Independent investigation: Lewis Hodge, Birmingham (1999)

a. Strategic Health Authority, the trust, the PCTs and Birmingham City Council No Response Published

Recommendation

That the Strategic Health Authority, the trust, the PCTs and Birmingham City Council forthwith jointly instruct an independent organisation such as the Audit Commission to examine the level of expenditure on mental health services in Birmingham, both at present and … Read more That the Strategic Health Authority, the trust, the PCTs and Birmingham City Council forthwith jointly instruct an independent organisation such as the Audit Commission to examine the level of expenditure on mental health services in Birmingham, both at present and in the recent past. This financial review should involve comparing NHS and social services expenditure on mental health services with that expended by a selection of authorities in other urban areas with a similar demographic profile. The organisation instructed should have free access to all relevant financial information possessed by the instructing bodies. No pressure should be brought on the organisation to reach a particular view. Only factual inaccuracies in the draft report should be corrected or amended. Such inaccuracies aside, the instructing bodies should commit themselves in advance to accepting the findings set out in the report, and any conclusions concerning the level of expenditure that is now necessary to correct and make good any shortfall in current or recent expenditure. The report should be published and made readily available locally. Show less

aa. managers of mental health services No Response Published

Recommendation

That managers of mental health services should seek to ensure that their employees are well treated and within resources that they receive those periodic rewards for good work, perquisites and other gestures of recognition that an employee of a non-public … Read more That managers of mental health services should seek to ensure that their employees are well treated and within resources that they receive those periodic rewards for good work, perquisites and other gestures of recognition that an employee of a non-public body of equivalent size and resources might reasonably expect to receive. Show less

b. Health Authority No Response Published

Recommendation

Having regard to the pressure on beds in Birmingham, that the Health Authority immediately takes advice from the local trust and from social services mental health team managers as to the number of additional local in-patient beds, crisis house facilities … Read more Having regard to the pressure on beds in Birmingham, that the Health Authority immediately takes advice from the local trust and from social services mental health team managers as to the number of additional local in-patient beds, crisis house facilities and intermediate residential facilities that are required in order to reduce bed occupancy to an average level of 90% across the trust; and that the Health Authority then attempts to broker an investment agreement between the local PCTs and Birmingham City Council that addresses the realities of the situation. This process should be transparent, and the Health Authority should publish a full and fair summary of the advice tendered by the trust and mental health team managers and of the investment decisions. Show less

bb. the trust and the social services authority No Response Published

Recommendation

That the trust and the social services authority devise simple procedures which ensure that, when a person in contact with either service commits homicide, the needs of the immediate family of both the deceased and the patient are ascertained, and … Read more That the trust and the social services authority devise simple procedures which ensure that, when a person in contact with either service commits homicide, the needs of the immediate family of both the deceased and the patient are ascertained, and they are supported. Show less

c. all local mental health services No Response Published

Recommendation

That all local mental health services must have access to crisis teams and crisis residential alternatives to hospital admission, and that additional funding should be made available for this.

d. ward managers No Response Published

Recommendation

That ward managers meet with the Director of Nursing in order (a) to review the range and quantity of documentation that ward nurses are required to complete, with a view to reducing the volume significantly and simplifying the demands made … Read more That ward managers meet with the Director of Nursing in order (a) to review the range and quantity of documentation that ward nurses are required to complete, with a view to reducing the volume significantly and simplifying the demands made of nurses; and (b) to devise a simple way of ensuring that nursing care plans are individualised. Show less

e. each patient's named nurse, keyworker No Response Published

Recommendation

That, in the case of in-patients, each patient‘s named nurse is formally responsible for obtaining all of the patient‘s previous hospital notes, and that, in the case of community patients, the keyworker is made responsible.

f. local PCTs, the Health Authority, the local mental health trust and Birmingham City Council No Response Published

Recommendation

That the local PCTs, the Health Authority, the local mental health trust and Birmingham City Council agree an action plan for the delivery of primary and secondary mental health care to South Asian communities that is based not on the … Read more That the local PCTs, the Health Authority, the local mental health trust and Birmingham City Council agree an action plan for the delivery of primary and secondary mental health care to South Asian communities that is based not on the notion of ‗an average citizen‘ but on the diversity of the services that are required. And that this action plan fixes dates for achieving the following objectives: (i) The assessment of people referred to mental health services Arrangements must be made as a matter of urgency to ensure that all patients presenting with mental health problems are assessed in their preferred language. All assessments and care plans must take account of and include the significance of the person‘s ethnicity, culture, language, and religion. All assessments must include the individual, their carer and family members, supported where necessary by an interpreter, translator or advocate. (ii) Staffing In order to improve assessment standards, communication and access to services, mental health services must employ more bilingual staff and interpreters, including Mirpuri-speakers. Front-line staff who speak languages that are necessary to the delivery of local mental health services should be paid a significant increment for this valuable additional skill. All in-patient units and community teams must include support workers and healthcare assistants who can speak the range of local languages, so that patients can always be assessed in their first language. (This should be achieved within two years.) The initiative developed by the trust and University of Central England that enables nursing assistants to move on to nurse training needs to be expanded. An agreed proportion of ‗space time and recovery workers‘ linked to assertive outreach and rehabilitation teams must be recruited from minority ethnic groups. A resident, qualified, interpreter who is fluent in languages relevant to the local community must be employed at Newbridge House. Their induction should include training in mental health, and local teams and wards should be able to access this person. The trust must employ a clinical psychologist who is proficient in the languages spoken locally, and if necessary pay a salary increment in order to achieve this. More minority ethnic staff must be appointed at all levels within all local service organisations, and these people need to be adequately supported and trained in their roles. Local people need to be encouraged to work in mental health services through on-going programmes that promote the opportunities locally, for example in schools and local Asian press and broadcasting outlets. The services must ensure and advertise the fact that facilities such as prayer rooms and menus which suit different religious requirements have been introduced in all professional settings. Employment workshops should be established for professionals from minority ethnic groups, where perceived obstacles to promotion can be discussed, as well as potential strategies to overcome them. The collection and publication of accurate, on-going, information from and about minority ethnic communities is necessary. Monitoring procedures are insufficient to identify unmet need, general patterns of use, and comparative service performance. Variations in consultation rates, referrals to specialist mental health services, and the use of psychotropic drugs for different ethnic groups should be audited every year. Show less

g. Birmingham's Muslim community leaders No Response Published

Recommendation

That leaders from Birmingham‘s Muslim community are fully involved in the development of this action plan, and that they are represented on any committees that are established in connection with the development and implementation of the action plan. For example, … Read more That leaders from Birmingham‘s Muslim community are fully involved in the development of this action plan, and that they are represented on any committees that are established in connection with the development and implementation of the action plan. For example, representatives of the Central Mosque; the Confederation of Sunni Mosques (Midlands); the UK Islamic Mission (Midland Zone); and the Islamic Society of Britain (Birmingham) Show less

h. mental health services No Response Published

Recommendation

That Islamic patients are treated in accordance with the Islamic Code of Medical Ethics.

i. each mental health team No Response Published

Recommendation

That each mental health team appoints a CPA convenor who, together with the team manager, is responsible for ensuring that all patients in contact with the team are (i) allocated to standard or enhanced CPA in accordance with national and … Read more That each mental health team appoints a CPA convenor who, together with the team manager, is responsible for ensuring that all patients in contact with the team are (i) allocated to standard or enhanced CPA in accordance with national and local guidelines; (ii) allocated a care co-ordinator; (iii) receive a periodic review of their care plan and, as part of that, risk assessment; and (iv) have a crisis and contingency plan. Show less

j. trust or social services employee No Response Published

Recommendation

That it should be a disciplinary matter for a trust or social services employee (including a consultant) to refuse to act as a patient‘s care co-ordinator when required to do so by the local CPA convenor, or without reasonable excuse … Read more That it should be a disciplinary matter for a trust or social services employee (including a consultant) to refuse to act as a patient‘s care co-ordinator when required to do so by the local CPA convenor, or without reasonable excuse to fail to attend a CPA meeting arranged by their local CPA convenor. Show less

k. community mental health staff No Response Published

Recommendation

That, provided community mental health staff make an adequate record of client examinations and interviews (in the patient‘s medical, nursing or social work notes, etc), keep their CPA documentation up-to-date, and complete any audit records required of them, they should … Read more That, provided community mental health staff make an adequate record of client examinations and interviews (in the patient‘s medical, nursing or social work notes, etc), keep their CPA documentation up-to-date, and complete any audit records required of them, they should not be required to complete any other documentation. Show less

l. Birmingham City Council No Response Published

Recommendation

That Birmingham City Council considers ‗purchasing‘ a number of police officers for mental health services, who can assist staff in conveying patients to hospital and returning to hospital those absent without leave.

m. Birmingham City Council No Response Published

Recommendation

That Birmingham City Council discusses with the police the need for the police to establish a dedicated mental health team (in the same way that the police have a dedicated domestic violence team and a dedicated child protection team).

n. approved social worker No Response Published

Recommendation

That detailed records, including a careful note of dates and times, are kept whenever an approved social worker makes an application and delegates the power to convey the patient to hospital. A form should be devised for the purpose, and … Read more That detailed records, including a careful note of dates and times, are kept whenever an approved social worker makes an application and delegates the power to convey the patient to hospital. A form should be devised for the purpose, and it should be attached to the application and the report left on the ward. This should record the name and details of the patient who is to be conveyed; the person (ASW) delegating the power; the person accepting this delegation; where the patient is to be transported; a risk assessment; and that the delegating ASW has been told that the admission has been completed. Show less

o. relevant authorities No Response Published

Recommendation

That the proportion of ASW assessments in each locality that result in an application being made under the 1983 Act, and the reasons for local variations, are examined.

p. qualified nurse No Response Published

Recommendation

That where a detained patient has recently harmed themselves or others, or an injunction is in force, their current mental state must always be assessed and recorded by a qualified nurse before they are permitted any leave in accordance with … Read more That where a detained patient has recently harmed themselves or others, or an injunction is in force, their current mental state must always be assessed and recorded by a qualified nurse before they are permitted any leave in accordance with their consultant‘s general authorisation. Show less

q. Newbridge House No Response Published

Recommendation

That the security arrangements at Newbridge House, and the arrange- ments there for protecting the physical safety of staff and patients, are immediately independently reviewed.

r. Birmingham City Council, the PCTs and the police No Response Published

Recommendation

That Birmingham City Council, the PCTs and the police should consider the need to establish a local control room staffed by Punjabi and Urdu- speaking operators for the purpose of dealing with police, ambulance and health calls from non-English speaking … Read more That Birmingham City Council, the PCTs and the police should consider the need to establish a local control room staffed by Punjabi and Urdu- speaking operators for the purpose of dealing with police, ambulance and health calls from non-English speaking members of the community. This might involve non-English speakers dialing ‗888‘ rather than ‗999‘. Show less

s. Birmingham City Council and the local PCTs No Response Published

Recommendation

That Birmingham City Council and the local PCTs provide additional funding to the Reducing Domestic Violence Project, so that it can provide a more extensive, city-wide, service.

t. local authority, the Strategic Health Authority, the NHS trust and the PCTs No Response Published

Recommendation

That the section of our report dealing with domestic violence locally is copied to local religious leaders; and that the local authority, the Strategic Health Authority, the NHS trust and the PCTs agree a strategy for reducing domestic violence with … Read more That the section of our report dealing with domestic violence locally is copied to local religious leaders; and that the local authority, the Strategic Health Authority, the NHS trust and the PCTs agree a strategy for reducing domestic violence with local religious leaders that is based on a common understanding that such behaviour can never be condoned. Show less

u. relevant authorities No Response Published

Recommendation

That the section of our report dealing with domestic violence locally is copied to the local civil and criminal courts.

v. mental health trust and learning disability psychiatry services No Response Published

Recommendation

That simple arrangements are agreed by the mental health trust and learning disability psychiatry services which ensure that patients are jointly assessed whenever one of them thinks that the patient would benefit from shared services.

w. mental health and learning disability psychiatry services No Response Published

Recommendation

That mental health and learning disability psychiatry services agree a joint clinical appointment at a senior level.

x. all frontline NHS staff No Response Published

Recommendation

That all frontline NHS staff, including consultants, are offered and required to attend care programme approach and risk management training during the next 12 months.

y. front-line NHS staff No Response Published

Recommendation

That a basic, rolling, training programme is provided for front-line NHS staff that includes mandatory training on the CPA and risk management, and for nurses training also on nursing assessment skills and care planning and review; and that their attendance … Read more That a basic, rolling, training programme is provided for front-line NHS staff that includes mandatory training on the CPA and risk management, and for nurses training also on nursing assessment skills and care planning and review; and that their attendance is recorded in a register. Show less

z. the trust and Birmingham City Council No Response Published

Recommendation

That the trust and Birmingham City Council agree a single management structure for mental health services, joint care programme approach documentation, and joint record-keeping.