Child and Adolecent Mental Health: Betsi Cadwaladr University Health Board

Mrs A complained about the care and treatment that her son, B, received from Betsi Cadwaladr University Health Board (“the Health Board”) between October 2020 and May 2022. Mrs A’s concerns were in relation to B’s assessment for autism spectrum disorder (“ASD”) and the support and interventions he received from both the Neurodevelopmental (“ND”) Team and the Child and Adolescent Mental Health Service (“CAMHS”). Specifically, Mrs A complained about the delay in diagnosing B with ASD following the request for a second ND assessment, and that the Health Board also failed to assess B for Pathological Demand Avoidance (“PDA”) as part of this assessment. Furthermore, Mrs A complained that from October 2020, and despite B’s later diagnosis of ASD, there had been an ongoing failure by the Health Board to recommend, and implement, appropriate support and interventions for B. Mrs A also complained that the Health Board had failed to adequately communicate with her to provide clarity on the re-assessment process and what support and interventions it could offer B.

The investigation found that although there was a delay in carrying out the second ND assessment, and therefore diagnosing B with ASD, such delays were a national problem across the whole of the NHS and were not limited to this Health Board or to this case. Whilst the Ombudsman did not condone this delay, there was no indication that B’s case should have been expedited for assessment and so the Ombudsman did not uphold this aspect of Mrs A’s complaint. The Ombudsman also concluded that it was reasonable that the Health Board did not assess B for PDA given its lack of clear definition or status. In addition, although the Health Board itself acknowledged that there were aspects of communication more generally that could be improved upon, the Ombudsman considered that communication with Mrs A by clinicians was, on balance, satisfactory. As a result, these aspects of the complaint were also not upheld. However, with regard to Mrs A’s concerns about the support and interventions for

her son, the investigation found that there was limited clinical intervention carried out in the period before B’s diagnosis and so the complaint was upheld on that basis.

The Ombudsman recommended that the Health Board apologise to B and Mrs A for the failing that she had identified in the investigation. Whilst the Ombudsman had also initially recommended that the Health Board review its guidance/processes for recommending and implementing support and interventions, particularly for those who were on the waiting list for ND assessments, the Ombudsman was later satisfied that the Health Board was already taking part in a wider review into ND Services and that suitable alternative action was therefore already being taken.