MENTAL HEALTH CAPACITY LEGISLATION COMMITTEE … · 2016. 11. 23. · d ± MHCL Report e ± MHA...

MENTAL HEALTH CAPACITY LEGISLATION COMMITTEE

10.00AM – 29th November 2016 CORPORATE MEETING ROOM, HEADQUARTERS

UNIVERSITY HOSPITAL OF WALES

Mental Health and Capacity Legislation Committee Front Cover

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MENTAL HEALTH AND CAPACITY LEGISLATION COMMITTEE Tuesday, 29 November 2016 at 10.00am

Corporate Meeting Room, Headquarters UHW

AGENDA

PATIENT STORY – Mental Health Measure

PART 1: ITEMS FOR ACTION

1 Welcome and Introductions Oral Chair

2 Apologies for Absence Oral Chair

3 Declarations of Interest Oral Chair

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Minutes of the Mental Health and Capacity Legislation meeting held on 9 August 2016

Chair

5 Action Log Review

Chair

6 Any Other Urgent Business Agreed with the Chair

Chair

MENTAL CAPACITY ACT & PRESENTATIONS

7 Clinical Board Presentations Children and Women - Dr Sian Moynihan

Dentistry – Dr Grace Kelly

Oral

8 Updated CAMHS Report

Director of Public Health

9 Issues related to Learning Disabilities

J Hunt/ Key Jeynes

10 Updated DoLS Report

A Cole

MENTAL HEALTH ACT & MENTAL HEALTH MEASURE

11 Mental Health Act Activity Report CAMHS

Adults a – MHM May Snapshot b – Annual Report 2015 c - MHA Act data report d – MHCL Report e – MHA Final Breaches

Chief Operating Officer

12 Mental Health Measure (all ages) CAMHS

Adults

Chief Operating Officer

13 Service Changes – Impact on legislation Oral

Mental Health and Capacity Legislation Committee Agenda

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I Wile

14 MHA 1983 Code of Practice for Wales 1983

I Wile

GOVERNANCE

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Remit and Frequency Oral Chair

PART 2: ITEMS TO BE RECORDED AS RECEIVED AND NOTED FOR INFORMATION BY THE COMMITTEE

Papers are available on the Health Board website

16 Hospital Managers Power of Discharge sub-Committee Minutes

Chair, PoD sub-Committee

17 Review of the Meeting Oral Chair

18 To note the date, time and venue of the next meeting:-

10.00am on Tuesday, 9 May 2017 Board Room Headquarters UHW

Mental Health and Capacity Legislation Committee Agenda

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UNCONFIRMED MINUTES OF THE MENTAL HEALTH AND CAPACITY LEGISLATION COMMITTEE

(MHCLC) HELD AT 9.00 AM ON TUESDAY 9 AUGUST 2016

CORPORATE MEETING ROOM, HEADQUARTERS, UHW

Present: Prof Marcus Longley MHCLC Chair and Vice Chair, Cardiff and Vale UHB Martyn Waygood Independent Member and MHCLC Vice Chair Margaret McLaughlin Independent Member – Third Sector Eileen Brandreth Independent Member – Information, Communication and

Technology In attendance: Clare Wade (part) Lead Nurse, Surgery Clinical Board Denise Shanahan (part) Consultant Nurse, Older Vulnerable Adults Dr Graham Shortland Medical Director Ian Wile Director of Operations, Mental Health Jane Hancock (part) Service User Representative Dr Jenny Hunt Clinical Psychologist Jo Jordan Director of Mental Health, Welsh Government John Owen

Chair, Hospital Managers Power of Discharge Sub-Committee

Julia Barrell Mental Capacity Act Manager Kay Jeynes Director of Nursing, PCIC Steve Curry Acting Chief Operating Officer Apologies

Alice Casey Chief Operating Officer (Lead Executive) Amanda Morgan Service User Representative Dr Annie Proctor Clinical Board Director, Mental Health Jayne Tottle Clinical Board Nurse Peter Welsh Director of Corporate Governance Dr Richard Evans Clinical Board Director, Medicine Andy Cole DNA Title Lucy Phelps DNA Service User Representative Rebekah Vincent-Newson DNA

Operational Manager, Mental Health, Vale of Glamorgan Social Services

Steve Lewis DNA Director, Advocacy Support Cymru Sunni Webb Mental Health Act Manager Secretariat:

Julia Harper

MHCLC 16/039 WELCOME AND INTRODUCTIONS The Chair welcomed everyone to the meeting.

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Mental Health and Capacity Legislation Committee Minutes of the Mental Health and Capacity Legislation meeting held on 9 August 2016

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MHCLC 16/040 APOLOGIES FOR ABSENCE Apologies for absence were noted. MHCLC 16/041 DECLARATIONS OF INTEREST The Chair invited Members to declare any interests in the proceedings on the agenda. None were declared. MHCLC 16/042 MINUTES OF THE PREVIOUS MEETING OF THE

MENTAL HEALTH AND CAPACITY LEGISLATION COMMITTEE HELD ON 10 MAY 2016

The minutes were RECEIVED and CONFIRMED as a true and accurate record. MHCLC 16/043 ACTION LOG REVIEW The Committee RECEIVED and NOTED the Action Log. The following points were highlighted:

1. MHCLC16/008 Mental Health Act Exception Report – A report was on the agenda and it was hoped to merge the adult and children reports in the future.

2. MHCLC 15/065 Learning Disabilities – The Director of Therapies and

Health Sciences would provide a report for the next meeting.

3. MHCLC 15/055 DoLS – The Medical Director advised that a report had not been received from the Local Partnership Board.

4. MHCLC 16/025 Integrated Assessment – The Medical Director advised that new junior doctors were undergoing training on IA and the need to record cognitive impairment as part of their induction. An update on funding would be provided later in the meeting.

5. MHCLC 16/028.3 Section 136 Partnership Arrangements – It was hard to obtain the data but it was believed that no children had been affected athough this would be double checked. Action – Mr Ian Wile Only 4 16/17 year olds had been cared for on adult wards in the last 18 months and all had been appropriate admissions. The environment at Hafan y Coed was much better with ensuite rooms and a discrete area for CAMHS patients. National policy permitted the admission of this

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age group to adult wards though all cases were reported to the Healthcare Inspectorate Wales The Chair asked for the figures for Section 136 to be broken down for adults and children in future reports, gaining the figures from specialist CAMHS if necessary which should be provided as part of the commissioning agreement. Action – Mr Ian Wile and Dr Jenny Hunt

6. MHCLC 16/026 Internal Audit DoLS – Following a limited assurance report, an action plan was being worked through and a follow up audit would be undertaken in February 2017. A progress report would be provided at the next meeting. Action – Dr Graham Shortland

7. MHCLC 16/027 DoLS Monitoring Report – There was no representative at this meeting. It was suggested that Mr Andy Cole, Vale Social Services was responsible for the DoLS service again.

MHCLC 16/044 ANY OTHER URGENT BUSINESS There was no other urgent business. MHCLC 16/045 PATIENT STORY – MENTAL HEALTH ACT S117 There was no Patient Story. MHCLC 16/046 MENTAL CAPACITY ACT CLINICAL BOARD

REPORTS TO COMMITTEE

1. Primary Community and Intermediate Care (PCIC) Ms Denise Shanahan presented the position in PCIC as the Mental Capacity Act (MCA) Champion. She advised that ongoing training was provided to district nurses and contractors. This was being rolled out but measurement was problematic. District Nurses were aware of how and where to access additional support for complex cases. In addition the action plan for consent had been reviewed. With regard to the Court of Protection, the Committee was advised that there was a long wait, stretching to several months, for cases to be considered due to the workload of experts. The need for the Coroner to be informed of all deaths involving people detained under a DoLS order was raised as the Out of Hours Doctor had not done this due to a lack of awareness. It was reported

Comment [C1]: I know Ian said MHAC, but they haven’t existed now for some years!

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that GPs had access to UHB resources and training and received the PCIC newsletter that always included items on mental capacity in order to share good practice and learning from other Clinical Boards. MCA was a regular item on the PCIC Quality and Safety sub-Committee agenda and a report on whether GPs believed they had received sufficient training would be considered in September.

2. Surgery Ms Clare Wade, Lead Nurse in Surgery presented the position in the Surgery Clinical Board. She advised that compliance with MCA was monitored via the Clinical Board Quality and Safety sub-Committee and that MCA training was part of the ward Dashboard. Mental capacity assessments were mainly undertaken in Trauma and Orthopaedics as this department dealt with many older people who had sustained hip fractures following a fall. T&O frailty practitioners co-ordinated care from admission to discharge and also worked on West 4 at UHL which was the T&O rehabilitation ward. A number of DoLS training sessions had been arranged for senior nurses. Again, the Clinical Board reported issues with measurement of training and whilst it was thought that around 27% of staff had undertaken training, it was not known which staff groups these staff belonged to. A 2 day training package had also been developed for the care of patients with dementia and around 140 nurses had already been trained. The practice educators had received a runner up award for this. In addition, Butterfly training had been rolled out. The Clinical Board had led on the 1,000Lives Learning Disabilities bundle and, as a result of this, a flag system was introduced onto the clinical work station with the appropriate paperwork embedded for completion. The case study of a patient death was also used for learning. A patient refused treatment for a fractured hip as she mistakenly believed and reported that she also had bowel cancer. Her wishes were discussed with her and her family but this was not formally recorded. She fell again and fractured her other hip which led to her death. The Chair invited comments and questions:

It was agreed to open up the 2 day dementia training to other Clinical Boards with encouragement to prioritise this training.

Asked about awareness of the Advocacy Service, both Clinical Boards were aware but were unsure of how well it was being used. PCIC also contracted for additional support when necessary for complex cases. It was agreed that Ms Barrell would circulate the IMCA reports to the

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MCA leads as there was evidence that IMCA had not always been used when it should have been. Action – Ms Julia Barrell

It was acknowledged that staff were under great pressures to undertake a wide variety of training and it was queried how managers checked understanding of the MCA. In PCIC capacity and consent issues were not new and therefore an action plan and appropriate training had been in place for some years. It helped that the workforce was mature and turnover was low. Seeking further support where staff had queries was also common place. CHC nurses also supported other Clinical Boards with best interest decisions and shared their knowledge and skills. On the whole there were good relationships with GPs to undertake capacity assessments when requested. It was agreed to request a UHB wide report from LED for the next meeting to include the reliability of data, the training target, the frequency of training, the groups of staff that should be trained, the need to record e learning within the electronic staff record, mandatory training and the timescale when this work would be completed. Action – Professor Marcus Longley

The Committee was concerned that accurate training figures were not available and all Clinical Boards needed baseline figures and then timely and accurate information and this should be viewed as a priority for the Learning and Education department. The Committee also gave its support to the inclusion of MCA within mandatory training.

It was agreed that Clibnical Board compliance with MCA training would be included within the performance management framework. Action – Mr Steve Curry

It was noted that the less capacity a patient had, the less say they had regarding their treatment.

The Committee NOTED the reports and the action that would be taken in support and AGREED to review the effectiveness of these presentations when all Clinical Boards had been heard. Action – Professor Marcus Longley MHCLC 16/047 MENTAL CAPACITY ACT (MCA) 2005 UPDATE

REPORT The Medical Director, Dr Graham Shortland presented the update report that dovetailed with the reports presented by the individual Clinical Boards. He drew the Committee’s attention to two issues: the report included details on activity and the balance between confidentiality and sharing information. It was also noted that Critical Care was piloting an audit on mental capacity assessments.

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Ms Barrell highlighted a complaint following the avoidable death of a patient where the UHB had breached its duty of care and there had been clear mental capacity issues. She pointed out that even the independent doctor who had been commissioned to review the case had not mentioned the capacity issue and this demonstrated how poorly understood MCA was. This highlighted the importance of using the limited resources to target the right training to the right staff and the need to learn from serious incidents. It was agreed that the Medical Director would discuss with the Nurse Director, the inclusion of details on learning from serious incidents where mental capacity was implicated within the twice yearly report and the inclusion of a patient story related to mental capacity at Board. Action – Dr Graham Shortland The Committee NOTED the report. MHCLC 16/048 DEPRIVATION OF LIBERTY SAFEGUARDS (DoLS) MONITORING REPORT The Medical Director, Dr Graham Shortland presented an oral report and agreed to circulate the written report following the meeting. In summary, he referred to the tripartite meetings with the local authorities, a significant increase in the number of DoLS referrals (55 in 2013/14, 406 in 2014/15 and 661 in 2015/16), the pressure on services to deliver IMCA, discussions on funding, the continued challenges and risks of the year-long backlog (within the Local Authorities) and the hope that the UHB could develop a pooled budget in partnership. The Committee NOTED the oral update and would await the written report. Action – Dr Graham Shortland MHCLC 16/049 DEPRIVATION OF LIBERTY SAFEGUARDS AUDITS It was noted that this item had been covered within Matters Arising. MHCLC 16/050 MENTAL HEALTH ACT MONITORING EXCEPTION REPORT The Director of Operations, Mental Health, Mr Ian Wile presented the report and advised there were no exceptions to report, however, the UHB was at the upper control limit for Section 136. It appeared the Police were being discouraged from using their powers of arrest and more people were being brought to mental health and the emergency unit.

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The number of invalid detentions had reduced by two thirds since the first report and no invalid detentions had come from the wards. The MHA office had amended its process since the mistake was identified. Mr Wile was also discussing data collection at an all Wales level where 5 of the 7 Health Boards were represented. The definition for invalid detentions and details for a core data set were agreed in order to benchmark performance. It was also possible that the data set could include the use of advocacy support. Directors of Primary Care were supporting this work. Asked about why the number of Section 136 assessments had increased it was noted that a large number were inappropriate and arrived in a confused or drunk state. Only 10% were appropriate admissions so there was a need to reconsider with partners the alternatives to cells and hospital. Discussions were ongoing with the Police about the level of training officers received and the improvements that were needed to consider preventative measures, including better use of the Crisis Teams. It was noted that a community psychiatric nurse was still attached to the Magistrates Court and Cardiff Bay Police Station. As things stood, the number of S136 referrals would not reduce until the Police had better training and alternatives and unfortunately the alcohol treatment centre was not open every day. It was noted that even when people were arrested following a crime, the Police were often unaware of the person’s mental health. It was important for a lower level of care including addictions services to be developed. In addition, greater analysis of “frequent flyers” would be undertaken to see what help could be provided. Asked about whether there were more admissions of people from the BME community, it was acknowledged that the UHB was poor at keeping such records but this would be addressed in the annual patient census and the Police would be asked to provide details of BME within the Section 136 figures. Action – Mr Ian Wile The Committee NOTED the report. MHCLC 16/051 MENTAL HEALTH ACT - HEALTH INSPECTORATE WALES (HIW) INSPECTION REPORT The Director of Operations, Mental Health, Mr Ian Wile gave an oral report on the unannounced visit to MHSOP at UHL in February. HIW had raised concerns about staffing levels, management and leadership, medication, documentation and pain assessments. A detailed action plan had been produced in response and the Clinical Board took the decision to request

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supported administration from the UHB. Improvements had been made and the supported administration would be reviewed in September. The Committee NOTED the report and that the Quality, Safety and Experience Committee had considered the report in private and was monitoring progress. MHCLC 16/052 MENTAL HEALTH CLINICAL BOARD HAFAN Y COED TRANSFER Mr Ian Wile had nothing to add to the report so the Chair invited comments:

The environment was impressive and there was a feeling of positivity within the unit. The planning and execution of the project was commended.

It was inappropriate for nursing staff to undertake cigarette runs for patients who were unable to get to the closest shop during their allocated leave period. To safeguard patients’ rights, taxis were being used until the issue was resolved. There were a number of options that could be considered including extending leave to 45 minutes or arranging for the on-site shop to stock cigarettes, even though this contradicted the UHB’s health message. As this was an anticipated issue, it was disappointing that measures had not been taken prior to the move. It was suggested that ideas be sought from volunteers and the Third Sector. Action – Mr Ian Wile

From 303 beds, the number of patients ready to leave the unit had risen from 13 to 17. The Welsh norm was 15% so the UHB was performing well in this area. Some patients stayed over a year and funding was awaited from the intermediate care fund to develop the ‘moving on’ team.

The correlation between transport issues and sickness was identified through local knowledge only. The Clinical Board continued to recruit as there was almost a constant 5% (over 50 nurses) vacancy rate.

The outside space was gradually beginning to be used by patients and staff. The unit had its own activities team and on-site access to a football pitch and gym.

The Committee NOTED the report and AGREED to receive a benefits realization report after the first year – August 2017. Action – Mr Ian Wile MHCLC 16/053 AUDIT OF PATIENTS REPRESENTED BY AN

ADVOCATE AT HOSPITAL MANAGERS’ HEARINGS

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The Director of Operations, Mental Health, Mr Ian Wile presented the audit findings and reported consistently low numbers of patients accessing the advocacy service. In particular, most patients with capacity chose not to use the service whilst those without capacity had an advocate. The next step would be to ask patients why they had not opted to use an advocate. Mr John Owen, Chair of the Hospital Managers’ Power of Discharge sub Committee reported that Hospital Managers had found the presence of an advocate helpful but they were not seeing as many patients represented in this way. It had been necessary, on occasion, to postpone Hearings to ensure an advocate could attend. The Committee NOTED the report. MHCLC 16/054 EXCEPTION REPORT / DETENTION WITHOUT AUTHORITY The Committee had no further questions or comments and the report was NOTED. MHCLC 16/055 MENTAL HEALTH MEASURE MONITORING REPORT JULY 2016 The Director of Operations, Mental Health, Mr Ian Wile reported that the UHB was compliant with all 4 parts of the Measure. However, it was anticipated that breaches would be shown for Part 1 (assessment within 28 days) in the July figures. Welsh Government had provided some investment for DoLS and £140k for the Measure. Discussions were ongoing with MHSOP and CAMHS as to how this funding should be distributed. Unfortunately there was a shortfall on GP liaison work and this was the area that could help to reduce the overall number of referrals into the secondary care service. There was still a huge unmet need in primary care as 70% of referrals were returned. The Clinical Board was trying to develop services in this area to support GPs and ensure patients received the right help. It was acknowledged that the need was much greater than anyone had anticipated. Demand continued to rise and a similar picture was seen in other Welsh Health Boards. It was noted that a short term business case had been approved and whilst the UHB had the best Welsh performance, this was not sustainable. The Committee AGREED the approach taken by the Mental Health Clinical Board.

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MHCLC 16/056 PROGRESS REPORT CHILDREN AND YOUNG PEOPLE’S PRIMARY MENTAL HEALTH SERVICE AUGUST 2016 Dr Jenny Hunt, Clinical Psychologist presented the first full report to the Committee following the overview that was provided for the last meeting. She highlighted that children who were transferred to the UHB had already waited over 30 weeks. Therefore, staff had arranged two blocks of intensive assessments to address these long waits. From the first fortnight it had been discovered that many patients on the waiting list for Part 1 had been wrongly referred and this raised concerns for the risks to those who were waiting. Further discussions were being arranged with the specialist CAMHS about this. The number of referrals varied but was high and 100 assessments had been booked to take place in August. In addition, the service was introducing an early triage in order to assess any risks. The focus was on securing delivery of Part 1 of the Measure but there were operational obstacles with regard to access to clinical space (one staff member had driven 1000 miles in 2 weeks seeing patients in clinics and GP surgeries and this was not the best use of time or money). In addition, an urgent assessment of demand and capacity was needed but the data was unreliable. With 164 patients waiting 16 weeks, the service was not compliant with the Measure and whilst there had been some good progress, it was still not possible to provide a timescale for getting to a sustainable position, though it was hoped that the picture would be clearer by the end of the financial year. The concern was that inevitably the large number of assessments would result in the need for further interventions and the specialist CAMHS waiting list was excessively long. Whilst an urgent specialist appointment could be obtained within 24 hours, the not so urgent were left a long time during which period they could deteriorate further. Unfortunately the CAMHS had a variety of waiting lists some of which were over a year for assessment followed by a further wait for intervention. The concern was that when GPs saw a big drop in the UHB’s waiting time for assessment, they may increase their referral rate. Of the 90 patients assessed in July, approximately 5 were considered urgent. A step change was needed to get the service into balance and this included the setting up of the Paris system, better data collection to enable demand and capacity modelling, access to clinical space and a full staff establishment.

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It was suggested that in the absence of good data, the service should continue to triage and address the backlog. The impact on patients and their families during the waiting period was acknowledged and this was unacceptable. Dr Hunt thanked the adult mental health service for supporting the assessments of older children. The Chair stressed that the Committee was focused on performance against legislation especially Part 1 of the Measure. The Committee NOTED the report. PART 2 REPORTS FOR INFORMATION MHCLC 16/057 HOSPITAL MANAGERS POWER OF DISCHARGE SUB-COMMITTEE MINUTES The Chair of the sub Committee, Mr John Owen reported that a new Hospital Manager had been recruited – Mr Singh. Hospital Managers hoped to see more activity in IMACs and there was concern that Hearings were being postponed because of the late arrival of professional reports, although this was now being addressed. The Committee NOTED the Minutes. MHCLC 16/059 REVIEW OF MEETING The Board would be made aware of the Committee’s support for the primary CAMHS. MHCLC 16/060 DATE OF NEXT MEETING The next meeting would be held at 9am on Tuesday 29 November 2016 in the Corporate Meeting Room, Headquarters, University Hospital of Wales (UHW).

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ACTION LOG FOLLOWING MHCLC AUGUST 2016

Minute Date of Meeting

Subject Agreed Action Action To Status

MHCLC 16/028.3 16/043

10.5.16 9.8.16

Section 136 Partnership Arrangements

Check figures for the under 18s, CAMHS absconders and children cared for on an adult ward. Figures for Section 136 to be broken down for adults and children in future reports, gaining the figures from specialist CAMHS if necessary.

I Wile Data was hard to obtain. It was believed that no children had been affected - this will be double checked. 4 16/17 year olds had been

cared for on adult wards in the

last 18 months. Update at Nov

meeting

MHCLC 16/046

9.8.16 MCA Clinical Board Reports

Request a report for the next

meeting to include the reliability

of data, the training target, the

frequency of training, the groups

of staff that should be trained, the

need to record e learning within

the electronic staff record,

mandatory training and the

timescale when this work would

be completed.

Include Clinical Board

Prof M Longley

Report and attendance requested of Director of Workforce and OD on 11 August. Programme agenda item for November Board

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compliance with the Mental Capacity Act and training within the performance management framework. Review the effectiveness of these presentations when all Clinical Boards had been heard.

S Curry Prof M Longley

MHCLC 16/048

9.8.16 DoLS Monitoring Report Circulate the written report to Committee.

Dr G Shortland

Graham to circulate report (will this also complete action 16/027 below when produced?)

MHCLC 16/052

9.8.16 Transfer to Hafan y Coed

Seek ideas from volunteers and the Third Sector to enable patients to purchase cigarettes.

I Wile

ITEMS TO BE BROUGHT TO A FUTURE MEETING

MHCLC 16/026 16/043

10.5.16 9.8.16

Internal Audit Report (DoLS)

Progress against the Audit Report recommendations to be considered at the August meeting.

G Shortland Following a limited assurance report an action plan was being worked through and a follow up audit would be undertaken in February 2017. A progress report would be provided at the next meeting. November 2016 meeting

MHCLC 16/027

10.5.16 DoLS Monitoring Report As no one at the meeting in May, the report was deferred to August at which point it should be strengthened with the most up to date position

R Vincent-Newson / A Cole

Deferred to Nov 2016 as no report was available at Aug meeting

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MHCLC 16/035

10.5.16 CAMHS Plan for clearing backlog and redesign of a sustainable service to be received.

J Hunt November 2016

MHCLC 15/065 16/043

2.02.2016 9.8.16

Issues related to Learning Disabilities

To ask Primary Community and Intermediate Care (PCIC) to provide report on legislation for learning disabilities

M Longley May 2016 meeting. The Director of Therapies and Health Sciences would provide a report for the next meeting in November.

MHCLC 16/052

9.8.16 Transfer to Hafan y Coed

Bring the benefits realization report for Welsh Government to Committee after the first year.

I Wile August 2017

MHCLC 16/050

9.8.16 MHA Exception Report Ask the Police to provide details of BME within the Section 136 figures.

I Wile July 2017

COMPLETED ACTIONS (TO BE REMOVED ONCE REPORTED TO MEETING AS COMPLETE)

MHCLC 16/008 16/043

2.02.2016 9.8.16

Mental Health Act 1983 – Exception Report Invalid Detentions

To include CAMHS compliance in report

J Hunt A general report was included in August but it was agreed to merge the adult and children reports in the future. COMPLETE

MHCLC 16/025

10.5.16

Clinical Board MCA Compliance Presentation

Consider the action to be taken following a failure to follow clerking (IA) documentation (ie cognitive impairment not being recorded )

G Shortland Medical Director to discuss at Medical Records Committee and review content of junior staff induction. August - The Medical Director advised that new junior doctors were undergoing IA training as part of their induction.

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COMPLETE MHCLC 16/047

9.8.16 MCA Update Discuss with the Nurse Director, the inclusion of details on learning from serious incidents where mental capacity may have been involved within the twice yearly report and the inclusion of a patient story related to mental capacity at Board.

Dr G Shortland

COMPLETE

MHCLC 15/055 16/043

08.09.15 Updated 03.11.15 9.8.16

Deprivation of Liberty Safeguards Report

Discuss outside the meeting with the Operational Manager and the UHB Deputy Director of Nursing optimal utilisation of £25,000 WG funding.

G Shortland Medical Director has met with Local Authority Partners to review current funding position. Currently under review. August - The Medical Director advised that a report had not been received from the Local Partnership Board. Graham – the Chair has asked if you are able to circulate the info you had in front of you at the meeting please? COMPLETE

MHCLC 16/046

9.8.16 MCA Clinical Board Reports

Circulate the IMCA reports to the MCA leads

J Barrell

COMPLETE

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Mental Health Legislation Application for Children and Young People

Name of Meeting : Mental Health and Capacity Legislation Date of Meeting Nov 16

Executive Lead : Executive Director of Public Health

Author : Commissioning Officer – Performance and Contracts

Caring for People, Keeping People Well : Delivering outcomes that matter to people; avoiding waste, harm and variation

Financial impact : none as a result of this report

Quality, Safety, Patient Experience impact : no changes as a result of this report

Health and Care Standard Number 2.7, 3.1

CRAF Reference Number 2.1, 2.5, 3.1, 5.1, 5.1.6, 5.5, 8.1, 8.1.2, 8.1.3

Equality and Health Impact Assessment Completed: Not Applicable - No policy changes as a result of this report

ASSURANCE AND RECOMMENDATION LIMITED ASSURANCE is provided by:

Existing reporting against the legislation

Development of guidance and code of practice for C&V The Committee is asked to:

APPROVE the development of guidance and code of practice for C&V AGREE the reporting of the proposed measures to future meetings

SITUATION The UHB Mental Health Measure performance is reported to and monitored by the Welsh Government on a monthly basis, with reports back to the UHB Performance Monitoring Committee. The differences in how the Mental Health Act applies to under 18s are not currently reflected in the reporting. BACKGROUND The Mental Health (Wales) Measure 2010 (the Measure), is a National Assembly for Wales law that has similar legal status to an Act of Parliament. The Measure introduces a number of important changes to the assessment and treatment of people with mental health problems in Wales. Parts 1 to 4 of the Measure set the main legislative requirements relating to Mental Health service provision and are supported by subordinate legislation and guidance.

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ASSESSMENT Within the Mental Capacity Act’s Code of Practice, ‘children’ refers to people aged below 16, ‘Young people’ refers to people aged 16–17. This differs from the Children Act 1989 and the law more generally, where the term ‘child’ is used to refer to people aged under 18. Children under 16 can be deemed competent and able to give consent to treatment if they have “sufficient understanding and maturity to understand fully what is being proposed” using Gillick Competency. If a child lacks competency then parental consent should be sought from whoever has parental authority (parent/carer/local authority). A competent child can refuse treatment and it should be respected. However, if it is in the best interest of the child to receive treatment then legal advice is recommended. Similarly if the parent (or whoever has parental authority) refuses treatment and the clinician feels it is in the child’s best interest they can apply for a court order. In emergencies, preservation of life and prevention of irreversible serious deterioration of the condition will override consent and a clinician can lawfully treat the patient. Deprivation of Liberty differs in under 16s, and 16-17 year olds and also for Looked After Children. Another thing to consider is whether the person with parental authority lacks capacity, in which case the clinician could obtain a court order. ASSURANCE In light of the complexities concerning consent and deprivation of liberty we recommend that guidelines are drawn up for CAV UHB as a code of practice to comply with the law and maintain consistency throughout the service. These should also be converted into measurable qualities for the UHB to be accountable. Recommend routine reporting on the following for under 18s: Under section 136:

MHA assessments undertaken within the health board,

The outcome number where hospital is the place of safety

Assessments undertaken within a police station

Outcome number where Cardiff Bay custody suite/police station is the place of safety

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CAMHS absconders

Children cared for on an adult ward As well as compliance with Part 1 of the Mental Health Measure:

Number/Percentage of the Mental Health Measure Part 1 Assessments completed within 28 days, between 29 and 56 days and more than 57 days

Number/Percentage of Therapeutic interventions started how many waited 28 days or less, between 29 and 56 days and more than 57 days.

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Briefing Note For: Mental Capacity Committee From: Kay Jeynes, Director of Nursing, PCIC Subject: Update on Cheshire West in respect to individuals with a Learning

Disability in Community Settings Date: November 2016

Background The Supreme Court judgment of 19 March 2014 in the case of Cheshire West clarified an “acid test” for what constitutes a “deprivation of liberty”2. The acid test states that an individual is deprived of their liberty for the purposes of Article 5 of the European Convention on Human Rights if they:

Lack the capacity to consent to their care/ treatment arrangements

Are under continuous supervision and control

Are not free to leave. All three elements must be present for the acid test to be met. A deprivation of liberty for such a person must be authorised in accordance with either the Deprivation of Liberty Safeguards (DoLS – part of the MCA), or by the Court of Protection or, if applicable, under the Mental Health Act 1983 (MHA). The Supreme Court further held that factors which are NOT relevant to determining whether there is a deprivation of liberty include the person’s compliance or lack of objection to the proposed care/ treatment and the reason or purpose behind a particular placement. It was also held that the relative normality of the placement, given the person’s needs, was not relevant. This means that the person should not be compared with anyone else in determining whether there is a deprivation of liberty. The Supreme Court also held that a deprivation of liberty can occur in community and domestic settings where the State is responsible for imposing such arrangements. This will include a placement in a supported living arrangement. 2 P v Cheshire West and Chester Council and another and P and Q v Surrey County Council

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Mental Health and Capacity Legislation Committee Issues Related to Learning Disabilities

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Hence, where there is, or is likely to be, a deprivation of liberty in such settings, this should be authorised by the Court of Protection. Given the large influx of applications to the CoP considered likely following guidance and processes have been being developed since 2015 to streamline and manage the associated application process however considerable backlogs are reported across England and Wales Practical implications in the Community The DoLS scheme can be used to assess and authorise deprivations of liberty in residential care home, hospice and hospital settings. However, a “deprivation of liberty” that is “attributable to the state” can occur in other “community settings”. This includes supported living arrangements and educational and domestic settings. In these settings, the DoLS scheme is not available and instead, an application must be made to the Court of Protection. The responsibility remains with those funding care in community settings (predominantly local authorities and Health Boards) to ensure they have a procedure and policy in place for identifying those individuals who may lack capacity and be subject to a deprivation of liberty. As with the wider response to the Supreme Court judgment, a response based on the MCA principles and which necessarily prioritises those individuals who stand to benefit most from this scrutiny of their care arrangements has been advised. Update October 2016 Since the Supreme Court judgment a multidisciplinary led review has been undertaken of residents with a Learning Disability living in the community to consider and identify those where appropriate authorisation of deprivations of liberty need to be put into place. ABMU has also considered all individuals within their residential and assessment and treatment units to ensure that appropriate legal authorisations are in place or need to be progressed. This review identified 207 Cardiff individuals and between 70-80 residents of the Vale in the community where it was considered that urgent Court of Protection applications need to be progressed and MDT’s are in the process of working through the necessary application paperwork. The Local Authority has agreed to lead on applications for individuals who are jointly funded but there are 2-3 cases that are fully funded by health where CoP applications will need to be considered and submitted by the Health Board individually.

9


23 of 117

Based on the above prioritisation a number of cases were identified to be progressed first. There are considerable resource implications associated with progressing the identified volume of applications within current resources which has hampered and delayed submission of applications to the CoP to this point. A CoP application and authorisation for one of the individuals fully funded by CHC has been processed as a result of an urgent requirement for consideration. Cardiff and Vale LA have now appointed a specialist legal advisor to support the process and 4 cases have now been submitted and it is planned that 4 cases per week will be prepared and submitted to manage the backlog of cases going forward. A programme of additional and update training for MDT members within Community LD teams has also been scheduled to commence October 2016.

9


24 of 117

Cardiff and Vale of Glamorgan Deprivation of Liberty

Safeguards and Mental Capacity Act Team

The Cardiff and the Vale DOLS / MCA Team operate the Supervisory Body responsibilities of the Deprivation of Liberty Safeguards on behalf of Cardiff and Vale UHB, City of Cardiff Council and Vale of Glamorgan Council, through a partnership management board consisting of senior representatives of each Supervisory Body. The team acts on behalf of the three Supervisory Bodies in the:

Coordination of DoLS assessments as requested by Managing Authorities by undertaking the following assessments: Age - 18 and over Mental Illness- Is medically diagnosed with a mental disorder Mental Capacity - Lacks capacity for the decision to be accommodated in the hospital or care home No refusals - there is no Advanced Decision previously made to refuse treatment or care, or conflict relating to this such as LPA or Deputy Eligibility - This determines whether the person meets the requirements for detention under the Mental Health Act 1983; Best Interests - The person needs to be deprived of liberty for reasons of health, safety and best interests.

Supervision and workload management of over 40 Best Interest Assessors;

Advice and support to health and social care teams across the sector in relation to MCA/DoLS issues;

Training for care homes and all inpatient sites across the hospitals of Cardiff and the Vale of Glamorgan areas.

10

Mental Health and Capacity Legislation Committee Updated DoLS Report

25 of 117

Referral rate…

The effects of the revised definition of Deprivation of Liberty following the Cheshire West Ruling continue to impact on the number of requests for Standard and Urgent Authorisations as described in the graph below. It is noticeable that following the first 18 months post Cheshire West, the number of referrals has remained relatively stable which enables more reliable workforce planning.

The table below shows the number of DoLS referrals per Supervisory Body over the last 3 years.

REFERRALS 2013/14 % of referrals

2014/15 % of referrals 2015/16 % of Referrals 2016/17

(end Oct)

% of Referrals

Cardiff Council 32 34.4% 866 49.1% 778 39.4% 382 35% Vale Council 6 6.4% 489 27.7% 534 27% 242 22% C&V UHB 55 59.1% 406 23% 661 33.5% 457 42% Total 93 100% 1761 100% 1973 100% 1081 100%

0

20

40

60

80

100

120

140

Cardiff & Vale UHB

Cardiff

Vale

10


26 of 117

Best Interest Assessments

The Welsh Government Expert Group have estimated by talking to each Supervisory Body that each DoLS Assessment takes on average one whole working day when taking into account the coordination, interview, consultation and administration for each assessment. The Cardiff and Vale DoLS Team averages 1.5 assessments per BIA, per working day. It IIIIt should be noted that the DoLS Team is not able to meet the statutory timescales (21 day) for Standard Authorisation Requests. We are currently one year behind timescale. The team is able to meet statutory timescales for Urgent Authorisation Requests which primarily are made from hospital wards, although care homes are making Urgent Authorisations requests in increasing numbers. To meet this increasing challenge the DoLS team is grateful to Cardiff Council and Vale of Glamorgan Council in providing additional full time Best Interest Assessors to the Team which has allowed for an increase in the number of assessments undertaken. However, there remains a large number of outstanding DoLS Authorisation requests that we have not been able to completed. It is noted that the number of BIAs working across the three organisations that are willing and able to commit to the DoLS rota is reducing despite 40 new BIAs being trained within the last two years. This is primarily due to the staff not having time available from their main jobs to undertake the BIA role. We currently only have 8 reliable BIAs on the rota.

It is estimated that the DoLS Team will need to coordinate approximately 80 Best Interest Assessments per week (an additional 10 Full-time BIAs) for a period of 12 months to make up the outstanding Assessments while ensuring compliance with new Authorisation requests. Thereafter a workload of 40 to 50 per week is likely maintain statutory compliance which is the equivalent of 6 full-time BIAs.

DoLS Authorisations

The Authorisation of completed DoLS assessments is an essential and important part of safeguarding vulnerable people. The Code is clear that the Authorisation must be undertaken by a senior manager independent of the provision of the care. The number of Authorisations required challenges already busy senior managers and had led to a number of outstanding Authorisations which adds to the risk of challenge for unlawful care and shortens Authorisation timescales and negates the effect of conditions.

ASSESSMENTS Completed Assessments

2014/15

% completed Assessments

2014/15

Completed Assessments

2015/16

% Completed Assessments

(2015/16)

Completed Assessments (to Oct 2016)

% completed assessments

(2016/17)

Outstanding Assessments

Cardiff Council 298 (38) 34.4% 305(177) 32.4% 346 37% 837 Vale Council 169 (16) 19.5% 216(125) 22.9%% 150 16% 438 C&V UHB 397 (52) 45.9% 419(237) 44.5%% 423 46% 88

AUTHORISATIONS Outstanding Authorisations

on 21st Nov 2016

Cardiff Council 122 Vale Council 4 C&V UHB 24

10


27 of 117

Cardiff and Vale Partnership Funding

Issues to consider

The Cardiff and Vale DoLS Partnership Board is asked to note and consider: Best Interest Assessors capacity/resource

The risk associated with the number of outstanding DoLS Authorisation requests.

Providing additional BIA resources to the DoLS Team

DoLS Team Funding

The UHB might wish to consider increasing funding to the DoLs Team to ensure continued compliance with the safeguards

Renegotiating the DoLS funding equation or revising funding arrangements

Andrew Cole Operational Manager Vale of Glamorgan Council Nov 2016

FUNDING Current Funding Equation

Current Funding Outturn

Actual Funding %

% of Referrals Funding based on Referrals

% Completed Assessments

(end Oct)

Funding Based on Comp Ass

Cardiff Council 40.74% (+2BIA) £41,765+£96,000

55.8% 39.4% £97,126 37% £91,210 Vale Council 14.65%(+1BIA) £15,018=£48,000 25.5% 27% £66,559 16% £39,442 C&V UHB 44.61% £45,732 18.5% 33.5% £82,582 46% £113,369 100% £246,515 100% 100% £246.515 100% £246,515

10


28 of 117

Cardiff and Vale of Glamorgan Deprivation of Liberty Safeguards and Mental Capacity Act Team

10


29 of 117

1

Report to the

Mental Health and Capacity Legislation Committee

on the use of The Mental Health Act, 1983

July – September 2016

11

Mental Health and Capacity Legislation Committee Mental Health Act Activity Report

30 of 117

2

0

2

4

6

8

10

12

14

16

18

ALDERWARD

BEECHWARD

CEDARWARD

OAK WARD WILLOWWARD

Nu

mb

er

of

pati

en

ts

Ward

The number of informal and detained patients on Acute wards

30th September 2016

Informal

Detained

0

2

4

6

8

10

12

ASH WARD ELM WARD MAPLE WARD PINE WARD

Nu

mb

er

of

pat

ien

ts

Ward

The number of informal and detained patients on Addictions, Neuropsychiatry and Low Secure wards

30 September 2016

Informal

Detained

11


31 of 117

3

0

1

2

3

4

5

6

7

8

9

10

CEFN ONN UNIT HAZEL WARD PARK ROADHOUSES

WORDSWORTHAVENUE

Nu

mb

er

of

pat

ien

ts

Ward

The number of informal and detained patients on Rehabilitation wards 30 September 2016

Informal

Detained

0

2

4

6

8

10

12

14

16

18

COED YFELINUNIT

COED YNANTUNIT

EAST 10 EAST 12 EAST 14 EAST 16 EAST 18 ST.BARRUCS

Nu

mb

er

of

pat

ien

ts

Ward

The number of informal and detained patients on Mental Health Services for Older People wards

30 September 2016

Informal

Detained

11


32 of 117

4

Section 135 – Warrant to search for and remove a mentally disordered

person/patient from private premises to a place of safety

During the period July - September section 135(1) powers were executed on three

occasions:-

All three patients were subsequently placed on Section 2.

Upper Control Limit

Lower Control Limit

Average

0

1

2

3

Jul 1

4

Aug

14

Se

p 1

4

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Au

g 1

6

Sep

16

Num

ber

of

patients

Month

Use of Section 135, Mental Health Act 1983 where Cardiff and Vale UHB is the place of safety

11


33 of 117

5

Section 136 – Mentally disordered persons found in public places

Mental Health Act assessments undertaken within Cardiff and the Vale UHB

In the period July – September 2016, a total of 74 assessments were initiated by Section 136 powers where the MHA assessment took place in a hospital as the place of safety.

The pareto chart highlights that 78.4% of individuals assessed under 136 were not

admitted to hospital.

Those individuals who are not admitted or discharged to another service are

Upper Control Limit

Lower Control Limit

Average

0

5

10

15

20

25

30

35

40

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Use of Section 136, Mental Health Act 1983 where hospital is the place of safety

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0

10

20

30

40

50

60

70

Assessed andDischarged

Assessed and AdmittedUnder Section 2

Assessed and AdmittedInformally


Nu

mb

er

of

pat

ien

ts

Outcome

Outcome of Section 136 assessments where hospital is the place of safety during the period

July - September 2016

11


34 of 117

6

provided with information on Mental Health support services for possible self referral.

Section 136 – Mentally disordered persons found in public places

Mental Health Act assessments undertaken within the police station

This chart is based on information provided by the Police for July – September 2016

During the period July – September 2016 a total of 1 assessment was initiated by Section 136 powers where MHA assessments took place at Cardiff Bay Custody Suite.

The pareto chart highlights that the only individual assessed under 136 was admitted to hospital.

Upper Control Limit

Lower Control Limit

Average

0

2

4

6

8

10

12

14

16

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Use of Section 136, Mental Health Act 1983 where Cardiff Bay Custody Suite is the place of safety

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0

1


Assessed andDischarged

Assessed and AdmittedInformally


Nu

mb

er

of

pat

ien

ts

Outcome

Outcome of Section 136 assessments where Cardiff Bay Custody Suite is the place of safety during the

period July - September 2016 11


35 of 117

7

Those individuals who are not admitted or discharged to another service are provided with information on Mental Health support services for possible self referral.

11


36 of 117

8

Section 5(4) Nurses’ Holding Power

Upper Control Limit

Lower Control Limit

Average

0

1

2

3

4

5

6

7

8

9

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Section 5(4) Nurses' Holding Power - Up to six hours

1, 14%

6, 86%

Outcome following Section 5(4) during the period July - September 2016

SECTION 2

SECTION 5(2)

11


37 of 117

9

Section 5(2) Doctors’ Holding Power

Upper Control Limit

Lower Control Limit

Average

0

2

4

6

8

10

12

14

16

18

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Au

g 1

5

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Au

g 1

6

Sep

16

Num

ber

of

patients

Month

Section 5(2) - Doctors' Holding Power - Up to 72 hours

31, 84%

6, 16%

Legal status prior to section 5(2) during the period July - September 2016

Informal

Section 5(4)

11


38 of 117

10

18, 49%

6, 16%

9, 24%

1, 3%

3, 8%

Outcome following section 5(2) during the period July - September 2016

Section 2

Section 3

Informal

Discharge

Remain 5(2)

11


39 of 117

11

Section 4 – admission for Assessment in Cases of Emergency

Section 4 was used twice and converted to Section 2 during the period July -

September 2016 for the following reason:

Potential immediate risk to themselves and others. No section 12 Doctor

available.

Upper Control Limit

Lower Control Limit

Average

0

1

2

3

4

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Section 4 Emergency Assessment - Up to 72 hours

11


40 of 117

12

Section 2 – Admission for Assessment

78, 69%

18, 16%

3, 2%

2, 2% 1, 1%

10, 9% 1, 1%

Legal status prior to section 2 during the period July - September 2016

No previous section

Section 5(2)

Section 135(1)

Section 4

Informal

Section 136

Section 5(4)

Upper Control Limit

Lower Control Limit

Average

0

10

20

30

40

50

60

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Se

p 1

5

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Section 2 - Admission for assessment - Up to 28 days

11


41 of 117

13

47, 42%

41, 36%

20, 18%

5, 4%

Outcome following Section 2 during the period July - September 2016

23(2) DISCHARGE

INFORMAL

SECTION 3

REMAIN ON SECTION 2

11


42 of 117

14

Section 3 – Admission for Treatment

Upper Control Limit

Lower Contol Limit

Average

0

5

10

15

20

25

30

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Section 3 - Admission for treatment

4, 8%

4, 9%

33, 70%

6, 13%

Legal status prior to Section 3 during the period July - September 2016

*No Previous Sect*

INFORMAL

SECTION 2

SECTION 5(2)

11


43 of 117

15

27, 57% 13, 28%

2, 4%

5, 11%

Outcome following Section 3 during the period July - September 2016

REMAIN ON SECTION 3

DISCHARGED

COMMUNITY TREATMENT ORDER

INFORMAL

11


44 of 117

16

Supervised Community Treatment

In the period July – September 2016, eleven patients were discharged to Supervised

Community Treatment (SCT).

As on 30th September 2016, 56 patients were subject to a Community Treatment

Order (CTO).

Upper Control Limit

Lower Control Limit

Average

0

1

2

3

4

5

6

7

8

9

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Community Treatment Order

11


45 of 117

17

Recall of a community patient under section 17E

During the period July – September 2016, the power of recall was used on one

occasion with the following outcome:

One patient recalled to hospital and revoked.

11


46 of 117

18

Part 3 of the Mental Health Act 1983

The number of Part 3 patients detained in Cardiff and the Vale University

Health Board Hospitals or subject to Supervised Community

Treatment/Conditional Discharge in the community as at 30th September 2016

0

5

10

15

20

25

30

35

40

45

SECTION 35 SECTION 37 SECTION 37/41 SECTION 47 SECTION 41 CTO (SECTION37)

Nu

mb

er

of

pat

ien

ts

Section

Inpatient Community

1, 2% 2, 3%

8, 14%

3, 5%

42, 74%

1, 2%

SECTION 35

SECTION 37

SECTION 37/41

SECTION 47

SECTION 41

CTO (SECTION 37)

11


47 of 117

19

Scrutiny of documents during the period

The chart above is a different type of control chart (P chart) which looks at the

proportions. The width of the control limits is dictated by the size of the denominator,

so a larger denominator will have narrower limits.

Upper Control Limit

Lower Control Limit

Average

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Au

g 1

6

Sep

16

Pro

port

ion o

f err

ors

Month

Document Scrutiny - Proportion that have at least 1 error

00.10.20.30.40.50.60.70.80.91

0

5

10

15

20In

com

plete o

r erron

eo

us

details - A

MH

P ap

plicatio

ns

Inco

mp

lete or erro

ne

ou

sd

etails - med

ical rep

ort

reco

mm

end

ation

Inco

mp

lete or erro

ne

ou

sd

etails - HO

14

(record

of

dete

ntio

n in

ho

spital)

Sup

ervised C

om

mu

nity

Treatmen

t error

Inco

rrect fo

rm u

sed

Failed

Med

ical Scrutin

y

Error o

n C

ou

rt Ord

er

Nu

mb

er

of

err

ors

Type of error

Rectifiable errors on legal documents during the period July - September 2016

11


48 of 117

20

Consent to Treatment

Urgent treatment

There are some circumstances in which the approved clinician may authorise a

detained patient’s urgent treatment under section 62 however this applies only to

patients whose treatment is covered by Part 4 of the Act which is concerned with the

treatment of detained patients and Part 4A supervised community treatment patients

recalled to hospital.

Urgent treatment is defined as treatment that is:

Immediately necessary to save the patient’s life; or

That is not irreversible but is immediately necessary to prevent a serious

deterioration of the patient’s condition; or

That is not irreversible or hazardous but is immediately necessary to alleviate

serious suffering by the patient; or

That is not irreversible or hazardous but is immediately necessary and

represents the minimum interference to prevent the patient from behaving

violently or being a danger to himself or others.

A patient’s treatment may be continued pending compliance with s.58, if

discontinuation would cause serious suffering to the patient.

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0

10

20

30

40

50

60

70

Treatmentwhere

consentgiven

Treatmentwhere

consent notgiven

Section 62 -emergencytreatment

Treatmentwhere

consent isgiven for thepurposes of

SCT

Treatmentauthorised

by SOAD forpurpose of

SCT

Section 64emergencytreatment -SCT patientsnot recalled

Treatmentwhere

consent isgiven for thepurpose of

ECT

Treatmentauthorised

by SOAD forthe purpose

of ECT

Nu

mb

er

of

cert

ific

ate

s

Type of certificate

Analysis of the consent to treatment provisions under Part 4 and part 4a Mental Health Act during the period July -

September 2016

11


49 of 117

21

Urgent treatment can be used in any of the following instances:

Where the SOAD has not yet attended to certify treatment within the statutory timeframe.

Where the SOAD has not yet certified treatment for ECT which needs to be administered as a matter of urgency.

Where medication is prescribed outside of an existing SOAD certificate.

Where consent has been withdrawn by the patient and the SOAD has not yet attended to certify treatment.

Where the patient has lost capacity to consent to treatment and the SOAD

has not yet attended for certification purposes.

The above chart highlights that Section 62 was used on ten occasions for the

following reasons:

Awaiting certification due to the three month consent to treatment rule x 6

Emergency ECT treatment x 1

Awaiting certification for a change in medication x 2

Patient withdrew consent x 1

Upper Control Limit

Lower Control Limit

Average

0

2

4

6

8

10

12

14

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Section 62 - Urgent treatment - Inpatients

11


50 of 117

22

The above chart highlights that section 64 was used on three occasions during the

period pending Part 4a certificate being provided by the SOAD.

Upper Control Limit

Lower Control Limit

Average

0

1

2

3

4

5

6

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Section 64 - Urgent treatment - Community Patients

11


51 of 117

23

Section 23 – Responsible Clinician Discharge

Upper Control Limit

Lower Control Limit

Average

0

10

20

30

40

50

60

Jun

14

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

patients

Month

Discharge from detention by Responsible Clinician

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0

20

40

60

80

100

120

Section 2 Section 3 Section 17A (CTO) Section 5(2) Section 5(4)

Nu

mb

er

of

pat

ien

ts

Section

Use of discharge by Responsible Clinicians during the period July - September 2016

11


52 of 117

24

Hospital Managers – Power of Discharge

Upper Control Limit

Lower Control Limit

Average

0

5

10

15

20

25

30

35

Jul 1

4

Aug

14

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

hearings

Month

Hospital Managers PoD Group hearings arranged

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0

10

20

30

40

50

60

Sectionupheld

Hearingpostponed

Dischargefrom

sectionprior tohearing

Hearingadjourned

by PoDPanel

CTOappliedprior tohearing

Cancelledby patient

prior tohearing

Sectiondischarged

by PoDpanel

CTOrevokedprior tohearing

Patienttransferredto another

hospitalprior to the

hearing

Nu

mb

er

of

he

arin

gs

Outcome

Outcome of Hospital Managers PoD Group hearings during the period July - September 2016

11


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25

Eleven hearings were postponed for the following reasons:

Two patients were unwell.

Four as the Responsible Clinician could not attend.

One clashed with the Power of Discharge group meeting (moved to later time on the same day).

One clashed with the patients Tribunal.

One where the advocate could not attend.

One where the Care Coordinator could not attend.

One Responsible Clinicians report was not received in time.

Six hearings were adjourned for the following reasons:

One as there was no advocate representation.

One to give time to the patient to read reports and consult with Advocacy.

One as the Responsible Clinician could not attend.

One as the patient decided to contest their legal status.

One as the panel requested the presence of the Primary Nurse.

One as the panel requested further information.

26, 68%

12, 32%

Number of patients represented by ASC during the period July - September 2016

Advocate not present

Advocate present

11


54 of 117

26

0

10

20

30

40

50

60

70

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

Oct

- D

ec

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

Oct

- D

ec

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

Oct

- D

ec

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

2013 2013 2013 2013 2014 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016

NU

mb

er

of

he

arin

gs

Quarter

Advocate attendance of hearings

Advocate Present

Not Present

Total Hearings

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

Oct

- D

ec

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

Oct

- D

ec

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

Oct

- D

ec

Jan

- M

arch

Ap

r -

Jun

Jul -

Sep

t

2013 2013 2013 2013 2014 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016

He

arin

gs

Quarter

Percentage of hearings with Advocates present

% with advocates

11


55 of 117

27

Mental Health Review Tribunal (MHRT) for Wales

67, 79%

17, 20%

1, 1%

Source of Applications to the MHRT for Wales during the period July - September 2016

Tribunal at the request of thepatient

Tribunal at the request of thehospital managers

Tribunal at the request of theWelsh Ministers

Upper Control Limit

Lower Control Limit

Average

0

5

10

15

20

25

30

35

40

45

Jul 1

4

Au

g 1

4

Sep

14

Oct 1

4

Nov 1

4

Dec 1

4

Jan

15

Fe

b 1

5

Ma

r 15

Apr 1

5

Ma

y 1

5

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct 1

5

Nov 1

5

Dec 1

5

Jan

16

Fe

b 1

6

Ma

r 16

Apr 1

6

Ma

y 1

6

Jun

16

Jul 1

6

Aug

16

Sep

16

Num

ber

of

applic

ations/r

efe

rrals

Month

Number of Mental Health Review Tribunal applications and referrals received

11


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28

Six hearings were postponed during the period for the following reasons:

On two occasions at the request of the legal representative.

On four occasions at the request of the Responsible Clinician.

Two hearings were adjourned for the following reasons:

On Two occasions at the request of the panel for further information

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

0

10

20

30

40

50

60

70

80

Nu

mb

er

of

he

arin

gs

Outcome

Outcome of Mental Health Tribunal for Wales during the period July - September 2016

11


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29

Summary of other Mental Health Act Activity which took place during the period July – September 2016

Exclusion of visitors

During the period the Exclusion of Visitors Procedure was not implemented.

Section 19 transfers to and from Cardiff and Vale UHB

Three patients detained under Part 2 of the Mental Health Act were transferred back

to their locality health board from Cardiff and Vale UHB to a hospital under a different

set of Managers.

Two patients detained under Part 2 of the Mental Health Act were transferred back to

Cardiff and Vale UHB as their locality health board from a hospital under a different

set of Managers.

Death of detained patients None to report. Section 117 Section 117 continues to be monitored by the MHA Department. As at 30 September 2016 Cardiff and Vale UHB maintain responsibility for 1677 patients eligible to section 117 after care. During this period Cardiff and Vale UHB updated the 117 register to include a further 28 cases and discharged 3. Training has now been delivered by NHS Wales Shared Services Partnership – Legal & Risk Services to all CMHT’s and was well attended by 153 members of staff from a range of disciplines including: Psychiatrists Social Workers Psychologists Community Mental Health Nurses Integrated Team Managers Administrators Support Workers Occupational Therapists Discharge Liaison and Repatriation Overall training was well received with 40% of those who attended providing the following feedback: Excellent 25% Good 62% Fair 13%

11


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30

Glossary of Terms

Definition Meaning

Informal patient

Someone who is being treated for mental disorder in

hospital and who is not detained under the Act.

Detained patient A patient who is detained in hospital under the Act or who

is liable to be detained in hospital but who is currently out

of hospital e.g. on section 17 leave.

Section 135 Allows for a magistrate to issue a warrant authorising a

policeman to enter premises, using force if necessary, for

the purpose of removing a mentally disordered person to

a place of safety for a period not exceeding 72 hours,

providing a means by which an entry which would

otherwise be a trespass, becomes a lawful act.

Section 135(1) Used where there is concern about the well being a

person who is not liable to be detained under the Act so

that he /she can be examined by a doctor and

interviewed by an Approved mental Health Professional

in order that arrangements can be made for his/her

treatment or care.

Section 135(2) Used where the person is liable to be detained, or is

required to reside at a certain place under the terms of

guardianship, or is subject to a community treatment

order or Scottish legislation. In both instances, the

person can be transferred to another place of safety

during the 72 hour period.

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Section 136 Empowers a policeman to remove a person from a public

place to a place of safety if he considers that the person

is suffering from mental disorder and is in immediate

need of care and control. The power is available whether

or not the person has, or is suspected of having

committed a criminal offence. The person can be

detained in a place of safety for up to 72 hours so that he

/she can be examined by a doctor and interviewed by an

Approved mental Health Professional in order that

arrangements can be made for his/her treatment or care.

The detained person can be transferred to another place

of safety as long as the 72 hour period has not expired.

Part 2 of the

Mental Health Act

1983

This part of the Act deals with detention, guardianship

and supervised community treatment for civil patients.

Some aspects of Part 2 also apply to some patients who

have been detained or made subject

MENTAL HEALTH CAPACITY LEGISLATION COMMITTEE … · 2016. 11. 23. · d ± MHCL Report e ± MHA...

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