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Findings of the Public Services Ombudsman for Wales
The Trust first became involved in this case when the Welsh Consultant was contacted by the English Consultant’s team in October 2006 to take over Miss S’s care. The Welsh Consultant refused. He argues that this was because his team lacked the resources and expertise to treat a patient suffering from advanced anorexia nervosa. While I note the constraints the Welsh Consultant faced, I am concerned that he refused to become involved in October 2006 because, as the Adviser has pointed out, Miss S’s main problem at that time appeared to be depression, a condition that it would have been reasonable to expect the Welsh Consultant to manage on an in-patient ward. While the Welsh Consultant has said that the impression he received from the English Consultant during their telephone conversation on 31 October 2006 was that the anorexia was more serious (paragraphs 65 and 67), this is not supported by the English Consultant’s letter to him of the same date (paragraph 26), which suggests that the depression was the most serious issue at that time. On balance, taking into account the information which was apparently available at the time to the Welsh Consultant, I conclude (having taken account of the professional advice I received) that it was not clinically reasonable for the transfer request to be refused outright in October 2006. That was a failure to provide a service. That said, I recognise that by December 2006, when Miss S’s condition had deteriorated and it was clear that the main problem was now her eating disorder, it would not have been clinically reasonable for the Welsh Consultant to have taken over her care.
I am not, therefore, critical of his decision not to agree to the transfer of Miss S at that stage. In view of the failure to provide a service which I have identified, and the consequent injustice or hardship identified later in this report, I uphold the complaint against the Trust.
I am concerned, also, about the level of provision for eating disorder patients in the Trust’s area. The Adviser has commented that this is surprising given that the Trust covers a population of around 500,000. I note that eating disorders are not unusual, and the Trust should ensure that there are adequate services available for patients suffering from them. The changes which have occurred since this complaint was made, outlined in the Trust’s response to our enquiries, seem a reasonable step forward, and in particular should help manage negotiations with HCW about eating disorder patients who require in-patient treatment. That said, I share the Adviser’s concerns that the service for eating disorder patients is limited, and I note the Trust’s own statement that while it does provide an out-patient service for patients suffering from anorexia nervosa, this is limited and does not receive specific funding.
