Here is the letter I have just sent

“Dear Mrs Bevis,

A decision has been made by the multi-disciplinary team (MDT)  the RC in charge of Elizabeth’s care to suspend your visits to Elizabeth for a further 4 weeks.

It had explained verbally at ward round that my ban will be indefinite on Thursday 28^th December 2023 and this meeting was witnessed, the reasons being of very serious nature.

I have been verbally accused of inciting violence in the form of attack on member/s of staff on Castle ward on Xmas Day.  I now do not feel safe visiting my own daughter ever again because of their bullying and this is what they have wanted to achieve. Not once have they offered an alternative place to visit my daughter who has been held like a restricted prisoner for 2.5 years. There is no accountability and noone cares under LINCOLNSHIRE PARTNERSHIP TRUST.

There was no attack though Elizabeth had raised her voice on those supervising my visit then next thing 5 stood outside the visitor’s room and when she came out to confront the staff they grabbed her leading to self defence not that she could have stood a chance against so many. She was then thrown into the seclusion room for 6 hours and injected when she came out without any checks on her blood oxygen levels being taken. The allegations are of a criminal nature towards me in that I caused this upset and once again Police were called by a nurse and I obtained the ref no and Police numbers of those who attended who I did not see as I would have liked to have done a Section 9 Statement as I had a witness with me who refutes the very serious allegations.

This follows the initial decision to suspend your visits which was made on 28th November 2023 and will be reviewed again on Thursday 25th January 2024.

The decision was made by the MDT/Dr K on 28th December 2023 was based on a review of your visit on 25th December 2023, the need to protect the safety and wellbeing of staff and other patients himself on the ward, and their his continued concerns about the impact of your my contact with Elizabeth on her wellbeing and presentation

The restriction on visiting will continue to be reviewed while police investigations and clinical reviews take place; we will be in contact in due course.

Kind Regards, The Mental Health Act Team. 

Chair: Kevin Lockyer Chief Executive: Sarah Connery http://www.lpft.nhs.uk“

In Confidence Mrs Susan Bevis Mental Health Act Administration Office Trust Headquarters St Georges Long Leys Road Lincoln LN1 1FS

29th December 2023

This letter above ends another year of hell under a Trust rife with bullying whose doctors hide behind MDT when it is one person’s power/decision to indefinitely ban me from visiting. I have been told that such a ban can only be done through the Court of Protection with very good reason.

This is the fourth time staff have called Police but not once has a Section 9 statement been taken yet the ban is said to be indefinite by the doctor and goes completely against Government Guidelines. I have also got quite a few threatening letters from the Trust trying to make out I am hostile, aggressive ect but when it comes to providing the proof which would have been recorded on CCTV there is nothing to show but certain members of staff are writing nasty things behind my back right now and although the letter states 4 further weeks it was crystal clear from the Dr’s verbal statement that this would be indefinite. On Xmas my daughter said she did not want to live and yet NOTHING is being done by LPFT - I have therefore written to Helen Whately and Will Quince to find out when the new law will come into effect.

I would not be writing here openly if I had something to hide.

Government to legally make visiting a part of care

Department of Health and Social Care, Helen Whately MP, and Will Quince MP

Published

21 June 2023

People in care homes and hospitals will be able to have visitors in all circumstances under law amendment.

Government announces proposed legislation on visiting in health and care settings

New regulations will make visiting a legal requirement for hospitals, care homes, mental health units and other health and care settings

Care regulator will have new powers to make sure providers are allowing families to visit loved ones

People in care homes and hospitals will be able to have visitors in all circumstances, thanks to the government’s plans to bring forward new legislation.

Health and care settings should be allowing visits, according to the guidance from the government and NHS England currently in place, but there are reported cases where visiting access is being unfairly denied.

As a result, the government is seeking views from patients, care home residents, their families, professionals and providers on the introduction of secondary legislation on visiting restrictions.

The new legislation will strengthen rules around visiting, providing the Care Quality Commission (CQC) with a clearer basis for identifying where hospitals and care homes are not meeting the required standard.

The government recognises the contribution that visiting makes to the wellbeing and care of patients attending hospitals, and residents of care homes, as well as the emotional wellbeing of their families and so is seeking views on what the new rules will look like.

For health settings, regulations will be reviewed in both inpatient and outpatient settings, emergency departments and diagnostic services in hospitals, to allow patients to be accompanied by someone to appointments.

Minister for Care, Helen Whately said:

I know how important visiting is for someone in hospital or living in a care home, and for their families. I know from my own experience too – I know what it feels like to be told you can’t see your mum in hospital. That’s why I’m so determined to make sure we change the law on visiting.

Many care homes and hospitals have made huge progress on visiting and recognising carers since the pandemic. But I don’t want anyone to have to worry about visiting any more, or to face unnecessary restrictions or even bans.

I have listened to campaigners who have been so courageous in telling their stories. I encourage everyone who cares about visiting to take this opportunity to have your say on our plans to legislate for visiting.

Minister of Health, Will Quince said:

Most hospitals and care homes facilitate visiting in line with guidance, but we still hear about settings that aren’t letting friends and families visit loved ones who are receiving treatment or care.

We want everyone to have peace of mind that they won’t face unfair restrictions like this, so we want to make it easier for the CQC to identify when disproportionate restrictions and bans are put in place and strengthen the rules around visiting.

It’s important that people feedback on the consultation, we want to make sure the legislation is right for everyone. If you’ve experienced unjust visiting bans, please share your experience.

Challenges around visiting were exacerbated during the COVID pandemic, with many health and care settings restricting and banning visits to stop the spread of the virus, ease pressure on the NHS and reduce the risk of transmission. Since restrictions were eased and there was a return to normality, many health and care settings have made efforts to return to pre-pandemic visiting. There are however still instances where, families and friends continue to face issues with visiting across the health and care sector.

The CQC does currently have powers to clamp down on unethical visiting restrictions, but the expected standard of visiting is not specifically outlined in regulations. Current guidance from government and the NHS is clear that all care homes and hospitals in England respectively are expected to facilitate visits in a risk-managed way, such as through the use of face coverings in the event of an outbreak or in the reduction of the number of visitors at one time.

Patricia Mecinska, Assistant Director of Patient Experience at King’s College Hospital NHS Foundation Trust said:

At King’s, our teams recognise the invaluable contribution that friends, carers and loved ones make to the patients under our care, including supporting us to provide care that’s respectful of our patients’ needs, so enabling them to make a positive recovery. Plans to involve care supporters in a more formalised way will be welcomed by many patients and will aid us in delivering our vision of providing outstanding care to patients and communities.

The hospital visiting guidance also includes an expectation that patients can be accompanied to hospital appointments when needed.

With the new legislation, the CQC will be able to enforce the standards by issuing requirement or warning notices, imposing conditions, suspending a registration or cancelling a registration.

Background information. See the visiting in care homes, hospitals and hospices consultation.

First of all Iike to wish all my readers a very Happy Xmas and New Year.

Elizabeth’s cat who she misses so much and adores. If only she could have come home. It was requested I bring the cat to see Elizabeth but it would not have been fair as he was suffering last time so much when we travelled from London to Lincolnshire to what we thought would be a wonderful area that would aid Elizabeth’s recovery. I was totally wrong about this as even in Enfield before at least we did not have the restrictions and appalling treatment as we have encountered under this Trust below.

“We are taking your complaint seriously”

I travelled from where I live to Lincoln to visit Elizabeth. It is about an hour’s journey. I did not know what to expect as the rest of the family said she was “not good”. I brought with me presents, chocolate and crisps. It was lunch time and Elizabeth had just eaten Xmas dinner. There did not seem to be that many patients on the ward and the atmosphere was more peaceful as usually alarms are going off every second.

I was led to a visitor’s room and came with a friend. They usually put HCA’s to sit there and take notes as I am clearly being targeted supposedly by an entire team of people ie the MDT or that is what they would like us to believe. The rest of the family visited yesterday (Xmas Eve). Their visit was not supervised. I did not know what to expect as the rest of the family had said she was “not good”. 

A female member of staff was in the small visitor’s room watching our every move in order to report back to Responsible Clinician Dr Waqqas Khokhar. Whilst God knows what could be written behind my back I make my own notes and records. Elizabeth was pleased to see me. She had been asleep earlier close to lunch time and I suggested someone woke her up as I was just half an hour away and she would miss out on her Xmas Dinner.

Anyway I proceeded to pass Elizabeth the presents, not all from me but friends. I bought nice sets of pyjamas, I left money so she has plenty of money to have her hair done but have no idea whether the ban on even going out in the grounds had been lifted. Elizabeth’s hair is now really long and needs cutting. I would always ensure that she was taken to the hairdressers and it was quite relaxing for her. I hope that additional ban has now been lifted so Elizabeth can have her hair done.

I then said to the HCA that as Elizabeth missed her cat perhaps LPFT could arrange for her to be brought back home to see her cat like Cambian did when she was sent from London to Wales some time ago.

Elizabeth was pleased with the presents. We only had one hour to visit. Another lady came to take over to watch our every move. I noticed that Elizabeth’s mood was changing. She seemed to resent the fact that staff were taking notes and supervising and who could blame her. She started to react as she thought this lady was looking at her and smiling and she started to say about her autism which I pointed out was something that Elizabeth considered she had and that these were not my words.  She started to get upset with this other lady supervising and there was a changeover – someone else sat there supervising and then Elizabeth became upset again and spotted a man outside – one of the team who she shouted to get away from the door. By this time there was about 5 members of staff outside the door and it was all too much for Elizabeth she got up and I followed and started to react to everyone around her. About 5 members of staff grabbed her and told me to leave the ward. 

I left the ward but said that I wanted to know exactly what change there had been in Elizabeth’s medication. I made a point of waiting until I got a list of the medication she was on as Elizabeth had told me about the change. I then made a point of saying that I hoped that I once again would not be blamed as being a “bad impact” and when you think anything could be written behind your backs. I am well aware that any changes in medication could cause instability and also I felt that if Elizabeth was left to see her visitors alone, none of this reaction would have occurred. Whilst I was with Elizabeth I wanted her to know that I was not going to sit back and do nothing this but I also tried to say not to react to the staff but unfortunately on Xmas Day, supposed to be a time for families to get together this is not respected by Lincolnshire Partnership Trust.  Elizabeth read the letter that I wrote earlier and approved it. I then openly showed Elizabeth two more letters which were only short letters. She was quite calm at this point and of course had a right to know as what they are doing is treating Elizabeth as though she has no capacity. That is totally wrong.

I sat downstairs waiting for the list of medication. I did not argue about leaving the ward but was heartbroken. This is no place to get better with such restrictions worse that you see in a prison. The treatment my daughter is getting is inhumane, undignified and I feel that this is bullying aimed at me with all the allegations of my “behaviour” being threatening, hostile you name it I have just been turned down for my request to see the files.  It is really important that records are correct and not full of inaccuracies and staff need to be aware that their comments could end up in the public arena. It is not nice to say things that are not true and then someone else looks at what is being written and forms an opinion. I am putting a stop to all this bullying now.

If Elizabeth was home today she would have been calm and happy to be with her cat. Even at times where she was previously unstable she would come home and the cat would be better than any amount of drugs given.

I have decided here and now that I am not prepared to stand for any bullying and any comments in the files that are defamatory will need to be altered. There was nothing to indicate me being “hostile, threatening” at Trust HQ when all I did was sit to one side and write a letter. That was confirmed by the CCTV footage i viewed last week.

Who is making these comments???

Who is really behind the banning and acting ultra vires???

The drugs have been reduced by 50mg but what they should have done was not inject her but leave her alone to settle down in her room. Luckily Elizabeth has her very own home which is much more suitable that a noisy ward where to this day not a scrap of therapy has been given.

I was upset at leaving Elizabeth with 5 members of staff who had grabbed hold of her on Xmas Day of all days. It most certainly was not my doing that she reacted.

The unsigned letter from the MHA and Legal Office state that a review of my month’s ban would take place on 28 December. I wonder what the outcome of this will be but hopefully my letter will have been submitted by then. I will keep you all informed of everything.

Having seen the reduction that has taken place without warning I am going to seek the advice of experts because I personally think that the reduction was too steep.  I do not intend to be blamed for my visit on Xmas Day and that I am responsible when I know about the reduction. It is really bad that the ‘episodes’ Elizabeth has had has also been blamed on me even partially in that I am said to be a contributory factor. 

I hope that the Neurologist will look into the private scans and explain exactly what has been noticed on the private scans which could be the cause of everything ie brain injury that was evident in the files going back to 2009. How can “anterior region medial temporal compromise just disappear into thin air.

There are “fundamental flaws” in how the Mental Capacity Act is understood and applied in practice, a report on findings from safeguarding adults reviews (SARs) has concluded.

The analysis of 27 SARs completed by authorities in London found mental capacity was the area of practice where lessons most commonly needed to be learned.

Mental capacity was mentioned in 21 of the 27 reports, the analysis found, and much of the learning was around missing or poorly-performed capacity assessments, an absence of best interests decision-making, and a lack of scepticism and respectful challenge of decisions.

Four of the reviews commented on the difficulties practitioners experienced in reaching a “confident or agreed decision” in a mental capacity assessment, the report said.

Another two mentioned the use of advocacy services as a significant area of learning. In both cases, a referral for an independent advocate was made too late to be effective in supporting the individuals, who had no other source of support to take part in decisions.

There was an “occasional comment” in one case where mental capacity had been well addressed, the report said, but the majority of the evidence pointed to “fundamental flaws” in how the Mental Capacity Act 2005 was being understood and applied in practice.

Other common practice issues included:

• Inadequate or absent risk assessments, or the failure to recognise escalating risks.
• A lack of personalised care.
• A failure to involve carers and recognise their needs.
• A lack of understanding or curiosity about people’s history and behaviours.
• A failure to be persistent and flexible when working with people who are reluctant to engage with services, and to take the time to build trust.

All of the above apply to Elizabeth under Lincolnshire Partnership Trust.

‘Lack of resources’ 

The report was produced by the London branch of the Association of Directors of Adult Social Services, and all the SARs were completed since the Care Act came into force in April 2015.

It also looked at organisational factors that influenced how practitioners worked, which included recording, resources, supervision and support, staffing levels, and legal literacy.

The analysis found 19 of the 27 reviews identified issues with how staff recorded information, or with the recording systems and processes provided by their organisation.

In some cases, records were missing, the report said, and in others too little information had been recorded or it was not up-to-date. This meant that concerns were not always picked up.

In 13 of the 27 cases, a lack of resources had also had an impact. The report pointed to one case where adult social care had refused to fund a care package for a person, even though the current level of support they were receiving was not meeting their needs.

Safeguarding Adults Reviews

Under the Care Act 2014, safeguarding adults boards (SABs) are responsible for safeguarding adults reviews.

A SAB must arrange a review when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and where there is concern that agencies could have worked more effectively to protect the adult.

A review must also be arranged if an adult has not died, but the safeguarding board knows or suspects that the individual experienced serious abuse or neglect.

The statutory guidance states that something can be considered serious abuse or neglect, where, for example, the individual “would have been likely to have died but for an intervention, or has suffered permanent harm or has reduced capacity or quality of life” as a result of the abuse or neglect.

A SAB can also arrange reviews in any other situations involving an adult in its area with care and support needs.

In another case, “the impact of austerity measures” on the care home had limited the opportunities available to a man, which had in turn affected his quality of life.

Almost all the SARs identified concerns about how agencies had worked together.

‘Organisational abuse’ 

The report also analysed the nature and characteristics of the SARs.

It found that more cases involved men and just under half of the reviews related to people who were living in a group setting, mainly residential care.

It also found that organisational abuse was the most common form of abuse present in the reviews. This is defined by the Care Act statutory guidance as including neglect and poor practice within a care setting, or in relation to care provided within a person’s home.

The second most common form of abuse was self-neglect, which the report said reinforced recent research findings about the complexities and challenges of this aspect of safeguarding.

The report concluded that learning from safeguarding adults reviews is “rarely confined to isolated poor practice on the part of the practitioners involved”. Instead, findings from the 27 reports showed that weaknesses existed in all parts of the system and there are structural, legal, economic and policy challenges that affect staff across all agencies and boroughs.

With heavy restrictions still in place extended incorporating Xmas, Lincolnshire Partnership Trust clearly are not up to date with the law – see below:

Visiting Report December 2023

https://www.gov.uk/government/consultations/visiting-in-care-homes-hospitals-and-hospices/outcome/government-response-to-the-consultation-on-visiting-in-care-homes-hospitals-and-hospices

It is all very well and good to go down the legal route and ban visitors but in the event of this, what should be in place is an alternative. Yes LPFT or any other Trust should provide alternative arrangements/somewhere else where Elizabeth can meet myself or any other family members if they are not allowed onto ward premises . 

I am now banned for a further two weeks, given only 1 hour supervised only on Xmas Day, total breach of Art 8 and even Xmas Day and religion is not respected under LPFT. Another unsigned letter came via email attachment stating the restrictions would be continued agreed by the MDT and I would say to LPFT they need to rewrite their whole policy as they are clearly out of date with everything. I am sure the law has changed in this respect and I will write about this another time. No longer can the Bolam test be applied.  

I am actually now thinking more and more that I myself am a victim of ultra vires acts and therefore I would be justified to take out a Judicial Review.

I reassured Elizabeth I would go to any lengths to do what is necessary to bring about accountability and look at the way staff are acting ultra vires whilst the Trust do nothing to intervene. They have done nothing but completely abuse the law and in particular MHA, MCA and HRA law.

Important Case Law on Denying Patients the right to order food and have food parcels externally

The other day Elizabeth told me that she was refused ordering food by Elizabeth, a nurse on the ward. She was starving hungry as she has once again been missing meals on Castle Ward and a ban was in place as punishment for being hostile, meaning she could not go out at all.  It is important for members of staff to know about the law and that the following is all about denying patients the right to have food parcels and to order food from outside. If Elizabeth is allowed to miss meals she is not going to feel her best what do they expect! On the first occasion it became evident I was banned I had brought a meal for Elizabeth to make up for not being allowed out to the Carlton Centre with myself and a friend. I was told quite clearly that there was no way food could be allowed onto the ward as staff did not know where it ha come from and this could have been proven of course. Not only did ill-informed nursing staff turn away the meal I brought as a consolation for missing her s17 leave, they did not have a clue about the law and here it is below –  Here is another interesting piece for LPFT to study and to review their whole policy in line with the latest or they could have to bear the consequences.

L v Board of State Hospital (2011) CSOH 21; 2011 SLT 233 - the hospital had been ultra vires in denying patients the right to have food parcels and to order food from outside.

A consultation argument succeeded in the unusual case of L v Board of State Hospital [2011] CSOH 21; 2011 SLT 233 where a decision of the board of the state hospital placing restrictions on patients’ food and drink fell to be reduced as the board had failed to consult the patients as required in terms of the Mental Health (Care and Treatment) (Scotland) Act 2003 s.1. Limitations arose from the nature of the hospital, but only did so because they were justified in terms of the European Convention on Human Rights 1950 Art.8(2): the loss of control over those aspects of life which would otherwise be under a person’s sole and direct control were all concominants of the justifiable deprivation of liberty which followed on imprisonment or detention in the state hospital. 

The board decided that visitors would no longer be allowed to bring food parcels for patients, and patients would no longer be allowed to order food from outside sources, other than one take away meal a month. The ultimate reason for recommending the changes related to patients’ health, and issues with obesity. L sought reduction of the decision on the basis that the board had failed to consult the patients as required in terms of the Mental Health (Care and Treatment) (Scotland) Act 2003 s.1, and, it being a public authority for the purposes of the Human Rights Act 1998, the decision constituted a breach of L’s rights under the European Convention on Human Rights 1950 Art.8. The board relied on the notification of changes to the availability of snacks and refreshments at a single meeting of the Patient Partnership Group (PPG), attended by 12 patients, and an email from the hospital’s lead dietician (D) referring to the response of patients when asked about the nature of items they purchased from the hospital shop, and the reason for their purchase. 

L submitted, inter alia, that interference with his right to choose what to eat and to restrict what had otherwise generally been available to him was an interference with his right to respect for his private life and home, and the exception based on the protection of health and morals did not entitle the board to act as it had, as that referred to action necessary for protection of public health in general. 

Lady Dorrian decided that the board had not been entitled to reach the decision.

(1) From such consultation as had taken place, it appeared that patients had been opposed to restrictions on external purchasing but their views had not been recorded or presented to the board prior to its decision. Moreover, it had been recorded that patients felt that visitors should continue to be able to bring in parcels.

(2) There was no indication that D had advised patients of the proposals which were being considered, or that she had asked them to give their views thereon. 

(3) The PPG meeting had failed to have an opportunity to consider the actual proposals made to the board in relation to visitors. The recommendation put to the meeting was simply that visitors should not be allowed to bring food into the hospital, and the rationale for that was said to be infection control and storage space, which was an explanation that played no part in the board’s decision. Further, it appeared that the issues discussed on external purchasing related to limits on spending rather than an outright ban. 

(4) It was highly questionable whether even such feedback as was obtained was properly put before the board and, in any event, such consultation did not enable patients to consider and to comment on the three options eventually put to the board regarding visitors. The option selected by the board in relation to purchasing did not appear to have been put before patients at all. Accordingly, the board had failed to consult as required by the legislation, and its decision fell to be reduced. 

(5) The opinion was expressed, that (a) although the state hospital was L’s home, it was not and could not be treated as equivalent in all respects to a private home, and while limitations did arise from the nature of the place, they only did so because they were justified in terms of Art.8(2). The loss of control over those aspects of life which would otherwise be under a person’s sole and direct control were all concominants of the justifiable deprivation of liberty which followed on imprisonment or detention in the state hospital, R. (on the application of G) v Nottinghamshire Healthcare NHS Trust [2009] EWCA Civ 795, [2010] P.T.S.R. 674 considered; (b) a person’s right to choose what they ate and drank was a matter in respect of which Art.8 was engaged, and the general restrictions which applied in the state hospital prior to the board’s decision were justified.

Thus, the additional restrictions which the board sought to impose had also to be justified, but it was unnecessary to pass further comment on the matter with regard to the views expressed by the court on the lack of consultation, except to say that a health reservation under Art.8 did not have to refer to public health. In general, it was perfectly capable of applying where one particular section of the community which required protection had been identified. 

MISSING MEALS

I complained about this two weeks ago and still it continues on a regular basis. Tonight Elizabeth told me she had not had either breakfast or lunch. She suffers extreme tiredness and has no quality of life thanks to LPFT. She also told me about the prone restraint and this is life threatening by either 3 or four men. I am quite disgusted. She then spoke about the CTR and that there were two ladies who concluded there and then she is in the right place in hospital. I asked Elizabeth to find out who these two ladies were as it would appear that the CTR has not been carried out correctly as it was finally done in Enfield and that is the reason why no-one in the family was invited. Her advocate from Voiceability was there but how comes they could put words in my daughter’s head and say “Castle Ward is the right place for her to be” or words to this effect. In my opinion it is the wrong place for anyone to be as there is nothing done correctly in terms of procedures, in terms of law, guidance and even their own Policy.

Research on Missing Meals:

“The researchers continued to fast mice for up to 24 hours, and then reintroduced food. The cells hiding in the bone marrow surged back into the bloodstream within a few hours. This surge led to heightened level of inflammation. Instead of protecting against infection, these altered monocytes were more inflammatory, making the body less resistant to fighting infection”

This should tell the clinicians at the PHC that missing meals is very bad for people with psychiatric disorders, however they were originally induced. Not that they listen!

Note heightened levels of inflammation again:

We already know that inflammation in the brain not only causes psychotic symptoms by interfering with neurotransmitter pathways but that it can block the receptors targeted by neuroleptic medication.

Missing meals also causes blood sugar fluctuations that can also cause psychotic symptoms. This, along with Elizabeth’s already established P450 deficiencies will create havoc with her state of health and with the ability of the drugs to work at target sites.

“The researchers continued to fast mice for up to 24 hours, and then reintroduced food. The cells hiding in the bone marrow surged back into the

bloodstream within a few hours. This surge led to heightened level of inflammation. Instead of protecting against infection, these altered monocytes were more inflammatory, making the body less resistant to fighting infection”

Clinicians at the PHC need to be aware that missing meals is very bad for people with psychiatric disorders, however they were originally induced.

Note heightened levels of inflammation again. We already know that inflammation in the brain not only causes psychotic symptoms by interfering with neurotransmitter pathways but that it can block the receptors targeted by neuroleptic medication. Missing meals also causes blood sugar fluctuations that can also cause psychotic symptoms. This, along with Elizabeth’s already established P450 deficiencies will create havoc with her state of health and with the ability of the drugs to work at target sites.

The practice of constantly giving her prn medication while allowing her to miss meals is ridiculous. If she was properly fed and hydrated this would probably not be necessary at all. Any nutritionist will tell you that missing meals interferes with the body’s ability to function and any pharmacist who is aware that the patient is not properly nourished will take that into account when advising on medication. They presumably are not bothering to tell the pharmacist that she is not eating.

The P450 cytochromes are activated or induced by food. A patient who is not eating will become a poor metaboliser. Elizabeth already is a poor metaboliser of the medications they are giving her, missing food can make that worse. Then in their usual ‘style’ instead of tackling the problem the attack the symptom with more prn. It is beyond foolish to allow a psychiatric patient to go under nourished. They should ensure that she consumes food at sufficient levels in every 24 hour period.

Cytochrome P450 induction properties of food and herbal-derived compounds using a novel multiplex RT-qPCR in vitro assay, a drug–food interaction prediction tool

Xue Fen Koe,1 Tengku Sifzizul Tengku Muhammad,2 Alexander Shu-Chien Chong,1,3 Habibah Abdul Wahab,1,4 and Mei Lan Tan1,5

Drug–food interactions or drug–nutrient interactions are gaining much attention recently as such interactions have the ability to influence patient outcome. These interactions need to be recognized, understood, predicted, and then managed as necessary as drug–drug interactions (Boullata ). Drug–food or drug–nutrient interaction is considered clinically significant if it alters therapeutic drug response and/or compromises nutrition status (Boullata and Hudson ; Boullata ). The severity of drug–food interactions can vary the same manner as drug–drug interactions. Specific food and nutrients are known to elicit changes in drug absorption, distribution, metabolism, and elimination (ADME) properties, often through specific mechanisms, and affecting the components of drug metabolism enzymes is common. For example, furanocoumarins from grapefruit juice such as bergamottin can cause irreversible inhibition of the cytochrome P450 enzyme, CYP3A4, mainly in the small intestine (Lown et al. ; Pirmohamed ).

Fasting-Induced Changes in Hepatic P450 Mediated Drug Metabolism Are Largely Independent of the Constitutive Androstane Receptor CAR

· E. M. de Vries ,L. A. Lammers,R. Achterbergh,H-J Klümpen,R. A. A. Mathot,A. Boelen,J. A. Romijn

Hepatic drug metabolism by cytochrome P450 enzymes is altered by the nutritional status of patients. The expression of P450 enzymes is partly regulated by the constitutive androstane receptor (CAR). Fasting regulates the expression of both P450 enzymes and CAR and affects hepatic drug clearance. We hypothesized that the fasting-induced alterations in P450 mediated drug clearance are mediated by CAR.

Impact of fasting followed by short-term exposure to interleukin-6 on cytochrome P450 mRNA in mice

Martin Krøyer Rasmussen a, Lærke Bertholdt b, Anders Gudiksen b,

Henriette Pilegaard b

, Jakob G. Knudsen b

The gene expression of the cytochrome P450 (CYP) enzyme family is regulated by numerous factors. Fasting has been shown to induce increased hepatic CYP mRNA in both humans and animals. However, the coordinated regulation of CYP, CYP-regulating transcription factors, and transcriptional co-factors in the liver linking energy metabolism to detoxification has never been investigated. Interleukin-6 (IL-6) has been suggested to be released during fasting* and has been shown to regulate CYP expression

Prone Restraint given by several Men 15.12.2023

Apparently Elizabeth refused the Clopixol depot today so 3-4 men pinned her face down to inject her. This is supposed to be her “treatment” under the MHA but what about the rest? Only a fraction of the quantity of drugs were prescribed under previous area and therefore no need to forcibly inject other drugs on top such as Procyclidine. Then on top of this are frequent rapid tranquilisations. Take a look at the article below. I have specifically asked CQC to check on the RT CP11 log. Also I do not think proper monitoring is going on.

A Questionable CTR

Elizabeth told me she had a CTR a couple of days ago but it sounded nothing whatsoever like a CTR. It was supposed to have an independent Chair and Elizabeth was supposed to have independent support. None of this was given. A nurse from the MDT was involved in supporting Elizabeth but at one point she told me she was just given a piece of paper to write on. Not one single member of the family were included and that would be my replacement NR who happens to be my younger daughter. Why wasn’t she invited at least. The conclusion of the CTR was that it was concluded that the best place for Elizabeth was on Castle Ward however this is even more questionable when every law has been abused by them and nothing has been followed correctly. Elizabeth told me CQC were on the ward but what are they doing about all of this – you never get to hear the outcome unless an institution is closed down because of total malpractice but this is what I see is going on under LPFT and it is all well and good the message being given “we take your complaint seriously”. Well how comes then this dreadful situation has gone on for over two years now under this DREADFUL area.

Whatever they think of me there is still such a thing as Duty of Care:

Here are just some of the NMC’s (Nursing Midwifery Council) guidelines/code of practice:

1. Treat people as individuals and uphold their dignity. To achieve this you must Supervised calls/visits/banning visits??? (even when instructed why isnt this questioned?)

1.1 Treat people with kindness, respect and compassion.   (Not kindness to punish someone by telling them you can no longer go to the shop in the grounds)

1.5  Respect and uphold people’s human rights (no-one has a clue about human rights yet continue to carry out their “duties” of a very questionable nature but for not wanting to challenge and no doubt the consequences under an area where there is no accountability.

3.4  Act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care. Poor practice is rife under LPFT and discrimination also rife and yet this has been going on for over two years now without any question.

4.4  Tell colleagues, your manager and person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care How many would dare to do that under LPFT where I have received nothing but bullying but I suppose this may be an explanation as to why several male nurses stepped in to forcibly give the depot today under prone restraint. I very much doubt they even bothered to check for blood oxygen levels or vital signs. This was the clopixol depot and Elizabeth had refused it on this occasion. Why though are other drugs being administered on practically a daily basis with several “nurses” pushing her up against a wall. The other drugs are not part of the treatment under the MHA. To think CQC SOAD agreed all of this well if the effect is that Elizabeth is too tired to move to get out of bed for breakfast and for lunch something needs to be done and the CQC SOAD need to look at the whole picture and come back and do something about this as this SOAD is clearly not taking into account Elizabeth’s physical health.

5.5 Share with people, their families and their carers as far as the law allows the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand. A CTR should have included family members or at least the NR but not under LPFT. The Tribunal also went on in secret. It is the worst experience of my life and I have seen at first hand how carers are treated if you dare to raise concerns which I did not do for a very long time.

16  Act without delay if you believe that there is a risk to patient safety or public protection to achieve this you must: 

16.1 raise and if necessary escalate any concerns you may have about patient or public safety or the level of care people are receiving in your workplace or any other health and carte setting an use the channels available to you in line with our guidance and your local working practices. Not sure whether anyone bothers to raise concerns apart from me and several other patients at the former hospital of Ash Villa.  If things go wrong I can visualise staff sticking together to protect one another.

16.3 tell someone in authority at the first reasonable opportunity if you experience problems that may prevent you working within the Code or other national standards, taking prompt action to tackle the causes of concern if you can 

17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse. I have not seen anything other than supporting each other to protect one another as in MDT where over 30 people are invited.

20.2 Act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment  this must be difficult to implement in an area where I myself have experienced ruthlessness and if you say or do something they do not like they use punishment.

24.1 Keep to the laws of the country in which you are practising

Treat people in a way that does not take advantage of their vulnerability or cause them upset or distress to take away a vulnerable’s person’s phone so they can no longer listen to their music, to deprive her from seeing photos of her cat and two weeks punishment for supposedly being hostile - it has caused distress without any doubt.  

never allow someone’s complaint to affect the care that is provided to them. Now this is an interesting point as I feel that the punishment dished out is aimed at me inflicting upon Elizabeth – how on earth can it be good for any vulnerable person to be cooped up on a ward 24/7 that is noisy, no psychological input and no encouragement to venture outside of what I can only call a prison.

Below is an interesting piece about Nursing staff mistreating vulnerable people – this seems to go on a lot and especially under the MH where a vulnerable patient can be drugged for no reason other than the convenience of nursing staff and when inspectors go onto the ward the first thing they should check is the CP11 RT log and go and speak to the patient instead of listen to a group of professionals who will stick together in the event of any adverse occurrence no matter what.

https://www.nursingtimes.net/news/hospital/nurse-on-trial-for-mistreating-and-drugging-stroke-patients-07-09-2023/

There has been substantial abuse to my vulnerable daughter over a period of over two years now and nothing whatsoever has been done about it. It makes you wonder how the current section can possibly be lawful by the way my daughter has/is being held. With such heavy restrictions it is no wonder patients ask to go to prison. If Responsible Clinicians do not know the law and decide that they will go down the legal route and use this as a form of punishment then this is impacting on a vulnerable person’s wellbeing and this is what I wish to contest. It also has a knock-on effect on the physical health of the family involved who have trouble getting through on the ward.

Unless very bad reasons for banning the person who has ultimate responsibility should know the law and be aware of human rights law and weigh up the benefits of such restrictions. 

The Responsible Clinician in this case states that Elizabeth is a free thinking person so from that they secretly recognise that Elizabeth has capacity but in order to control her and make decisions they have to rely on three completely flawed not fit for purpose capacity assessments done for another court case that was not even relevant. These were all done dishonestly so as to take control of Elizabeth’s life and try and send her the other side of the country so they can sever contact as I suppose this is a stepping stone in the severance of contact and completely unlawful.

There are so many other cases like mine where Xmas this year will be a very sad occasion and this is why I want to get the word out there to everyone affected that a few days ago this paper has come into effect:

Visiting Report December 2023

https://www.gov.uk/government/consultations/visiting-in-care-homes-hospitals-and-hospices/outcome/government-response-to-the-consultation-on-visiting-in-care-homes-hospitals-and-hospices

Just to reflect this has been the “appropriate care” provided under LPFT of practically daily injections and prone restraint by several men and missing meals evident at Ash Villa too, as well as banning visits and taking away the phone. It is not just the Oliver McGowan training they need but also on the MHA, the MCA and HRA and also medical ethics.

5 institutions – one out of area: namely Charlesworth Ward, Ash Villa, Cygnet Durham, Ward 12 and now Castle Ward.

Here are the Doctors employed/were employed under LPFT:

Dr Ismail

Dr Shahpasandy

Dr Ismail again

Dr Kumar

Dr Islam

Dr Suleman

Dr Greenall

Dr Memons This Doctor employed by Cygnet spoke nicely to me and seemed concerned for physical  health

Dr Khokhar