Report to: Board of Directors (Public) FoI status: Report ... papers/6.1... · 3 1 Introduction The report covers the period from 1 April 2018 to 31 March 2019 and examines not only

Report to: Board of Directors (Public)

Paper number: 6.1

Report for: Information

Date: 4 July 2019

Report author: Dominique Merlande, Mental Health Law Manager

Report of: Dean Howells, Director of Nursing & Quality

FoI status: Report can be made public

Strategic priority

supported:

Early and effective interventions / Helping people to live well

Cultural pillars

supported:

We value each other / We are empowered / We keep things

simple / We are connected

Title: Mental Health Law Annual Report 2018/19

Executive Summary

This report describes how the Mental Health Act 1983 and the Mental Capacity Act 2005 have been used in the Trust in 2018/19. It also draws on internal and external assurance sources to establish areas of compliance and non-compliance with both pieces of legislation. This report presents the forward plan as agreed by the Mental Health Law Committee for 2019/20.

Report History

This report was discussed by the Quality Committee on 22 May 2019 where it was presented by Ms Merlande. The Committee commented very positively on the great progress that had been made over the past few years and had no concerns. It approved the report on behalf of the Board.

Recommendations to Board

The Board of Directors is requested to:

RECEIVE this report for information.

2

Risk Implications

This report highlights the risk of legal challenge arising from the implementation of aspects of the Mental Health Act 1983 and the Mental Capacity Act 2005.

Legal and Compliance Implications

This report highlights areas where the Trust’s practice is not in line with the Mental Health Act 1983 and the Mental Capacity Act 2005.

Finance Implications

This report makes recommendations for the training of all staff on capacity and consent provisions.

Single Equalities Impact Assessment

N/A

Mental Health Law

Annual Report 2018/19

2

Contents

1 Introduction .................................................................................................................... 3

2 Use of the Mental Health Act 1983 ................................................................................. 3

2.1 National context – Detentions in Hospital and Use of Community Treatment Orders

3

2.2 C&I Data – Detentions in Hospital and Use of Community Treatment Orders ......... 4

2.3 Legislative Changes and Impact on C&I ................................................................. 5

2.3.1 Independent Review of the Mental Health Act.................................................. 5

2.3.2 Change to Licence for Sodium Valproate ......................................................... 5

2.4 Associate Hospital Managers.................................................................................. 5

2.4.1 Terms of Appointment ...................................................................................... 6

2.4.2 AHM Review Timeliness .................................................................................. 6

2.4.3 AHM Training ................................................................................................... 7

2.4.4 AHM Activity .................................................................................................... 7

2.5 Care Quality Commission MHA Monitoring Visits .................................................... 8

2.6 MHA Related Clinical Audits ................................................................................. 10

2.6.1 Section 17 Leave ........................................................................................... 10

2.6.2 Validity of Statutory Documents ..................................................................... 10

2.6.3 Compliance with S132 for CTO Patients ........................................................ 10

2.7 MHA Related Incidents, Complaints and Claims ................................................... 11

2.8 MHA Training ........................................................................................................ 11

2.9 MHA Administration .............................................................................................. 12

2.9.1 Staffing .......................................................................................................... 12

2.9.2 Standardisation of procedures ....................................................................... 12

2.9.3 Service Level Agreements ............................................................................. 12

3 Use of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards ............... 12

3.1 Mental Capacity Amendment Bill .......................................................................... 12

3.2 NICE Guidelines on Assisted Decision Making ..................................................... 13

3.3 DoLS Figures for Camden and Islington NHS Foundation Trust ........................... 13

3.4 MCA Related Clinical Audits ................................................................................. 13

3.5 MCA & DoLS Training .......................................................................................... 14

4 Mental Health Law Committee ..................................................................................... 14

5 Conclusion ................................................................................................................... 14

3

1 Introduction

The report covers the period from 1 April 2018 to 31 March 2019 and examines not only the data and activity in relation to the use of the Mental Health Act (MHA) 1983 and the Mental Capacity Act (MCA) 2005 but also how the Trust discharges its statutory duties and responsibilities under both pieces of legislation.

2 Use of the Mental Health Act 1983

2.1 National context – Detentions in Hospital and Use of Community Treatment Orders

In 2017/18, NHS Digital reports that 49,551 new detentions under the Mental Health Act and 4784 new Community Treatment Orders (CTOs), but the overall national totals will be higher

as not all providers submitted data. It is estimated that there was an increase in detentions of 2.4% from the previous year.

The chart below shows the trend of increasing detentions under the MHA between 2009/10 and 2017/18:

Source: NHS Digital

Note: Detentions under the MHA figures exclude: short term detention order (Sections 4, 5(2), 5(4), 135 and 136); Detentions following recalls from CTO and conditional discharge.

On the 31 March 2018, there were a total of 21439 people subject to The Act. Of these people, over three quarters were detained in hospital, the others being subject to a CTO. NHS Digital reports that these numbers are incomplete due to coverage issues mentioned above. It is expected that national figures for 2018/19 will be issued by NHS Digital in October 2019.

46600 46348 48631 50408

53176

58399

63622 64894 66451

0

10000

20000

30000

40000

50000

60000

70000

2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

Detentions under the MHA - National Data

4

2.2 C&I Data – Detentions in Hospital and Use of Community Treatment Orders

In 2018/19, according to the C&I Mental Health Act Dashboard, there were a total of 1130 new detentions within the Trust. Compared to 2017/18 that is a decrease of 241 (or 18%), which is not in keeping with the national trend (2.4% increase). It appears that although the number of detained admissions increased by 133 (or 17%), the number of detentions following voluntary admission decreased by 374 (or 63%).

The following chart shows new detentions under the MHA in C&I between 2009/10 and 2018/19:

Source: C&I MHA Dashboard

On 31 March 2019 there were a total of 380 people subject to the MHA in C&I (similar figure on 31 March 2018: 384). Of these people, 175 (46%) were subject to a CTO (similar figure on 31 March 2018: 173). The remaining 205 were being detained in hospital (a decrease of 6 or 3%).

In 2018/19, 202 new CTOs were made within C&I, compared to 186 in 2017/18 (9% increase). The table below shows the number of new Community Treatment Orders (CTO) made in C&I since 2009/10.

Source: MHA Dashboard

622

745

654 637 590

514

715

845 774

907

389

378 402

463 470

435

434

491 597

223

0

200

400

600

800

1000

1200

1400

1600

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Detentions under the MHA - C&I Data Detentions subsequent toVoluntary Admission

Detained Admissions

91 118

132 134 127 131 151

174 186 202

0

50

100

150

200

250New CTOs Made in C&I

5

At national level less than three quarters of people subject to the MHA are on CTO, compared with 46% in C&I. A piece of research commissioned by the C&I Medical Director which suggests that on-going CTOs are associated with reduced rates of re-hospitalisation, but only when the analysis includes patients who have had more than one CTO. This is being peer-reviewed and will hopefully be published in 2019/20.

2.3 Legislative Changes and Impact on C&I

2.3.1 Independent Review of the Mental Health Act

The Review issued its final report on 6 December 2018. It makes a total of 154 recommendations. The government has already accepted two of the recommendations although it is unclear when new legislation is likely to be presented to Parliament:

the introduction of Advance Choices Documents (ACDs), in which a patient can set out his or her choices and preferences about treatment; and

a Nominated Person to replace the Nearest Relative, but with similar powers, with a fall-back “interim nominated person” appointed by an AMHP on applying for admission if the patient lacks capacity to nominate.

The report recognises the role of the combination of “unconscious bias, structural and institutional racism”, which contributes to the over-representation of those from a BAME heritage in the use of compulsory powers as well as the role of the culture of risk-aversion, especially leading up to the amendments in the 2007 Act.

Recommendations on Community Treatment Orders (CTOs), although not accepted by the government yet, are of particular interest to C&I, which reports a higher use of CTOs than any other London based mental health provider (see 2.2 above). The review considered the effectiveness of CTOs and, finding that the latest research was inconclusive, recommended to halve the use of CTOs. If accepted by the government, those recommendations might impact significantly on the way C&I provides care to detained patients following their return to the community. As discussed at 2.2 above, recent research commissioned by the C&I Medical Director, and yet unpublished, found that people subject to more than one CTO have a reduced rate of readmission to hospital.

2.3.2 Change to Licence for Sodium Valproate

To protect public health, the Medicines and Healthcare products Regulatory Agency (MHRA) changed the licence for valproate medicines in April 2018. Valproate must no longer be prescribed to women or girls of childbearing potential unless they are on the pregnancy prevention programme (PPP).

Valproate is a treatment for epilepsy and bipolar disorder. Children born to women who take valproate during pregnancy are at significant risk of birth defects and persistent developmental disorders. If valproate is taken during pregnancy, up to 4 in 10 babies are at risk of developmental disorders, and approximately 1 in 10 are at risk of birth defects.

Healthcare professionals who seek to prescribe valproate to their female patients must make sure they are enrolled in the PPP. This includes the completion of a signed risk acknowledgement form when their treatment is reviewed by a specialist, at least annually. The trust policy on Consent to Examination and Care has been amended to reflect this change.

2.4 Associate Hospital Managers

Associate Hospital Managers (AHMs) are lay people, who are appointed by C&I to review the cases of patients who are subject to the MHA. Their role and powers are set out in in the Code of Practice to the MHA.

6

2.4.1 Terms of Appointment

There are currently 21 AHMs appointed by C&I. There were no resignations or new appointments in 2018/19.

C&I terms of appointment currently require that AHMs:

complete a minimum of 12 reviews per annum (Two AHMs have failed to meet this standard due to personal circumstances. It is recommended to grant both of them short extensions – until June 2019 for AA and July 2019 for GB); and

attend a minimum of 2 AHM Group meetings per annum (Four AHMs have failed to meet this standard due to personal circumstances. It is recommended to grant them short extensions – until July 2019 – to make up the numbers).

2.4.2 AHM Review Timeliness

The backlog of AHM reviews which was cleared in 2017/18 following the allocation of extra resources (band 4 WTE 1.4 then filled via NHSP) led to a business case being submitting to FTE for the creation of substantives posts. It was approved in December 2018 and C&I is aiming to recruit in April 2019.

The Mental Health Law Committee (MHLC) has been monitoring the timeliness of AHM reviews on a quarterly basis via the AHM Group in 2018/19. The CQC identified timeliness of AHM reviews as a “should do” and this has therefore also been monitored by the CQC Programme Board in 2018/19. Results were as follows.

Month:

AHM reviews

held within 8

week target:

AHM reviews not

held within 8 week

target:

Compliance rate:

Apr 2018 11 2 85%

May 2018 12 2 86%

Jun 2018 18 6 75%

Jul 2018 15 6 75%

Aug 2018 24 6 75%

Sep 2018 13 8 62%

Oct 2018 12 4 75%

Nov 2018 16 4 80%

Dec 2018 31 8 79%

Jan 2019 22 3 88%

Feb 2019 21 2 91%

Mar 2019 10 1 91%

The periods when the compliance rate was below 80% coincide with times when the AHM Coordinators posts were vacant or when a new flexible worker was being given induction. A total of 9 different flexible workers have occupied the positions since 2017. Recruiting to these posts on a fixed term basis will allow C&I to maintain its compliance rate above 80%.

7

2.4.3 AHM Training

The AHMs received training on:

how to test the statutory criteria;

chairing AHM reviews; and

mental disorder awareness.

The session on chairing did not deliver the desired outcome and the AHM Group requested more in-depth training so as to ensure all AHMs can chair panels by October 2019.

2.4.4 AHM Activity

There were a total of 298 AHMs reviews held in 2018/19 (a 37% increase compared to 2017/18):

Like in 2017/18, a third of cases were reviewed on paper in 2018/19, therefore freeing valuable time for C&I professionals without compromising patients’ rights or the lawfulness of the process.

In 2019/20 C&I will endeavour to ensure all AHM panels are diverse and reflecting our service users’ ethnicity backgrounds.

11 6 8 12

114

70

114

175

0

0

57

105

0

20

40

60

80

100

120

140

160

180

200

2015/16 2016/17 2017/18 2018/19

Appeals

Renewals (full)

Renewals (paper)

Barring orders

8

2.5 Care Quality Commission MHA Monitoring Visits

The use of the Mental Health Act is monitored by the Care Quality Commission (CQC) via unannounced MHA Monitoring visits to each inpatient ward every 18 months. The CQC conducted a total of 13 MHA monitoring visits to the following trust wards in 2018/19. The table below sets out the issues identified by the CQC on their ward visits:

Domain Area:

Am

ber

Su

therl

an

d

Jad

e

Pea

rl

Ru

by

Garn

et

Ro

sew

oo

d

Laff

an

To

paz

Mala

ch

ite

Op

al

Mo

nta

gu

e

Sap

ph

ire

Care Plans

S132 Rights

S17 Leave

Consent to Treatment

General Healthcare

Keys:

Statutory requirements met

Improvement required

The top three concerns raised by the CQC are:

- Consent to treatment: when seeking the patient’s consent prior to first administration and assessing the patient’s capacity to consent to treatment, the nature of the decision for which the patient’s capacity was being assessed was not recorded and/or the evidence for the conclusion of the capacity assessment (when the patient was found to lack capacity) was not available (Breach of paragraph 24.41 of the Code of Practice to the Mental Health Act and Section 5 of the Mental Capacity Act); and

- Section 132 rights: evidence of attempts made on admission to explain their rights to patients, when unsuccessful, could not always be found (Breach of S132 of the Mental Health Act); and

- Care plans: patients’ views were not adequately reflected and copies were not always shared with patients (Breach of Chapter 1 of the Code of Practice to the Mental Health Act).

9

The above concerns have, broadly speaking, been the top three domains causing concerns since the Mental Health Law Committee started reporting to the Board in 2015 however the specific issues within each domain have evolved as follows:

Domain 2015/16 2016/17 2017/18 2018/19

Consent to treatment

Evidence in some records




Evidence in all records




Capacity test correctly recorded




Section 132 Rights

Successful attempts recorded in some records




Successful attempts recorded in all records




IMHA information evidenced




Unsuccessful attempts recorded in some records




Care Plans Some are up to date

Some are up to date

Some are up to date

Some are up to date

All are up to date All are up to date All are up to date All are up to date

Keys:

Standard met

Improvement

required

The CQC findings are corroborated by internal assurance sources (see clinical audit results at 2.6). C&I introduced MHA key performance indicators (KPIs) for all divisions in July 2017 to reinforce accountability of Operations and make non-compliance issues more visible. Those KPIs will be reviewed in 2019/20.

The CQC commented on the fact that patients could not control viewing panels on 7 wards in 2018/19. Those concerns had never been raised before. They were escalated to the C&I Estates and Facilities department.

C&I did not revisit its MHL Link strategy in 2018/19.

10

2.6 MHA Related Clinical Audits

2.6.1 Section 17 Leave The audit results show that:

Secretary of State approval is sought and obtained for the leave when necessary and this is recorded on the Section 17 leave form in line with C&I policy;

Most Responsible Clinicians indicate on the C&I Section 17 leave form whether the risk assessment process has been completed;

0nly 2 wards have good systems in place whereby, when Section 17 leave has expired or has been cancelled, a line is placed through the form which is signed and dated by the RC; and

where section 17 leave is granted for over seven consecutive days, the reason that a community treatment order has not been progressed, is not indicated on the Section 17 leave form (this is a breach of the requirement of the MHA).

The Mental Health Law Committee recommended that:

all RCs get reminded of the provisions of the trust policy; and

the results of this audit be shared with the Policy Lead on Patient Leave so that a discussion may be initiated on how to make documentation easy and on a possible revision of the existing Section 17 Leave form (with consideration of creating an electronic form on EPR if it makes documentation easier).

This audit will be repeated in 2019/20.

2.6.2 Validity of Statutory Documents The audit results show that:

Tribunal Full Decisions are not always filed or uploaded to Carenotes;

original section papers cannot always be located; and

statutory documents are not always sent to the Receiving Hospital following transfer. The Mental Health Law Committee recommended that the Deputy MHL Manager reviews the MHA administration procedures together with the MHA Office Managers. This audit will be repeated in 2019/20.

2.6.3 Compliance with S132 for CTO Patients A Quality Improvement project launched in Oct 2018, as a result of the S132 audit carried

out in 2017/18, proved very beneficial in improving compliance with Section 132 for CTO

patients in the R&R division. The below table shows compliance rated (in %) for each R&R

team:

Cam

den

AO

T

Islin

gto

n

AO

T

Cam

den

EIS

Islin

gto

n

EIS

No

rth

Cam

den

So

uth

Cam

den

No

rth

Islin

gto

n

So

uth

Islin

gto

n

FO

CU

S

Cam

CR

T

Isl C

RT

July 2017

50 50 0 0 0 100 0 50

Oct 2018

50 50 0 0 0 100 0 50

Jan 2019

50 50 50 50 50 100 0 50

March 2019

50 100 50 100 100 100 0 50 50 50 50

C&I aims to continue with this QI project in 2019/20 so as to bring compliance rates to 100%

for all R&R teams above.

11

2.7 MHA Related Incidents, Complaints and Claims

In 2018/19, 30 incidents were reported which were related to the application of the MHA. This is in keeping with previous years. Themes were as follows:

Incidents Themes: Number:

1 AHM Review Adjourned/Cancelled due to Failure on AHM Coordinator’s Part 10

2 Failure to Duly Scrutinise Statutory Documents 5

3 Section Expiry Date Reminder not Issued 4

4 Loss of Original Statutory Document 4

5 S136 Expiry 2

6 Statutory Document Fraudulently Backdated 1

7 RC's Failure to Complete Medical Recommendation 1

8 Failure to follow CTO Extension procedure which led to CTO lapsing 1

9 RC’s failure to prepare for Tribunal which led to adjournment 1

10 Manager on Call giving unlawful advice 1

Action plans have been put in place by the Deputy MHL Manager/MCA Lead to address themes 2, 3 and 4. Theme 1 is being addressed through the creation of substantive AHM Coordinators posts (see 2.4.2 above).

Three mental health law related complaints were received in 2018/19:

one complaint from a patient alleging unlawfulness detention (investigated and not upheld);

one complaint from a patient alleging failure of trust’s staff to inform them of their rights under the MHA (investigated and not upheld); and

one complaint from a legal representative alleging failure to submit reports in a timely fashion for an AHM review (investigated and upheld). AHM Coordinators’ procedures have been reviewed as a result of this 3rd complaint.

No mental health law related claim was made in 2018/19.

2.8 MHA Training

In 2018/19 C&I improved its MHA training compliance rate from 62% to 86%, therefore exceeding its own target of 80%.

C&I intends to maintain its MHA Training compliance rate over 80% in 2019/20.

19

62

86

0

10

20

30

40

50

60

70

80

90

100

2016/17 2017/18 2018/19

Training compliance rate

Training compliance rate

12

2.9 MHA Administration

2.9.1 Staffing

The recruitment of two Mental Health Act Officers took place in 2018/19. Both posts had been fixed term contracts but were made permanent. As mentioned in 2.4.2, approval has been obtained for the creation of fixed term AHM Coordinator posts. New staff have been equipped with necessary skills and knowledge and are confident in advising staff on legal aspects of the MHA and ensuring that all staff keep within the strict legal parameters of the MHA, reminding staff on time limits and legal duties under the Act.

New MHA Office Managers have been equipped with necessary management skills and knowledge assisting with several complex management processes such as probation extensions and flexible working applications. Both MHL Office Managers are on the waiting list for C&I Management Training.

New job descriptions and job titles were introduced for Band 5s to reflect the changes in the Mental Health Law Hub structure.

2.9.2 Standardisation of procedures

The Mental Health Act Administration Standard Operating Procedure was not produced in 2018/19 and this will remain an objective for 2019/20.

Receipt and Acceptance of Statutory Documents systems were standardised across the trust. A new process was introduced at the Highgate Mental Health Centre in August 2018, in consultation with the Duty Nurses Manager and the relevant Matron. It has reduced the number of scrutiny incidents from 15 in 2017/18 to 5 in 2018/19.

2.9.3 Service Level Agreements

The Trust’s MHA administration SLA with University College London Hospital Trust (£15k) was renewed in August 2018. A new MHA administration SLA was signed with Whittington Health in March 2019, generating an additional income of £10k. Negotiations are underway for SLAs with the Royal Free Hospital and Great Ormond Street Hospital.

3 Use of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards

3.1 Mental Capacity Amendment Bill

The Mental Capacity Amendment Bill is expected to be approved by Parliament on 24 April 2019 and to receive Royal Assent shortly after. It provides for the repeal of the Deprivation of Liberty Safeguards (DoLS) contained in the Mental Capacity Act 2005 (MCA), which were described in 2014 by the House of Lords Select Committee as “used to oppress individuals, and to force upon them decisions made by others without reference to the wishes and feelings of the person concerned.”’ They have also been widely criticised for being overly complex and bureaucratic. A new scheme called the Liberty Protection Safeguards (LPS) was put forward by the Law Commission and a lengthy parliamentary process of ping pong between the House of Lords and Houses of Parliament on amendments to the Bill is expected to conclude in April 2019. The government will need to compile the LPS code of practice, which it has committed to publish for public consultation in 2019. A number of regulations will also need to be drafted before the legislation can be implemented.

13

The government has not yet announced the date on which the legislation will come into force. But it is possible that this could be in Spring 2020. The government has confirmed that for up to a year the DoLS system will run alongside the LPS to enable those subject to DoLS to be transferred to LPS in a managed way.

3.2 NICE Guidelines on Assisted Decision Making

The National Institute for Health and Care Excellence (NICE) produced extensive guidelines on Assisted Decision Making for service users in October 2018. The guideline focuses on the following key areas:

advance care planning;

supporting decision-making;

assessment of mental capacity to make specific decisions at a particular time; and

best interests decision-making for individuals who are assessed as lacking capacity to make a specific decision at a particular time.

The Trust is currently 71% compliant with the new NICE Guidelines. Work is currently being undertaken to identify where there are gaps in Trust practices that need to be addressed. The MCA lead will produce a gap analysis by end of June 2019.

3.3 DoLS Figures for Camden and Islington NHS Foundation Trust

There were 20 DoLS application in 2017/2018 and 12 in 2018/19 (a 40% decrease due in most part to the winding down of services at Stacey Street prior to its closure). All the applications were for the SAMH division (10 for Stacey Street and 2 on Garnet Ward).

91% of DoLS applications were granted and, where they were not, this was due to patients regaining their capacity to make decisions. C&I had set itself the target of 80% of applications being granted and has therefore exceeded this target. This is due to DoLS procedures being well embedded into clinical practice.

3.4 MCA Related Clinical Audits

Three MCA audits were conducted in 2018/19:

- Staff evidencing lack of capacity;

- Informed Consent to Voluntary Admission; and

- Advance Decision recording in the Trust.

The regular quarterly audit on staff evidencing lack of capacity shows that staff are evidencing their capacity assessments using the correct form 80 % of the time. This

indicates that whilst there is still room for improvement the majority of capacity assessments are correctly recorded and the Trust target of 80% has been reached. However the CQC have found issues on all wards with the quality of the narrative in the capacity assessments. This audit will therefore be refined in 2019/20 to look at the quality of recording of the specific decision being asked of the patient, in order to further improve the quality of capacity assessment recording.

The informed consent to voluntary admission audit sought to establish whether trust staff had obtained valid (informed) consent from patients whose admission was facilitated without the use of the MHA or MCA. It was found to be the case in 59% of cases, an improvement on results from 2017/18 (42%). This re-audit still demonstrates a need for further staff training which is being implemented by Trust MCA Lead, including visits to all wards across

14

all divisions by the end of October 2019. Ward Managers will also be sent and reminded of the Voluntary Consent leaflet and form tools for use on the wards by June 2019. The Divisional Directors/Clinical will continue to be made aware of the results of the quarterly audits.

Advance decisions and advance statements/crisis planning ensure that the wishes of our service users and those who care for them are taken into account in the future. The audit results show that 40% of Advanced Decisions to Refuse Treatment were not witnessed, which is not following C&I policy and, in the case of one where lifesaving treatment was being refused, is unlawful. An action plan is being implemented by the MCA Lead to address those concerns. This audit will be repeated in January 2020.

The Trust EPR system does not currently provide reports on the use of the MCA and DoLS and this data is therefore currently kept manually. C&I was not able to address this gap in 2018/19 but aims to address it in 2019/20.

3.5 MCA & DoLS Training

A MCA/DoLS e learning package from Health Education England was launched in April 2018 via ESR. MCA/DoLS training stopped being delivered as part of induction as a result.

The MCA Lead formulated an action plan to increase the MCA training compliance rate (75.9% on 31/03/2018) targeting specific groups of staff, gaining support from divisional and team leaders to support staff to complete training and running drop in training clinics at venues across the Trust so that staff could complete their e learning in a quiet environment away from the workplace. This has meant that 83.2% were compliant with their MCA Core Skills training on 31/03/2018, which has exceeded the 80% target.

4 Mental Health Law Committee

The monitoring of compliance with Mental Health Law is overseen by the Trust’s Mental Health Law Committee which was chaired by Patrick Vernon, Non-Executive Director until June 2018. The MHL Committee would like to extend its thanks to Patrick for his diligence and leadership.

The appointment of a new Non-Executive Director, Dal Babu, in 2019, to chair this Committee has helped to strengthen the governance of mental health law and the benefits of this will be clearly demonstrated in the work programme for 2019/20.

The new chair has already put a strong emphasis on working closely with service users and carers and introduced separate meetings with Service User and Carers’ representatives at the beginning of his tenure.

5 Conclusion

The Trust is going from strength to strength in terms of MHA and MCA compliance although some work remains.

The following Mental Health Law Priorities are proposed for 2019/20:

Produce MHA administration Standard Operating Procedure;

Carry out appraisals for those Associate Hospital Managers whose terms of appointment are coming to an end in March 2020;

Recruit to AHM Coordinator posts (1.4 WTE);

Ensure BAME representation on AHM panels;

15

Provide EPR generated reports on the use of the MCA and DoLS;

Maintain MHA and MCA training compliance rates above 80%;

Review membership of the MHL Committee and appoint new Carer Representative;

Bring S132 compliance for CTO patients to 100% for R&R teams;

Share S117 reports with local authorities partners on monthly basis;

Sign SLAs with GOSH and the Royal Free Hospitals; and

Ensure adequate MHA administration service is provided following opening of new place of safety at the Highgate Mental Health Centre.

16

Appendix 1 Associate Hospital Managers’ Compliance with Terms of Appointment

AHM Number of sessions

(minimum 12 a year)

Attendance at AHM Group meetings

(minimum 2 a year)

Q1 Q2 Q3 Q4

David Barry 86

Winston Brandt 81

Norman Hamilton 71

Jeremy Walker 54

Tony Bowyer 42

Kathleen Lee 41

Mark Parr 40

Lidushi Nagularaj 39

Therese Kabega 38

Penny Mellor 31

Fatima Asadi 30

Paul Jacques 29

Jennifer Seres 29

Sophie Kussan 24

John Rahman 24

Petra Leseberg 21

Susan Plowden 19

Muna Ali 18

Pamela Ormerod 18

Gill Bennett 9

Adeola Akande 6

Attended/Met requirements of terms of appointment Did not meet requirements of terms of appointment Did not attend meeting

17

Appendix 2

Attendance at MHLC and Sub-Groups

Member

MH

L P

olic

ies

and

Pro

ced

ure

s

Gro

up

MH

L T

rain

ing

Gro

up

MH

L

Mo

nito

ring

Gro

up

MH

L

Co

mm

itte

e

Tota

l

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Mental Health Law Manager 80%

Deputy Mental Health Law Manager/Mental Capacity Act Lead

90%

Head of Social Work and Social Care 71%

Acute division representative 17%

SAMH division representative 33%

R&R division representative 0%

Patient Experience Lead 50%

Learning and Development representative

50%

Service users’ representative 86%

Carers representative 66%

Recovery College rep 100%

AMHP Service representative 37%

Equality & Diversity Lead 100%

Practice Development Nurses representative

0%

Medical Studies representative 0%

Clinical Governance representative 0%

Operations representative 0%

Medical Directorate representative 66%

Nursing Directorate representative 80%

Non- Executive Director (Chair of MHLC)

66%

Associate Hospital Managers representatives

100%

Quorum met