working with adults, their intention was to be kind and protective rather than cause harm or act in a manner which may be perceived as deceitful. They have made a commitment as a direct result of this learning to take a more open and transparent approach in future, acknowledging that from your perspective an open dialogue would have been of benefit.

7. I hope that my response above explains the reasons for the meeting being cancelled. I do offer unreserved apologies for the delay in communicating with you and I reiterate Wanda Reynolds, General Manager CAMHS, previous apology for this and her acknowledgement that in hindsight it is accepted that the situation could have been approached differently and it would have been helpful to you if Wanda had discussed this with you at the time over the telephone.

8. As above.

9. I am sorry to read your reflections here in relation to point 9. I can assure you that it was not our intention for you feel this way and we do accept that our communication with you should have been more consistent.

10. As previously explained you were not personally in receipt of care and treatment from SPFT therefore there was not an active case to be closed in respect to yourself.

11. Again, I note your reflections on this issue and how it left you feeling. Leadership Teams have a responsibility to consider the safety of patients, carers, family members and staff when facing complex situations and have to balance many variable factors when reaching a decision. All decisions were made with the best of intentions and I am sorry that this caused you further upset.

12. I understand that the process of releasing information is ongoing and I acknowledge that this has taken longer than we would ideally like. I believe that some of this delay is due to the files held by SPFT pertaining to be in relation to Meg who was in receipt of services rather than yourself.

Points 13 to 18 inclusive do not involve SPFT therefore we are unable to make any comment

19. As previously explained SPFT do not hold a medical file for you as you have never been in receipt of care and treatment provided by us. Appropriate information that has been recorded on your daughter Meg's file either has been or is in the process of being made available to you both.

Points 20 to 25 inclusive - SPFT are unable to provide any further comment as these relate primarily to Southern Health.

26. Wanda was involved in discussions that led to the appointment being cancelled, as previously explained, the offer of this appointment was not in keeping with usual practice. Wanda was not in attendance at the subsequent Professionals Meeting.

Points 27 to 31 inclusive relate to Southern Health.

Part two

I can confirm that Dr Natalie Roberts was originally invited to the meeting in her role as Clinical Lead for Hampshire CAMHS. It was felt it may be helpful for her to be available to answer any questions from a Clinical Leadership perspective in relation to the Parent Work that had been provided. It is unfortunate that she was unable to attend the meeting but I can assure you her role would not have been in an assessment capacity. As previously stated our CAMHS teams work specifically with young people and we would not be involved in any clinical assessments required by yourself regarding your own individual treatment needs.

With regards to your request for Wanda to put into writing a quote you attribute to her "we have damaged you", having discussed this with Wanda she has no recollection of saying these words to you but she does acknowledge having stated both verbally and in writing that she is very sorry that the purpose of the Parent Work was not explained in more explicit detail to you, that it evoked painful feelings and left you feeling exposed and raw. I can see from our previous response that Wanda has also previously acknowledged the impact the decisions that were reached have had on you personally and apologised for these and I would like to take this opportunity to re-iterate this apology on behalf of SPFT again.

Records

1. I wish to take this opportunity to clarify particular meetings that have taken place. A discussion took place involving the Operational Leads, Clinical Lead and Professional Lead and I believe this is what you refer to as an "extensive meeting". This discussion was not recorded and therefore there are no minutes or documentation available. Discussions such as these, whereby it was decided to cancel the meeting with you often take place within the work place and are not recorded as they are considered to be of an operational nature. It is important to also remember my previous point that you personally were not "open" as a patient to SPFT therefore we did not hold clinical records for you and it was not considered appropriate to record this on Meg's file. Our services do acknowledge the feedback you have provided though and this matter will be considered with the Governance team to explore if any changes to practice are indicated across the Trust. Subsequent meetings that took place under the identity of Professional meetings and Safeguarding meetings have been recorded separately on Carenotes and you have shared with me two case notes that reflect the discussions that took place in these specific meetings.

2. As previously explained there are no medical Carenotes files held for you individually by SPFT.

3. I am satisfied that the records held by SPFT are in accordance with both national and local Policy. As you have never been a patient of SPFT we do not hold health files for you. All reference to the Parent Work that has been provided will be, where necessary and appropriate held on Meg's patient notes.

4. The minutes of the professionals meeting were recorded by Southern Health as you have been receiving care from them rather than Hampshire CAMHS. I understand these minutes have been shared with you following a request from you to have access to your medical files held by Southern Health. SPFT are unable to comment any further on the content of these minutes.

5. It is best practice for the Chair or nominated person to agree minutes as correct prior to their confirmation as a final document. Whilst a document is in draft form it is appropriate for changes to be made. At times due to a variety of reasons there may be a delay in the minutes being approved as complete. Minutes are not always shared amongst all attendees, at times it is sufficient for actions to be shared.

6. As above.

7. I would like to take this opportunity to thank you for sharing your concerns in relation to record keeping. Although I am satisfied that records have been kept in accordance with expected standards this has not prevented consideration of whether these standards require review to determine if they meet the needs of our current clinical practice therefore a further review will take place across SPFT at a Senior level to review our management of record keeping in similar situations. Due to the nature and complexity of the circumstances involved in the review in addition to pre-existing workloads I am unable to provide a timescale for this review.

During our telephone conversation on 22nd August you asked for documentation to be made available to you in relation to the Internal Safeguarding discussion. You also emailed me copies of two documents that had been provided to you by Health Records. I can confirm that the document referencing Internal Safeguarding discussion is the formal record of that specific discussion between Sally Mungall, Mark Birbeck and Julie Yalden and there is no other record of this meeting. This adheres to our policy and procedures that are in place.

I can also see from the second document you sent me that this is the clinical case note providing a summary of the discussion which took place at the Safeguarding meeting that was held on 9th February 2022 and attended by representatives from CAMHS, Southern Health and your GP.

Part Three

1. I have reviewed the points provided that relate to SPFT and where possible I have provided additional response. I hope that these answers help to provide some clarification for you. Where indicated SPFT are not able to provide further comment and I would respectfully suggest that you approach Southern Health directly in order for them to respond.

2. I believe that any additional questions have been responded to accordingly.

3. I am very sorry that Meg had a significant wait to receive support from CAMHS. Our services have received unprecedented levels of referrals over the past years and this has unfortunately caused a delay in us being able to provide assessment and subsequent treatment. We accept this is frustrating for young people and their families and we are working continuously with Commissioners to resolve this situation.

4. I am aware that you have previously met with Wanda Reynolds to discuss your complaint prior to submitting your original concerns in May 2022. We are unable to facilitate a meeting as you requested with the staff members involved in the decision-making process.

5. I have not identified any evidence of CAMHS intentionally lying to you, acting in a deceptive manner or trying to manipulate you. I am genuinely very sorry that this is how you have perceived our actions and it is with very sincere regret that our intentions to act in the best interest of both yourself and Meg have caused you such distress. I believe that clinicians have acted in the best interests of Meg and yourself when considering the potential role of Safeguarding measures. Clinicians are expected to escalate any concerns over child welfare and safety, this includes the potential psychological impact that may be experienced as a consequence of a parent feeling significant levels of distress.

6. This has been addressed in Part Two.

7. The Parent Work that was initiated was commenced with the view of supporting the therapeutic work that was being provided to Meg. It is standard practice for our CAMHS teams to consider providing this support alongside therapeutic work with the young person to supplement the therapeutic outcomes. Our teams firmly believe that as a parent you are well placed to provide invaluable insight into the situation and provide support to assist Meg's recovery.

In this particular situation it has been identified that the Parent Work you were undertaking did transition into a piece of work which adopted a more supportive therapy approach. The sessions clearly evoked significant painful feelings for you and our learning from this has highlighted the need for us to take into consideration the additional support that parents may require from adult services when this happens.

8. We are unable to reinstate your meeting with Sally. Meg no longer has an open referral with SPFT and as previously explained you are not a patient of SPFT and therefore it would not be appropriate for us to facilitate this meeting.

9. This is not an expectation that SPFT are able to accommodate for many professional and ethical reasons.

10. Records that are able to be released to you are in the process of being put together. I would like to reiterate though that there are sometimes occasions where some documents are withheld due the information being considered to have the potential to cause serious harm to the physical or mental health or condition of the patient, or any other person. If this is relevant to your request or Meg's request for information then Health Records will write to you / Meg separate from this response providing a full written explanation.

Any actions taken in respect of service contact with Police was as a direct outcome of the Safeguarding meeting that took place where professionals considered the clinical aspects of the situation and decided upon appropriate action.

11. As previously explained the discussion between Operational Leads, Clinical Leads and Professional Leads was not recorded. The Leadership team have reflected on this and have subsequently made changes to working practice so that notes are recorded to reflect discussions of a similar nature. They will consider each individual case on its own merit bearing in mind that in your individual case documents were being uploaded onto Meg's file so were necessary to be pertaining to her care and treatment.

12. Learning from your complaint will be shared as appropriate across CAMHS services.

13. CAMHS are committed to developing and improving their services and this includes administrative tasks. We will be working in partnership with colleagues in the Information Governance team to ensure that learning is taken forward in order to provide greater clarity for clinical staff of the required expectations.

14. through to point 20 inclusive. These relate to Southern Health therefore SPFT are unable to provide any comment.

To conclude my final response to you, I wish to apologise, firstly for the delay in SPFT being able to provide you with our initial response, I am aware that we missed our intended deadline. This falls below our usual standards and we endeavour to provide people with a timely response.

I am so sorry to hear of your experiences whilst you and Meg have been involved with CAMHS and the distress you have experienced, not only at the time but during the intervening months. I share heartfelt apologies for what you went through and what you continue to go through. I appreciate that the responses I have provided and that those previously provided by Wanda may not be to your full satisfaction and I am sorry for this but we have to be mindful of what can be realistically provided by SPFT in terms of resolving your complaint.

In regards to your ongoing health needs and accessing appropriate care and treatment I would urge you to discuss this with your GP and / or Mental Health team at Southern Health. We do not have access to this information therefore are not certain of your current support arrangements and are unable to provide any more specific advice.

I note that in your correspondence you have referred to seeking financial compensation for the harm caused. If you wish to pursue this course of action then I must advise you to seek independent legal advice and signpost you towards AvMA (Action against Medical Accidents) https://www.avma.org.uk/

Once again, I would like to take this opportunity to apologise for the distress that you have experienced but I would also like to acknowledge your bravery in reaching out to us at this time and thank you for bringing these concerns to our attention. As an organisation SPFT are fully committed to hearing all feedback that is provided and taking forward any learning that comes from this.

I hope that this response has addressed your concerns that are relevant to SPFT. If you remain unsatisfied with our response then please may I respectfully ask you to contact the PHSO, an information leaflet is attached. This response will conclude our response to your complaint and the file will be closed.

Finally, may I take this opportunity to sincerely wish you and your family well for the future.

Yourssincerely

AndyAshby

LeadNurse

Complaints&PALS’