Variation in quality of assessments driven by gaps in guidance and oversight
Our complaints show that people can receive very different experiences of care depending on the individual provider carrying out their assessment and the technologies used. We have seen variation in the quality and structure of assessments, differing interpretations of NICE guidelines and cases where diagnoses have not been accepted by other NHS organisations, forcing patients to re-enter waiting lists or seek further assessments.
Evidence from NHS services suggests that remote ADHD and autism assessments became substantially more common during and after the COVID-19 pandemic. However, there is no national data on the proportion of assessments conducted remotely. Many Right to Choose and independent providers conduct most of their assessments remotely.
Patient case study: assessment quality and robustness
The complaint
Miss T complained about the way an NHS-funded independent provider, Psychiatry UK, had carried out her autism assessment online. She said the assessment felt rushed, did not consider her poor working memory or masking behaviours, and did not give enough attention to information given by her parents. Miss T told us this experience negatively affected her mental health and confidence and left her concerned about accessing support at university.
‘The whole process was rushed and paid no consideration to us [the parents] or importantly our daughter [Miss T].’ Complainant’s parent
The outcome
We found that the provider did not carry out a comprehensive assessment in line with NICE guidance. The assessment lasted about 50 minutes. It did not use a recognised structured autism assessment tool, explore evidence of masking or appropriately consider information from Miss T’s parents. We found these were failings in the assessment process.
We found that the failings undermined confidence in the assessment and left Miss T without answers about whether autism could explain the difficulties she was experiencing. This caused ongoing uncertainty, distress and a loss of trust in the assessment process.
We recommended that the provider apologise, arrange a new autism assessment, make a financial payment to recognise the impact on Miss T, and review its assessment processes in line with relevant guidance.