4th December 2003. The meeting last night was a follow-up to the MENTAL HEALTH CRISIS meeting last Monday 25th November called by frontline staff of the Norfolk and Suffolk Mental Health Trust. Last Monday’s open generic meeting, packed and overflowing into the corridors of the Norwich Vauxhall centre, had pretty well unanimously decided something must urgently be done. Last night’s meeting was to decide on what actions we will take in the near future.
The circumstances of mental health service non-provision demand urgency. We have:
- waiting lists of people needing treatment and attention stacking up because there is not the community staff to pick them up, an example was given of people waiting for prescribed injections which should only be started in hospital - no staff available and no access to hospital facilities.
- requests for assessment for (compulsory) admission to hospital unable to be met because so many hospital beds have been closed. The example given was that the nearest available hospital bed today was in Bedford. And there are many accounts of people having to be sent to various places far from Norfolk (and the friends and relatives of those persons) because of the Trust closing beds and wards. Desperation was indeed expressed that there are further pending closures.
- Dilemmas facing frontline staff: if they refuse to carry out the Trust’s wishes they are in danger of detriment to their jobs and careers. If they do carry out the Trust’s wishes in the present circumstances, much of the time they could be in breach of their laid down occupational standards. for example:
“You must not do anything, or allow someone else to do anything, that you have good reason to believe will put the health, safety or wellbeing of a service user in danger. This includes both your own actions and those of other people. You should take appropriate action to protect the rights of children and vulnerable adults if you believe they are at risk, including following national and local policies” (Standards of conduct, performance and ethics, Health and Care Professions Council).
And for Nurses:
“Generic standard for competence - All nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks. They must work in partnership with other health and social care professionals and agencies, service users, their carers and families in all settings, including the community, ensuring that decisions about care are shared. Field standard for competence - Mental health nurses must work with people of all ages using values-based mental health frameworks. They must use different methods of engaging people, and work in a way that promotes positive relationships focused on social inclusion, human rights and recovery, that is, a person’s ability to live a self-directed life, with or without symptoms, that they believe is meaningful and satisfying“ ( Nursing and Midwifery Council, Competencies for Registration to Practice).
It has to be noted that given the paucity of resources the NSMHT imposes on frontline staff whether in the community or on the few remaining wards it will frequently be impossible to meet these standards and each member of staff faces continuous risk of losing their registration. They are, as professionals, aware of this and that factor alone imposes intolerable stresses on them. They are, through no fault of their own, being made ill.
And Service Users are suffering - not only because they are not receiving the initial assessment and treatment asked for, they are receiving either curtailed follow-up or no follow-up at all.
Detention in hospital
When Approved Mental Health Practitioners (AMHPs), those professionals legally approved to carry out assessments for compulsory admission to hospital (usually social workers), make their decisions they have to take account of several factors. The Mental Health Act 1983 Code of Practice is one source of guidance in this. It says:
“AMHPs must also be satisfied that detention in a hospital is the most appropriate way of providing the care and medical treatment the patient needs. In making that decision, AMHPs are required to consider “all the circumstances of the case”. In practice, that might include the past history of the patient’s mental disorder, the patient’s present condition and the social, familial and personal factors bearing on it, as well as the other options available for supporting the patient, the wishes of the patient and the patient’s relatives and carers, and the opinion of other professionals involved in caring for the patient.”
In my opinion (as a former Approved Social Worker - the AMHP’s predecessor), this puts the AMHP in serious conflict when the only available hospital bed is several miles away from the Service User’s home, familial and social environment. This cannot be “...the most appropriate way of providing the care and treatment the patient needs,” In fact it is tantamount to locking the Service User up in isolation and I would have to refuse to make the application for admission!
But what of the employer - the Trust? It is the Trust that is responsible for these circumstances by cutting vital facilities; and it seems employers can get away with almost anything. They are though, certainly failing to meet their common law duty of care: to its employees and the care and treatment of its Service Users and Carers.
What can be done?
There are several options for action by the group. These are:
- Write a formal report directly to The NHS Trust Development Authority which oversees the performance of NHS trusts. The report should include a request for action by the authority. This will be about gathering the factual evidence;
- Write the same kind of report to Monitor. Monitor currently states: “...we make sure foundation hospitals, ambulance trusts and mental health and community care organisations are run well, so they can continue delivering good quality services for patients in the future”;
- the Care Quality Commission is currently telling us they are developing a special inspection system intended as a remedy for badly run mental health services (http://www.cqc.org.uk/public/news/inspecting-and-regulating-mental-health-services) However, they are starting this with a small midlands based pilot with the full service being launched in October 2014. It would do no harm though, to send copies of the above reports to CQC.
- Healthwatch Norfolk (HWN) does appear to be taking some action, their current newsletter says: “Many of you have contacted us with concerns about elements of the services provided by Norfolk and Suffolk Foundation Trust (the mental health trust), this reflects the concerns widely voiced in the press and in various public forums. Healthwatch Norfolk was also present at the recent public meeting in Norwich called by service users and staff where a number of harrowing examples were given of when services have not worked as they should. We are currently meeting with service users, carers and others to understand just how Healthwatch can make the most constructive contribution to making sure services meet the needs.” I’m a member of HWN but I’ve heard nothing about such meetings. I think though, positive communication would be a good move.
- Lobby the N&SMHFT at a near future board meeting in Bury St Edmunds.
- Lobby the NCC Health Scrutiny Committee at their December meeting.
- Organise a large open public meeting in a large Norwich open space. This meeting will be DVD recorded.
- Organise a demonstration at the end of February.
- Get the service users and carers to make a group complaint with the aim of involving the Ombudsman.
- The Management of Health and Safety at Work Regulations 1999: Risk assessment says:
- “Every employer shall make a suitable and sufficient assessment of—
- (a) the risks to the health and safety of his employees to which they are exposed whilst they are at work; and
- (b) the risks to the health and safety of persons not in his employment arising out of or in connection with the conduct by him of his undertaking, and;
- Health and safety arrangements: Every employer shall make and give effect to such arrangements as are appropriate, ...for the effective planning, organisation, control, monitoring and review of the preventive and protective measures...Employers have a duty under the Health and Safety at Work etc Act... to ensure, so far as reasonably practicable, the health, safety and welfare of their employees at work...These Regulations apply to a very wide range of workplaces, not only factories, shops and offices but, for example, schools, hospitals, hotels and places of entertainment...These Regulations aim to ensure that workplaces meet the health, safety and welfare needs of each member of the workforce, which may include people with disabilities.”
Eighth December 2013.