Source · Investigations in the NHS
An independent investigation into the care and treatment of mental health service user Mr E : Published April 2023
North West
Published 01 Apr 2023
Trust Mersey Care NHS Foundation Trust
Subject Mr E
Index summary
These are the full report and lessons learned bulletin of the independent investigation report into the care and treatment of service user Mr E. Following an incident in January 2019, Mr E was convicted of murder. At the time of the incident, Mr E was under the care of Mersey Care NHS Foundation Trust. These documents have also been published by:
Recommendations
Recommendation · source text
The Trust and the probation service should agree a protocol for the management of MHTRs. This should include an information sharing agreement, key milestones for contact/meetings and escalation pathways when concerns are identified.
Recommendation · source text
The Trust should review the provision of forensic services input to community services to ensure community teams have access to forensic assessments for CMHT-based high-risk service users.
Recommendation · source text
The Trust should ensure that its process for involving affected families in its internal investigation process includes providing an opportunity for families to submit feedback on the draft report.
Recommendation · source text
The Trust should review its CPA policy to ensure it reflects best practice guidance in relation to the involvement of the families of service users, beyond those formally considered ‘carers’, in CPA and care planning.
Recommendation · source text
The Trust must ensure a service user’s plan of care remains continuous if admitted to an inpatient ward from the community, with appropriate liaison and engagement with the community team and other services as required.
Recommendation · source text
The CCG/ICB should ensure the Trust has addressed the outstanding elements of its internal investigation action plan within six months of receipt of this report.
Acceptance status
No Response Published
6
Total recommendations
6