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.

Update.

Had appointment with ward manager today. Despite my request to fully participate in the assessment process, the DST had been completed by the MDT.

The ward manager took me through it. I disagreed on many of their comments, but he said he'd go through it first and then discuss points at the end.

They had assessed my dad in the managed environment that he is in, (hospital ward) in his present state. I said that my father should be assessed as if in his home environment but he said he could only be assessed in his present environment!!!!!!!!!!

I quoted him from the NF that 'eligibility should not be based on the fact that a need is well managed' but he said that he could only be assessed in the environment that he was in as it was similar to the environment that he would be going into (nursing home) and therefore his needs would be the same!!!!

He eventually offered to write on the DST that had my dad been assessed at home he may have an entitlement to CHC. This was the only amendment made.

Behaviour Domain (with attempted suicide) scored a HIGH.

Nothing else scored above moderate.

Over all recommendation for NHS funded Nursing Care in a secure home for people with mental illness with qualified staff.

I told him that I did not agree and that as my dad's primary need is for health care and that is why he is being placed in nursing accommodation. Therefore the NHS were responsible for the full cost of the package. (CHC)

He disagreed and said that he really needed to get it sent off. I declined to sign and said that I would appeal if the outcome was not satisfactory.(CHC) He said that he would put on the DST that I disagreed with the MDT recommendation for Nursing Care and would leave me a photocopy when I next visit.
He also said regardless of the outcome there was no need for my father to remain on the ward and if there was a dispute it could still be sorted out while my father was in the nursing home. I told him that until it had been decided otherwise, my father was the responsibility of the NHS. He is not cured, and is never likely to be (which the WM agreed) and as such will be staying on the ward.

I took a signed statement along to add to the DST (just as well as the option wasn't offered to me). If I had gone into this meeting 'cold' as he expected I had, I would have been completely flummoxed. Part of my statement reads:

Following the ward round at .............. Ward on ...... it has been concluded by the health professionals who are responsible for the care for my father, that he presents a serious risk to himself if treated at home. This is evidenced by 2 failed attempts to send him home ‘on leave’ with a full ‘home care support package’ in place and while under full medication. In both cases this resulted in relapse within a few days and immediate re-admittance to the ward. The second episode resulted in attempted suicide while at home.

After nearly 18 months since his original admission, the health professionals do not consider it appropriate to continue treatment on ......... Ward. The health professionals recommend that as a long term solution he be put into a care home and continue his treatment there. As the judgement in the ‘Coughlan case’ clearly establishes, if his primary need is for health care, and that is why he is being placed in nursing home accommodation, the NHS is responsible for the full cost of the package.


Something that the WM did say as we were leaving was that even if my father was assessed (as if) at home and qualified for CHC, that when it was reviewed after 3 months (in nursing home) the CHC would be withdrawn as the risk would no longer be there because it was being managed.

Is it possible that they would try to do this and could they get away with it?

Yorks.

Yorks it seems that it is going that way now. Even if they give NHS Full Funding they will go in and assess again after 3 months and then withdraw it. Its a disgrace but there it is. The only way to counter this is to delay and don't bring the subject up and hope their admin skills are inept. BTW you did very well indeed with the ward manager WELL DONE I'm sure we are all very proud of you!! And their score of high after suicide attempts is .... well ...... quite pathetic. Just keep appealling and disagreeing with their scores.

One thing I must relay to you. There is a HUGE difference between an NHS Hospital Ward and a Nursing Home. In a NH there is usually only 1 registered nurse per floor the rest are ' carers ' who are not trained in the psychiatric side of ' care'. The ratio of expert staff to ' client ' in a NH is appallingly low when compared to that of a Hospital. A NH is ran for PROFIT not for care I'm afraid.

Right at the start of the process for my father's CHC claim the PCT continuing care lead wrote to me and stated "simply put an NHS funded bed for life is not an option". In other words it was saying "we may give you CHC if you are lucky but we will eventually stop paying by hook or by crook".

So even though he is mentally ill and tormenting himself with delusional thoughts - which the health professionals say will probably never go away, if he is in a nursing home it is being 'managed' and so he doesn't have a primary health need?

When is a primary health need not a primary health need?

When it is managed.

Ludicrous!

Sorry you have been having such a bad time lately, you must have been so worried.

Have a goodlook at the New Framework and remind the Assessors that a "managed need" is still a need and has not gone away! It doe still count in relation to NHS funded care.

I think it was Mick ? who advised that anyone on medications for Mental Health reasons should be assesed as though they were without ? I hope I'm right about this - maybe a message to him may help ? I think his username is Patrick ?

fimac4 wrote:Sorry you have been having such a bad time lately, you must have been so worried.

Have a goodlook at the New Framework and remind the Assessors that a "managed need" is still a need and has not gone away! It doe still count in relation to NHS funded care.

Thank you fimac4. Yes I quoted him 'Needs should not be marginalised because they are successfully managed'. But his reply was that his needs in the current environment were being assessed. He was having none of it.

bodecia2007 wrote:I think it was Mick ? who advised that anyone on medications for Mental Health reasons should be assesed as though they were without ? I hope I'm right about this - maybe a message to him may help ? I think his username is Patrick ?

Yes. I told the Ward Manager that I could demand an assessment without medication. (This was my intention had they not stormed off without me). His reply was,

"You wouldn't want to do that though would you! You wouldn't want put him through that. I don't think his consultant would allow that"

Actually I don't think his consultant could oppose it - but I didn't bother wasting my breath.

I am going to write to the PCT, to let them know that although it was me who requested the assessment,(rather than the hospital as preparation for discharge) I was excluded from the process, despite both a verbal and written request to fully participate (request received and acknowledged by his consultant and cc'd to the ward manager).

There was clearly no point in arguing with the WM. I will see what the PCT say. If they do not take my comments on board I will insist that the assessment was not conducted fairly and will ask for it to be redone with my full paticipation and assessment without medication, to expose all my Dad's problems. This would be unfair on my Dad because it would cause him added stress and anxiety. They do know how bad he is without medication so
could do it theoretically. But they may think they can call my bluff by refusing.

The more difficult they try to make things - the more determined I am becoming.

Yorks - in a defiant mood!

bodecia2007 wrote:I think it was Mick ? who advised that anyone on medications for Mental Health reasons should be assesed as though they were without ? I hope I'm right about this - maybe a message to him may help ? I think his username is Patrick ?

Hi, Bodecia

Yes i did advise anyone on medications for Mental Health reasons should be assesed as though they were without,I have been through this with my mother. I want you all to bear in mind that If they were going to Medicate my mother with dangerous drugs then i was determined that it would be done on a legal basis

I protested vigilantly, I read them the riot act Re Medication in her best interest Aka the nursing Staff's Best interests I protested that they could not medicate my mother without her fully informed consent which they never had.also they tried and tried to get me to agree to medication for my mum.

I had to show them a copy of the mental health act 1983/5 that no one a relative or carer of the patient canott lawfully give consent on behalf of another adult who has lost capacity, they then stated that they would have to section my mother under the mental health act 1983/5 Section 3 in order to medicate her and to put it on a legal basis


Mum who is imobile has lost the use of one hand cant weight bear. is incoherent in speech doubly incontinent verbaly aggressive and is totaly reliant on others for all daily living was sectioned 3

bear in mind if i hadnt of known our legal rights, they would have continued to medicate with the knowledge of our ignorence, Hence a small victory on our behalf as mum was sectioned. she is now covered by section 117 of the mental health act Fully funded for the rest of her life, Mum has vascular dementia has suffered left sided stroke is resistant on intervention


Advice to Yorks. I had everything including the kitchen sink slung at me. DONT GIVE UP

Below is part of a letter from the consultant spyco. you will see part of it blocked out my mistake. i tired to highlight it so you would see the wording. so just substitute the blank out with the words LACK OF AGREEMENT

Hope this helps. just be strong and loud dont let them bully you BECAUSE THE CAN AND WILL Stick to the law and you will

Mick



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Mick,

Thank you for the useful info. Although according to the Consultant my Dad does not have capacity to make a rational decision re: nursing home accommodation (I do agree that his delusional thoughts interfere with this decision - regardless of his reluctance to pay), I think I could get him to refuse medication. I am just not certain how long he would resist. It would only need to be long enough for me to insist on a section 3 I suppose, but then the hospital could probably stall before getting a second opinion for sectioning him. In the meantime they would no doubt do everything to convince him to take his medication.

Are you saying that if my Dad hasn't agreed in writing to medication and has since lost capacity that I can accuse them of unlawfully medicating him? And if they want to continue medication they need to section him under section 3. They are well aware of section 117. Could they find a loop hole? If I don't get any joy with the assessment for CHC then I am considering this more radical approach, but need to be aware of any potential 'get out of jail cards' that the NHS may have up their sleeve.

Yorks

Yorks wrote:Mick,

Thank you for the useful info. Although according to the Consultant my Dad does not have capacity to make a rational decision re: nursing home accommodation (I do agree that his delusional thoughts interfere with this decision - regardless of his reluctance to pay), I think I could get him to refuse medication. I am just not certain how long he would resist. It would only need to be long enough for me to insist on a section 3 I suppose, but then the hospital could probably stall before getting a second opinion for sectioning him. In the meantime they would no doubt do everything to convince him to take his medication.

Are you saying that if my Dad hasn't agreed in writing to medication and has since lost capacity that I can accuse them of unlawfully medicating him? And if they want to continue medication they need to section him under section 3. They are well aware of section 117. Could they find a loop hole? If I don't get any joy with the assessment for CHC then I am considering this more radical approach, but need to be aware of any potential 'get out of jail cards' that the NHS may have up their sleeve.

Yorks

Yorks

Of course they will try every trick in the book and more. just use the law laid down in the mental health act 1983/5 Relatives legal rights To demand (Request) a mental health assessment Under the mental health act 1983/5 You also have a legal right as next of kin to object to medication that you believe to have adverse effects putting his/her life in danger(use that as your argument)

They then have to prove that the medication is being given as a last resort after all else has failed. they have to give full written clinical reasons for medicating your relative and lawfully they must have his/her's Fully informed consent they have to prove this

they are not allowed by law to force or trick any patient into taking medication a patient can legaly withdraw his/her consent at any time ( only under section 2 for 28 day's not renewable. they then have to apply for section 3 for 3 months renewable if necassary to force a patient to take medication demand a mental health tribunal hearing see them jump then. or alternatively a court of protection hearing

My advice stay with the request for a mental health assessment Object strongly to medication without a section three if you win at this stage you wont have to apply a FF/CC As you relative will be covered under section 117 of the M.H.A 1983/5 Fully Funded in any setting in the inviroment. Good luck

Mick


Mick

Thanks Mick.

If it does come to sectioning, I am sure that they would try to section him under section 2 - where section 117 doesn't apply. But as he has been in hospital on medication for 18 months, assessment is not necessary and I would insist on section 3. This may be of use to anyone else in a similar situation. Note when I say assessment, I am referring to 'assessment before treatment' and not CHC assessment.

I will keep you informed. In the meantime any further information would be most welcome.

Yorks

Yorks wrote:Thanks Mick.

If it does come to sectioning, I am sure that they would try to section him under section 2 - where section 117 doesn't apply. But as he has been in hospital on medication for 18 months, assessment is not necessary and I would insist on section 3. This may be of use to anyone else in a similar situation. Note when I say assessment, I am referring to 'assessment before treatment' and not CHC assessment.

I will keep you informed. In the meantime any further information would be most welcome.

Yorks

Yorks,

The hospital would have already used up the Section 2 option in the first instance, I,e. Informal patient section 2 not renewable,( note section 2 only allows for a patient to be detained and medicated for 28 day's and no longer. if it is deemed that the patient needs mental health medication on a long term basis this can only be done under section 3) you need to find out about what medication is being given. how many medication reviews changes to medication Ect, Ect,Ask for absolute proof of you farthers Fully Informed Consent on each and every occasion if drugs were changed

Make an access to medical records from the hospital,When you have the L.P.A, Make that request for medical records under section 35 Of the Data Protection Act 1999 and for good measure also use the Freedom of Information Act 2000. As power of attourney you have the legal right to access your living relatives Medical Records, Again use this as your argument

I request my farthers/mothers medical records to establish his/her legal rights, Do not be fobbed off. you are legaly entitled to the medical records, Dont fall the we will only release them to your solicitor, That is not the law, The law is a power of attourney can make access to records and they must be delivered up to them

Data Protection Act: Section 35
May 25, 2009 — 585

Part 35 Disclosures required by law or made in connection with legal proceedings (1) Personal data are exempt from the non-disclosure provisions where the disclosure is required by or under any enactment, by any rule of law or by the order of a court.

(2) Personal data are exempt from the non-disclosure provisions where the disclosure is necessary—

(a) for the purpose of, or in connection with, any legal proceedings (including prospective legal proceedings), or

(b) for the purpose of obtaining legal advice,

or is otherwise necessary for the purposes of establishing, exercising or defending legal rights.

Has your farther been in the same hospital for the 18 months?


Mick

Yorks

A little more Info,


Sectioning literally means being taken to hospital, and detained and usually treated against your will. It is referred to as "sectioning" because it is legal under a section of the Mental Health Act. This can obviously be a very frightening experience for someone already distressed by severe mental illness. It can be good for the family of the ill person because they don't have to worry. For mental health professionals, sectioning is always someone to try to be avoided. But is done when they think the dangers for a person remain without treatments are too great.

The Mental Health Act sets out clear circumstances when someone can be taken to hospital, or made to take some treatment when they don't want to.

Firstly they have to be suffering from a mental disorder severe enough to warrant hospital treatment, and serious enough to mean that they can't make sensible judgements for themselves. They also have to be at risk to themselves or others. Appropriate treatment must be available. It must also be the case that there is no realistic alternative to hospital treatment and no alternative other than to use compulsion.

The good thing about sectioning is that it is not like a criminal record that stays with you, and you are protected by the Disability Discrimination Act like anyone else with a long term disability.

Professionals are very aware of the effects of using a section and they act both within what they see as the patient's best interest but also within a tight legal framework.

There are 5 commonly used sections each designed for different circumstances.

SECTION 4

If a doctor wants to act quickly to stabilise a situation they might use an emergency section 4 to detain someone for up to 72 hours for assessment only.

SECTION 136

If a person appears to be mentally ill and in need of care, and out of control in a public place, then a senior police officer can authorise Section 136. So the person can be taken to a place of safety, usually a hospital.

SECTION 2

There are times when a person needs to be assessed in a safe therapeutic environment before treatment is commenced, usually when they first come in to contact with services. At these times a section 2 would be appropriate.

This requires 2 doctors and an approved mental health professional and it lasts up to 28 days.

SECTION 5.2

When a person who is already in a psychiatric ward voluntarily but then withdraws their consent to the treatment program, if the doctors feel that this decision places either them or others at risk , they maybe placed on a section 5.2

This last up to 72 hours to allow for a proper reassessment of the situation.

SECTION 3

When an appropriate treatment plan has been formulated, then Section 3 may be used. This requires 2 doctors and an approved mental health professional, this last up to 6 months and enables treatments, usually medication. Treatments such as ECT (Electro convulsive therapy) can not be used without another thorough assessment

COMMUNITY TREATMENT ORDERS

If a person is in hospital on a treatment section, they can be discharged in to the community and still remain on section,(Section 117) on a community treatment order. This requires a responsible clinician, an approved mental health professional and most importantly the patients consent.

Once in the community if the patient does not comply with their treatment program they can be recalled to hospital


Mick

Mick - Thanks very much.

As my father went into hospital of his own free will, will he have already had section 2 applied? I know what you are saying that only section 3 would apply. It's just that I wouldn't put it past them going for section 2 and getting him back on medication within 28 days - if he refused medication.
Can you tell I don't trust them? I know they can't legally do it, but if they think I don't know that they would probably try it.
I thought of getting him to say "If you think I'm well enough to leave then I don't need to take these tablets any more". At which point I appear from around the corner and request that he be sectioned under section 3 to continue his medication. Am I dreaming? lol.


If I use the argument that you did (unlawful medication,without consent - have I got this right?), then it is me who is throwing the spanner in the works, rather putting the onus on my Dad to refuse taking his medication. However, I would need to be sure that there had been no consent given. They are well aware of section 117 and unless I get it right, will avoid it at all costs.

I have emailed the PCT today to say that I was excluded from the CHC assessment.

I think I have too many balls in the air at the moment.

Hoping to get both LPA's in 2-3 weeks.

Yes, my Dad has been in the same hospital for 18 months.

Yorks

Just seen your latest comment (15.06). Will post this and then read

Thanks Mick - redit
Unfortunately I'm a slow typer.

Ok so, if I try to get my Dad to stop taking medication could they refute my request for section 3 and go for section 5.2 and get him to agree within 72 hrs?

Yorks

Hi, Yorks

They are not legaly allowed to coerce any one in to taking medication unless they are detained under section 3, A patient is legaly allowed to (withdraw consent If it was ever given at any time)

A section 2 canott be renewed, you say a head scan was done which rueld out Alzhimmers/Dementia, Thus he is under treatment for a mental disorder, if they have not Sectioned him at this moment in time they canott legaly hold him he is free to leave Now He dose not have to take the medication if he dosen't want to. no one can force him to do so, The loss of capacity without a diagnoses of Alzhimmers/Dementia is indicative to the side effects of Strong medication. Slured speech,incoherent thinking even Incontinence iratic behaviour Ect, Ect

Force their hand and try to have him discharged. see what happens, if they refuse to let him go into the comunity, then you enforce you rquest to have him sectioned, If they let him go and he relapses then call the police and then have him sectioned, all very duanting I know but you have to try everything to force them to obey the LAW

Mick

Yorks

I forgot to answere your question Re section 5.2 SECTION 5.2

When a person who is already in a psychiatric ward voluntarily but then withdraws their consent to the treatment program, if the doctors feel that this decision places either them or others at risk , they maybe placed on a section 5.2

This last up to 72 hours to allow for a proper reassessment of the situation. Hence this is only for A Further Assessment Not medication

You can Read Section 5.2 HERE http://www.nelft.nhs.uk/_documentbank/SECTION_5_2___DRAFT_FT_POLICY_MHA016.pdf

Mick

Thanks Mick,

It would appear that section 5.2 is similar to section 2 but to detain someone rather than admit them. Do you have a similar link for Section 3?

I have been to see my Dad this evening and he tells me that he hasn't signed anything while he has been in hospital to give consent for medication. He says the only thing he has signed is his cheque book, in and out of the hospital safe.

If I can be certain of this then I can insist that they need to legally medicate him - as you did with your Mother (Section 3). I would feel happier having seen his medical records first, so may need to wait for the LPA.

I think first I need to see what happens with the assessment. I would expect to hear from the PCT having told them that I was not involved in the process. If after considering my contribution, the panel decides that Dad still doesn't qualify for CHC I will appeal and request that he be assessed 'without medication'. Unfortunately if it's done by the same MDT I can't guarantee that they will change their findings.

In the meantime if I get the LPA through I will look into the fact that they are illegally medicating - without patient consent.

I wish I could force their hand by threatening to take my Dad home, but I am certain that they would allow me to do this. However he would then be my responsibility and I would fear that he would try to commit suicide while left alone at home. I am unable to look after him 24/7. This is why I objected to them sending him home.
As I previously said, due to my ignorance of the law, and in shock from the fact that he had tried to commit suicide for the first time, I missed the trick of insisting he be sectioned there and then. He was taken back to hospital of his own free will, having not been formerly discharged - just on 'home leave'.

By the way, I got a copy of the completed DST this evening.

Was the individual involved ..........? Yes (No!)
Was the individual offered a rep/advocate present when DST completed?... Yes (No!)
If yes, did the representative attend the completion of the DST?....... Yes (No!)

Scores - without my contribution: 2H, 1M, 2L, 7N.

Don't trust any of these professionals. They are not there to help you.

Yorks

Yorks

Some Good info in this link Re Section 3 Hope it helps


http://en.wikipedia.org/wiki/Mental_Health_Act_1983

Mick

Yorks

If they try the mental capacity act 2005, Remind them that this Act is only for treatment of a pysical illness for a person with tempory lack of capacity, The pysical illness may be the cause of the lack of capacity, in cases such as these they can medicate or opperate on that patient in his/hers Best interest's

But a pysical illness must be present and be the predominent illness,They must prove that it is the pysical illness that is cauesing the lack of capacity, and by medicating Or opperating for that pysical illness, capacity will be restored, If Mental capacity is not restored after best interest's Intervention they must then have another reassessment under the mental health Act 1983

Mick

Thank you for the link Mick. Useful info. The MCA information is good to know. This is the kind of thing that I am trying to avoid being tripped up on. I'm learning slowly.

The more I think about it, the more I am inclined to try to invoke section 3. My concern is that 'they' know the implications of it just as well as I do. I have to make sure it's water tight if that is possible. They will have to have no other option. I really don't like playing dirty, but it's a case of fighting fire with fire I suppose.

Yorks

Yorks wrote:Thank you for the link Mick. Useful info. The MCA information is good to know. This is the kind of thing that I am trying to avoid being tripped up on. I'm learning slowly.

The more I think about it, the more I am inclined to try to invoke section 3. My concern is that 'they' know the implications of it just as well as I do. I have to make sure it's water tight if that is possible. They will have to have no other option. I really don't like playing dirty, but it's a case of fighting fire with fire I suppose.

Yorks

Yorks

Another little bit of good info for you to read

Here http://www.communitycare.co.uk/Articles/2009/01/29/110508/Free-aftercare-services-under-section-117-of-the-Mental-Health-Act.htm


Mick

Thanks Mick.


"The local government ombudsman found maladministration. The fact that a person is settled is irrelevant. It said the key question is: "Would removal of this person (settled or not) from this nursing or residential home mean that she is at risk of readmission to hospital. If the answer is yes then the person cannot be discharged from aftercare."

To be fair this really should apply to anyone who currently qualifies for CHC, and should prevent CHC from being withdrawn after reassessment, even if a person is settled or their needs are now managed. But it seems to carry more clout if a section 117 is in place. The judge or ombudsman frown upon a 117 being discharged if a patient is still ill - and rightly so!

Yorks

Yorks wrote:Thanks Mick.


"The local government ombudsman found maladministration. The fact that a person is settled is irrelevant. It said the key question is: "Would removal of this person (settled or not) from this nursing or residential home mean that she is at risk of readmission to hospital. If the answer is yes then the person cannot be discharged from aftercare."

To be fair this really should apply to anyone who currently qualifies for CHC, and should prevent CHC from being withdrawn after reassessment, even if a person is settled or their needs are now managed. But it seems to carry more clout if a section 117 is in place. The judge or ombudsman frown upon a 117 being discharged if a patient is still ill - and rightly so!

Yorks

Yorks

I can feel that swagger in your walk Go Get Em m8. I feel good if i have helped you and any one else looking in on this thread

Mick

patrick11 wrote:

I can feel that swagger in your walk Go Get Em m8. I feel good if i have helped you and any one else looking in on this thread

Mick

Thank you Mick

Everyone's help on here is invaluable. Please keep the advice coming as I head into battle.

Will keep you posted.

Yorks

My Father was 'voluntary' but I think he was sectioned some years ago and am not certain if he was ever taken off continuing healthcare. He has been under a consultant and GP due to his mental health for many years. I thought this may be a possible angle - but how would I find out if his CHC (if he did have it) was stopped?

Yorks

I Re Read Your First post, you say your father was Sectioned some years ago I strongly advise you to make an access request to his medical records Also Social Services Records to find out what section he was under, If it was a section 3 He would be covered under Section 117. Section 117 Canott be removed (Section 117 rights cannot be signed away)

Again Read Here http://www.communitycare.co.uk/Articles/2009/01/29/110508/Free-aftercare-services-under-section-117-of-the-Mental-Health-Act.htm

Make your Request for access to all records (now) Make sure to get all records His G.P's Records will also throw any light on the section as he/she will have been involved. Dosent matter you havent got P.O.A Registered yet. It is with the court

Alternatively, Do you think that your father is able to give his consent to you to make an access to his medical records If so write a letter for him to give you that consent. for the sake of £200/£300 ask for a solicitor to witness his signiture, a solicitor can determin if he has the capacity to understand,

Going this avenue could save you a lot of time Where the P.O.A is concerned. Then make that request for all records to each department I,e. His G.P. The Hospital. Also Social Services, Each will Charge you A maximum of £50.00 Thus a total of £150. You can legaly pay for this using your farthers money from his bank account


I read in your post's that your farther is able to signe his cheque book Do you keep tabs on this. One thing to bear in mind. if the Hospital are saying he lacks capacity to suit there End. how come he has capacity to signe his cheque Book

I strongly Advise the use of a solicitor just to witness his signiture of consent (but no more than that) Do not let the solicitor talk you into any more than this.

Get the solicitor to meet with you and your farther on the Ward in the hospital. Then watch the Hospital jump

If at the end of the day you find that your farther was Sectioned (3) in the past. then you are home and dry

Mick

Thanks Mick,

Unfortunately I have had his previous records searched and there is no mention of sectioning. My dad didn't think that he had been sectioned, but wasn't certain.

Taken from my dad's recent assessment (DST), the MDT only believe that my Dad lacks mental capacity to make the decision about his future care needs given the impact his delusional disorder has on his thinking. Outside of this his cognition remains wholly intact. Yes of course he does. So it goes without saying that he scores a LOW in the cognition domain.

Yorks

Yorks this is the meaning of ' Cognition ' that I found :-

cognition [kɒgˈnɪʃən]n1. (Psychology) the mental act or process by which knowledge is acquired, including perception, intuition, and reasoning
2. the knowledge that results from such an act or process[from Latin cognitiō, from cognōscere from co- (intensive) + nōscere to learn; see know]
cognitional adj



Collins English Dictionary – Complete and Unabridged © HarperCollins Publishers 1991, 1994, 1998, 2000, 2003
So if any of these apply with your relative maybe you could challenge the Cognition scoring ?

---

And from my Oxford Concise Medical Dictionary [ a huge help with my Mums appeals along with the British BNF Book !! ] =

Cognition - the mental processes by which knowledge is acquired. These include perception, reasoning, acts of creativity, problem-solving, and possibly intuition. Compare Conation.

Mun scored Severe in Cognition on the 2nd DST on the 1st they scored her as High.

This Counsel & Care doc gives some indication of the way in which different domains may be scored in the DST.

http://www.housingcare.org/downloads/kbase/3033.pdf

Para 7 in particular deals with the domains.

VM

Thank you all!

Yes, I scored Cognition as High in my Dad's case.

"finds it extremely difficult to make their own decisions/choices, even with prompting and supervision which places them at high risk of harm, neglect or deterioration in health."

When he was first admitted to hospital he couldn't even make the decision to have a a shower. When I went to visit him in the evening he had been worrying about it all day long.

I am hoping that the PCT contact me for my input before they make their decision, as I have requested. If not I shall ask for my Dad to be assessed without medication.

Yorks

Update

The PCT still have the health care assessment. After speaking to the assessor two days ago, it is on the pile waiting to be looked at. At my suggestion I dropped a copy in yesterday, with my scores and comments added - after explaining that the MDT had gone ahead and done it in my absence.

Just received a phone call from social worker wanting to move on to the next step!! Could she arrange an appointment to discuss my Dad's finances?

I told her that no decision had been reached yet and so there was no point.
She seemed to think that he'd not even warranted a full assessment according to the hospital because he wouldn't qualify.
But she was at the last ward meeting when I requested that one was done!

I told her it had been submitted and that the MDT had recommended RNCC but that the PCT hadn't dealt with it yet. She replied by saying in that case he would still have to pay for the other costs, ans so we could still arrange a meeting! I told her that if I didn't agree with the decision of the PCT, I would be appealing and so there was no point in discussing my Dad's finances at this stage.

A word of warning for anyone in a similar situation. It has been iterated on this forum many times - but once more won't hurt!

DO NOT DISCUSS ANYTHING WITH SOCIAL SERVICES. MORE IMPORTANTLY DO NOT SIGN ANYTHING.

While ever the ball is in the court of the NHS it is nothing to do with Social Services. They will make out that they are trying to help you, when in fact they are trying to help you to pay.

Yorks (Wound up again).

Yorks

Here is a link to an online book that may be useful to you


Mick

http://books.google.co.uk/books?id=Duuyb7T0ZiIC&pg=PA42&lpg=PA42&dq=can+you+be+medicated+under+the+mental+health+act&source=bl&ots=cHDJvopQFX&sig=MicY2QWMzXzMjECVJqFdrk59T-I&hl=en&ei=DNNjTaXPLMWbOvDLzeMN&sa=X&oi=book_result&ct=result&resnum=2&sqi=2&ved=0CCkQ6AEwAQ#v=onepage&q&f=false

Thank you Mick. Some very useful reading .

Update.

Had a phone call today from one of the nurse assessors at the PCT.

She wants a meeting with me and the health professionals to discuss the DST. She seems to have taken my separately submitted points into consideration and I think she wants a more comprehensive report from the hospital. Obviously I can't read too much into this, but at least the PCT haven't gone with the MDT's decision in the first instance. All too often the MDT seem to use the DST as a Decision Making Tool and not a decision support tool. In my dad's case there were no other reports submitted. If things were done fairly then I would have perhaps expected a report from his psychiatric consultant who is in charge of his treatment and reviews it on a weekly basis with the medical team. But then that would only reinforce his eligibility for CHC and so one could say that it is conspicuous by it's absence.

I submitted to the PCT in writing that my father's primary need is for health care which is the sole responsibility of the NHS. I also told them that the services required to assure continuing treatment and monitoring of his illness were beyond the nature that the L.A. can be expected to provide. Maybe this stalled them from endorsing the MDT recommendation for RNCC only, without further investigation.

We fight on.
Yorks

Dear all,

It has been some time since I last posted - in fact some of you will probably not remember me. Anyway, my dad has now been in hospital for over two years. The DST has been completed three times (between February and October), before the PCT were happy with the submitted document. At the third attempt they have concluded that my father does not have a primary health need.

'Although he has a health needs, the overall need is not of a level of intensity and/or unpredictability between the domains within the assessed level of need. He is entitled to social care and mainstream services'.

I still have the right to appeal to the PCT. I have requested, but still not received the 'finished' copy of the DST with the MDT's submitted recommendation. I obviously need this before I can appeal against their decision.

I bumped into my old friend the ward manager on Friday, who asked where we were at. He said that my dad needed to be moving on and said that I was invited to a ward meeting this coming Thursday. His consultant, members of the MDT and his social worker would also be there and his consultant would sign him over to the SS. He said that as I was to appeal the decision that SS would ask to see his finances, and would arrange care home accomodation which would be paid for by them on a 'loan' basis pending the outcome of the appeal. At this point I would like to add that I have both LPAs registered. The hospital are aware of this. I am also next of kin.

Yesterday morning my dad told the hospital staff that he no longer wanted to take his medication as he thought that he was getting worse and not better. He said all the staff told him that they were very sorry to hear it. His senior psychiatric consultant told him that she was concerned, and asked him if he would carry on taking his tablets (would he do it for her) just until Thursday, when it could be discussed at the ward meeting! He said that he was told that they had recently changed his tablets, obviously without his consent) which could be a cause of him feeling worse. He agreed after being persuaded by the staff, to continue his medication.
Nobody from the hospital has contacted me and told me about this! My dad told me tonight, when I visited. He told me that they never told him when they made changes to his medication.
I spoke to the nurse about this incident, and asked if she knew about it. She said not. I asked her to check to see if there was anything in his medical records. She brought them up on computer and found the latest entry, which said that my dad had recently said that he didn't want to take his medication any longer as he didn't feel well and didn't feel that it was doing him any good.

I told the nurse that I should have been informed and that if my dad hadn't mentioned it, I would not have been aware. She said that probably because he had taken his medication, they hadn't thought it necessary, but had made a note in the diary to arrange a time for a meeting with me on Thursday!

His 'named nurse' has left word to say that she will contact me tomorrow to arrange a time for a meeting for Thursday.

I am absolutely appalled that they haven't contacted me on such a serious matter. Looks like I will have a battle for the next couple of days. They know full well that if they have to section him it's game over.

Tired and stressed!

Yorks

For the time being I have batted them off re meeting with MDT,SS, consultant.

I am trying to push them into sectioning him, but I feel I need to tread carefully. I will be visiting him tomorrow to confirm, but it would appear that they are persuading him to continue with his medication.

Yorks

Update..

1. Although my father told the staff on the ward that he no longer wanted to take his medication he was persuaded by his consultant to carry on as he would get ill if he stopped taking it.

2. The MDT,SS and my dad's consultant had their meeting in my absence and apparently agreed (without informing me) that as a result of my father's failed CHC Assessment, he was medically fit for discharge. This only came to my attention when the social worker called me wishing to discuss the next step. I told her that I was unaware that this decision had been reached.

3. No doubt in order to set the record straight, I have received a letter from my father's consultant which states that his mental health is stable and as the assessment deems that he fulfils Social Care needs only, therefore he is inappropriately placed in an acute mental bed. The local authority will be proceeding to place him in an appropriate care setting with ongoing monitoring/support via a Community Psychiatric Nurse.

The letter goes on to say that "the local authority have the power to move your father into an appropriate care setting with or without your consent".

Is this correct?

I certainly won't consent to him being moved.

Due to the above I will be writing to the PCT to appeal the decision - until now it has been in our interest to drag things out.

Any advice welcome.

Yorks.

My advice would be to make sure the Hospital carry out the correct procedures. A CHC assessment needs to be properly carried out involving the Consultant if possible. If they discharge him, the correct discharge procedures should be followed. Do not talk finance to anybody. Talk continuing health care - if the hospital are no longer able to accommodate his needs they must find somewhere suitable for him to move to at their cost(with some input from the family regarding which home & location). If your Dad can understand, please tell him not to say he wants to go home (just to save him from selling his home), tell him he can save his home by making the NHS accept their responsibility to care for his mental health needs - he's earned it! It's not your problem if they have a bed blocking situation.
Also, and not wanting to sound callous - if your Dad were to be sectioned properly (not 117, cannot remember the section no) the NHS have no choice but to pay for his care from thereon in.

Think this is all right - somebody with a clearer mind will soon tell you if I'm wrong. But these are grass route comments.
Try to start things as YOU mean to go on. Please don't let it get out of hand, it'll kill you!
SBD
X

Hi SBD,

Thanks for the reply.

I am still trying to pursue the 'section 3' route, but it is difficult, as the hospital staff seem to persuade my dad to take his medication rather than take the matter more seriously. They have never told me that he has shown any reluctance, until I questioned them. It was recorded in his notes, but concluded that he had agreed - after discussion, to take it. At the time I said I was concerned that nothing had been said to me, but they said that they didn't think it necessary, as he had agreed to carry on with medication.

His consultant was not involved in the assessment. At the last attempt of the DST the MDT consisted of his 'named nurse', a member of the physiotherapy team, and the PCT representative, who also coordinated the process.

As a matter of interest the nurse and physio recommended CHC. This (not surprisingly) was not echoed by the PCT rep. or panel. I know that they are not supposed to go against the PCT recommendation without good reason, but I'm sure that they can think of one if pushed!

Yorks.

'Yorks' - you are experiencing what I call the NHS continuing care 'deliberate bloody shambles'. You seem to have reached the 'bed blocking' stage where the NHS simply ignore the law and the patient/family to free up a bed! They CANNOT hand his care over to social services as they must first implement the correct discharge procedures and where a dispute arises they must exhaust all local and statutory resolution procedures, including an appeal to the Ombudsman. All this can take months. In the meantime social services have no role to play so DO NOT agree to or sign ANYTHING and if they attempt to move your father into a care home register your objection in writing and advise the home that you will not accept liability for the placement or pay any care fees. I will look out my earlier postings on this common situation and forward the links direct. Steve.

Thanks Steve,

Would I be right in thinking that they cannot discharge Dad without his and/or my agreement - I have both POA's, at least until the appeals process has been exhausted?

My father is still mentally ill, and as such I believe that he is entitled to NHS care. If he goes home, he will without doubt relapse (again) and try to commit suicide. If they cannot find a more suitable long term solution then it is my view that is their problem. They don't actually need the bed - the ward has never been full in all the time that he has been there - so of course it is down to money, as is every other case.

Yorks.

Hi Steve,
can you send me the links too. I am currently helping a family who are being told....'mom doesn't qualify for NHS funded care'.....etc...the usual. Despite telling the hospital they wanted to be involved in any assessments...and being told first one had not been done, then that it had and the date being days earlier...the usual con trick.....they are determined to discharge mom and have now issued the section5 notice to do that. I have offerred to go with them to a meeting if they can get one arranged ASAP. Any links you have will save me trawling through my mountain of stuff.
My last success as a helper was for a gentleman who's funeral I went to last Monday, 8 weeks after they finally decided he had health needs!
Regards and good luck York.
Fimac4

Hello Yorks

Sorry to hear about your Father and your situation.

Both you and Steve are holding the view that the hospital cant discharge without your consent.
However, this point of view is incorrect. No one can by law stay in hospital indefinitely.

Much would depend however, on the medical grounds of the individual, just how long that stay will be for.
If a patient is not fit to be discharged because of medical grounds ( and this is the important bit and it would be medically unsuitable to be discharged either to the patients own home or to a care home ) then I would think the person could stay in hospital.

It is about money obviously, but not totally.

There is the factor of your Fathers mental health and the real risk of suicide. The question must be asked if a general hospital settting for him in those circumstances is the most appropriate and whether a discharge to a mental hospital would be the best course to follow.

If this was done under the mental capacity act your Father wouldnt have to pay for his own care, by law.

This is the position with Mick.

If your Father can walk then that poses a real high-level risk in a general hospital setting.
Much will depend on the actual cognitive state of your Father.

I should also point out as I observed you had POA for your Father and that if he is discharged into a care home it would be a very high risk strategy to withold paying the care fees. No solicitor activately involved in CHC work would advocate this course of action or indeed continue to support someone who did so.

The fact that you hold POA in that set of circumstances would work against you and it is very likely the LA/SS OR care home will take you to court and very likely ( as seems the rule more and more today ) The Court of Protection on the grounds that you are not acting in the best interests of your Father and non-payment of fees is one of their grounds ( by law ) for revoking your authority to act on behalf of your Father.

Very kind regards Ian

Hello Yorks

Just realised I have made a error in that last post.

I said under the mental capacity act when in effect it is THE HEALTH ACT.

Sorry for that. But thats what route Mick took.

Very kind regards Ian

Hello Yorks

The relevent information is THE MENTAL HEALTH ACT, SECTION 117 AFTER-CARE.

Under that The NHS has to fund the care, possibly with a little help from the LA/SS.

Very kind regards Ian

Hello Ian - and thanks.

Yes, this is what I am trying to pursue. However the consultant and ward manager know that if he is sectioned (section 3) then he will qualify for full funding. Unless they are stuck down a blind alley, they aren't going to section him, but rather persuade him to continue medicating.

Yorks

Hello yorks

Keep hitting them on those lines and try them to agree to a full mental health assessment review.

I dont know if thats the proper term to use. But he are having problems we have lost our main researcher VM .

Your Fathers worsening mental state would force their hand. If say and God forbid he was to attack someone, then that is the only safe course of action for them to take.

Have got somewhere on computer file a case in Morecambe involving someone I know whose Father was sectioned because of his aggressive behaviour and cognitive and emotional problems. His family did not have to pay for his care the NHS I asume did.

I actually have the report from the senior clinical psychiatrist at Lancaster Royal Infirmary stating that his needs had to be funded. Will try to find it, I havent deleted it. But I have forgot what name I have given the file. Worse comes to worse will try to see people involved and they should have a copy still.

Very kind regards Ian

Hello yorks

Here is a link I have just had a look at, there will be more so will keep looking for you.

If the link doent work ( and knowing me with links ) just google rethink org.

http:/ rethink org/howwecanhelp/ouradviceinformation/factsheets/2 html

Click dentention under the Mental Health Act.

Very kind regards Ian

Hello yorks

If no luck try this its easier and it works, onto google put in www:rethinkorg.

Very kind regards Ian

Hello Yorks

When I was faced with the situation you are now in (albeit before the current Framework existed) I kept writing and complaining to the Chief Exec as each assessment they did was inaccurate, incomplete and they did not follow the proper procedures. I also included objections to the 'criteria' they were then using.

I objected in writing when they threatened to move my mother to a nursing home and said she would not move anywhere unless they agreed to continue funding her care until the whole matter was properly resolved. At that point they then tried to get me to agree that we would refund all care costs incurred from that point on, if funding was eventually refused after the whole appeals process had been exhausted. Needless to say I refused that too and as Steve says you should not agree to pay any care costs at this stage.

My advice would be to complain about everything that is wrong in writing - do not accept the MDT meetings/assessments if they do not follow the guidelines. You should definitely have been at every assessment meeting as your father's advocate and so should the relevant professionals. They should have proper reports from the Consultant if he is not present and they should have done risk assessments. It seem strange that a physio would be included in the MDT when your father's problems are mental issues? I can't recall if you have obtained your father's medical records from the hospital - including the nursing records - but if not get them and go through them with a fine tooth comb, they are often a mine of information and 'proof'. They have to follow the proper procedures and if they are not doing that they cannot discharge your father.

As regards the question of withholding payment, they cannot attempt to charge you father for any care until the proper appeals process has been exhausted. I would argue (sorry about this Ian) that you would not be acting in the best interests of your father to agree to funding if proper process has not been followed or the assessments are inadequate or incorrect. You would be putting your father, his health (life) and future security (including financial) at risk by not standing up for his rights. That is how you act in his very best interests.

I am sure Steve will be able to provide you with all the links you need to keep on with your struggle so this is just intended to offer a personal account of how I tackled the same situation and provide some moral support.

Could I also suggest you copy the CQC and DofH on every letter of complaint and send every letter to the Chief Exec not to personnel in the CHC department. When the PCT accused me of 'bed blocking' I sent every complaint and all the 'assessments' to the Health Commission (now disappeared) - before we were anywhere near the 'appeals' stage - escalate everything up the chain, all the time, when they are not playing by their rules.

Spell out absolutely everything that is wrong and does not follow DofH guidelines on operating the Framework until they get it right - if they can

Best wishes
H