Summary
Mr C complained to me about Grampian NHS Board (the Board)'s failure to assess and treat him for adult attention deficit hyperactivity disorder (ADHD - a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness).
In 2018, Mr C felt he was struggling to lead a balanced life and having difficulties coping within society. Mr C asked his GP about getting referred to the Board for an ADHD assessment. Mr C was told that due to service pressure, the Board had decided not to carry out adult ADHD assessments. When we made enquiries with the Board, we found that they had made that decision in 2015.
We took independent advice from a consultant psychiatrist, which we accepted. We found that the Board had unreasonably failed to provide Mr C with access to diagnostic services and treatment for ADHD. We found the Board's overall approach to adult ADHD assessments was unreasonable, as they should have assessed adults presenting with ADHD on a case-by-case basis. We also found that their approach was not in keeping with the relevant clinical guidance or the Scottish Government's mental health strategy that was in place at the time. We found that this had led to a service gap in diagnosing and treating adults with ADHD over an extensive period of time. We were critical that although the Board had acknowledged this to Mr C, they failed to take urgent action to address it and the impact it had on him. We were also critical of the explanation the Board gave to Mr C for taking this approach.
We made a number of recommendations to address the issues identified. The Board have accepted the recommendations and will act on them accordingly. We will follow up on these recommendations. The Board are asked to inform us of the steps that have been taken to implement these recommendations by the date specified. We will expect evidence (including supporting documentation) that appropriate action has been taken before we can confirm that the recommendations have been implemented.
Redress and Recommendations
The Ombudsman's recommendations are set out below:
What we are asking the Board to do for Mr C:
|
What we found |
What the organisation should do |
Evidence SPSO needs to check that this has happened and the deadline |
|---|---|---|
|
The Board failed to take action to address Mr C's lack of access to ADHD diagnostic services and treatment, despite acknowledging the problem when responding to his complaint |
Apologise to Mr C for failing to address his lack of ADHD service provision. The apology should meet the standards set out in the SPSO guidelines on apology available at: www.spso.org.uk/leaflets-and-guidance |
A copy or record of the apology By: 25 November 2019 |
|
The Board failed to provide Mr C with access to ADHD diagnostic services and treatment |
The Board should carry out an urgent ADHD assessment for Mr C; if Mr C still wishes this and if his GP refers him to the Board |
Confirmation that the Board will urgently assess Mr C for ADHD, if he is referred by his GP By: 25 November 2019 |
We are asking the Board to improve the way they do things:
|
What we found |
What should change |
Evidence SPSO needs to check that this has happened and deadline |
|---|---|---|
|
The Board's approach in Mr C's case and adult ADHD assessments in general was unreasonable |
Adults presenting with symptoms suggestive of ADHD should be assessed appropriately, taking into account the relevant clinical guidance
|
Evidence that the strategic review, when complete, appropriately addresses the issues my report has highlighted, including the Board's role in challenging any preconceptions surrounding mental health issues By: 23 April 2020 |
Evidence of action already taken
The Board told us they had already taken action to fix the problem. We will ask them for evidence that this has happened:
| What we found | What the organisation say they have done | Evidence SPSO needs to check that this has happened and deadline |
|---|---|---|
|
The Board told us that until they complete their strategic review, they have put in place interim measures to ensure that patients, presenting with ADHD, will be assessed on a case-by-case basis |
Adults presenting with symptoms suggestive of ADHD should be assessed on a case-by-case basis, taking into account the relevant clinical guidance |
Evidence that these interim measures are in place and are working appropriately By: 4 December 2019 |