First topic message reminder :

Hello,

As a new member with rather an overload of information, I wonder if anyone could advise me - I'll try to be brief!

My father is 88 years old, has a long history of mental illness, and currently an inpatient on a mental health ward for the elderly in an NHS hospital and has been so for around 15 months.

He is suffering from clinical depression and recently has had 2 failed rehabilitations to his home, the latter ending in an attempted suicide. NHS Home Care was arranged and in place on both occasions.

The hospital were trying to send him home again less than 1 week after his overdose, but I said that I could not agree to this due to the potential risk to himself.

The only permanent solution for him in my opinion is a nursing home. He is reluctant to take this option as he has been told by the hospital that he will have to sell his house to pay - hence their persitance with sending him home.

Does he have a case for "Continuing Care" in a nursing home? According to the clinicians at the hospital he does not. But they are working to the National Framework and not the law. To my mind his primary need is a health need and going home results in deep depression and risk of suicide.

Any advice would be greatly received.

Thanks,

Yorks.

My experience is that the current version of The National Framework does not oblige the PCT to offer anything other than "support" (not finance and not a bed) after the initial CHC refusal, and that this alteration is clearly stated in the appendix of the NF. However, there is an important interplay with the Delayed Discharges Acts 2003 and 2009, the NF and The Continuing Care (Responsibilites) Directions 2009. All of this is well and clearly set out in Factsheet 37 by AgeUK. It is a current and accurate statement of the law and procedure, and I know it works when applied.

Refuse to pay threatened care home fees as POA with great caution is my now reluctant but informed stance. Do everything you can to demonstrate their breaches in procedure regarding discharge and assessments before you are boxed into that position, and know what can happen along the way to prevent that boxing in.

I agree with HS. Write every time to the CE of the PCT. They delight in passing the letters to "complaints managers" (how busy must they be?) or anyone else. KEEP ON AT THE TOP LEVEL and hold them to account. Copy in your MP although this has variable levels of success. We found it a useful lever on the CE of the PCT who seemed willing to answer letters headed in that direction even when avoiding mine!

Also helpful are the AgeUK factsheets on Mental Capacity and on the CHC procedure which will help to pinpoint where you should have been informed and been "invited " to attend and assist your father. Once again clear and accurate references to follow are all stated on them.

All the information Mick has previously given on the MHA sectioning is equally valuable, and provides you with an alternative route.

Above all, ensure all you quote is up to date and relevant, know when the whole process is generating more heat than light or when your own health is affected.

You're a long way into this already, so really well done. I suspect you must have done or discovered all I've suggested - so don't get thrown off course now.

Hello HS

Very interesting and informative post with a lot of advice.

But regarding the NHS/LA/SS not being able to take action against anyone refusing to pay care home fees.
The present day reality of the situation shows that this isnt the case. There have been a number of people on this forum who have been taken to court and lost over witholding fees. I am also aware of someone else who is in the same position.

Your sentiments and arguments regarding best "interests" I have great symmpathy for and in the ideal world it would be a perfect argument and I too would be likely to use it. But unfortunately this isnt the ideal world and there is the real possibility that this line of argument will be rejected by a judge, either in court or at the COP.
I have a very interesting document concerning this and how it could effect someones right to carry out their POA for a loved one, I will try to get it on here later.

Very kind regards Ian

In practice it is normal prior to discharge from hospital for the NoK/PoA to be consulted as their input must be sought. You can object if you disagree with their decision: eg. if they propose a discharge home, if a care package is not in place or there are no near relatives, or to a care home which you consider unsuitable or too far away for relatives to visit or a funding package has not been agreed. They cannot just impose one! Before a care home can accept a patient they must do their own assessment to ascertain that they are licensed to provide the care required. This in turn is specified in the MDA carried out by the NHS. Social services CANNOT provide care which is 'beyond the scope of local authority services' - confirmed by the Appeal Court in 'Coughlan'.
If the hospital ignore your objections and attempt a discharge you could obtain an injunction from the County Court - but you would need to first seek legal and medical advice endorsing the basis of your objection or the Court may overrule you. If the NHS move a patient into a care home of their own volition then THEY are responsible for ALL care fees - not you as it is they who would be responsible for signing the placement order; they cannot simply tell the home to 'send the care invoices to the patient/relatives/PoA' . . etc. In general, if the NHS or SS do not obey the law - or their own rules - then you can serve the Chief Executive with an injunction although a solicitors letter threatening one may concentrate minds! Steve.

Hello Steve

In the event of someone refusing to accept a discharge into a carehome yes the NHS would have the responsibility for that placement order. But would it not be important just what the wording of that placement order was.
Is it not beyond the bounds of possibility that they will introduce some neat little clause into it that still puts payment onto the self-funder?

I am not sure if a placement order is the same thing as a contract to provide care ie; between the patient/representative and the care home.

An assessment for CHC should always be carried out before discharge, but so often that doesnt happen.
Under the delayed discharges act ( and I am hoping I am right....its difficult without our research director... ) as long as they issue a section 2 social services can take over, so it is no longer the responsibility of the NHS.

CHC assessments can be done in a care home just as they can in a hospital.

If the NHS are responsible for funding during a period of witholding payments, either in hospital or in a care home during a dispite between patient/representative and The NHS. Then WHY are people being taken to court for non-payment and being threatened by the COP that their POA will be revoked. And if its against the law and against their rules, WHY dont the judges in these cases state that. A judge is neutral, he is there to uphold the law and to see that justice is done. Why Steve, why?

Ian

Lots to digest here!

I think for now I will try to take a similar route to Mick (section 3 > section 117). If my father gets it, it's for life. If this proves impossible to secure then obviously I will have to concentrate fully on the appeals route - which I feel if successful would be likely to be revoked at the obligatory 6 week assessment, on the grounds that all his needs are being managed!

Thank you for your continued support.

Yorks.

Hello Yorks

I think you have made the right decision as to which approach you will take.

If you want any more info just ask.

Very kind regards Iam

Hello yorks

Want to deal with two things in this post.

1. Right to remain in hospital.

2. Mental Health Act.

1. Right to remain in hospital; I have a couple of friends, one of which is a very close friend, both of whom work in a local hospital, not in management, but in very responsible positions, both of which obviously are versed in hospital procedure, including that relating to discharge.

What they have told me confirms what I have already posted that no one has the right to remain in hospital unless there is medical justification for it. The supposed problem of bed-blocking? was tackled by The Delayed Discharges Act which imposes fines on hospitals who do not discharge in a given time if there are no serious medical justification for not doing so.

It appears to me that we have over-looked something vital here about this issue and that concerns the role of the patients hospital consultant, the actual he/she in charge of the case. The consultant makes the decision concerning discharge. I will in a moment try to remember what my friend Heather told me ( very difficult when we have no research director to fall back on, so you are stuck with me ).

I think it was Steve, or it might have been Robin who caught a consultant altering medical records.

The other friend I know who works in a hospital had a aweful time over a consultant had had committed a serious professional act after she whistleblowed and the consultant started a vindictive attack on her which eventually resulted in three more consultants backing this very senior consultant.
Cant go into detail because they all still work in the hospital together and the position is delicate.

I just hope I have got this right ( if not blame me and not Heather ):

Section 2 notification is the first referal stage and informs the SS/LA that someone is seen by the consultant in charge of his/her care to be in need of care services and it is the NHS requesting assessment of/by SS.
Section 2 notification must be sent 48 hours pre-discharge.

Section 5 notification is notifcation of "imminent discharge" and informs the SS/LA that the consultant has decided that the patient is medically ready for discharge from hospital. Sent at least 24 hours pre-discharge.

If both notifications are sent at the same time, they must be sent 72 hours before discharge.

It should be remembered that the consultant is a medical professional person who is personally charged with making those type of decisions. Otherwise if anyone went into hospital with shall we say with a broken leg, for example, they could stay there forever?, if the consultant didnt say at some point " you need to go home".

It may not be realised but the hospital discharge procedure starts from the day of admission to hospital and is a way of planning for the " safe " discharge of a person, who may or may not be in need of further care services, and the NHS is not responsible for those services.

2 Mental Health Act:

I must admit I am on careful reflection somewhat surprised that few people have gone down this road.
It seems to me to be a very good alternative way of making sure your loved ones care is paid for by the NHS.
Many of our cases involve dementia which whether it be caused by a stroke ( vascular ), infection, injuries,degenerative, really should be classed as a form of mental illness. It was always regarded as such, and if I get the time I will do a special topic on this, for the debate chamber.

With dementia as you all will be aware very often there are behaviour patterns that put the patient in great danger of one sort or another, this in effect means that the person cant function within a normal environment.
Especially so if the individual is very aggressive to other people, or towards him/herself, and is suicidal, or has drink, drug, or sexual problems.

I am aware of a case dating back to 2004 where a man with early stage dementia was placed under section and therefore funded by the instruction of the senior psychiatric consultant at Lancaster Royal Infirmary.
His behaviour was getting more and more demanding. He started to refuse to have his cares at home, he was aggressive towards other people, he became very sexually active. He wasnt a young guy, late 6os.

His wife had died a number of years prior and he lived alone. His grand-daughter occupied the house after he went into care and still remains there with her boy friend. The local authorities could do nothing about finance or property because he was sectioned.

He was taken to LRI AT Lancaster treated at first in a general ward, then transfered to a mental health unit because of his aggression and other behaviour, where the consultant made his decision for his discharge.

Very kind regards Ian


.

Hello yorks

I knew I would get something mixed up, like I said I am no at research.

The Community Care ( Delayed Discharge) Act allows hospitals to charge social services departments if a discharge is delayed because the social service department hasnt arranged the required "social services".

So its not the hospitals that are fined. Every hospital has its own hospital discharge policy and everyone can ask for a copy of it. These can be found on line.

I will probably do a post here on one of these policy documents very soon.

Again sorry for that and really there is no excuse I should have know that one. Information given has to be correct and thats why it is vital that if something is wrong its right for someone to come on and say "hey thats not right and it says here". We are all on the same side!

Very kind regards Ian

ABSOLUTELY RIGHT IAN - well done. We none of us are perfect but we're all travelling the same road and if someone says must turn right (particularly to a person who's already lost their way) but the road ends up in Lands End it's easier to point this out so the next person has a hope of reaching the correct destination. No disgrace in being wrong is there - it's the honourable thing to do.
SBD
xx

Thanks Ian.

Not sure whether the document below is current, but if it is, and I am reading it correctly, then according to paragraph 2 the act cannot be extended to mental health care.

'With respect to mental health care only, the Act cannot be extended to include this as one of the qualifying types of care without the approval of Parliament'.

www.dh.gov.uk/en/Healthcare/IntegratedCare/Delayeddischarges/DH_4000508

My father is diagnosed with psychotic depression and fixed delusional disorder - which (quoted from the initial DST Summary) 'is not responding to treatment and remains as fixed as ever. Treatment options are significantly limited'.

However, as they feel that he is 'stable', the consultant says that he can be discharged and transferred to SS.

Yorks.

Hello yorks

I will try to get this clarifyed with Heather but I think that what it is referring to is that the rules of imposing a penalty on social services if they dont provide services within a given time are differnt in Mental illness.
What the reference to parliament could mean is that when someone is detained in a mental unit under the mental health act. There have been several high court cases over unlawful detention. It could refer to the law on detention having to be looked at in parliament.

If your Father has been diagnosed with psychotic depression with delusional patterns of thought fixiated, then he is clearly suffering from a mental illness and therefore his care should come under the Mental Health Act.
If you have got that on his medical record get a copy now.
Does his mental illness because of his delusional pattern of thought mean he is a danger to others or himself?

By their own admission he is psychotically depressed. Thats not just ordinary depression. Its very high risk and should entail 24/7 care in a secured unit for mental illness.

Does he also have suffer from hallucinations? There is internal functional depression and there is organic depression and there is depression thats related to external events.
There are many ways that a Person can play out depression and especially related to psychotic depression.
Depression often is a expression of anger, maybe against someone that consciously that anger cant be expressed to and it can be then mixed with guilt, with the danger that suicide is very possible. Or the person will turn the depressive anger away by projecting it onto the external world in general, which can lead to anti-social patterns of behaviour or far worse.

A very extreme example of this ( but there were other emotions involved ) was that Bird guy in Cumbria who killed all those people, part of his problem was for want of a better word was psychotic depression that was mixed with anger and hate that was turned away from himself with terrible results.

In the old days psychotic depression was known as manic/depressive psychosis, its now known as bi-polar disorder.
An even worse problem occurs if this depressive state is linked to schizophrenia, a state in which hallucinations are nearly always present. They can be visual or sound. These people in severe cases have to be detained under the Mental Health Act and full provision of care has to be provided by the NHS, free of any charge..

Your Father is mentally ill it is not the same as dementia. Check out psychiatric sources, check out The Royal College of Psychiatry and Psychiatrists. I think it is in London.

I hope I havent upset you by being blunt about the serious possible outcomes of a psychotic state ( of any type )
such as your Father has been diagnosed with. He cant be regarded as a dementia case. Even if there was dementia present, the psychosis would be the most important factor.

Very kind regards Ian.

Hello Ian,

Yes my father suffers from hallucinations (voices), has attempted suicide due to his depression and psychotic thoughts - which torment him when left to them, but he keeps them very much to himself unless questioned. All of this is documented in the DST.

At one stage (while still in hospital), he went 3 months without mentioning the fixated thoughts, and then spoke of them out of the blue. I asked him why he had suddenly started with these thoughts again, and he said that they hadn't gone away but as there was nothing anyone could do he had chosen not to speak about them.

I think there may have been a misunderstanding on the diagnosis: my father has not been diagnosed with dementia - and his symptoms don't really point to it; in fact he has had a routine brain scan to rule it out. However the PCT insist that his needs are social and the hospital say that they are not providing him with anything that social services couldn't supply in a care home setting. My argument is of course that as a patient with a mental disorder, my father is entitled to CHC in whatever setting and if the hospital want to move him to a more appropriate care facility then they are still obliged to fund his care.

On the delayed discharge - yes I agree, if correct it means that the SS can't be 'billed' for any delay by the NHS, which stops them hitting me so hard from both sides.

I have told the social worker that I deem my father's needs to be beyond the scope of SS, but she says that as the PCT have passed the case to them that they have to place him in a suitable home. She hasn't been in touch for over a month, but I am expecting her to any time.

Can I request his medical notes in writing, I do not have a good relationship with the Ward Manager and choose to avoid him whenever possible.

Yorks.

Hi Yorks, all this sounds dreadful and it is my opinion that your best cousre of action is to request your father's notes ( see the sticky and previous posts on the correct way to do this under The Data Protection Act as a subject access reuqest ). Do it in writing to the medical records department of the hospital or the regional hospital trust - do this by phoning the hospital and asking how you go about getting copies of your father's receords while he is still a patient. Explain you have POA and don't stand any nonsense that they can't do this while he is still receieving treatment there.
Therefater, it seeems to me your most relevant course of action is to request in writing and as a relative that your fathere has a full mental health assessment without medication asap or is sectioned to allow this to happen.
I'll go back to the Ageuk fact sheet No. 37 (as should you - cos it's very clear and helpful!) re Delayed Discharge and passing over to SS by s2 notice, but I think MH cases are not covered by this ie a MH patient is still under the PCT. All of which suggests the PCT is doing its best to shunt this to SS who shouldn't have it and have as much hope of placing your father safely as a (fill in appropriate non starter!). It seems to me what is needed is a clear diagnosis and statement of his needs and then a placement.

If your are feeling battle weary then either ask for more help here or even read up - get your plan of campaign clear and enlist any appointed case manager (or anyone higher up the chain of command) to shove it back to the PCT. I've found you'll probs have to do most of the research to achieve that, but once shown why it isn't "theirs" (SS), they do help. It's in their interest to do so after all.

If you can bear to - get your research done - bang out letters at the highest level to SS and PCT - drop CHC if it seems best to do so - and push on for what seems most relevant, helpful to your father and right.

Good luck.

Hello yorks

You have a right to both see your Fathers medical records and to request a copy of them.

Very interesting that they have ruled out dementia. I would think that would weaken their stance.

Its clearly a mental health problem and to say that the care is social is total toss, if that was the case then why are patients suffering from schizophrenia having their care for paid by the NHS and SS? By your PTCs line of argument then their needs are purely, or mainly social too. So by their arguments someone like Ian Brady main care needs are social. So why is his care being paid for by The NHS? Its because of his behaviour and what he is likely to do if he was free. Its not about just the fact that he murdered people, its about what he could do if free.

I am sorry to bring someone like that up in connection with your situation but I am trying to show the total nonsense of what they are telling you. But its your Fathers behaviour and what he possibly could do that would be the determing factor in care under the Mental Health Act.

He would have to be in a setting where he would be safe and that he couldnt harm others. There clearly is a limitation for the majority of Nursing care home placements because of this. We are dealing with mental illness, psychosis ( the hallucination another vital area of contention, voices. Very dangerous potential there, if a psychotic acts on those voices anything could occur.
If he is so disturbed then for his own safety and for those around him he must be detained to a secure care setting that meets the requirements of the Mental Health Act.

I have managed to get hold of Heather for you, but shes not clear about your reference to mental health act and parliament. Doesnt understand really what you are meaning? These are times when one has to ask the question why is this forum being denied the services ( free ) of someone who could provide this information.
Heathers good, but shes not . I am involved in so much else and can only give so much time, Steve sure to God cant do more with all those cases hes working on.

Asked Heather again about Section 117 After-care; Mental Health Act and I hope Ive got it right, Heather now at work, cant contact her.

" The responsibility for providing aftercare services RESTS WITH THE PATIENTS PRIMARY CARE TRUST OR HEALTH AUTHORITY AND THE LOCAL SOCIAL SERVICE AUTHORITY. "

" Services provided under section 117 are COMMUNITY CARE SERVICES FOR THE PURPOSE OF THE NATIONAL HEALTH SERVICE AND COMMUNITY CARE ACT 1990. A person who falls within the scope of this section may be in need of community care services and therefore must be assessed by the local authority, which then as a duty to provide those services which are identified as meeting the need."

Heather mentioned there could be a complication if your Father was admitted to hospital voluntary, but still would think that it is all down to his behaviour and the risks and 24 hour care needed to meet his very intensive care needs. Heather has got assess to data bank information and probably could have a word at discharge management level. But see how it goes. Will soon have to go off-line. But I have been glad to have been available to try to assist you. Please come back any time.

Any mistakes in the above are down to me

Very kind regards Ian

Hello yorks

Just one more for today. Concerns your social worker she should challenge the PCT if she believes that yoour Father should be in receipt of CHC, or sectioned under the Mental Health Act.

Your social worker is under no obligation to accept the case. But your social worker is under obligation to challenge the PCT about any case that is passed on.

When you request medical records make sure you do so formally and send with it the proof of POAs and make sure it is registered and that you make sure they have received it.

I will leave you in peace now I am sure your mind must be bogged with all this info, but if you have any more questions get in touch.

Very kind regards Ian

Thank you sillysally and Ian.

The social worker seems to think that she just needs to discuss my dad's finances, and then place him in a home - job done, case closed - next please. When she contacted me last, I told her that I was still waiting for the fully completed copy of the DST (with MDT recommendation), to be sent to me. I asked her if she had received a copy. She said that she had seen the DST from May. I told her that it had been rejected by the PCT and had been redone in September. I told her that it might be a good idea for her to obtain the current copy, so that she could see what the MDT had identified as his needs, and whether SS thought that they were within their scope before they accept responsibility for his care. She seemed quite surprised that anyone should question a PCT decision.

I cannot believe that SS accept any NHS recommendation/PCT decision without question, - or do they only question the referrals that SS will be responsible for funding. ie. the ones that have no means of paying for themselves.

Yorks

'Yorks' You may find it helpful to check my 'Sticky' on
'Vital Advice . . ' Particularly posts No.1 and 23. What social services can do is defined by S2 of the National Assistance act - which has NOT been repealed!

To avoid paying for long term care the NHS hand patients over to Social services who, under S21 of the National assistance Act, ostensibly provide them with accommodation and then charge them for all the continuing care they require. (The House of Lords call it ‘Cost Shunting’) So let's take a closer look into this particular ploy: The Act says:

'21 Duty of local authorities to provide accommodation'

(1) Subject to and in accordance with the provisions of this Part of this Act, a local authority may with the approval of the Secretary of State, and to such extent as he may direct shall, make arrangements for providing]—

(a) residential accommodation for persons aged eighteen or over who by reason of age, illness, disability or any other circumstances are in need of care and attention which is not otherwise available to them . . .

Thus the SS can provide 'residential accommodation' for those who are in need of 'care and attention'- but NOT the actual 'care and attention' which they may require.

The question has been clarified by case law:
In the High Court, Queens Bench Division, on 28th. July 1999, Mr. Justice Sullivan addressed the meaning of Section 21 of the National Assistance Act, and in his summation said "The duty under s21 of the National Assistance Act 1948 to provide accommodation for those in need of care and attention arose only where the accommodation was not otherwise available" (ie. NOT where the care and attention was 'not otherwise available')

In the Court of Appeal, case No. QBCOA99/0940/0941/0942/0943, on 27th. July 2000, Lord Justice Otton, on behalf of his colleagues said, "I now turn to consider the language and effect of section 21 of the 1948 Act: Sub-section 21 authorises the provision of accommodation to a person only where accommodation is not otherwise available to them. In the present case accommodation was (or is) available to the respondents by virtue of section 117. (MH Act). Thus on my interpretation, the section 21 (1) power does not arise"

When this case went to the House of Lords, (25th. July 2002), Lord Steyn for his colleagues, dismissed the Appeal by Local Authorities, having commented that the two previous rulings were "careful judgements"

In view of the forgoing judgements, social services departments clearly have no lawful role to play in meeting continuing health care needs unless they are also providing accommodation which is not otherwise available. Where there is a 'health need' (an illness or disability) this is the sole responsibility of the NHS - and County Council involvement is totally unlawful unless any care they provide is 'incidental and ancillary’ to the provision of the accommodation’ (Coughlan judgement)
Note that the CoA confirms that under a S117 order the NHS NOT social services MUST pay for ALL care. Steve.

Thank you Steve.

Excellent information. Post 23 contains many useful points - in a nutshell!

In addition to pursuing a section 3, I am also appealing the PCT decision.

I have written to the Medical Records Manager requesting all medical notes from admission to present date.

Yorks.

Fair enough Yorks, and obviously you know your own case thoroughly and best. However, from an outsider's reading your father appears to have clear Mental Health Needs, and not least the need to be kept in a secure environment. If you pursue this with his consultant psychiatrist (not a community MH nurse - which is likely what will be offered!)you will probably get further. If he does have clear MH needs and can be Sectioned under the Mental Health Act, then the utter nonsense that is the CHC procedure shouldn't be relevant to his case and you will save yourself many frustrating meetings and hours writing letters to people who are happy to play endless games at you and your father's cost. My advice is if you are able to - give CHC a very wide berth.

Hello Silly Sally, yorks

I fully agree with those comments it definitely would save you a lot of wasted time going through all the hoops.

Your Fathers safety too is the most important factor, alongwith the circumstances of his condition.

He requires specialised 24/7 care, the nature of which would be best supplied within a specialised unit.
Not a standard nursing home environment.

Very kind regards Ian

ian wrote:

Hello Silly Sally, yorks

I fully agree with those comments it definitely would save you a lot of wasted time going through all the hoops.

Your Fathers safety too is the most important factor, alongwith the circumstances of his condition.

He requires specialised 24/7 care, the nature of which would be best supplied within a specialised unit.
Not a standard nursing home environment.

Very kind regards Ian

I agree whole heartedly.

However the problem that I am faced with is that the 'health care professionals' are no more likely to section him, than they are to tick all the boxes on the DST to award him CHC. For them, the implications are the same. The consultant at one stage said that sectioning could be a possibility - but having consulted her boss, did a complete u-turn.
My dad is very submissive, and is a danger to himself, but not to others. He torments himself with persecutory thoughts, but keeps them very much to himself. For this reason the consultant has no reason to section him and has informed me that, 'your father is medically fit for discharge from the ward. The local authority will therefore be proceeding to place him in an appropriate care setting and we (NHS) will provide ongoing monitoring/support via a Community Psychiatric Nurse.

According to his consultant he is on the highest permitted dosages of his psychiatric medication, and still his fixated thoughts prevail. But the conclusion of the DST that he does not have a primary health need at this present time.

Yorks

A 'Health Need' is NOT synonymous with a need for health care or treatment - despite what the NHS says! A 'Health Need' simply means an illness, disability or injury and the actual care a patient requires or receives is completely irrelevant. ALL care is 'nursing' which as Lord Woolf said in coughlan is simply the OED definition 'caring for the sick' There is thus no lawful demarcation between nursing care and so-called 'social care' - it's ALL 'nursing' care. Many patients receive ONLY 'social care' as that is all they require. Interventions by nurses (registered or otherwise) or any other 'specialists' are NOT prerequisite to patient entitlement to NHS funded care. Many patients neither require nor benefit from specialist nursing care, many cancer patients and paraplegics - and in fact Pam Coughlan for example, require and receive primarily social or personal care. The NHS practice identified by the Appeal Court in 'Coughlan' of 'attempting to redefine health care as social care' was denounced by the court with Lord Woolf's ruling ' ... here the needs of Miss Coughlan were primarily health needs for which the NHS is a matter of law responsible'. His Lordship added that 'Miss Coughlan's needs were clearly beyond the scope of local authority services' Yet it is clear from Miss. Coughlans daily care regime that her care is predominently 'social and personal' care. "The judgment in Coughlan clearly establishes that where a person's primary need is for health care, and that is why they are placed in nursing home accommodation, the NHS is responsible for the full cost of the package." (Law Society evidence to Commons select committee)
In other words: 'Anyone who is so ill that they need to be in a care home is entitled to have ALL their care provided by the NHS' 'free at the point of need regardless of the ability to pay' THAT IS THE LAW!
Despite what they would have us believe the DoH, NHS and Social Services are not exempt! Steve.

Yorks, I understand the difficulties and how frustrating this must be. You could try sending much of what Steve has written to the CE of the PCT and to the most senior Psychiatrist in the PCT. You might also try your MP in conjunction, or if you have any access to funds or private med care seek a second opinion. Might MIND help with procedure or with access to a solicitor specialising in MH issues, I feel sure that under the MH Act you can insist on a full MH assessment, and at that you could indicate that your Dad is submissive at times but not at others - why else would he be on such powerful medication?

I once paid £10 to an online doctor to discuss my father's symptoms. It proved very useful in building up my case for CHC funding. Don't know if there are psychiatrists online. Just a thought.

If your father returns home with a CPN's support, there is a good chance the CPN will recognise the seriousness of his problems and readmit him to hospital. It was a CPN who admitted Mum due to her distress/disorientation. I know it would be back on the treadmill. Perhaps then you could make your stand again and insist he needs to be somewhere safe and secure and caring to avoid any further disruption to him - let them suggest where.......and them to pay.
Your poor Dad and poor you.
SBDxxxxx

Good point SBD, and another option in what looks to be a very difficult situation. I can understand your reluctance to consider a return home give the outcome last time, but perhaps SBD's suggestion provides something of a way forward if you can get close enough management of his care.

It would be an option, but as I couldn't be there 24/7, I'm sure that you will understand that the risk of suicide would be a risk that I would be unwilling to take. Further to to this, my father has begun to have falls in the last 12 months or so while on the ward, and so I think that the hospital would deem it unsafe for him to return home.

Yorks - under the Health Act NHS care shall be provided 'free at the point of need regardless of the ability to pay' Thus care can be provided in a hospital or hospice, a care home or some other institutional environment, in the patients own home or that of a relative or carer or, for that matter, in a garden shed or tent in a field!
Where the care required constitutes primarily health care its provision and funding is the sole responsibility of the NHS and they are required to provide a suitable care package in any of the venues listed above. You could then press for a NHS home care package providing 24/7 care for your father. A precedent for this was set by Barbara Pointon who obtained such a package for her late husband, Malcolm, who suffered from Alzheimer's disease, following an appeal to the Ombudsman. Check Barbara's own web site and the Ombudsmans report for details. Steve.
Footnote: If the NHS say it's too expensive then refer them to the 'Booker' judgement!

That is a good point Steve.
However as PCT don't admit responsibility, at discharge the NHS say that they will pass care/responsibility/costs to SS, who in turn will pass the bulk of them on to my father.
Under the circumstances my father would be better suited to a care home as opposed to 24/7 care at home.
The NHS are saying that they have done all they can for him and admit that he is not cured, but that he is stable and can be discharged. I disagree. It is up to them to find and pay for alternative accommodation for him if they do not think that the hospital ward is appropriate, and to continue to treat him as a mental health patient.

Hello yorks

This is such a diffficult situation for you and for your Father.

The point That Steve makes about The Pointon case is a very good one. They cant refuse to discharge into your care PROVIDING YOU CAN SATISIFY THEIR CARE AND SAFETY REQUIREMENTS.

That was at the root of the Pointon case. But they will make it very difficult.

Or you could go down The Mental Health Act road, like Mick did.

There will be a fight either way, but play it right and stick to it and you shouldnt have to pay for care.

Very kind regards Ian

Thanks Ian,

Once I have my dad's medical notes I will have a better idea of how strong an appeal I can make. The mental health route would be more water tight, but either way I have to get the NHS to admit responsibility for care.
I will also be using points which Steve has supplied to reinforce my argument.

I am very grateful for everyone's help and support.

Regards,

Yorks.

Yorks, I think it probably will be a wise decision to have your father looked after in a care home as opposed to your home. It would be very stressful to you and your family having carers coming into your home 24/7 as your home then becomes a care home and the stress and lack of privacy to you would be phenomenal.
I know its hard having our loved ones placed into a care home and the worst part is the guilt feelings, but if you find a good home that you are happy with and they are able to give your father the appropriate care he needs then I'm sure that will be the best thing for your father. We would all love to be able to have looked after our relatives at home but sometimes its just not possible. Best wishes

Hello Pussycat,

Thanks for your kind words.

Yes, in my father's situation I think that a care home would be the best option. But it is a good thing that Steve reminds us all that for some, 24/7 care at home (or in a tent in a field!) should be an option, if preferred.

I had a meeting on Thursday with SS (senior practitioner and social worker), on the ward. They said (knowing that I had both LPAs), that under the Mental Capacity Act the LA had the power to place my dad in a home. They said that they would like me to be involved in the process but were happy to do this - if I didn't want to be involved. I said that my dad's illness (psychotic depression) was beyond the remit of LA/SS. They said that as the PCT had concluded that my dad didn't have a PHN and as his consultant had deemed him fit for discharge that the LA could take over. I asked in view of the fact that I was appealing the PCT decision, if the LA would be funding the costs for the placement. they said that it was in our interested to have a financial assessment done asap, and that the LA would only fund (on a loan basis) until then. I said that under no circumstances would I agree to pay anything towards residential care home costs - and that I needed to seek advice on this matter.

Are they talking out of their backsides? Can they place him in a home and make him pay?
Is it time for legal advice? I am still waiting for medical notes and trying to pursue a section 3 ( difficult as my dad is being submissive), but they are pushing hard for discharge.

Yorks.

Sounds very confused - and not surprisingly so! Well done for standing firm. If the SS say this is beyond their remit, then that logically means it is a Health funded matter!! They have interpreted this section to mean you are funding it. Similarly it seems somewhat confusing to say your father is medically fit for discharge and also say he has psychotic depression! Once again I refer to the AgeUk factsheet number 37 on their website. Seems to me he can't be discharged at this stage and certainly can't be discharged to a care home for which you pay. It sounds like they're invoking "best interests" under the MCA - but you have POA, so I'm not clear how they can lawfully leap frog that! Unless they are suggesting they'll apply for his Sectioning? It all sounds like they've got the whole thing hopelessly confused and have probs been spun a few lines of this by the PCT who'd be keen to get him off the ward and certainly not keen to have him as a MHA patient.
Still sounds to me that your best (but no doubt not easy) option is under S3 MHA. In summary it seems you are having it all thrown at you - but it also all sounds unlawful and outside procedure. Read the factsheet, and I think you'll see your Dad's case is outside any discharge procedure they have cobbled together so far - so push like mad for S3.

Hello sillysally.

No - lol, it was me who told them that it was beyond their remit

I will take a look at the fact sheet.

Thank you!

Regards,

Yorks.

Yorks wrote:Hello sillysally.

No - lol, it was me who told them that it was beyond their remit

I will take a look at the fact sheet.

Thank you!

Regards,

Yorks.

Hi, Yorks

You need to make a complaint to the Mental_Health_Review_Tribunal, stating that you want your father assessed legaly for sectioning, As you have L.P.O.A You can make welfare decisions, complain that you are not happy with the use of antipsychotics Chemical cosh Ect,
complain to the tribunal that you think it is unlawful that they are medicating your relative for a mental illness, and not dementia there is no known treatment for demntia it is untreatable, So ask why are they medicating him and treating him as a social patient

if you have L.P.O.A You have been given the right to refuse any medication on behalf of that patient if they have lost capacity, but i think it has to be written into your L.P.O.A

http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=154


Personal welfare LPA
A personal welfare LPA allows the person/s you have chosen as your attorney to make decisions on your behalf about your personal welfare, eg where you live. It can include the power for the attorney to give or refuse consent to medical treatment if this power has been expressly given in the LPA. You have to fill in the form appropriately if this is the option that you require. If you do state that you do not wish to consent to specified life sustaining treatment to be given at a future time, the LPA giving the attorney the decision making power will invalidate a previous advanced decision refusing treatment, thus giving the attorney power to make the decision. A subsequent advanced decision (if applicable in the circumstances) would be binding on the attorney.

A personal welfare LPA can only be used once the form is registered at the OPG and you have become mentally incapable of making decisions about your own welfare.


Remember they can only prescribe medication for up to 12 weeks, Then it must be reviewed a patient can withdraw consent at any time, with your L.P.O.A You can make them respect your relatives wishes, this may not stop them from medicating your relative in the future, but it will speed things up Section 3 wise

Tell the Hospital you are going to make a complaint to the Mental_Health_Review_Tribunal as you beleive they are acting unlawfully Re medication, the Hospital then have to prove the reasons for medicating, They have to be seen to be using the least restrictive options to stabalise your relative

http://en.wikipedia.org/wiki/Mental_Health_Review_Tribunal_(England_and_Wales)


Mick

That sounds like excellent and helpful advice Mick and clearly stated.

sillysally wrote:That sounds like excellent and helpful advice Mick and clearly stated.

Hi, SillySally

Thank you for your nice comment, Hospitals P.C.T's Social Service Rely totaly on our ignorence of the law,they shot them selves in the foot really when they brought in the L.P.O.A trying to stop us, they actually have opened up doors that were firmly shut before

Because you have more say in matters with the L.P.O.A you are in the driving seat and you can force them to jump, but you have to be firm and be prepared to get court orders if necassary to make them follow the guidelines correctly


Mick

patrick11 wrote:

Yorks wrote:Hello sillysally.

No - lol, it was me who told them that it was beyond their remit

I will take a look at the fact sheet.

Thank you!

Regards,

Yorks.

Hi, Yorks

You need to make a complaint to the Mental_Health_Review_Tribunal, stating that you want your father assessed legaly for sectioning, As you have L.P.O.A You can make welfare decisions, complain that you are not happy with the use of antipsychotics Chemical cosh Ect,
complain to the tribunal that you think it is unlawful that they are medicating your relative for a mental illness, and not dementia there is no known treatment for demntia it is untreatable, So ask why are they medicating him and treating him as a social patient

if you have L.P.O.A You have been given the right to refuse any medication on behalf of that patient if they have lost capacity, but i think it has to be written into your L.P.O.A

http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=154


Personal welfare LPA
A personal welfare LPA allows the person/s you have chosen as your attorney to make decisions on your behalf about your personal welfare, eg where you live. It can include the power for the attorney to give or refuse consent to medical treatment if this power has been expressly given in the LPA. You have to fill in the form appropriately if this is the option that you require. If you do state that you do not wish to consent to specified life sustaining treatment to be given at a future time, the LPA giving the attorney the decision making power will invalidate a previous advanced decision refusing treatment, thus giving the attorney power to make the decision. A subsequent advanced decision (if applicable in the circumstances) would be binding on the attorney.

A personal welfare LPA can only be used once the form is registered at the OPG and you have become mentally incapable of making decisions about your own welfare.


Remember they can only prescribe medication for up to 12 weeks, Then it must be reviewed a patient can withdraw consent at any time, with your L.P.O.A You can make them respect your relatives wishes, this may not stop them from medicating your relative in the future, but it will speed things up Section 3 wise

Tell the Hospital you are going to make a complaint to the Mental_Health_Review_Tribunal as you beleive they are acting unlawfully Re medication, the Hospital then have to prove the reasons for medicating, They have to be seen to be using the least restrictive options to stabalise your relative

http://en.wikipedia.org/wiki/Mental_Health_Review_Tribunal_(England_and_Wales)


Mick

Thanks Mick. Some excellent advice. I am almost certain that I haven't been given the right to make decisions about life sustaining treatments but need to check the LPA. (I am at work atm)

I need to research what you have told me and start complaining.

Thanks,

Yorks.