Independent investigation: Camille Remy (pregnant), Hackney (2006)

The ELC NHS trust should keep the staffing levels of the SE CMHT under review to ensure that casework pressures do not adversely influence the way patients are managed and to ensure that individual caseloads are manageable and allow staff to fulfil all their professional obligations, including record-keeping, satisfactorily.

The SE CMHT should consider holding regular team meetings to discuss and review individual case-handling and any issues and lessonsarising.

ELC NHS trust should review the effectiveness of its arrangements for ensuring and verifying that consultants appropriately fulfil their responsibilities for supervising and appraising other medical staff.

ELC NHS trust should ensure that all staff with responsibility for the care of patients are subject to compulsory and ongoing training in risk assessment and risk management.

ELC NHS trust should amend its clinical risk assessment and management policy to set out the requirement for training ofthe kind recommended in recommendation 4 above.

BEH NHS trust should keep the patient numbers of individual medical staff under review to ensure that they are at all times manageable and allow staff to fulfil their professional obligations, including allowing them to have an appropriate grasp of the issues relating to their patients.

BEH NHS trust should keep the occupancy rates of its wards to the levels recommended by the Royal College of Psychiatrists and other professional bodies in order to ensure a safe environment.

BEH NHS trust should ensure that staff have regular planned opportunities for in depth consideration of and reflection on issues and challenges relating to their professional practicesand the care of individual patients.

BEH NHS trust should devise a system for ensuring thateach patient has a named nurse who is available to:
· provide comprehensive nurse assessment
· share and communicate thatassessmentappropriately
· ensure appropriate nursing care planning and management.

Where the named nurse is not available for a significant time or is unable to fulfil the requirements referred to at recommendation 9 above, another named or associate nurse should be appointed.

The BEH NHS trust should continue to monitor the implementation of the internal inquiry recommendations with regard to the need for compulsory and continuing training in risk assessment and risk management.

Newham council’s housing services should develop a multi-agency memorandum of understanding setting out the terms on which they can share information about clients thought to pose a risk to themselves or others with other relevant agencies and bodies, (including landlords), so that appropriate CPA and risk management plans for such clients can be devised and delivered.

The HPU should develop a process under which a pivotal person or persons within the HPU ensures on an ongoing basis that relevant information about clients’ mental health needs is gathered and reported back (in accordance with the suggested memorandum of understanding) to CMHTs, and any other relevant agency, as well as to Newham’s accommodation team and other staff in Newham council’s housing services.

In discussion with the CMHTs, Newham’s housing department should review the risk documentation that it receives in respect of clients with mental health needs to ensure that it encompasses and focuses on relevanthousing issues, including:
· the suitability of certain types ofaccommodation
· risks that the client might pose to housing workers, landlords, their employees and other tenants
· the oversight or other input to the client’s care plan that is required from housing workers
· the need to share information.

The HPU should amend its ‘procedure for mental health clients’ document to require that the risks relating to housing a client are reassessed in the event of a significant change in the client’s circumstances, such asa period in hospital, or a lengthy unexplainedabsence.

The ELC NHS trust should ensure that all staff caring for patients undertake robust care planning in line with current policy and best practice in relation to the care programme approach, which includes risk assessment and risk management, and that they understand where responsibility for such assessments and plans lies.

The ELC NHS trust should amend its clinical risk assessment and risk management policy to reflect the fact that the risk assessment and management process begins the moment a person is first assessed and not merely when they are registered for CPA or are deemed to be receiving specialist mentalhealth care.

Adherence to the requirement for proper CPA planning (see recommendation 16 above) and the need to begin risk assessment and risk management from the time a person is first assessed by services (see recommendation 17 above) should be monitored through regular audits undertaken as indicated in the ELC NHS trust’s response to the internal investigation.

The ELC NHS trust should continue to monitor the implementation of the internal investigation recommendations in relation to patient discharge.

The BEH NHS trust should ensure that risk assessments and risk management plans are discussed in multidisciplinary team meetings so that all professions can contribute relevant information and understand any plans devised.

North East London Mental Health Foundation Trust should ensure that medical staff carry outa physicalexamination on patients as part of the admission procedure.

ELC NHS trust, BEH NHS trust and the HPU should remind all staff of the need to keep a full record of the contacts that they have with a patient and all significant discussions that they have in relation to a patient.

BEH NHS trust should ensure that staff required to prepare reports or give evidence before a MHRT are informed immediately of any application to the MHRT and of any date fixed for a MHRT hearing so they can prepare for the hearing.

BEH NHS trust should ensure that trust staff required to prepare reports or give evidence to a MHRT are adequately:
· trained
· supervised
· supported
· updatedon new developments
in relation to the practice and procedure of the MHRT, report writing for the MHRT and presenting evidence and argument to the MHRT.