Independent investigation into the care and treatment of patient H: December 2015

Joint policies for section 117 after care between BSMHFT and Birmingham city council and BSMHFT were Solihull council are in place. In July 2015 they were reviewed and agreed. For further review in 2017. In January 2014 the Mental Health Legislation Committee acknowledged a more robust process for the recording of service users on section 117. All service users are on a central database held by the MHA legislation team.

Since the initial report, the team, through functionalisation and the service integration process, has undergone significant review. Ladywood CMHT and Handsworth CMHT have merged to become Ladywood and CMHT and catchment areas have been rationalised. Whilst at the time of the incident in 2009, the Responsible Clinician had a catchment population of 62 000, this has now reduced to 42 000 as there are now 3 consultant psychiatrists covering the CMHT area. All job plans for consultants in Ladywood and Handsworth CMHTs have been completed by the Clinical Director. An Advanced Nurse Practitioner is now working in the Ladywood and Handsworth CMHT who sees the less complex cases and carries a caseload of around 150 patients. As a result of Service Integration programmes there have been some non- acute patients referred back to primary care, although there have been delays. The Medical Director and the Director of Operations are currently overseeing a major review of all community mental health teams under the New Dawn transformational redesign programme. Under the proposals for the community mental health teams, the caseloads will be stratified into three categories – high need, medium need and low need informed by risk, complexities and cluster groupings. The consultant psychiatrists will have direct responsibility for those patients identified as high need.

The team have established dedicated slots specifically for weekly CPA reviews. Additionally, should a staff member feel that a CPA is necessary, an out patient slot will be upgraded to a CPA review. Current performance on CPA reviews, completed in 12 months is 91.5%.

There was a social worker allocated at the time of the incident, who was based with the team. The Trust and city council are no longer co-locating. However, social workers are routinely invited to CPA reviews. CTOs and section 117 are core business for CPA reviews. Compliance for CTOs is monitored via the Mental Health Legislation Committee. Compliance for Ladywood and Handsworth CMHT reported as 100% in October 2015 committee. The CPA policy has been updated and specifically incorporates guidelines for monitoring 117 and CTO issues and concordance.