Independent investigation: Richard Price, Bromley (2009)

We agree with the Internal Investigation that there should be a Trust policy setting out agreed timescales for seeing urgent and routine referrals. The operation of these timescales by CMHTs should be audited.

We also agree that patients should continue to be reviewed and discussed by the CMHT, until their discharge to another service (GP, CFT etc) has been formally agreed and documented.

When a patient is discharged to another service, there should be clear communication and a formal handover to ensure the receiving service is aware of important background information.

We would recommend that the Trust reviews its processes and protocols for managing referrals, paying particular attention to communication between teams and efficiency/flexibility of response, bearing in mind the following: o Attention needs to be focused on processing new referrals more efficiently. Processes for referring on to and working with other teams within the Trust should be reviewed in order to clarify the lead responsibility for an individual’s care. The Trust would benefit from reviewing its approach to communication with other agencies.

The CFT should redraft their operational policy describing in detail their processes for managing community patients. The policy could extend to cover joint working with the CMHT in certain cases, though this requires negotiation with general psychiatric services.

The CFT should always try to get background information about a patient through other agencies such as Probation, MAPPA, previous providers of psychiatric services etc, so as to get as full a picture as possible of the patient and the risks they present.

We recommend that the CFT has regular documented MDT meetings to discuss patients on the caseload, so that any significant incident can be raised, and the team as a whole can consider what the appropriate response is. Specifically any incidents which may justify referring to MAPPA should be noted, a decision made whether to disclose or not, and the rationale recorded.

Details of contact with the patient, emails and letters by all CFT members should be uploaded to RiO in a timely fashion. Emails and letters can be uploaded directly into the progress notes, which can save time by avoiding writing a separate entry, and means that a coherent, chronological record about the care of the patient can be found in one place.

We asked that the Trust provide us with documentary evidence that actions which emerged from the Internal Investigation had been acted upon and completed. The information sent to us by the Trust, did not, in our view, adequately address action points 1.1 and 2.3 of the Action Plan. We are not therefore able to attest confidently that robust and effective systems are in place to ensure that standards and compliance with Trust policies relating to referrals are being regularly audited/measured. We would strongly suggest that the Trust revisits its original action plan and seeks validation that actions have been completed and changes in practice have been made.