Independent investigation: Tom Easton, Old St, London (2006)

The ELFT should undertake a joint strategic needs assessment of the population of each CMHT catchment area and link this to a review of the workload of each of the four CMHTs to determine the actual workload of each and then adjust the staffing to better reflect the known needs as indicated by the statistics and information gathered. The information should include population size, morbidity, weighted caseload analysis, turnover data, referrals and assessments.

The Operational Service Manager, Clinical Leader (Consultant) and the Associate Clinical Director should make sure that they regularly discuss the running of the CMHT and how it functions. Their discussion should include how risk is assessed and managed, how work is prioritised, the management of particularly complex cases and whether there are any issues which adversely affect the expected flow of communication between members of the multidisciplinary team. If such issues cannot be resolved locally they should be ‘escalated’ to the Borough Director for resolution. There should also be a system to ensure that all cases are regularly reviewed.

The consultant psychiatrists should hold regular medical reviews and routinely see their patients at CPA meetings. If there are significant concerns about the patient’s health or social care, then the consultant psychiatrist should ensure a full review is undertaken him/her or a senior deputy.

When patients are with a service for a period of three months or longer, the timely introduction of treatment and medication and the review of dosage and type of medication should be reviewed on a regular basis. This should also be discussed at CPA Meetings.

The carers of patients must be offered an assessment of their own needs and any help that they may require in order to fulfil their caring role. The East London Foundation Trust should undertake an audit of case records to determine whether Carers’ Assessments are being offered and whether their identified needs are being met.

The East London Foundation Trust should audit the training on Safeguarding Children to ensure that all relevant community staff have received the training and any follow-up or updating training and that they are sure of their responsibilities under this legislation

Any systems of care and treatment for service users with severe and enduring mental ill health should be as simple as possible and encourage the individual to engage and cooperate with mental health services and not place unnecessary and cumbersome barriers in their path. The processes in place within the community should be regularly tested to ensure there are no disincentives to active engagement with the mental health services.

The East London Foundation Trust should take steps to identify the family of any person murdered or injured by a patient in the care of the Trust and to offer themany help and support they feel they would like. The Trust should also be open about the Internal Investigation and provide details of the findings and recommendations. Identification of any family of the victim and making contact with them should occur within one week of the incident.

The East London Foundation Trust should liaise with NHS London to ensure that discussions take place between the NHS in London and the Metropolitan and City Police Forces to ensure that in future the Memorandumis implemented effectively.