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Clinical Harm Review Policy

Reference: 25-26062

Date response sent: 04/06/2025

Details of enquiry

Applicant’s Original Request:

I would like for you to provide the following information:

  1. Your Trust’s Clinical Harm Review policy
  2. The number of individual Clinical Harm Reviews completed in calendar year 2024 broken down by month
  3. The number of which were categorised as Low/Moderate/Severe broken down by month
  4. The number of patients currently on waiting lists that have waited longer than 18 weeks for initial treatment following referral (18 week RTT breaches)
  5. The number of patients currently on waiting lists that have waited longer than 52 weeks for initial treatment following referral (52 week RTT breaches)

For requests 4 and 5 I would like the most up to date and complete information you can provide.

 

Applicant’s Queries on Trust’s Original Response, Provided 04/06/25

I wondered if I might ask some questions for clarification.  You stated that there were 2,638 18-week RTT breaches, but the numbers in the first graphic suggest 21,477 have been waiting more than 18 weeks for a 1st appointment.

You also stated 1,764 52-week RTT breaches, compared to a suggestion of 12,537 in the graphic. Could you explain the discrepancy in these numbers?

Further – to clarify I specifically wanted numbers that were in breach of the referral to treatment, i.e. when first definitive treatment takes place. Does your service (of most relevance the Adult gender dysphoria service) classify initial assessments as definitive treatment (when the RTT clock stops) as a rule? My understanding of the Gender Dysphoria Pathway in the service specification indicates that treatment is not initiated until after a 2nd assessment. If my understanding is correct – could you confirm whether numbers given are accurate with respect to referral to treatment, rather than 1st appointment as appears to be the case.

Response sent

The Tavistock and Portman NHS Foundation Trust is a small specialist NHS mental health trust with a focus on training and education, as well as providing a full range of mental health services and therapies for children and their families, young people and adults.

We provide outpatient, and mainly psychological services via talking therapies. We do not provide acute services, nor inpatient patient services, nor detention facilities, and do not have an A&E department

  1. Your Trust’s Clinical Harm Review policy

The Trust has a Clinical Harm Review Framework (attached), there is no policy..

  1. The number of individual Clinical Harm Reviews completed in calendar year 2024 broken down by month

Nil.  Whilst the new Clinical Harm Review Framework was ratified in October 2024, the subsequent development and launch of the related digital forms took until March 2025.

  1. The number of which were categorised as Low/Moderate/Severe broken down by month

Nil – See our response to Question 2 above

  1. The number of patients currently on waiting lists that have waited longer than 18 weeks for initial treatment following referral (18 week RTT breaches)

2,638 patients, as of 23rd May 2025

See both graphics below for further detail.

 

It should be noted that these figures are predominantly weighted to the Adult Gender service which has approximately 16,500 patients waiting (see GIC website for exact latest figure  Gender identity clinic – Tavistock and Portman)

  1. The number of patients currently on waiting lists that have waited longer than 52 weeks for initial treatment following referral (52 week RTT breaches)

1,764 patients, as of 23rd May 2025.

See Question 4 above and the graphics and narrative there for further information.

 

Applicant’s Subsequent Queries on Trust’s Original Response to Questions 4 and 5,

Further Response sent 26/06/25

I wondered if I might ask some questions for clarification.  You stated that there were 2,638 18-week RTT breaches, but the numbers in the first graphic suggest 21,477 have been waiting more than 18 weeks for a 1st appointment.

You also stated 1,764 52-week RTT breaches, compared to a suggestion of 12,537 in the graphic. Could you explain the discrepancy in these numbers?

Further – to clarify I specifically wanted numbers that were in breach of the referral to treatment, i.e. when first definitive treatment takes place. Does your service (of most relevance the Adult gender dysphoria service) classify initial assessments as definitive treatment (when the RTT clock stops) as a rule? My understanding of the Gender Dysphoria Pathway in the service specification indicates that treatment is not initiated until after a 2nd assessment. If my understanding is correct – could you confirm whether numbers given are accurate with respect to referral to treatment, rather than 1st appointment as appears to be the case.

 

Upon review of your comments and questions regarding our initial response, we see that we misunderstood the scope of your request, leading to a conflation of several data fields.

To clarify, we have revised our response as follows:

  1. National Service Specification and Appointment Guidance
    Thank you sharing your understanding of the National Service Specification, however, please note that while it recommends two appointments before treatment commences; this is a guideline rather than a strict requirement as clinically, treatment decisions and timescales are led by patient need.
  • In some cases, treatment may be recommended after the first appointment, depending on the individual’s psychological and physical preparedness for treatment.
  • Conversely, some patients may require more than two appointments before their assessment is complete and treatment can commence, particularly where needs are more complex.
  • Please note: This does not include assessment and recommendations to the surgical pathway, as this requires a separate assessment process, following which, if the patient meets the referral and diagnostic tests, GIC clinicians make a recommendation for referral to the surgical pathway. The Tavistock and Portman NHS Foundation Trust delivers the non-surgical pathway only.
  1. Clarification on Data Provided
    While the graph below, titled “First Appointment Waiting Bands”, contains correct data, there was an error in our written response to Question 4. Specifically, the total number of patients who breached the 18-week Referral to Treatment (RTT) target was misstated.

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  • To confirm the answer to question 4: based on the data provided, above the total number of RTT breaches in the Trust, is 21,477 as at 23 May 2025, as shown as the last 5 bars to the right in the above bar chart.

This represents patients who exceeded the 18-week target from referral to first definitive assessment and is the sum of all patients represented in the graph above in the X axis (horizontal line) in number of weeks and in the Y axis (vertical line) in total number of patients.

  1. Misinterpretation of “Average Waiting Weeks” Graph

On reflection, the blue graph titled “Average Waiting Weeks” does not directly address your request. This graph measures waiting time to the first appointment only, which constitutes assessment rather than treatment. As your request pertains specifically to RTT, which refers to the time from referral to the start of treatment, the data in this graph is not applicable to your query.

Accordingly, we advise disregarding the related narrative regarding the figure of 1,764, as this too reflects a conflation of assessment and treatment timelines and does not accurately respond to your question.

  1. RTT Definition for Context
    As a general principle, the RTT clock starts at the point of referral and stops when the patient receives their first definitive clinical treatment. This may occur following the first appointment (if treatment is initiated at that point), or after a subsequent appointment, depending on clinical need, as further explained in point 1 above.
  2. Regarding question 5 the number of patients that have waited longer than 52 weeks for a first appointment/assessment. This is the sum of the last 3 bars to the right of the graph which totals as 12,537 across the Trust. Please note that the waiting times data are primarily weighted to GIC, ASD and Trauma services where we have the longest waiting times.
  3. Regarding the Clinical Harm reviews our response remains as originally stated: the trust has a clinical harm review framework and not a policy we have reattached the document for completeness.
  4. No clinical harm reviews have been completed in the reporting period as the framework was ratified in October 2024, and the reporting digital reporting forms were added to our electronic record system in March 2025. Teams are currently implementing the framework therefore there are no reports to share.

We hope that this responds to your query. Should you require further details regarding waiting times, the Trust publishes an annual report which covers, in part, the waiting times and general performance against targets. This is publicly available on our website and may be reached via the following link: Annual Reports – Tavistock and Portman

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