Pennine Care NHS Foundation Trust
NHS / Health Body
Action Planned
The Trust has drafted a process for requesting second opinions from consultant psychiatrists, healthcare professionals, patients, families, and carers which will be submitted to the Trust's Quality Group for scrutiny and sign-off and implemented across Pennine Care NHS Foundation Trust's services. They are also working to improve adherence to the Triangle of Care standards, including surveys, workshops, and relaunching the program trust-wide. (AI summary)
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Dear Ms McKenna
I write in response to your Regulation 28 report dated 28th May 2021 and in respect of the concern you have highlighted after hearing evidence of the inquest of Ms Angela Frost.
Your concern has been reviewed and Pennine Care's response is outlined below.
Coroners Concern
(1) There is no formal guidance or process in place at the Trust for Consultant Psychiatrists to seek a second opinion in relation to diagnosis, treatment plans or whether a patient meets the criteria for detention under the Mental Health Act. The evidence was that while there is nothing to prohibit a Consultant requesting a second opinion, it rarely happens in practice.
(2) There is no formal guidance or process in place at the Trust for health care professionals or family members to seek a second opinion in relation to the matters set out above.
Since Ms Frost's untimely death, the Triumvirate Leadership Team for Oldham's Mental Health Services has reviewed the Trusts internal processes to request second opinions. Below is a summary of the work that has been done so far:
- A draft process for requesting second opinions has been written, and this will be submitted to the Trusts Quality Group for scrutiny and sign-off. The process includes guidance for how Consultant Psychiatrists, Health Care Professionals, patients, families and carers can request a second opinion.
- The process will be implemented across all of Pennine Care NHS Foundation Trust's (PCFT's) services.
- The draft process is attached.
(3) The court heard evidence that there is a lack of understanding on the part of inpatient Consultants as to rules around confidentiality and the nature/extent of permissible communication with family members i.e.: the difference between receiving information which might inform diagnosis, treatment and risk planning and discussions which involve sharing confidential health information.
(Consultant Psychiatrist and Clinical Director) has reviewed the concerns related to Consultant Psychiatrists lack of understanding of rules pertaining to confidentiality and sharing information with family and carers.
Consultant Psychiatrists The serious incident investigation that was submitted to HM Coroner as evidence for the Inquest of Ms Frost identified individual performance issues with the Aspen Ward Consultant Psychiatrist involved in Ms Frosts care and treatment. The Consultant Psychiatrist is involved in an informal performance management programme.
All Consultant Psychiatrists employed by PCFT complete training, which covers issues related to information sharing. The training courses include:
- Mental Capacity Act
- Deprivation of Liberty Safeguards
- Safeguarding Children and Adults
- Section 12 and Approved Clinician Course (Mental Health Act, 1983)
Consultant Psychiatrists also access annual appraisals and can access case-based discussions with senior consultants, both of which are supportive mechanisms that support clinical practice. Triangle of Care PCFT is also a member of the Triangle of Care initiative. The 'Triangle of Care' is a working collaboration, or "therapeutic alliance" between the service user, professional and carer that promotes safety, supports recovery and sustains well- being.
PCFT first introduced our Trust-wide Triangle of Care steering group in 2014, followed by the establishment of each borough's local steering group to build on our success. This included Oldham. Before the Covid-19 pandemic, our momentum slowed as some of the local steering groups Chairs were lost, and carer champions moved posts. Covid-19 compounded these difficulties as a result of the pressures placed on services. Our Trust-wide steering group has re-commenced following it being stood down due to Covid-19.
To regain our momentum with Triangle of Care, we are currently:
- Undertaking a survey of inpatient and community service managers about the extent to which services are currently able to meet standards, seek examples
of good practice and understand any barriers that there may be implementing. This includes our services in Oldham.
- Collating a survey of carers undertaken where we sought examples of how it feels when we achieve each of the six key standards and when we do not. This will supplement the survey sent to inpatient and community service managers to provide a lived-experience context to the exercise. We will also consider how else this could usefully be used, for example, in training.
- We are working with our Network Directors of Quality to identify Chairs and local approaches to steering groups; again, this includes Oldham.
As we complete the work outlined above, we will move forward by:
- Holding a co-design workshop with the identified local lead/Chairs and carers to establish the framework/agenda that local forums will work to and decide the areas that should be prioritised. The outcome of our survey across our services will be used to inform this piece of work.
- Arranging a co-designed re-launch of the Triangle of Care, Trust-wide and in each borough, to reinvigorate our work and to promote it and build engagement internally and externally.
- Complete our annual report to ensure that we retain our first star and co- design a plan to move towards our second.
- Continue national conversations and if there is a continued absence of regional or national groups, seek to establish a group with other Trusts to promote inter-organisational learning.
In January 2021, PCFT appointed to the new role of Head of Patient and Carer Experience and Engagement. continues to work with services across the Trust to develop further and embed the principles of Triangle of Care in mental health services.
I trust this response assures you that the Trust has taken your concern seriously and has thoroughly reviewed the issues raised.
I write in response to your Regulation 28 report dated 28th May 2021 and in respect of the concern you have highlighted after hearing evidence of the inquest of Ms Angela Frost.
Your concern has been reviewed and Pennine Care's response is outlined below.
Coroners Concern
(1) There is no formal guidance or process in place at the Trust for Consultant Psychiatrists to seek a second opinion in relation to diagnosis, treatment plans or whether a patient meets the criteria for detention under the Mental Health Act. The evidence was that while there is nothing to prohibit a Consultant requesting a second opinion, it rarely happens in practice.
(2) There is no formal guidance or process in place at the Trust for health care professionals or family members to seek a second opinion in relation to the matters set out above.
Since Ms Frost's untimely death, the Triumvirate Leadership Team for Oldham's Mental Health Services has reviewed the Trusts internal processes to request second opinions. Below is a summary of the work that has been done so far:
- A draft process for requesting second opinions has been written, and this will be submitted to the Trusts Quality Group for scrutiny and sign-off. The process includes guidance for how Consultant Psychiatrists, Health Care Professionals, patients, families and carers can request a second opinion.
- The process will be implemented across all of Pennine Care NHS Foundation Trust's (PCFT's) services.
- The draft process is attached.
(3) The court heard evidence that there is a lack of understanding on the part of inpatient Consultants as to rules around confidentiality and the nature/extent of permissible communication with family members i.e.: the difference between receiving information which might inform diagnosis, treatment and risk planning and discussions which involve sharing confidential health information.
(Consultant Psychiatrist and Clinical Director) has reviewed the concerns related to Consultant Psychiatrists lack of understanding of rules pertaining to confidentiality and sharing information with family and carers.
Consultant Psychiatrists The serious incident investigation that was submitted to HM Coroner as evidence for the Inquest of Ms Frost identified individual performance issues with the Aspen Ward Consultant Psychiatrist involved in Ms Frosts care and treatment. The Consultant Psychiatrist is involved in an informal performance management programme.
All Consultant Psychiatrists employed by PCFT complete training, which covers issues related to information sharing. The training courses include:
- Mental Capacity Act
- Deprivation of Liberty Safeguards
- Safeguarding Children and Adults
- Section 12 and Approved Clinician Course (Mental Health Act, 1983)
Consultant Psychiatrists also access annual appraisals and can access case-based discussions with senior consultants, both of which are supportive mechanisms that support clinical practice. Triangle of Care PCFT is also a member of the Triangle of Care initiative. The 'Triangle of Care' is a working collaboration, or "therapeutic alliance" between the service user, professional and carer that promotes safety, supports recovery and sustains well- being.
PCFT first introduced our Trust-wide Triangle of Care steering group in 2014, followed by the establishment of each borough's local steering group to build on our success. This included Oldham. Before the Covid-19 pandemic, our momentum slowed as some of the local steering groups Chairs were lost, and carer champions moved posts. Covid-19 compounded these difficulties as a result of the pressures placed on services. Our Trust-wide steering group has re-commenced following it being stood down due to Covid-19.
To regain our momentum with Triangle of Care, we are currently:
- Undertaking a survey of inpatient and community service managers about the extent to which services are currently able to meet standards, seek examples
of good practice and understand any barriers that there may be implementing. This includes our services in Oldham.
- Collating a survey of carers undertaken where we sought examples of how it feels when we achieve each of the six key standards and when we do not. This will supplement the survey sent to inpatient and community service managers to provide a lived-experience context to the exercise. We will also consider how else this could usefully be used, for example, in training.
- We are working with our Network Directors of Quality to identify Chairs and local approaches to steering groups; again, this includes Oldham.
As we complete the work outlined above, we will move forward by:
- Holding a co-design workshop with the identified local lead/Chairs and carers to establish the framework/agenda that local forums will work to and decide the areas that should be prioritised. The outcome of our survey across our services will be used to inform this piece of work.
- Arranging a co-designed re-launch of the Triangle of Care, Trust-wide and in each borough, to reinvigorate our work and to promote it and build engagement internally and externally.
- Complete our annual report to ensure that we retain our first star and co- design a plan to move towards our second.
- Continue national conversations and if there is a continued absence of regional or national groups, seek to establish a group with other Trusts to promote inter-organisational learning.
In January 2021, PCFT appointed to the new role of Head of Patient and Carer Experience and Engagement. continues to work with services across the Trust to develop further and embed the principles of Triangle of Care in mental health services.
I trust this response assures you that the Trust has taken your concern seriously and has thoroughly reviewed the issues raised.