Recommendation
We recommend that Whitepost Healthcare Group now commissions an independent, top to bottom, governance review at Shrewsbury Court with the objective of consolidating and building upon on the improvements made there since the homicide and supplementing the Recommendations and Requirements …
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We recommend that Whitepost Healthcare Group now commissions an independent, top to bottom, governance review at Shrewsbury Court with the objective of consolidating and building upon on the improvements made there since the homicide and supplementing the Recommendations and Requirements provided to date by the HC.
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Recommendation
We recommend to PCTs, Trusts and Social Services that the process of monitoring a patient’s placement in an “out-of-area” hospital should always include active consideration of whether the hospital in question is providing a service of an acceptable standard. A …
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We recommend to PCTs, Trusts and Social Services that the process of monitoring a patient’s placement in an “out-of-area” hospital should always include active consideration of whether the hospital in question is providing a service of an acceptable standard. A starting point for any such consideration ought to be a regular consideration of recent reports from the HC and the other regulatory authorities. But additionally, on any occasion when a CPA meeting is held for a patient who is placed “out-of-area”, consideration ought specifically to be given by the care co-ordinator to the question of whether there are any grounds for concern about the quality of care being provided. A “checklist” of points to consider should be prepared. Such a checklist should include, as a minimum, the most recent reports from the HC; whether the patient, or the patient’s family, have raised any concerns about the quality of service; whether there are any obvious environmental issues apparent when visiting the premises; and whether the documentation prepared for the CPA meeting complies with the standards normally to be expected. This should be a routine part of any CPA meeting in respect of a patient placed “out-of-area”. It should also be a routine part of this process to consider whether CPA meetings are being arranged with appropriate frequency/regularity.
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Recommendation
We recommend to PCTs, Trusts and Social Services that consideration should be given by those purchasing or commissioning services from the independent sector to the creation of a post, or a team, specifically employed to follow up patients placed in …
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We recommend to PCTs, Trusts and Social Services that consideration should be given by those purchasing or commissioning services from the independent sector to the creation of a post, or a team, specifically employed to follow up patients placed in the independent sector, with a view to ensuring that the placement remains appropriate and cost-effective; and with a view also to preparing annual reports for the PCT upon each independent hospital from which services are being purchased. These annual reports should be accessible to all involved in making placement decisions and should also be provided to the HC to assist it in the process of determining how best to focus its resources.
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Recommendation
We recommend to PCTs, Trusts and Social Services that it should be re-emphasised to those involved in making recommendations for placements for psychiatric patients that the primary concern must always be the patient’s individual needs, rather than financial considerations.
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We recommend to PCTs, Trusts and Social Services that it should be re-emphasised to those involved in making recommendations for placements for psychiatric patients that the primary concern must always be the patient’s individual needs, rather than financial considerations.
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Recommendation
We recommend to SHAs that consideration should be given to the question of whether the needs of patients with a significant forensic history, who would normally fall within the care of the forensic services, are adequately met by existing old …
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We recommend to SHAs that consideration should be given to the question of whether the needs of patients with a significant forensic history, who would normally fall within the care of the forensic services, are adequately met by existing old age psychiatric services; or whether there is a need, locally or regionally, for a unit with the expertise to provide care, to the level of medium security, specifically for older adult males with a forensic history. Similarly, the need for forensic psychiatrists, and for multi-disciplinary forensic teams, specialising in old age should be assessed and appropriate posts created accordingly, as a central initiative if necessary.
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Recommendation
We recommend to Trusts that a formal handover / discharge report should be completed whenever an in-patient at a mental health hospital is transferred, even temporarily, to another hospital; and also when that patient is subsequently returned to the mental …
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We recommend to Trusts that a formal handover / discharge report should be completed whenever an in-patient at a mental health hospital is transferred, even temporarily, to another hospital; and also when that patient is subsequently returned to the mental health hospital.
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Recommendation
We recommend to PCTs and Trusts that, when commissioning mental health services, whether from within the NHS or from the independent sector, evidence should be sought and obtained from service providers that they have incorporated the guidance from the Department …
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We recommend to PCTs and Trusts that, when commissioning mental health services, whether from within the NHS or from the independent sector, evidence should be sought and obtained from service providers that they have incorporated the guidance from the Department of Health’s “Best Practice in Managing Risk” publication2 into their risk assessment and management policies and procedures; and have adopted a structured, validated risk assessment tool with all clinical staff trained and regularly updated in its use.
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Recommendation
We recommend to the Department of Health that its advice on risk assessment should be adapted to incorporate (a) passages emphasising the difference between dangerousness and disturbed behaviour; and (b) a discussion of age and risk.
Recommendation
We recommend to SHAs that interfaces between general psychiatry, old age psychiatry services and the forensic psychiatry services in each region should be clearly defined. Clear protocols and pathways for the transfer of care and responsibility between different elements of …
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We recommend to SHAs that interfaces between general psychiatry, old age psychiatry services and the forensic psychiatry services in each region should be clearly defined. Clear protocols and pathways for the transfer of care and responsibility between different elements of a psychiatric service should be drawn up by provider organisations.
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Recommendation
We recommend to Trusts providing mental health services that no reports for Managers’ hearings or Mental Health Review Tribunals should be prepared in isolation from other members of the multi-disciplinary team.
Recommendation
We recommend to Trusts that the guidance given to Hospital Managers, in the course of their training, should include the strongest possible caution against discharging a detained patient against the advice of the RMO without having first taken oral evidence …
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We recommend to Trusts that the guidance given to Hospital Managers, in the course of their training, should include the strongest possible caution against discharging a detained patient against the advice of the RMO without having first taken oral evidence from the RMO (9.155).
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Recommendation
We recommend to the Department of Health and to SHAs that consideration should be given to the creation of a National Directory of organisations (both within the NHS and in the independent sector) which provide services to the mentally ill, …
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We recommend to the Department of Health and to SHAs that consideration should be given to the creation of a National Directory of organisations (both within the NHS and in the independent sector) which provide services to the mentally ill, with details of those organisations’ admission criteria.
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Recommendation
We recommend to Trusts that there should be a comprehensive review of the nature and extent of the training given to hospital managers before they sit on appeals of cases admitted under Part III of the Mental Health Act (9.162).
Recommendation
We recommend to SLaM that the nature and extent of the training given to hospital managers before they sit on appeals of cases admitted under Part II and Part III of the Mental Health Act 1983, in order to assess …
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We recommend to SLaM that the nature and extent of the training given to hospital managers before they sit on appeals of cases admitted under Part II and Part III of the Mental Health Act 1983, in order to assess whether that training, even as already improved in the aftermath of AT’s death, is sufficiently detailed and wide-ranging to enable those managers to have a proper understanding of the legal principles which need to be applied, and of the distinction between issues concerning the “nature” of the mental illness and the “degree” of that illness.
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Recommendation
We recommend to the Ministry of Justice that the new guidance to be issued to judges in 2008 make prominent the fact that hospital managers can (and do) discharge Section 37 Orders against medical advice, if restriction orders under Section …
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We recommend to the Ministry of Justice that the new guidance to be issued to judges in 2008 make prominent the fact that hospital managers can (and do) discharge Section 37 Orders against medical advice, if restriction orders under Section 41 are not made concurrently.
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Recommendation
We recommend to Trusts that all units providing residential care to the mentally ill should have a formal policy relating to sexual relationships involving in-patients; and that whenever a placement is being considered “out-of-area”, or in the independent sector, steps …
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We recommend to Trusts that all units providing residential care to the mentally ill should have a formal policy relating to sexual relationships involving in-patients; and that whenever a placement is being considered “out-of-area”, or in the independent sector, steps are taken to ascertain the policy adopted in this regard by the establishment(s) under consideration.
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Recommendation
We recommend that the HC give urgent consideration to the ways in which it might better publicise its role, with a view to ensuring that members of the public who may have concerns about an independent hospital are aware that …
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We recommend that the HC give urgent consideration to the ways in which it might better publicise its role, with a view to ensuring that members of the public who may have concerns about an independent hospital are aware that the HC exists; that it has a regulatory role; that it exists to ensure that standards are maintained at independent hospitals; and that it is an appropriate place to communicate concerns about standards at an independent hospital.
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Recommendation
We recommend to the HC that it takes steps also to encourage healthcare professionals to communicate any concerns which they may have about standards at any independent hospital to the HC, with a view to creating a culture whereby any …
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We recommend to the HC that it takes steps also to encourage healthcare professionals to communicate any concerns which they may have about standards at any independent hospital to the HC, with a view to creating a culture whereby any healthcare professional who has concerns about a particular establishment will communicate those concerns to the HC.
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Recommendation
We recommend to the HC that it should liaise with those responsible for commissioning or purchasing services from the independent sector with a view to putting in place systems whereby i. Those commissioning/purchasing services from the independent sector prepare regular …
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We recommend to the HC that it should liaise with those responsible for commissioning or purchasing services from the independent sector with a view to putting in place systems whereby i. Those commissioning/purchasing services from the independent sector prepare regular formal assessments of the quality of care being provided by establishments in the independent sector, ideally with criteria being agreed with regard to the nature and extent of those assessments; and ii. Those assessments are provided to the HC to assist in the process of assessing how best to focus resources.
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Recommendation
We recommend to the HC that it should continue to work towards producing a system of categorising establishments by reference to objective criteria, with a view • to producing some form of objective assessment of the overall quality of an …
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We recommend to the HC that it should continue to work towards producing a system of categorising establishments by reference to objective criteria, with a view • to producing some form of objective assessment of the overall quality of an establishment. • to providing an internal record of the extent of concern about an establishment and, accordingly, information about the extent to which that establishment was in need of follow-up. We further recommend that this information should be incorporated within the publicly available reports about each establishment, so as to provide service-users with a clear and easily accessible picture of the HC’s overall views about that establishment.
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Recommendation
We recommend to SHAs that consideration should be given to ways of encouraging smaller independent hospitals, which have only limited infrastructure for the implementation of clinical governance, to look at partnership working with other providers or to join appropriate networks …
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We recommend to SHAs that consideration should be given to ways of encouraging smaller independent hospitals, which have only limited infrastructure for the implementation of clinical governance, to look at partnership working with other providers or to join appropriate networks to access expertise and peer support.
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Recommendation
We recommend to the HC that it reconsiders the extent to which reliance upon “self-assessment” declarations by establishments in the independent sector is of any significant value in determining how best to allocate the HC’s resources, and in deciding the …
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We recommend to the HC that it reconsiders the extent to which reliance upon “self-assessment” declarations by establishments in the independent sector is of any significant value in determining how best to allocate the HC’s resources, and in deciding the frequency with which such establishments are visited by the HC’s inspectors.
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Recommendation
We recommend to Primary Care Trusts (PCTs), NHS Trusts providing mental health services (Trusts) and Social Services that, whenever placement decisions are being made, care co-ordinators should be required to compile and maintain a formal record, in a single, easily …
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We recommend to Primary Care Trusts (PCTs), NHS Trusts providing mental health services (Trusts) and Social Services that, whenever placement decisions are being made, care co-ordinators should be required to compile and maintain a formal record, in a single, easily accessible document, which sets out each of the placement options considered from time to time for the patient in question; which documents the approaches made to each, and the response(s) received; and which explains the reasons why the placement eventually selected was chosen in preference to other possible options.
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Recommendation
We recommend to the HC that it makes representations to the Department of Health, urging it to take such steps as may be necessary to enable the Mental Health Patient Survey to be extended to the independent sector.
Recommendation
We recommend to the HC that it reviews the issue of whether it is appropriate for establishments in the independent sector to be given advance notice of impending inspections by the HC, and that it should aim to minimise the …
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We recommend to the HC that it reviews the issue of whether it is appropriate for establishments in the independent sector to be given advance notice of impending inspections by the HC, and that it should aim to minimise the number of occasions upon which such notice is in fact given.
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Recommendation
We recommend to the HC that it should use its powers of enforcement to ensure that, save in exceptional circumstances, no independent hospital is without a Registered Manager, who has been approved by the HC as a “fit person”, for …
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We recommend to the HC that it should use its powers of enforcement to ensure that, save in exceptional circumstances, no independent hospital is without a Registered Manager, who has been approved by the HC as a “fit person”, for a period of more than six months.
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Recommendation
We recommend to the Department of Health that it consider taking ownership of many of the recommendations of this Inquiry and incorporating them into central guidance.
Recommendation
We recommend to PCTs, Trusts and Social Sevices that, when considering commissioning services from a hospital in the independent sector, those involved in the placement decision should, as a matter of routine, always look at the latest reports prepared by …
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We recommend to PCTs, Trusts and Social Sevices that, when considering commissioning services from a hospital in the independent sector, those involved in the placement decision should, as a matter of routine, always look at the latest reports prepared by the HC and the MHA Commissioners on any hospital under consideration, in order to ascertain whether there are any concerns about the establishment which might be material to the placement decision.
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Recommendation
We recommend to PCTs, Trusts and Social Serivces that in any case in which an out–of-area placement is being considered at an establishment with which those responsible for the patient’s care are unfamiliar, it should be mandatory for a visit …
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We recommend to PCTs, Trusts and Social Serivces that in any case in which an out–of-area placement is being considered at an establishment with which those responsible for the patient’s care are unfamiliar, it should be mandatory for a visit to be made to that establishment, in order to assess its suitability for a patient, and that such visits should be made by an individual, or by a team which has both a proper understanding of the patient’s needs and sufficient experience/expertise to make an informed assessment of the establishment in question.
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Recommendation
We recommend to PCTs, Trusts and Social Serivces that when an “out-of-area” placement is being considered, care co-ordinators should obtain and formally record a standard set of basic information relating to the establishment under consideration and the care which they …
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We recommend to PCTs, Trusts and Social Serivces that when an “out-of-area” placement is being considered, care co-ordinators should obtain and formally record a standard set of basic information relating to the establishment under consideration and the care which they provide before services are commissioned. The nature and extent of the information to be gathered in this way is a matter for detailed consideration – this Report includes a number of suggestions in this regard.
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Recommendation
We recommend to PCTs, Trusts and Social Services that those responsible for placing patients in the independent sector should consider adopting significantly more detailed contracts with the hospitals with which they contract, with a view to imposing specific and detailed …
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We recommend to PCTs, Trusts and Social Services that those responsible for placing patients in the independent sector should consider adopting significantly more detailed contracts with the hospitals with which they contract, with a view to imposing specific and detailed contractual obligations with regard to level of service to be provided, and with consideration also being given to the imposition of proportionate financial penalties in the event of non-compliance. (8.186) Among other matters, we recommend that it should be made clear to service providers that it is expected, as a matter of routine, (and will be required, as a matter of contract) that at the pre-transfer case conferences, both hospitals will be represented by appropriately senior staff; and that, in all but the most straightforward cases, this means that there should be a multi-disciplinary representation, including the presence of both the transferring and the receiving consultants.
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Recommendation
We recommend to Trusts that consideration should be given to the adoption of a policy that, when teams are referring a patient “out-of-area”, or to a unit in the independent sector, they should routinely ask to see the written assessment …
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We recommend to Trusts that consideration should be given to the adoption of a policy that, when teams are referring a patient “out-of-area”, or to a unit in the independent sector, they should routinely ask to see the written assessment report carried out by the assessing team at the establishment to which the transfer is contemplated; and ensure that that assessment is reviewed by or on behalf of the current RMO before the transfer takes place.
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Recommendation
We recommend to PCTs, Trusts and Social Services that cases brought to a placement panel should be accompanied by a full, up to-date, chronology, with a view to ensuring that all past behaviour is fully realised and considered by the …
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We recommend to PCTs, Trusts and Social Services that cases brought to a placement panel should be accompanied by a full, up to-date, chronology, with a view to ensuring that all past behaviour is fully realised and considered by the panel when deciding whether or not to endorse a recommended placement.
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