Roderick McIntosh Donnet

Changes must be made utilising modern technology to end this unacceptable state of affairs to ensure that GPs are made aware as soon as possible, and in any event within no more than seven days, by a doctor who played an active role in the patient's in-patient treatment, what was the basis for the discharge, what was the diagnosis and prognosis, what investigations were undertaken and what were their results, what further hospital in or out-patient treatment is planned and what further care or treatment it is recommended should be managed by the GP.

The management of Ninewells Hospital should examine and assess the establishment in Edinburgh of the availability of a liaison nurse for persons with learning disability who are admitted to general hospital suffering from a physical illness to ascertain whether there would be merit in introducing a similar provision at Ninewells.

There might be merit in adding to the CentralVision process some means of flagging that a result from one of the laboratories was outstanding.

Something fundamental requires to be done by Ninewells management to reduce the pressure on hospital beds. It was increasingly apparent, listening to the evidence of the doctors based in various hospitals that the pressure caused by an insufficient number of beds may from time to time lead to questionable decisions being made about patient discharge. It is clear with hindsight that Roddy's diagnosis would have been definitive had he co-operated with a fexible sigmoidoscopy and then effective treatment, whether in hospital or, taking proper account of his management difficulties, in the community.

The Scottish Executive require to consider the problems associated with providing hospital care to persons who are incapacitated when they develop physical disorders. It is unhelpful both to them and other patients to be admitted to and nursed in a normal ward setting. Sheriff Dunbar, in the Mauchland case, also highlighted the risks inherent in putting such a patient with an inability to communicate when something was wrong, in a side room. I do not consider that it would be appropriate on the evidence I heard to suggest a solution to the problem and so I simply record that both Dr. Starr and Dr. Morrison believed that specialist units, in which an incapacitated patient with a physical disorder would be cared for by a mixture of general and psychiatrically trained nurses working together, and under the care of a consultant psychiatrist and the consultant relevant to the particular medical specialty also working together, would provide a more satisfactory outcome for patients.