PFD report

Alan MacDONALD · Prevention of Future Deaths report

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Issued 21 Feb 2018•Inner North London

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

View original report
Concerns
3

Raised in this report

Recipients
1

Named on the report

Responses found
1

Of 1 recipient

Stated actions
13

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

Select any concern, action or position to view the source wording.

Concerns raised3

  1. Failure to close Addcounsel files when patients require inpatient admission
  2. Failure to highlight NHS care access to patients with financial concerns
  3. Failure to escalate patients’ financial concerns for consideration of charge reductions
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.6

  1. Action

    Develop a policy requiring financial concerns to be documented and communicated, enabling consideration of reduced costs or alternative providers.

    Stated by AddcounselStated in progressThe respondent said that this action was in progress when they made their response on 8 June 2018.
  2. Action

    Record clients discharged to another service as discharged and reopen their records if they later return.

    Stated by AddcounselStated completedThe respondent said that this action was complete when they made their response on 8 June 2018.
  3. Action

    Discharge clients not receiving Addcounsel treatment to the suitable provider and case-manage only clients receiving Addcounsel services.

    Stated by AddcounselStated completedThe respondent said that this action was complete when they made their response on 8 June 2018.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.1

  1. Position

    The clinical director was present when financial concerns were raised only during the initial assessment, not when the later inpatient concerns were expressed.

    Stated by AddcounselDisputes the concernThe respondent disagreed with part of the concern or the basis for it.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to close Addcounsel files when patients require inpatient admission

Wider context from the report

“Addcounsel’s clinical director, a non medically qualified counsellor, continued to visit Mr MacDonald while Mr MacDonald was being treated as an inpatient at the Nightingale by a consultant psychiatrist. The clinical director told me that he was in a therapeutic type relationship, but he was not treating Mr MacDonald or giving him therapy. In addition to the psychiatrist consultations, therapy was available at the Nightingale. The daily Addcounsel visits inevitably entailed further cost to Mr MacDonald, as well as the additional cost of going through Addcounsel to the Nightingale in the first place, without giving treatment in return. I understand that this issue has been addressed by Addcounsel, following Mr MacDonald’s death. I was told at inquest that in future, when Addcounsel recognises that a patient is too unwell to be treated in the community and requires admission, Addcounsel’s file will be closed. In this way, a patient will not pay for visits at which no treatment is being offered. One of Mr MacDonald’s worries, expressed at consultation with his psychiatrist when Addcounsel’s clinical director was present, did centre on his financial situation. He was very anxious that his money was running out and he was not earning while he was in hospital. (After discharge from hospital, he told a friend that he had paid Addcounsel £20,000, and was not going to pursue follow up treatment.) Despite the fact that the Addcounsel clinical director knew of Mr MacDonald’s money worries, he neither brought this to the attention of Addcounsel’s relationship director, the person responsible for charging Mr MacDonald, to enable consideration to be given to reducing the charges, nor did he highlight to Mr MacDonald the potential to access care via the NHS. This seems to be a potentially devastating omission, not simply on an individual basis but also in terms of Addcounsel’s systems. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to highlight NHS care access to patients with financial concerns

Wider context from the report

“Addcounsel’s clinical director, a non medically qualified counsellor, continued to visit Mr MacDonald while Mr MacDonald was being treated as an inpatient at the Nightingale by a consultant psychiatrist. The clinical director told me that he was in a therapeutic type relationship, but he was not treating Mr MacDonald or giving him therapy. In addition to the psychiatrist consultations, therapy was available at the Nightingale. The daily Addcounsel visits inevitably entailed further cost to Mr MacDonald, as well as the additional cost of going through Addcounsel to the Nightingale in the first place, without giving treatment in return. I understand that this issue has been addressed by Addcounsel, following Mr MacDonald’s death. I was told at inquest that in future, when Addcounsel recognises that a patient is too unwell to be treated in the community and requires admission, Addcounsel’s file will be closed. In this way, a patient will not pay for visits at which no treatment is being offered. One of Mr MacDonald’s worries, expressed at consultation with his psychiatrist when Addcounsel’s clinical director was present, did centre on his financial situation. He was very anxious that his money was running out and he was not earning while he was in hospital. (After discharge from hospital, he told a friend that he had paid Addcounsel £20,000, and was not going to pursue follow up treatment.) Despite the fact that the Addcounsel clinical director knew of Mr MacDonald’s money worries, he neither brought this to the attention of Addcounsel’s relationship director, the person responsible for charging Mr MacDonald, to enable consideration to be given to reducing the charges, nor did he highlight to Mr MacDonald the potential to access care via the NHS. This seems to be a potentially devastating omission, not simply on an individual basis but also in terms of Addcounsel’s systems. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to escalate patients’ financial concerns for consideration of charge reductions

Wider context from the report

“Addcounsel’s clinical director, a non medically qualified counsellor, continued to visit Mr MacDonald while Mr MacDonald was being treated as an inpatient at the Nightingale by a consultant psychiatrist. The clinical director told me that he was in a therapeutic type relationship, but he was not treating Mr MacDonald or giving him therapy. In addition to the psychiatrist consultations, therapy was available at the Nightingale. The daily Addcounsel visits inevitably entailed further cost to Mr MacDonald, as well as the additional cost of going through Addcounsel to the Nightingale in the first place, without giving treatment in return. I understand that this issue has been addressed by Addcounsel, following Mr MacDonald’s death. I was told at inquest that in future, when Addcounsel recognises that a patient is too unwell to be treated in the community and requires admission, Addcounsel’s file will be closed. In this way, a patient will not pay for visits at which no treatment is being offered. One of Mr MacDonald’s worries, expressed at consultation with his psychiatrist when Addcounsel’s clinical director was present, did centre on his financial situation. He was very anxious that his money was running out and he was not earning while he was in hospital. (After discharge from hospital, he told a friend that he had paid Addcounsel £20,000, and was not going to pursue follow up treatment.) Despite the fact that the Addcounsel clinical director knew of Mr MacDonald’s money worries, he neither brought this to the attention of Addcounsel’s relationship director, the person responsible for charging Mr MacDonald, to enable consideration to be given to reducing the charges, nor did he highlight to Mr MacDonald the potential to access care via the NHS. This seems to be a potentially devastating omission, not simply on an individual basis but also in terms of Addcounsel’s systems. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Develop a policy requiring financial concerns to be documented and communicated, enabling consideration of reduced costs or alternative providers.

Verbatim wording from the response

“When Addcounsel was set up we made a conscious decision to keep the discussion of finances separate from the therapeutic process, to avoid the latter being compromised. We still maintain that it is not the role of the clinician/therapists to discuss the cost of treatment with a client and this is why we employ a dedicated relationship manager to do this. However, we do recognise and appreciate that in a situation such as Mr MacDonald’s, there needs to be a system in place to make sure that clinicians/therapists are able to bring relevant financial concerns to the attention of the relationship manager.”

Source location

2018-0053-Response-by-Addcounsel
Page 2 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Record clients discharged to another service as discharged and reopen their records if they later return.

Verbatim wording from the response

“As set out in your Report, this issue has been addressed and the actions set out in the Client Death Review undertaken following Mr MacDonald’s death have now been put in place. Our system has changed in the following ways:”

Source location

2018-0053-Response-by-Addcounsel
Page 1 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Discharge clients not receiving Addcounsel treatment to the suitable provider and case-manage only clients receiving Addcounsel services.

Verbatim wording from the response

“As set out in your Report, this issue has been addressed and the actions set out in the Client Death Review undertaken following Mr MacDonald’s death have now been put in place. Our system has changed in the following ways:”

Source location

2018-0053-Response-by-Addcounsel
Page 1 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Require a new referral before restarting Addcounsel services after discharge to another provider.

Verbatim wording from the response

“As set out in your Report, this issue has been addressed and the actions set out in the Client Death Review undertaken following Mr MacDonald’s death have now been put in place. Our system has changed in the following ways:”

Source location

2018-0053-Response-by-Addcounsel
Page 1 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Write to every multidisciplinary team member about the forthcoming policy and interim procedures for handling financial concerns.

Verbatim wording from the response

“Pending ratification of the policy we have already put in place interim measures to ensure our MDT is aware of this change in practice. ████████ have taken place and ████████ will write to every member of our MDT to advise them about the new policy which will be coming into place at the end of May 2018 and to give them instructions as to how to approach relevant situations in the meantime. Members of the MDT will be told by any concerns to ████████ to be dealt with appropriately (and in a way which reflects the new system coming into place).”

Source location

2018-0053-Response-by-Addcounsel
Page 3 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Distribute the approved financial-concerns policy to the multidisciplinary team with instructions for relevant situations.

Verbatim wording from the response

“• This policy will need to be agreed by our Independent Governance Committee and we hope to have it in place by the end of May 2018. It will then be distributed to each member of our multi-disciplinary team (MDT) by Michael Ishmail with a clear reminder of the process to follow in relevant situations.”

Source location

2018-0053-Response-by-Addcounsel
Page 3 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

The clinical director was present when financial concerns were raised only during the initial assessment, not when the later inpatient concerns were expressed.

Verbatim wording from the response

“I would like to take this opportunity to highlight that our understanding of the evidence was that Addcounsel’s clinical director, Michael Ishmail, was present on one occasion when Mr MacDonald told ████████ that financial concern was sometimes a trigger for his depression/anxiety; this was during the initial assessment on the day of admission to the Nightingale Hospital. The reference in the PFD report to Mr MacDonald stating that ‘he was very anxious that his money was running out and he was not earning while he was in hospital’ is presumably a reference to a comment made later on during his period as an inpatient, to an employee of Nightingale Hospital and, I would say, not in ████████ presence.”

Source location

2018-0053-Response-by-Addcounsel
Page 2 · response
Published 8 June 2018

Open published response

Other statements in published responses

These actions and other statements could not be clearly connected to one concern in this report.

Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.7

  1. 1

    Implement interim measures informing the multidisciplinary team about the changed practice before policy ratification.

    Stated by AddcounselStated completedThe respondent said that this action was complete when they made their response on 8 June 2018.
  2. 2

    Write to the Nightingale Medical Director and request a meeting to clarify referral processes and communication channels.

    Stated by AddcounselStated completedThe respondent said that this action was complete when they made their response on 8 June 2018.
  3. 3

    Write to other referring organisations to clarify referral processes and future working arrangements.

    Stated by AddcounselStated plannedThe respondent said that this action was planned when they made their response on 8 June 2018.
  4. 4

    Rewrite the client Terms and Conditions to explain Addcounsel’s bespoke treatment and resulting financial implications.

    Stated by AddcounselStated in progressThe respondent said that this action was in progress when they made their response on 8 June 2018.
  5. 5

    Explore increased investigation of clients’ ability to pay for Addcounsel services at initial approach.

    Stated by AddcounselStated in progressThe respondent said that this action was in progress when they made their response on 8 June 2018.
  6. 6

    Hand responsibility for financing onward referral and treatment to the new provider when Addcounsel provides no immediate care.

    Stated by AddcounselStated completedThe respondent said that this action was complete when they made their response on 8 June 2018.
  7. 7

    Obtain Independent Governance Committee agreement for the new financial-concerns policy.

    Stated by AddcounselStated plannedThe respondent said that this action was planned when they made their response on 8 June 2018.

Recipient positions A position is what a recipient says about a concern when they do not describe a specific action.1

  1. 1

    The reported £20,000 included Nightingale Hospital accommodation and treatment costs and did not represent Addcounsel’s services alone.

    Stated by AddcounselDisputes the concernThe respondent disagreed with part of the concern or the basis for it.

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Implement interim measures informing the multidisciplinary team about the changed practice before policy ratification.

Verbatim wording from the response

“Pending ratification of the policy we have already put in place interim measures to ensure our MDT is aware of this change in practice. ████████ have taken place and ████████ will write to every member of our MDT to advise them about the new policy which will be coming into place at the end of May 2018 and to give them instructions as to how to approach relevant situations in the meantime. Members of the MDT will be told by any concerns to ████████ to be dealt with appropriately (and in a way which reflects the new system coming into place).”

Source location

2018-0053-Response-by-Addcounsel
Page 3 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Write to the Nightingale Medical Director and request a meeting to clarify referral processes and communication channels.

Verbatim wording from the response

“• I have written to the Medical Director at the Nightingale Hospital and requested to meet with him in order to discuss the changes to our processes; and to ensure that there is a clear communication channel between us and that everyone has a clear understanding of how our referral process will work.”

Source location

2018-0053-Response-by-Addcounsel
Page 2 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Write to other referring organisations to clarify referral processes and future working arrangements.

Verbatim wording from the response

“• I will also be writing to the other organisations to which we refer patients to ensure our process is clearly set out and understood; and that everyone has a common understanding of how we will work going forwards.”

Source location

2018-0053-Response-by-Addcounsel
Page 2 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Rewrite the client Terms and Conditions to explain Addcounsel’s bespoke treatment and resulting financial implications.

Verbatim wording from the response

“We are also exploring ways in which we can put in place increased investigation into a client’s ability to pay for Addcounsel services when they first approach us. We are in the process of re-writing our ‘Terms and Conditions’, which are provided to all clients when they first register with Addcounsel; and consideration is being given to including information within this document about the bespoke nature of the treatment provided by Addcounsel and the resulting financial implication of this. We always aim to ensure that all clients are fully aware of the type of service they are signing up to and the likely costs involved, so that they can withdraw if they feel it is not suitable for them.”

Source location

2018-0053-Response-by-Addcounsel
Page 3 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Explore increased investigation of clients’ ability to pay for Addcounsel services at initial approach.

Verbatim wording from the response

“We are also exploring ways in which we can put in place increased investigation into a client’s ability to pay for Addcounsel services when they first approach us. We are in the process of re-writing our ‘Terms and Conditions’, which are provided to all clients when they first register with Addcounsel; and consideration is being given to including information within this document about the bespoke nature of the treatment provided by Addcounsel and the resulting financial implication of this. We always aim to ensure that all clients are fully aware of the type of service they are signing up to and the likely costs involved, so that they can withdraw if they feel it is not suitable for them.”

Source location

2018-0053-Response-by-Addcounsel
Page 3 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Hand responsibility for financing onward referral and treatment to the new provider when Addcounsel provides no immediate care.

Verbatim wording from the response

“As set out in your Report, this issue has been addressed and the actions set out in the Client Death Review undertaken following Mr MacDonald’s death have now been put in place. Our system has changed in the following ways:”

Source location

2018-0053-Response-by-Addcounsel
Page 1 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Obtain Independent Governance Committee agreement for the new financial-concerns policy.

Verbatim wording from the response

“• This policy will need to be agreed by our Independent Governance Committee and we hope to have it in place by the end of May 2018. It will then be distributed to each member of our multi-disciplinary team (MDT) by Michael Ishmail with a clear reminder of the process to follow in relevant situations.”

Source location

2018-0053-Response-by-Addcounsel
Page 3 · response
Published 8 June 2018

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

The reported £20,000 included Nightingale Hospital accommodation and treatment costs and did not represent Addcounsel’s services alone.

Verbatim wording from the response

“Further, it is important to highlight that the reference to £20,000 includes the cost of Mr MacDonald’s stay and treatment at Nightingale Hospital and is not representative of the cost of Addcounsel’s services alone.”

Source location

2018-0053-Response-by-Addcounsel
Page 2 · response
Published 8 June 2018

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026