Independent investigation: Henrietta Leane, Cricklewood (1997)

The Trust should ensure that the case of every new patient referred to the Out-patient Clinic is initially screened by a multi-disciplinary team and that a decision is then taken as to whether the patient is a suitable candidate for … Read more The Trust should ensure that the case of every new patient referred to the Out-patient Clinic is initially screened by a multi-disciplinary team and that a decision is then taken as to whether the patient is a suitable candidate for mental health or social care and, if so, by whom the assessment of that patient is best to be undertaken. Show less

The Trust should devise and implement a procedure whereby every patient whose assessment is to be carried out in the Out-patient Clinic is so far as possible seen by a Consultant Psychiatrist or (if this proves impracticable) discussed with the … Read more The Trust should devise and implement a procedure whereby every patient whose assessment is to be carried out in the Out-patient Clinic is so far as possible seen by a Consultant Psychiatrist or (if this proves impracticable) discussed with the Consultant and the outcome of that discussion recorded in the case notes. Show less

The Trust should ensure that every assessment includes an evaluation of risk and that this is properly documented.

The Trust should ensure that following assessment of a patient a Care Plan which complies with the requirements of the CPA is always formulated and recorded and that it includes express reference to the Level on which the patient is … Read more The Trust should ensure that following assessment of a patient a Care Plan which complies with the requirements of the CPA is always formulated and recorded and that it includes express reference to the Level on which the patient is to be managed and a review date. Show less

The Trust should ensure that the case notes of every patient attending at the Out-patient Clinic have a front sheet setting out primary information about the patient and summarising the actions taken.

The Trust should encourage a greater input by carers into the information on the basis of which the Care Plan is prepared.

The Trust should undertake a review of the process of appointment of key workers and should not permit a junior psychiatrist to undertake the role of key worker for a patient unless the Care Plan is straightforward, short term and … Read more The Trust should undertake a review of the process of appointment of key workers and should not permit a junior psychiatrist to undertake the role of key worker for a patient unless the Care Plan is straightforward, short term and does not necessitate the involvement of other professionals. Show less

The Trust should devise and implement a procedure whereby a patient who has attended at the Out-patient Clinic for a period in excess of one year is thereafter invariably seen by a Consultant.

The Trust should carry out a general review of the functioning of the Out-patient Clinic for the purpose of achieving an equitable distribution of the workload between the senior and junior psychiatrists.

The Trust should introduce a handover procedure, to be supervised by the Consultants, whereby junior psychiatrists coming to the end of a placement are required to make an entry in the case notes of their patients describing the salient problems … Read more The Trust should introduce a handover procedure, to be supervised by the Consultants, whereby junior psychiatrists coming to the end of a placement are required to make an entry in the case notes of their patients describing the salient problems and the way in which they are being managed. Show less

The Trust should carry out a review of the appointments system in the Out-patient Clinic so as to achieve so far as practicable consistency between the recommended and actual intervals and expeditious follow up in the event of non-attendance.

The Trust should impress upon patients and their General Practitioners the importance of adhering to the regime of medication recommended in the Out-patient Clinic.

The Trust should ensure that in any case in which it is suspected that a social problem is significantly contributing to a patient's illness or disorder action is taken with a view to assessing the extent of that problem and … Read more The Trust should ensure that in any case in which it is suspected that a social problem is significantly contributing to a patient's illness or disorder action is taken with a view to assessing the extent of that problem and that if upon such assessment it is apparent that the patient would benefit from support careful consideration is given to the best method of providing it and in particular to the need for referral to the Social Services. Show less

The Trust should carry out a review of the process of referral of patients from the Out-patients Clinic to the Day Hospital, psychotherapy services and voluntary counselling organisations so as to ensure that sufficient and suitable use is made of … Read more The Trust should carry out a review of the process of referral of patients from the Out-patients Clinic to the Day Hospital, psychotherapy services and voluntary counselling organisations so as to ensure that sufficient and suitable use is made of these facilities. Show less

The Trust and the Social Services Department should ensure that there are effective channels of communication between the medical teams and the Social Services.

The Trust and the Social Services Department should work together to co-ordinate the processes of the CPA and Care Management in order to avoid differences in policy and practice, duplication of effort and inefficient use of resources.

The Trust, the Health Authority and the Social Services Department should review the allocation of resources so as to ensure as far as possible that an adequate range of services is available for individuals with a mental illness or personality … Read more The Trust, the Health Authority and the Social Services Department should review the allocation of resources so as to ensure as far as possible that an adequate range of services is available for individuals with a mental illness or personality disorder who require a medium level of support. Show less

The Health Authority should monitor the performance by the Trust of its obligations under the CPA.