Summary: Mrs X complains about the care and support provided to her daughter after her autism diagnosis. Based on current evidence I have found fault by the Trust and the Council. However, they have accepted this and provided a suitable remedy for most of the complaint. We have recommended the Trust apologises for distress caused by fault relating to a delayed referral for therapy. We have also recommended the Trust acts to ensure safeguards are in place to prevent similar fault in future.

The complaint

1. Mrs X complains on behalf of her daughter, Miss Y, about Sussex Partnership NHS Foundation Trust (the Trust) and Brighton and Hove City Council (the Council). Mrs X complains the Trust and the Council failed to provide adequate care or support for Miss Y between 2021 and 2023. Her concerns include that:
• The Council’s School Wellbeing Service failed to take appropriate action to address Miss Y’s needs (mental health or suspected autism) after she completed a counselling course from November 2021 – February 2022;
• The Trust’s Child and Adolescent Mental health Service (CAMHS) failed to provide Miss Y with any support or treatment for around 18 months after it had agreed her autism diagnosis in 2022;
• The Trust misdiagnosed Miss Y with “situational anxiety” and discharged her back to the School Wellbeing Service in July 2023, despite this not helping her previously and she was not attending school;
• The Trust discharged Miss Y from CAMHS even though it was aware Miss Y had been self-harming, could not leave her room or attend school due to anxiety;
• The Council has not taken appropriate action to ensure Miss Y’s educational needs have been met, particularly in school years 10 and 11.
2. As a result of the failings Mrs X says:
• she had to pay for private therapy and assessment for Miss Y;
• Miss Y became more isolated and could not leave her room or attend school due to her anxiety; and
• Miss Y has missed nearly two years of school and been unable to take her exams because her educational needs have not been met.
3. Mrs X wants the Trust and the Council to acknowledge the failings and the effects these have had on Miss Y. She wants to know what went wrong and how appropriate support can be put in place to support Miss Y’s mental health needs and address her missed education. She would also like consideration of a financial payment to recognise the effect of the failings and help provide for Miss Y’s future needs.

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The Ombudsmen’s role and powers

4. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
5. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
6. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
7. We will not generally investigate a complaint unless we are satisfied the matter has been brought to the relevant organisation’s attention and that organisation has had a reasonable opportunity to investigate and reply to the complaint. (Local Government Act 1974 section 26(5), as amended and Health Service Commissioners Act 1993, section 9(5))
8. We cannot investigate most complaints about what happens in schools. (Local Government Act 1974, Schedule 5, paragraph 5(2), as amended)
9. If we are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(1), as amended)

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How I considered this complaint

10. I considered evidence provided by Mrs X, the Trust and the Council as well as relevant law, policy and guidance.
11. All parties had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Brief background

12. In 2020 Miss Y need to move schools. Mrs X says she believes the cause of the problems that led to this were because Miss Y was autistic, which had not been diagnosed at this point.
13. Miss Y found the move to a new school, away from her friends, difficult. Mrs X explained this caused Miss Y anxiety and she struggled to attend school regularly. When she had reached Years 10 and 11, she did not feel able to attend school much at all.
14. In 2021, the School Wellbeing Service (part of the Council) arranged a six-week counselling course. She was discharged from its service following completion of this course.
15. Mrs X said the Council and the Trust did not take any further action or address Miss Y’s suspected autism. Mrs X therefore arranged for private trauma therapy and autism assessment. The outcome from the assessment was that Miss Y was autistic.
16. In 2022 the Trust’s Child and Adolescent Mental Health Services (CAMHS) reviewed Miss Y. They wanted to complete a new autism assessment. Mrs X said she complained about this and CAMHS later agreed to review the private assessment and accepted the diagnosis.
17. Mrs X said Miss Y told CAMHS about her extreme anxiety that meant she could not attend school. However, in 2023 CAMHS referred Miss Y back to the School Wellbeing Service.
18. Mrs X explained that Miss Y missed out on the opportunity to take her GCSE exams. This was because she had felt unable to attend school at such an important time of her education.

Legal and Administrative Context

Autism diagnosis

19. National Institute for Health and Care Excellence (NICE) guidelines (CG128) has issued guidance for recognising and diagnosing autism spectrum disorder in children and young people under 19 years old. The guidance states, an autism diagnosis should be based on criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) or the International Classification of Diseases 11th Revision (ICD-11).
20. At the time of the complaint CAMHS at the Trust was commissioned to assess for autism and offer signposting to local support.
21. The Trust’s routine pathway was:
• Referral - screening - waiting - assessment – Multidisciplinary Team – discharge.
22. If someone received a private diagnosis of Autism before completing the pathway, the Trust would discharge the person from its Neurodevelopmental Pathway because an assessment and diagnosis has already been given.

Treatment for children and young people with social anxiety disorder

23. NICE guidance (CG159) “Social anxiety disorder: recognition, assessment and treatment” covers recognising, assessing and treating social anxiety disorder (also known as ‘social phobia’) in children and young people. It aims to improve symptoms, educational, occupational and social functioning, and quality of life in people with social anxiety disorder.

The guidance sets out the steps for treating children and young people with social anxiety disorder. This says NHS organisations should offer individual or group Cognitive Behavioural Therapy (CBT) which is a talking therapy where a therapist helps someone change how they think and act, focused on social anxiety.

EHC Plans

24. Children who have special educational needs may have an Education Health and Care Plan (EHC Plan). This sets out the child’s special educational needs and the provision needed to meet them. Local authorities have a duty to secure the special educational provision set out in an EHC Plan, unless the parent or young person has made suitable alternative arrangements. (Children and Families Act 2014 section 42)

My Findings

School Wellbeing Service

25. Mrs X says the School Wellbeing Service failed to act to address Miss Y’s needs (mental health or suspected autism) after she completed a counselling course from November 2021 – February 2022.
26. Records show Miss Y attended sessions for low intensity CBT from November 2021. The aim was to support Miss Y to try to attend lessons at school. The records suggest Miss Y was making some progress and she reported feeling better about attending school and lessons. However, Miss Y did not attend two CBT sessions and did not respond to contact the service tried to make to rearrange. The complaint response noted this was because Miss Y felt the sessions were not working for her. The Council therefore ended the sessions.
27. The Trust’s complaint response noted that CAMHS and the Wellbeing Service then became involved.
28. The Council’s role for this referral was to deliver low intensity CBT to support Miss Y with attending lessons in school. The records show the School Wellbeing Service arranged this support soon after the Council received the referral. It provided these sessions, although this was when the country had restrictions in place because of Covid-19 and some sessions were delivered remotely. Miss Y chose not to continue with the CBT before the sessions were meant to end. The Council tried to contact Miss Y and Mrs X about this without success. It explained it would need to end the sessions if they did not respond.
29. Mrs X or Miss Y did not respond. I understand this may have been because Miss Y did not feel the sessions were helpful for her at that time. However, I do not consider it was fault that the Council ended the sessions when it did.
30. In response to the Ombudsmen’s enquiries, the Council has acknowledged that with the sessions ending sooner than planned, it could have provided information about how extra support could be sought. It said the practitioner may have had good reason to believe this information was not necessary, but the practitioner no longer works for the Council, so it could not clarify this. The records do not provide any further clarification. The Council also said there were no records to show what the practitioner discussed with the school when the sessions ended.
31. Without records or other evidence we cannot say why the Council did not signpost or provide advice on other support that may be available. I consider this lack of record keeping to be fault and not in line with the Principles of Good Administrative Practice. However, The Council has already accepted this.
32. The Council’s response to the Ombudsmen said:

“The Local Authority is working with parents, schools and children to ensure improved sense of belonging and inclusion for children with neurodivergence, mental health and special needs.

We have updated our recording guidance as a service and on reflection of this complaint will be undertaking further audits to ensure information is recorded accurately.”

33. I consider this provides a proportionate outcome to address the fault identified, particularly about record-keeping.

CAMHS

34. Mrs X complains the Trust’s Child and Adolescent Mental health Service (CAMHS) failed to provide Miss Y with any support or treatment for around 18 months after it had agreed her autism diagnosis in 2022.
35. When Miss Y was referred to CAMHS for an autism assessment, the waiting times for these assessments were long. Mrs X understandably chose to seek a private assessment for Miss Y. This assessment was completed in June 2022.
36. The Trust was not aware of the private assessment and it offered Miss Y a Neurodevelopment History appointment in October 2022 to start the autism assessment process. Mrs X contacted the Trust to advise Miss Y had already had a diagnosis of Autism completed privately. The Trust reviewed the diagnosis report and noted her diagnosis of Autism Spectrum Condition and that it was in line with the diagnostic criteria set out in the NICE guidelines. The Trust therefore removed Miss Y from its waiting list and provided advise on how to access further support through Brighton & Hove Inclusion Service (BHISS).
37. Miss Y’s referral to the Trust was for an Autism assessment. Because she had received a private diagnosis, she no longer needed the assessment and the Trust removed her from the waiting list. However, the records show the Trust did review the assessment report and it provided advise on how Miss Y could access further support. This was in line with its clinical assessment procedure and fulfilled the service it was commissioned to provide. There was therefore no fault by the Trust in relation to its decision to discharge Miss Y with advice.
38. I appreciate Mrs X did not necessarily agree with the advice to seek support from BHISS, but this was in line with local agreements and does not mean the Trust’s decision was wrong.
39. In terms of further support from the Trust, Miss Y’s GP referred her back to CAMHS in June 2023 because she was experiencing social anxiety. The Trust saw Miss Y in July 2023 and completed a review of her mental health needs. The Trust noted Miss Y’s anxiety was situation specific and recommended autism‑specialist counselling or Cognitive Behavioural Therapy to help her manage her anxiety. The records show the Trust referred Miss Y to the Wellbeing Service to arrange this. It also provided advice to contact a charity organisation that could provide extra support around managing her anxiety.
40. The Wellbeing Service noted Miss Y’s presenting difficulties were around attending school, so she was referred back to the School Wellbeing Service.
41. Mrs X’s complaint said the Trust misdiagnosed Miss Y with “situational anxiety” and discharged her back to the School Wellbeing Service, despite this not helping her previously and she was not attending school. I have not seen any record of a diagnosis of “situational anxiety” in any of the medical or Council records. There is reference in the records and clinic letters to Miss Y’s anxiety being situation‑specific and to her anxiety about going into school. It may be this phrasing has caused some confusion.
42. I understand Mrs X was unhappy about Miss Y being referred back to the School Wellbeing Service as she understandably felt this was a backwards step. However, it should be noted that events had moved on since her previous sessions with the School’s Wellbeing Service. Miss Y now had a diagnosis of autism and had seen a psychological therapist about her anxiety.
43. As the Trust has noted, CBT is the recommended treatment pathway under NICE guidelines. The Trust has also provided further information to us as part of our investigation. It explained the School Wellbeing Service has experience working with neurodiversity and it has good links with CAMHS if any advice or support is needed.
44. As the previous sessions with the School Wellbeing Service did not work out for Miss Y, I can understand why she may feel this was the decisions were wrong. However, the Trust was following national guidelines and it did not have the benefit of hindsight. The records show the Trust discussed the possibility of Autistic Spectrum Condition (ASC) counselling with Mrs X after she raised concerns about Miss Y returning to the School Wellbeing Service. The Trust’s clinical lead was unsure if this would meet Miss Y’s needs. The waiting time for this therapy was over 12-months, so it would not have been helpful practically in helping Miss Y return to school.
45. The records show the Trust followed NICE guidance. While it may not have been obvious to Mrs X, there were links between CAMHS and the School Wellbeing Service. In addition to following national guidance, the records show the Trust engaged with Mrs X and explained the drawbacks of alternative pathways, even if these were not applicable. I have therefore found no fault by the Trust in this regard.
46. The Trust arranged a further review of Miss Y’s mental health in March 2024. The records show Miss Y was struggling with attending school and had not been since October 2023. A medication trial was started for her anxiety. The Trust reviewed Miss Y’s medication regularly.
47. Shortly after, the Trust provided a statement to the Council as part of a statutory assessment of Miss Y’s special educational needs. The Trust set out its view that Miss Y would “benefit from receiving autism-specialist counselling or CBT to help her manage the intensity of her anxiety about going into educational environments, and to help her with any possible self-esteem or confidence building.” The Trust did not take any action on this recommendation until April 2025.
48. In response to our enquiries the Trust has recognised it did not follow this up in a timely manner and there was a significant delay in the team becoming aware of this recommendation. The Trust has said this was due to “human error”.
49. The Trust did not notice the lack of action for this recommendation for autism‑specialist counselling or CBT until after Mrs X complained and a review took place following a change of CAMHS Consultant. At that point the Trust arranged for Miss Y to receive CBT sessions and these started in June 2025.
50. The lack of action on the recommendation for specialist therapy is fault. The Trust has accepted this was due to human error, and it took quick action to put this right when it realised the error. However, it does not seem there were fail-safes in place or if there were, these did not work until nearly 12-months later. Miss Y therefore potentially missed the opportunity to receive specialist ASC CBT sooner.
51. In considering the effect of the fault, I have considered what would have happened if the Trust, and CAMHS had made a referral sooner. The Trust had previously explained the waiting times for this therapy was around a year. When the Trust noticed the oversight, it managed to arrange an appointment within three months. The Trust therefore effectively remedied the delay and mitigated the effect of not making an earlier referral. It is understandable that Mrs X and Miss Y would feel upset at the oversight and I have seen from the records Mrs X has had to push for help at times. Ideally this should not happen and having to do this while caring for and supporting Miss Y has clearly added to her distress.

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What I have not investigated

52. We have not investigated the complaint that the Council did not act to ensure Miss Y’s educational needs were met, particularly in school years 10 and 11.
53. The complaint to the Council was about how it acted on referrals to help Miss Y with her anxiety around attending school. This is what the Council investigated and responded to. If Mrs X wishes to complain about Miss Y’s educational support, including attendance and her ECH Plan, these complaints would need to considered by the Council first.
54. If Mrs X has any specific concerns about the school’s actions, it will have its own complaints procedures, but these are not in our remit to consider.

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Actions

55. The Trust has agreed the following actions to be completed within one month of the date of the Ombudsmen’s final decision statement:
• The Trust will apologise to Miss Y and Mrs X for the distress caused by the fault with delays in arranging ASC adapted therapy for Miss Y.
56. The Trust has also agreed to the following actions to be completed within three months of the date of the Ombudsmen’s final decision statement:
• If the Trust has not already done so, it will review procedures to ensure safeguards are in place to prevent referrals and/or recommendations for treatment from not being actioned in a timely manner. These actions will be shared with Mrs X and the Ombudsmen.
57. The Trust should provide us with evidence it has complied with the above actions.

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Decision

58. I find fault causing injustice. Although some of the injustice has already been remedied by the Council and the Trust, I recommended the Trust apologises to Miss Y and Mrs X for the distress caused by the faults identified and review procedures to ensure appropriate safeguards are in place to avoid similar issues in future. The Trust has agreed to these actions. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman