Independent investigation: Edward Miles, Tower Hamlets (2003)

The Trust must ensure that all consultants working in Tower Hamlets are fully integrated into the community mental health teams. This must include regular attendance at team meetings, supervision of junior doctors and other staff, and active involvement in the day-to-day care of patients. The Trust must monitor the attendance and involvement of consultants in community teams and take action where there is insufficient engagement.

The Trust must ensure that there is a clear and consistent policy for the supervision of junior doctors and other clinical staff, and that this policy is rigorously implemented. Supervision must be regular, documented, and provide opportunities for junior staff to discuss cases, seek advice, and receive feedback on their practice. The Trust must monitor compliance with this policy and address any shortcomings.

The Trust must review and update its policies and procedures for care planning and the Care Programme Approach (CPA) to ensure they are fully compliant with national guidance and best practice. This must include clear guidance on the content of care plans, the frequency of reviews, the involvement of patients and carers, and the documentation of all aspects of the CPA process. The Trust must provide comprehensive training to all staff involved in care planning and CPA, and regularly audit compliance with the updated policies.

The Trust must ensure that all patients under section 117 of the Mental Health Act 1983 receive a comprehensive and regularly reviewed care plan, developed in full consultation with the patient and their carers. This care plan must clearly outline the patient's needs, the services to be provided, and the responsibilities of all involved professionals. The Trust must monitor compliance with this requirement and take action where care plans are not being developed or reviewed appropriately.

The Trust must develop and implement a strategy to increase the range of therapeutic options available to patients in Tower Hamlets, moving beyond a narrow medical focus. This should include greater access to psychological therapies, social interventions, and vocational support. The Trust must ensure that staff are trained in and encouraged to utilise a broader range of interventions, and that these are integrated into individual care plans.

The Trust must ensure that all inpatient reviews of patients on acute admissions wards are conducted in a standardised and systematic manner, with clear protocols for who should attend (including the responsible medical officer, care co-ordinator, and relevant nursing staff), the agenda for the review, and the documentation of decisions. These reviews must include a thorough assessment of the patient's mental state, risk, and progress towards discharge, and involve the patient and their carers where appropriate. The Trust must audit the quality and consistency of these reviews.

The Trust must ensure that the needs of children of service users are systematically identified and addressed within the care planning process. This must include routine enquiry about children, assessment of their needs and risks, and appropriate referral to children's services where concerns are identified. The Trust must establish clear pathways for liaison and information sharing with children's social care and other relevant agencies.

The Trust must ensure that its Incident Reporting Policy is fully and effectively implemented across all services. This includes ensuring that all serious untoward incidents are promptly reported, thoroughly investigated, and that lessons learned are disseminated and acted upon. The Trust must regularly audit compliance with this policy and demonstrate that it is leading to continuous improvement in patient safety.

The Trust must review its Equality and Diversity Action Plan to ensure it includes concrete, measurable actions and clear accountability for delivery. The plan must specifically address how the Trust will more effectively meet the diverse cultural and linguistic needs of its service users, including those from Pakistani Muslim backgrounds. This should involve active engagement with service users and community groups in the development and evaluation of services.

The Trust must ensure that all staff receive regular and comprehensive training on cultural competence and diversity, with a particular focus on understanding the specific needs and cultural contexts of the diverse communities it serves in Tower Hamlets. This training should aim to improve communication, build trust, and ensure that care is delivered in a culturally sensitive and appropriate manner.

The Trust must take immediate steps to address the issues identified regarding Doctor Falkowski's clinical practice, including his engagement with community teams, supervision of junior staff, and decision-making processes. This should involve a formal review of his practice, appropriate support and supervision, and, if necessary, disciplinary action. The Trust must ensure that all consultants adhere to the expected standards of clinical practice and engagement.

The Trust must implement a robust system for managing and storing patient records, ensuring that all documentation is complete, accurate, chronological, and easily accessible. This includes both inpatient and community notes, and Mental Health Act documentation. Regular audits of record-keeping practices must be conducted, and staff training provided to ensure compliance with standards.