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Mental Health Act Administration Office

Trust Headquarters

St Georges

Long Leys Road

Lincoln

LN1 1FS

25th January 2024

Dear Mrs Bevis,

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

This follows the initial decision to suspend your visits which was made on 28th November 2023 and will be reviewed again on Thursday 22nd February 2024.

The decision made by the MDT on 25th January 2024 was in response to ongoing clinical concerns regarding the impact of your visits on Elizabeth’s presentation, In addition to security concerns raised following the events of 25th December 2023 which are currently being investigated.

Kind Regards,

The Mental Health Act Team.

EMAIL FROM MARK MHA OFFICE COMPLAINTS CQC TEAM

Dear Ms Bevis

We are writing to you from the Mental Health Act complaints team at the Care Quality Commission (CQC).

We have now received a copy of the letter summarising the outcome of the investigation into your complaints. We believe that a copy of this letter dated 14 November 2023 and signed by Dr Toby Greenall the Consultant Psychiatrist at Peter Hodgkinson Centre has already been sent to you, but please let us know if this is not so.

The Mental Health Act grants the CQC a discretionary power to investigate complaints where they are about the use of the powers and duties in the Act. If you are not satisfied with the response provided to you by the service, you could request that the CQC consider reviewing your unresolved concerns.

We do sometimes receive complaints about matters that we are not able to investigate because they are not within these powers. The CQC complaints process cannot make any recommendation about matters that can only be decided by a court of law. For example, we cannot rule on whether a detention is lawful, nor would we be able to provide any clinical opinion re diagnosis.

Before we could decide if there is a role for us, we would need a clear statement from you outlining what you are unhappy with in the provider response, any outstanding issues and your desired outcome.

Alternatively, you can contact the Parliamentary and Health Service Ombudsman Office (PHSO) within the next twelve months, saying why you are not satisfied. Their address is: –

The Parliamentary and Health Service Ombudsman for England

Citygate

Mosley Street

Manchester

M2 3HQ

www.ombudsman.org.uk/making-complaint

Telephone: 0345 015 4033

The PHSO can consider whether to investigate complaints that the NHS (and NHS funded care) in England have failed to act properly or fairly or provided a poor service. If the Ombudsman feels that it is more appropriate for the CQC to consider the outstanding concerns, they may refer you to our organisation.

The PHSO is the final arbiter in any complaint matter and therefore the CQC cannot consider any request for investigation once the Ombudsman has either completed or declined an investigation into your complaints.

Could I please request that you use the above reference number on any correspondence in relation to this case. If we do not hear from you within 15 working days of the date of this letter, we will assume that you have received satisfactory answers to the issues you have raised through Local Resolution and your enquiry will be closed.

Yours sincerely

Mark

Mental Health Act Complaints Team

Email to Mark and to David Inspectors of the CQC

I have already responded to David in his most unsatisfactory response to me so I am now going to respond to Mark.

I do not wish to hear a lecture on what the CQC can and cannot do when I contacted you re Ash Villa the only people doing the safeguarding were the patients themselves. I do not wish to be signposted to the Ombudsman who have only ever conducted 1 report satisfactorily on the safeguarding going on behind my back for which Elizabeth kindly gave me the minutes.

There is plenty for your team to look into and I am not happy with your email below for the reason that it is now 2.5 years of restricted detention and that you should refer me to PHSO when I do not see anything being done about the current situation which is unlawful. Most of all when you get a complaint the first person you should go and see is the patient and their advocate.

The last letter re Dr Greenall was on medication and I know that is something you will say you cannot get involved in however you do have SOAD’s who have rubber stamped everything including massive dosage of drugs without reading the files properly or seeing my daughter. What about the private scans and Neurologist appointment that has been missed.  A SOAD only agrees with the drug regime for the convenience of psychiatrists who may be in favour of certain drugs they promote and drugs that despite being on S3 should have the patients consent. How convenient going down the route of no capacity and best interests. However now that I have done a course on this I have become very knowledgeable about how things should be done properly.  MDT in meetings that consist of around 30 people all agree with one another or else if they do not agree God help them as I have experienced bullying like never before.  These same doctors blatently ignore the law or else they are ignorant towards the law whilst management pretend they do not know it when I am sure they do know.  They act ultra vires including all the staff on that ward, all backing each other in what they blindly see as “best interest” and the come up with “best interest”.  Off the record they may have differing opinions and as one RMN said previously “it is more than my job is worth”.  Others might comment “it is evil to keep her from her mother on her Birthday” - here is another comment “I quite understand how your mother feels”.

Anyway getting back to your letter so an inspector cannot/will not look into medication but RT is not part of the treatment and comes under Art 3 -degrading treatment and how regularly this is being administered for instance should be of interest and whether correct blood oxygen levels are being monitored before/after RT as well as the forced blood tests which are not part of MHA treatment from what I understand.

Moving on, what your organisation should be looking at is the breaches in law and cruelty to people like my daughter with her phone taken away and although they say “the phone is there if she wants it” – what is being said otherwise is “she can only have her phone if she asks for it.  OR ”I will see if she WANTS to speak to you.  Sometimes it is necessary to phone the ward. Sometimes you need to ask questions even though you get varying answers. If something like a bank card for instance goes missing and Elizabeth has commented it has been missing a week but I have only just found out. This is of concern and family need to be informed. Without a phone, without any contact with the outside world Elizabeth is cut off from reality. It could be that the card is somewhere in her room. Today I visited the ward but I could not even go into the reception area. I just drove over an hour’s journey just to drop in some food. I was then told she could not have some of the food because of health and safety and storage. Staff (2 of them) came outside the building to pick up the food. They straight away said “there are new rules”. I said what are these new rules? mentioned above. I asked if I could bring a miniature fridge to the ward that has just been pat tested. I was told a firm no to that.  I just commented that this shows being on the ward is far too restrictive and today is takeaway day – the only thing Elizabeth has to look forward to and I am left wondering if the card has been taken away and put in the office or whether it has been stolen. I have mentioned this to other family members tonight and that they should find out as there have been conflicting answers. Some have said the card is in the office whilst others confirm it has gone missing which will leave me with no alternative but to report the missing card to the Police if I do not hear further.

I have asked the rest of the family to find out and to arrange for a takeaway for Elizabeth as otherwise she will be left out of the only day patients can look forward to ordering what they want unlike the rest of the week when they are under strict control.  I thought the MHA and MCA were all about the least restrictions but not under LPFT. I have seen other patients going out unescorted but Elizabeth is treated differently in breach of the Equality Act 2010 and so am I.

As regards ban I have heard six months mentioned. I wonder why that is??? No doubt all will be revealed and the truth always comes out in the end. I just do not understand why the NHS are not decent enough to speak the truth and as regards the records I have been refused my own data by LPFT and no doubt this is to protect themselves. Is it a six month ban? or else is it indefinite whilst they put her in a care home out of area like they are trying to do. Nothing has been done right. To invoke an ongoing ban should go before CoP. Only the CoP can decide on banning someone indefinitely.

In the unsigned letter from the MHA it says about ongoing investigations against me. I have requested that Dr Khokhar and whoever called the Police on Xmas Day be requested to do a s9 statement just as I have volunteered to do. I bet nothing is done about this but if I was in the Police I would be investigating why Police time has been wasted on several occasions and I am only too happy for an investigation to go into the very serious allegations made against me by Elizabeth’s RC.  Those at the top of the Trust are only too away and although they say they are taking my complaint seriously this is not the case otherwise something would have been done after all this time.

It is bullying when a team of so many say nasty things about you behind your back and I have featured similar things from Enfield. I thought I might as well get all the files from there also especially from social services.  Apparently you cannot have comments deleted – they remain in the files however you can correct them but this will be a huge task for me. However when it comes to paperwork I have a lot of patients and tolerance as I am keen to see things recorded accurately.

The comments can/have been really nasty and adverse in opinion backed by all their MDT colleagues to to make you look bad. This in turn builds up a profile that can be passed from one area to another.  I would like to see these comments though nothing will shock me. I have welcomed safeguarding to be done on me. In fact I would like to share the safeguarding previously carried out and it was very helpful when Elizabeth handed me the minutes of the safeguarding meetings in Enfield. I have everyone’s email addresses. The Police were there, the GP and about 9 coercing Elizabeth to tick boxes. Both Council and Trust were forced to apologise.  Since then I have been waiting for same in this area but it has not got further than a referral on the part of one or two nurses who have “concerns”.

This is what I would like the CQC or have wanted the CQC to look into thoroughly: No vulnerable person should be subject to this kind of treatment and the phone should not be taken away or any other possessions.

The CP11 RT log and seclusion

How many episodes and how may have led to A&E?

Records of blood oxygen level tests

Record of the accident in the seclusion room.

I would like the CQC to find out why an Impact Assessment has not been carried out in accordance with NHS Guidelines

If everyone or was it just the Clinical Lead unaware of the Neurologist appointment Elizabeth did not attend on 3 January?

How many times has Elizabeth missed meals.

How many times has she had prone restraint and administering of depot by male only staff

Why the Trust has not consulted the CoP about their indefinite as voiced by Dr Waqqas Khokhar

What they are trying to pin on me in terms of criminal allegations exactly? – I would like the Police to get those concerned to sign the s9 statements as there was serious allegations of conflicting nature.  There are contradictions between RC and MHA re banning me indefinitely and the Trust’s MHA Legal Team write to say this is not so. Who is telling the truth when the MHA legal team have sent yet another four week ban. Dr Khokhar said he did not like the word BAN. Well I cannot think of a better word than BAN.

What I would be reassured about was if the CQC could contact Elizabeth and go and see her if on the ward.

Professional Standards Authority: Healthcare Regulation

Professional Standards Authorityhttps://www.professionalstandards.org.uk › …

We protect the public by overseeing the regulation and registration of healthcare professionals · How we help to protect the public.

Consultation on the Professional Standards Authority’s good practice guidance documents in support of regulatory reform

What is this consultation about?

Context for our consultation

The Government is in the process of reforming the way that health and care professionals are regulated. It is planning to change the legislation for nine out of the 10 healthcare professional regulators we oversee, giving them a range of new powers and allowing them to operate in a very different way.

The changes the Government intends to roll out will give regulators greater freedom to decide how they operate, including introducing the flexibility to set and amend their own rules. There will also be changes to regulators’ powers and governance arrangements.

The changes will also create an entirely new process for handling fitness to practise (the process by which concerns about healthcare professionals are dealt with). Under the new system, more cases are expected to be dealt with on paper through a process called an ‘accepted outcome’ rather than going to a formal hearing.

We have produced two sets of guidance to help regulators use their new powers effectively:

  1. Guidance on the use of Accepted Outcomes in Fitness to Practise
  2. Guidance on Rulemaking

Guidance on accepted outcomes in fitness to practise

Our guidance on the use of Accepted Outcomes in Fitness to Practise identifies key factors for regulators to consider when developing their own guidance on the use of accepted outcomes. The guidance includes factors to consider when deciding whether a case is best resolved by an accepted outcome or a fitness to practise panel (the disposal route) as well as factors for regulators to consider to ensure the accepted outcomes process is fair and transparent, and to promote effective decision-making.

Guidance on rulemaking

Our guidance on Rulemaking aims to help regulators make effective use of their new rulemaking powers in a way which prioritises public protection. It includes some principles to guide what good rules should aim to do or be, and the rulemaking process.

We are seeking your feedback on both pieces of guidance through this one consultation. The consultation paper explains more about the structure and sets out clearly which questions relate to which guidance.

Read through the full consultation to find out more. It is available in English and Welsh.

Why are we consulting?

We support the reforms to healthcare professional regulation but have also identified certain risks that may arise from the new ways of working. Developing the guidance that we are now consulting on is one of the steps we are taking to help make the reforms a success mitigate any potential risks and realise the opportunities of the reforms.

It is also one of our core roles (under the National Health Service Reform and Health Care Professions Act 2002 to promote best practice in the performance of regulators’ functions, to formulate principles relating to good professional regulation, and to encourage regulators to conform to them). We want to make sure that reformed regulation is as effective as possible at protecting the public.

We are therefore seeking views from everybody with an interest in healthcare professional regulation, including patients, the public, registrants, regulators, professional bodies and employers.

How can I respond?

Please respond to this consultation paper by completing the online survey available in English here or in Welsh here. When using the online survey don’t forget to save your answers as prompted. 

You can also submit your response by email – please include the name of the consultation in the subject line. When submitting by email, please reference your responses using the question numbers. Email responses should be sent to: policy@professionalstandards.org.uk

We welcome responses to any or all of the questions in the consultation.

Please respond by 5pm on Monday 15 April 2024.


This looks interesting – if the public are not being protected by the likes of CQC, PHSO, GMC and others it is good that there is such consultation and I am more than happy to take part.

The Care Quality Commission (CQC) is the independent regulator for the quality and safety of care in England (with Scotland and Wales regulating the same under their own independent Care Inspectorates), responsible for regulating providers of healthcare services, social care services and services for those whose rights are restricted under the Mental Health Act 1983. These powers extend to oversight of the NHS, local authorities, independent providers and certain voluntary organisations. The CQC registers and carries out inspections of care services and issues public information in relation to them. Under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 the CQC also holds a range of enforcement powers, including penalties and prosecution, where it finds that fundamental care standards have been breached.

Here are two responses I have received:

The latest one just received from Mark.

Dear Ms Bevis

We are writing to you from the Mental Health Act complaints team at the Care Quality Commission (CQC).

We have now received a copy of the letter summarising the outcome of the investigation into your complaints. We believe that a copy of this letter dated 14 November 2023 and signed by Dr Toby Greenall the Consultant Psychiatrist at Peter Hodgkinson Centre has already been sent to you, but please let us know if this is not so.

The Mental Health Act grants the CQC a discretionary power to investigate complaints where they are about the use of the powers and duties in the Act. If you are not satisfied with the response provided to you by the service, you could request that the CQC consider reviewing your unresolved concerns.

We do sometimes receive complaints about matters that we are not able to investigate because they are not within these powers. The CQC complaints process cannot make any recommendation about matters that can only be decided by a court of law. For example, we cannot rule on whether a detention is lawful, nor would we be able to provide any clinical opinion re diagnosis.

Before we could decide if there is a role for us, we would need a clear statement from you outlining what you are unhappy with in the provider response, any outstanding issues and your desired outcome.

Alternatively, you can contact the Parliamentary and Health Service Ombudsman Office (PHSO) within the next twelve months, saying why you are not satisfied. Their address is: –

The Parliamentary and Health Service Ombudsman for England

Citygate

Mosley Street

Manchester

M2 3HQ

www.ombudsman.org.uk/making-complaint

Telephone: 0345 015 4033

The PHSO can consider whether to investigate complaints that the NHS (and NHS funded care) in England have failed to act properly or fairly or provided a poor service. If the Ombudsman feels that it is more appropriate for the CQC to consider the outstanding concerns, they may refer you to our organisation.

The PHSO is the final arbiter in any complaint matter and therefore the CQC cannot consider any request for investigation once the Ombudsman has either completed or declined an investigation into your complaints.

Could I please request that you use the above reference number on any correspondence in relation to this case. If we do not hear from you within 15 working days of the date of this letter, we will assume that you have received satisfactory answers to the issues you have raised through Local Resolution and your enquiry will be closed.

Yours sincerely

Mark

Mental Health Act Complaints Team

Here is another response received from:

I cannot think of a greater abuse than to take away the phone from a vulnerable patient, already cut off from the outside world and reality such as my daughter. She is on an ongoing section renewed only recently without any family being present.  Abuse is taking place like this all over the Country under the NHS but in Lincolnshire it is particularly bad. The very worst treatment of all has been under NHS not as you would expect from private sector which is mainly documented fully but when such abuse goes on under the NHS they are totally unaccountable. There is no external intervention and CQC have even supported them during the time at Ash Villa judging from the email I received at the time calling the CQC a business. All I know from Elizabeth is that CQC were on the ward and referred as safeguarding matter to Adults Safeguarding but no-one is giving thorough information as I was kicked out of my role as Nearest Relative and displaced last year so that Lincolnshire Partnership Trust supported by Lincolnshire County Council could abuse power and process and they most certainly have done by way of their legal department and went down the capacity route with three completely flawed capacity assessments. Now I have done the course myself I can see just how wrong this is and am shocked that such abuse of power can go on so that professionals such as social workers, doctors and legal professionals representing them can just be totally and utterly unaccountable. Once someone is deemed to have no capacity that is when they can abuse that vulnerable person, taking away their autonomy and choices and the course I have done is quite fascinating and highlights everything being done wrongly under LPFT and of course other Trusts who use this to cut out family and take control of that person’s life without any regard for their human rights or that of their family.  

The Responsible Clinician of this ward is called DR WAQQAS KHOKHAR who revealed he is “protecting his patient” and has “concerns” against my “impact” and “bad influence” on my daughter. Nothing like this appears under s11.15 of MHA Code of Conduct Justification for banning visits.He has no respect for the law and neither does anyone under Lincolnshire Partnership Trust. I am supposed to be invited to ward rounds and am giving 10 minutes to say what I want but last week was cut out completely and this has not been the first time. I have been allocated one email address but do not get satisfactory responses and some of my questions are right here such as when is a decision legal or medical?

The MHA Legal Team are behind the issuing of one banning letter after another trying to say this is an MDT Decision relying on one another for backup when things go wrong. This is a big disgrace and some measures need to be put in place to ensure responsibility. The one and only person responsible is DR WAQQAS KHOKHAR who is instructing everyone else to act ultra vires against their own code of conduct and often Healthcare Assistants are the ones that have to sit in during supervised calls and visits or staff from other wards, although visits have stopped altogether. 

Those who have the overall control are none other than those at the very top IE SARAH CONNERY AND KEVIN LOCKYER (CHAIR)

I have just received another letter from Sarah Connery via my MP who happens to be Victoria Atkins Health Secretary. Every time I get a response it is not addressing my concerns whatsoever so I have said it is pointless sending any more emails because it is a waste of time. Instead I stated that I would like Victoria Atkins to do something about a huge national problem where thousands of vulnerable people are locked up and abused under totally unsuitable settings such as acute wards and even high secure hospitals although my daughter’s treatment is befitting for the very worst places and even they offer better entitlements and regard to human rights. I have written several times but never 70 as suggested. I have had to apply for file records through the ICO as I feel that are staff are being instructed to write adversely behind my back. I am entitled to see what is written.

On Xmas Day we had just 1 hour visiting cut short to 45 minutes with staff listening in and during the second member of staff supervising in the small visiting room Elizabeth became upset and shouted at her. She spent 6 hrs in seclusion on Xmas Day so she told me.  I am quite frankly now very concerned about her wellbeing. It is not conducive for recovery to prevent a vulnerable person seeing their mother or having family contact/any leave, fresh air and exercise even if a certain responsible clinician does not approve and has a personal dislike towards me. He has handled everything in the most unprofessional manner and has said to Elizabeth he is going nowhere and is a very good doctor. He is in fact acting ultra vires but did not know the meaning of this and is totally disregarding of human rights. Xmas restrictions were undignified and degrading (Art 3). Staff called Police and Dr Khokhar has said he was indefinitely banning me from visiting my daughter due to ongoing police investigations. How very threatening of Dr Khokhar to say this but this is not true as I telephoned Police myself.  Dr Khokhar also said that I incited my daughter to attack members of staff and I have all of this RECORDED just like they are making false records only mine is such that noone can contest or twist the content of. This is totally untrue so you can imagine what their file records look like.  Dr Khokhar has been extremely untruthful. The other doctor who in the background now promoted to a Director is DR TOBY GREENALL from Ash Villa has said Elizabeth is ‘only partially treated.’ and kept going on about Clozapine, a drug she previously had bad reaction to.

Below is some interesting consideration, especially when both doctors have ignored physical health which should come well and truly BEFORE MH and they have denied all the pathological tests. Shame on the NHS/LPFT for allowing this to happen especially when there are concerns and abnormalities found on scans more than once.  Dr Khokhar is even saying that I am partially responsible for the ‘episodes’ that are happening that last hours and hours on end and sometimes end up in A&E. For the most part I have not been present and these episodes of extreme distress where she is completely inconsolable, shaking all over with tremors and screaming is being looked upon as MH rather than Neurological yet she is supposed to now be under Dr C Solinas. I feel the psychiatrists are denying these appointments for physical health and do not want them to reveal anything so that their goal of treating her with Clozapine already tried and nearly threatened her life is once again considered and she has been FORCED according to Elizabeth to have a blood test. This is the real reason why I think these two Doctors want me out of the way.  MY DAUGHTER JIS BEING ABUSED WHILST THE LIKES OF SARAH CONNERY AND KEVIN LOCKYER, SHARON HARVEY AND MARTIN FAHY do nothing! They say it is a clinical decision however there is more than one thing to consider here. A blood test is optional and should not be forced by the likes of a nurse called Grace. There is an Advanced Declaration which her advocates know all about. There are so may people now involved and all appear to be doing NOTHING. There is no communication so what else can I think.

Why is a drug banned by the UK being given to vulnerable people anyway?  and is available in some areas? Perhaps Victoria Atkins can answer this question WHY IS CLOZAPINE LIQUID INJECTIONS GIVEN WHEN IT IS BANNED BY THE UK IN SOME AREAS?

The former deputy Manager KS of Ash Villa sent Elizabeth away and had provoked her and called police. She then said to my younger daughter appointed Nearest Relative in my place that it was best I did not see Elizabeth for six months. She was then sent to Cygnet Durham where I had no contact hardly.

Six months they want me out of the way no doubt so I cannot see how ill my daughter becomes whilst they experiment to their hearts content on a drug she nearly died on. If anything happens to my daughter I want everyone to know the names of these two doctors who have stood in the way of her physical health appointments and have not read the files properly DR WAQQAS KHOKHAR AND DR TOBY GREENALL and those who hold the ultimate responsibility for power and have failed to provided the necessary pathological tests and refused the MRi originally. These doctors have ignored physical healthcare. She has what looks like a cavernoma and lesions and one previous doctor employed by LPFT Dr H Shahpasandy stood in the way of his own research into the Limbic System.  

Throughout 2.5 years she has been held like a restricted prisoner under this LINCOLNSHIRE - wish we had never moved – all that was ever needed was compassionate care but the NHS is devoid of compassion and kindness under the MH. This is a profession where staff forget their Code of Conduct and what they went into the profession for in the first place. There is definitely no accountability here whatsoever.

There is a reason why they want me out of the way and they are using bullying tactics to prevent me from having contact with my daughter for a reason and that reason is NOT because I am abusive. The Police on every occasion were called out, their time wasted whilst various staff had obviously said adverse things and on the most recent occasion at Xmas it was due to “concern” or should I say “instructions” and that was because I had insisted on wanting to know about what they were doing with the medication. I did as they said – left the ward and waiting downstairs whilst they carted Elizabeth off to the seclusion room for yet another injection. They are also not monitoring her blood oxygen levels which can be life threatening. Elizabeth has said they are not taking vital signs before/after administering rapid tranquilisation. They held her in seclusion for 6 hrs on Xmas Day according to Elizabeth. They injected her when they allowed her out. I hardly saw my daughter on Xmas Day. It was heartbreaking.  It was the worse Xmas I have ever had. 

The NHS as a whole is an absolute disgrace to ignore so many patients who are said to have MH problems when in fact they have Neurological or some other physical health condition. The NHS stand in the way of physical health checks when someone has a MH label and simply do not wish to look into matters further as this of course would reveal what is really the matter and underlying cause. Before even prescribing the NHS should provide all patients with a P450 liver enzyme test and check for problems with drug metabolism before prescribing. I have been told LPFT are in the dark ages when it comes to prescribing and can see truth in that and negligence if a pharmacist ignores what you tell them and I have met this pharmacist myself and explained.

There is no thought either to Elizabeth’s religious needs.  I do not know how anyone can just go along with this kind of abuse in the profession. If I was a nurse or doctor or healthcare assistant I would have to say something and report it but this is an area rife with bullying.  If this is what they are doing to me then just imaging what these people will do to anyone who dares to rock the boat. 

From: susan bevis

Sent: Wednesday, August 23, 2023 11:44 am

To: CONNERY, Sarah (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) sarah.connery@nhs.net; PATIENTEXPERIENCE (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) lpft.patientexperience@nhs.net; Subject: Clozapine and sending Elizabeth back to London

Dear Ms Connery, Ms Harvey and Mr Fahey

Please can you explain as per the email below.  My daughter nearly died on the titration of Clozapine and I have the entire files.   At the specialist hospital (ROYAL BETHLEM) I was very concerned my daughter was put on 2 x BNF levels of drugs including max level of Olanzapine.   They did not have a single ECG machine working there and she was critical.  I have all the files to prove it.  It was when they made her lose capacity that she was put on Clozapine, a drug she nearly died on and one that did not benefit her at all.

She is of high risk of mortality and of high risk of choking.   She could barely walk on this drug.   Once capacity lost they prescribed Clozapine. Her face was covered in bruises through restraint. Elizabeth does not want to go back to this dreadful place and now I would like an explanation for the real reason why sending her back to London is necessary?

From: xxxxxx

Sent: 22 August 2023 10:00

To: susan bevis susanb255@outlook.com

Subject: Re: Court of Protection

“I fail to see why Elizabeth would need to be set to London to be given Clozapine unless the local Clozapine clinic has refused to allow this.  

The drug needs very careful monitoring because of the risk of agranulocytosis and it may be that they will not allow it without her consent.  If there is a clinical rationale for moving to Clozapine it should be explained in full.

This looks suspicious to me.  

I think a full explanation is needed.  

High doses of neuroleptic medication will reduce capacity as they affect both motor and cognitive function.  Patients should not be given more than the minimum effective dose and no patient should be on protracted periods of maximum dosing, that is a clear indicator of metabolic dysfunction and a failure of the duty of care. 

Clozapine is not approved for intramuscular depot injection in the UK but some trusts are using it nonetheless.  

I do not know if LPFT is one of them or whether they are thinking about sending her to London because they are using it.  

It is crazy to use a drug with agranulocytosis as an ADR since the drug needs to be immediately stopped if the blood test shows a fall in white blood cells.  Immediate cessation is self-evidently not possible with a depot.  I am shocked that some trusts are doing this at all.

Clozapine injection can only be prescribed if approved by MDT, SOAD, Clinical Director and DTC. It can only be prescribed by a Consultant.   THE CLINICAL DIRECTOR IS DR TOBY GREENALL.

Some Trusts have approved its use, in exceptional circumstances during the two weeks at the initiation stage if the patient refuses the oral administration by tablet.  

Here is the set of rules that apply (somewhat bizarrely since the drug is not approved for use)

IM Clozapine Depo: Key Points 

Clozapine injection is not licensed for use in the UK. 

Some trusts have approved its use, in exceptional circumstances, for service users that are inpatients. 

Clozapine injection should only be used as a last resort and is limited to two weeks at the initiation stage. 

Clozapine injection can only be obtained by following these guidelines. 

Clozapine injection can only be prescribed if approved by a Second Opinion Appointed Doctor (SOAD). 

It can only be prescribed by a Consultant and use of the product must be approved by the Clinical Director on an individual basis. 

The oral bioavailability of clozapine is about half that of the intramuscular injection.

Clozapineinjection is expensive. Dose titration over 2 weeks costs £2000. 

  1. What is IM Clozapine? 

Intramuscular clozapine is an unlicensed product made in the Netherlands by Brocacef and imported to the UK via Durbin PLC. 

It is a clear yellow solution for injection. 

The strength of the injection is 25mg/ml and each ampoule contains 5mls (125mg). 

It is administered by deep intramuscular injection into the gluteal muscle. 

The injection is painful and the maximum volume that can be injected into each site is 4ml (100mg). 

For doses greater than 100mg daily, the dose may be divided and administered into two sites. 

The clozapine titration should follow once daily doses as per Appendix 1. 

Injection sites should be rotated as per usual IM practice. See Trust Injection Procedure policy 

Click to access Injection%20Procedure.pdf

  1. Which service users can be prescribed IM Clozapine? 

IM Clozapine is indicated ONLY for inpatients with a treatment-refractory psychotic disorder that are refusing oral treatment. 

IM Clozapine may need to be administered under restraint if the service user declines IM administration. To be administered in line with the Trust’s RESPECT training.  An all male team of “nurses” pin her down and someone called Matthew shouts “shall we get her on the bed” Someone called Grace forces her to have blood tests.This is nothing but torture by LPFT who refuse to look into her underlying physical health conditions and I have had private scans done.They could not care less.

It can be prescribed for service users who have never previously received clozapine or for service users who have previously been treated with clozapine and are known to have responded to it but who have subsequently relapsed owing to non-adherence.  Elizabeth nearly died on it.

The initial need for clozapine injection MUST be: 

Agreed by the multidisciplinary team (MDT)  A GROUP OF PEOPLE WHO ARE TOTALLY UNACCOUNTABLE AND IN BREACH OF EVERY HUMAN RIGHTS LAW.
Approved by the Clinical Director (CD) and SOAD  How can a CQC SOAD approve an injection banned in this country?????

Clozapine injection must specifically referenced by the SOAD on the T3 form as a named drug, stating the route of administration and dosing information. 

These recommendations, from three independent parties (MDT, CD and SOAD) MUST be fully documented on the IM Clozapine MDT Assessment Form (Appendix 2) and must be signed by the Consultant and recorded in the service user’s electronic notes. 

The completed MDT Assessment Form (along with T3 form) must be emailed to the Chair of the Drugs and Therapeutics Committee (DTC) and to the Chief Pharmacist together with the completed “Request and Risk Assessment for the use of Unlicensed Medicines” form found in the Medicines Policy –  The Pharmacist is truly aware of inflammation of the brain and underlying physical health conditions. The pharmacist will also be responsible if anything happens to my daughter on Clozapine which is why I assume I am being prevented from contact altogetherand from what I gather her name is Charlotte Bellamy.Noone has looked into past reactions to this drug and I have all the files for the Bethlem.

http://trustspace/InformationCentre/TrustPolicies/Pages/Medicines.asp

These two forms will form the basis upon which the DTC Chair and Chief Pharmacist (CHARLOTTE BELLAMY) will formulate their decision to either grant their approval for use of IM Clozapine for a particular service user, or to refuse such approval. 

IM Clozapine may only be prescribed and administered following the written approval of the DTC Chair. 

IM Clozapine injection MUST be requested on an individual service user basis only.

I had reported this drug due to adverse reaction.

Good morning Susan

Thank you for your enquiry concerning Clozaril (Clozapine) Tabs.

Viatris are unable to make any specific treatment recommendation to individual patients or carers.  We would advise patients to contact their healthcare provider for further guidance.

As you have mentioned an adverse reaction to a pharmaceutical product, please can I pass your details onto the appropriate Viatris department, who may wish to contact you for further details?

If you have a medical enquiry, please contact our Medical Information department on 01707 853 000 Opt. 1

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Customer Relations Executive

Customer Service

Viatris

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When is a healthcare professional’s act non-medical, and how might such non-medical acts be classified?

One approach, analogous to the substantive due process inquiry employed by  courts weighing the constitutionality of legislative acts, would involve consideration of the following questions: 

1) Is a legitimate medical goal being pursued?  Dr Waqqas Khokhar and staff have allowed Elizabeth to go without her Neurologist appointment.This was on the 3 January 2024 with a Dr C Solinas.I turned up to the appointment.Elizabeth was nowhere to be seen.I handed Dr C Solinas the disk with all the scans on I had done privately.It is sheer neglect of any doctor, in this case a psychiatrist to ignore underlying causes that were shown on the private scans and to deny her with an appointment to see a physical health expert in the field of Neurology and to cancel all previous appointments as unnecessary.Dr Greenall who praises Clozapine yet who has never tried it himself has stated that she is only ‘partially treated’ and he is another doctor who could not care less because all her Neurologist appointments previously arranged by Enfield were cancelled as “unnecessary” and he knew about these. Elizabeth previously nearly died on Clozapine previously.The liquid injection form banned in the UK is still given at certain hospitals like the ROYAL BETHLEM.This is where she was previously put on this drug and nearly died.I’ve got all the files.

 2) Are the means being employed legitimately medical? It is not medical to deprive contact with family and to restrict leave and keep a vulnerable patient a virtual prisoner.

 3) Are the goals and means appropriately related? Accordingly, a healthcare professional acts medically when employing legitimate and appropriate medical means in pursuit of a legitimate medical goal.  My daughter is being injected on virtually a daily basis and this is degrading treatment.

In contrast, when the goals pursued or means employed are not legitimately medical, or when the two are not appropriately related, the act is medically ultra vires (“beyond the powers”)–that is, an act beyond the professional’s power or authority–and consequently non-medical. 

 If an act designed to achieve an end such as restricting visits had a purpose of simply punishing the visitor, to the detriment of the patient then it would have no legitimate medical purpose.  Yes punishment to deny ground leave to the hospital shop as well as any kind of leave.

Denying a patient activities that are beneficial to them in order to apply some form of sanction is a matter ultra vires.  This was the failing of the ‘token economy’ system used in psychiatric hospitals where patients were coerced into behaving in a particular way for favours. Not only is this a flagrant breach of the principlist ethics of beneficence & autonomy & possible non-maleficence but it represents a violation in many cases of the patients human rights. Denial of all psychology and stuck in an untherapeutic enviroment for years and years on end like a prisoner.This is care under LPFT rated Good!!!!!

 Section 17 leave and visits from friends and relatives are rights not favours. 

Medicating patient with prn medication for the purpose of keeping them quiescent is arguably a non-medical intervention and is often used to give staff a quiet time rather than to benefit the patient.  The usual reason given is that the patient was distressed.  There are many ways a distressed person can he supported without prn injections.  Giving drugs in the is way is both ultra vires and ultra fines. But since nothing has worked they are now looking to experiment further without any regard to risks or looking for underlying pathological physical health reasons.THIS IS NHS CARE AT ITS VERY WORST.

 Medically ultra vires acts may be further sub-classified depending upon which prong of the above trident is defective. Where the goal of the act, though achievable, is not legitimately medical, the act is medically ultra vires because of goal illegitimacy, or medically ultra fines (“beyond the ends”). To deprive leave is ABUSE.to take away the phone is to protect themselves and stop Elizabeth from sharing information.

Where the means employed are not legitimately medical, the act is medically ultra vires because of means illegitimacy, or medically ultra modos (“beyond the means”). Where the means and goals are not appropriately related, the act is medically ultra vires because of means-goals disjunction, or medically ultra nexus (“beyond the connection”). 

Medical futility (where the medical goal in question, albeit legitimate, cannot be achieved by the act under consideration) represents the paradigmatic example of the latter.

NURSING AND MIDWIFERY CODE OF CONDUCT

I attach some of the Code of Conduct from the Nursing Midwifery Council and would comment on one or two points here:

1 Treat people as individuals and uphold their dignity To achieve this, you must:

1.1 treat people with kindness, respect and compassion  There is no kindness or compassion.

1.5 respect and uphold people’s human rights No human rights

3.4 act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care  Total Discrimination under Equality Act

4.4 tell colleagues, your manager and the 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 Rife with bullying so each and every employee going along with their instructions.

17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse Not one of them protecting

20.2 act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment  Total dishonesty in the case of LPFT with a doctor who uses threatening and bullying techniques and even dishonesty about Police investigations being ongoing.We decided to do a Section 9 Statement even though Police did not wish to take matters further.

So here is what nursing staff have done instead:

Tell Elizabeth  she can no longer go out to the shops any more as a punishment for being hostile.

Stand in front of the ward door (2 nurses) barring my visit whilst my daughter was on the other side of the door and could see our arrival.  Then say “it is an executive decision“.   I was then told to move away from the door and that I was upsetting my daughter by 1 nurse.  We had no warning of the ban and had agreed the visit beforehand.   The food I brought was a healthy meal to make up for being informed all S17 leave was banned without any notice.   I was told no food was allowed onto the ward because they did not know where it came from.   Please see below law on bringing food/ordering food from outside. Snatch food and water away whilst eating/drinking. Allow her to sleep on a faulty bed. Leave needle covers lying on table next to bed not caring whether she chokes on them, brutal prone restraint by several men.

This is the worst area we have ever encountered in all these years and yet they are rated Good. There are serious safety issues here as well and if vulnerable patients lives are put at risk then the CQC needs to act fast. All the CQC have done is refer to Adults Safeguarding and look what Adults Safeguarding did last time at Ash Villa NOTHING.  Safeguarding was instead pointed at me but I found out what was going on and then I sent all the S42 minutes from former area and my apology letter from Trust and Council. I have thought that a Section 42 meeting would have been good to have if certain professionals had any doubts about me and because I have nothing to hide I suggested a Section 42 meeting and nothing was done.

As for the promised CTR from Martin Fahey that was not done properly at all as Elizabeth said “two ladies came up to her”. She did not know who they were who they were. She was then told she had to stay on the ward. What kind of CTR is that. One HCA even wrote on her wrist “wish not allowed”.

This is Elizabeth’s wish: Friday 10th November

“My idea”

I want to eventually come home to live with my mum in the annex through the Court of Protection. I miss my |Mum greatly and want to go home to her”

Now I will it to my readers to come to their own conclusions. Elizabeth has a separate living accommodation in the back garden and misses her cat. She wants to be at home. I have been in touch so many times with Victoria Atkins, MP now Health Secretary and she has passed letters on and I have got nowhere and this has left me with only one option.

Code of Conduct from Nursing Midwifery Council examples:

1 Treat people as individuals and uphold their dignity To achieve this, you must:

1.1 treat people with kindness, respect and compassion

1.5 respect and uphold people’s human rights

3.4 act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care

4.4 tell colleagues, your manager and the 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

17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse

20.2 act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment

Two nurses were acting on orders from a superior but were in fact acting ultra vires.  Neither had challenged whether their actions were lawful or abided by their own code of conduct.  If someone is requested to do a duty such as turn away visitors they should have reported concerns.  This is clearly over and above their duty and detrimental to my daughter’s wellbeing.   Each and every medical practitioner has a duty to abide by the NMC Code of Conduct first and should know about human rights law, MHA law, MCA Law and NHS Guidelines.     My daughter was looking forward to our visit.  She was excited about seeing us, reflected in her text messages.  We had pre booked this visit.   How do you think my vulnerable daughter felt the other side of the glass door being refused her visitors when other visitors were being allowed onto the ward?    Why then was there not an alternative as to where we could see my daughter if I was not allowed to visit her on the ward? 

To advise Elizabeth she could not order food when she was starving hungry (having missed all her meals) as it was too late in the evening is also extremely wrong.  Nursing staff should know this is wrong and unlawful too (see below).  Elizabeth was denied even to even walk escorted to the shop/restaurant as punishment for being hostile by a nurse acting on instructions (ultra vires). She was not even allowed to order shopping by another nurse acting ultra vires.  She is held under the MHA which should be the least restrictive care and there is case law on ordering food from outside of hospital which has also been refused to Elizabeth by two further nurses acting ultra vires who first notified myself of the ban on visiting. 

Use of conditions in deprivation of liberty safeguard authorisations

06 April 2023

Richard Griffith

The deprivation of liberty safeguards were introduced into the Mental Capacity Act 2005 schedule A1 following the decision of the European Court of Human Rights in HL v United Kingdom (45508/99) (2005). The safeguards can be used to authorise the deprivation of liberty of an adult in a care home or hospital where this is necessary to protect the person from harm and is proportionate to the risk and seriousness of that harm, as set out in the Mental Capacity Act 2005, schedule A1 paragraph 16.

Protecting dignity and autonomy

To protect the dignity of patients by ensuring that restrictions imposed to protect that person and not overly intrusive, best interests assessors are commissioned to review the restrictions and satisfy themselves that the protective measures in place are necessary and proportionate. Restrictions that disproportionately interfere with the autonomy of the person will be unlawful. In Re MK[2014] the Court of Protection held that the removal of a woman with severe learning disabilities from her family was a deprivation of liberty that was disproportionate and unnecessary. The woman was not at risk, her wishes and feeling were to be at home with her family and the standard of her day-to-day care had been good. The woman had been unlawfully deprived of her liberty and unlawfully denied contact with her family. Both were unjustifiable interferences with her human rights under article 5 and 8 of the European Convention on Human Rights (ECHR) (Council of Europe, 1950).

Using conditions to ensure necessary and proportionate restrictions

Local authorities and health boards, in their role as supervisory bodies, are tasked with sanctioning a deprivation of liberty standard authorisation under the safeguards (Mental Capacity Act 2005, schedule A1 paragraph 50). To ensure that hospitals only impose proportionate restriction that are necessary to protect the person from harm, the supervisory body can make the authorisation subject to conditions that are legally binding on the hospital. The supervisory body will consider the recommendations of the best interests assessor when deciding if an authorisation should be subject to conditions (Mental Capacity Act 2005, schedule A1 paragraph 53).

In Re G [2016] the court considered the case of a woman, aged 92, who had dementia and lacked capacity. Her care plan involved the administration of medication covertly. No conditions had been placed on the authorisation of her deprivation of liberty. The court found that the use of covert medication had not been subject to proper safeguards; the decision to administer medication covertly did not appear to have been communicated to the supervisory body. The court issued guidance that best interests assessors and supervisory bodies should place conditions on the authorisation to ensure that covert administration was regularly kept under review and that it continued to be a necessary and proportionate response to the needs of the person.

Recommending conditions

The code of practice for the deprivation of liberty safeguards (Ministry of Justice, 2008) highlights that attaching conditions to a deprivation of liberty standard authorisation should relate to the restrictions and should not be used as a substitute for a properly constructed care plan. As the conditions in a deprivation of liberty authorisation are binding on the hospital it is good practice for the best interests assessor to discuss proposals for conditions with the staff caring for the protected person (Ministry of Justice, 2008: paragraph 4.75).

To ensure that conditions are appropriate to the protected person they must (Welsh Assembly Government, 2009):

  • Be relevant to the role of the managing authority
  • Relate directly and specifically to the deprivation of liberty, and
  • Should not be general in nature, or
  • Be a lever to improve the overall care plan.

To ensure that those requirements are met best interests assessors and supervisory bodies are required to subject any proposed conditions to a ‘but for’ test. That is, would the conditions be needed ‘but for’ the protected person being deprived of their liberty. A valid condition would be one that meets that test, it is needed only because the person is being deprived of their liberty.

Purpose of conditions

The code of practice to the deprivation of liberty safeguards (Ministry of Justice, 2008) suggest that conditions might be used to:

  • Ensure the deprivation of liberty is secured
  • Limit the restrictions that amount to a deprivation of liberty
  • Work towards ending the deprivation of liberty.

Ensuring the deprivation of liberty is secured

The code of practice (Ministry of Justice, 2008) suggests that conditions could be imposed on a deprivation of liberty authorisation to ensure that the deprivation of liberty is secured. This might arise where it is necessary to ensure that the person will not leave the hospital. In A local authority v D [2013] a woman with Huntington’s disease was prevented from returning home to her husband following a period of respite care. The husband was also denied access to his wife to secure the deprivation of liberty by preventing him from taking his wife home.

Although conditions can be used to immediately secure a deprivation of liberty, the use of conditions for such purposes must only be for a short period. A deprivation of liberty safeguard authorisation cannot generally be used to authorise limited or no contact with the protected person. ‘No contact’ issues can only be authorised by the Court of Protection. The code of practice to the deprivation of liberty safeguards stresses that it must be for the Court of Protection to make decisions when contact between family members or close friends is being restricted. The deprivation of liberty safeguards cannot be relied on to manage no-contact cases.

In A local authority v D [2013] the Court of Protection held that the delay of some 3 months between the initial authorisation of the deprivation of liberty and bringing the case before the court was a breach of the couple’s right to respect for a family life under article 8 of the ECHR (Council of Europe, 1950) and an unlawful deprivation of liberty contrary to article 5 of the ECHR. Damages were awarded to both the husband and wife for these breaches.

Limiting the deprivation as much as possible

This purpose allows best interests assessors and supervisory bodies to impose conditions where they are satisfied that the restrictions being imposed are disproportionate to the risk of harm. The conditions can be used to ensure that the protected person continues to enjoy access to fresh air or meaningful activities, or to maintain social contacts.

Working towards or bringing about an end to the deprivation

Supervisory bodies can use conditions for this purpose to ensure the person’s timely and appropriate discharge from hospital. The conditions might require assessment to facilitate discharge to be completed within a given time frame. This might include obtaining a occupational therapy home visit assessment report or a physiotherapy report.

Conditions are binding on managing authorities

The Mental Capacity Act 2005, schedule A1 paragraph 53(3) states that:

‘The managing authority of the relevant hospital must ensure that any conditions are complied with.’

The Mental Capacity Act 2005 schedule A1 paragraph 4(3) also states that:

‘In a case where an authorisation is in force, a person is not authorised to do anything which does not comply with the conditions (if any) included in the authorisation.’

The Local Government and Social Care Ombudsman found that Barchester Healthcare had failed to fulfil the conditions attached to a man’s deprivation of liberty authorisation that related to the provision of meaningful activities and his interaction with a fellow resident. The man’s wife felt compelled to find her husband a different care provider due to these failures. Barchester Healthcare offered a £5000 payment in recognition of their shortcomings relating to the authorisation conditions, which the ombudsman found to be appropriate in the circumstances (Peart, 2020).

Changing or removing conditions

The only lawful way for a hospital to vary a condition attached to a deprivation of liberty authorisation is to seek a review of the best interests requirement under part 8 of schedule A1 of the Mental Capacity Act 2005. Varying in this context includes amending, adding to or omitting conditions. Where a request for a review is received then the supervisory body will commission a best interests assessor to reassess the protected person’s best interests and make recommendations as to whether the supervisory body should vary the conditions.

Enforcement of conditions

In Re W [2016] the Court of Protection held that it was for the supervisory authority that had granted a standard authorisation, under the Mental Capacity Act 2005, to deprive a person of their liberty that was responsible for monitoring compliance with the conditions it had imposed. The frequency of such monitoring depended upon the circumstances of the case rather than there being any need to fix a period that would be applicable to all authorisation cases.

Conclusion

Under the deprivation of liberty safeguards, local authorities and health boards, in their role as supervisory bodies, can attach conditions to a deprivation of liberty authorisation to ensure that the restrictions imposed on the protected person are necessary and proportionate to the risk of harm the person faces. Conditions are binding on the hospital where the person is being deprived of their liberty and it would be unlawful not to implement the conditions attached to an authorisation of a deprivation of liberty. It is the duty of supervisory bodies to ensure the conditions they attach to authorisation are implemented by the hospital through regular review and monitoring.

Key points

  • A supervisory body can make the authorisation of a deprivation of liberty subject to conditions that are legally binding on the hospital
  • Conditions attached to a deprivation of liberty standard authorisation must relate to the restrictions and should not be used as a substitute for a properly constructed care plan
  • Conditions must meet the ‘but for’ test to be valid
  • Conditions are binding on the hospital where the person is deprived of their liberty

It is as though Elizabeth’s human rights are being completely abused.

I would like to see some kind of Landmark case. I cannot find a solicitor to help. I cannot sit by and do nothing whilst my daughter is being abused. It is organisational abuse at the worse and those at the top of the Trust whilst saying they take my complaint seriously cannot be doing so because it is now 2.5 years of this same abuse and noone should have to go through what I am going through or my daughter.

I am not going to sit back and do nothing. I wish I could find a solicitor but unfortunately this Government has made things impossible to get someone to back you in the High Court which is why there is no justice.  Occasionally a case comes to court and there is a new ruling and this is what I would like to see. I know there are so many others in my situation who have had their sons and daughters taken from them and contact severed.

I have been accused of writing 70 letters - I most certainly do not recall writing 70 letters coming from me. It has been mentioned by Elizabeth Dr’s his concerns on my mental health! He is not even my doctor – what on earth is he talking about and this is not good or right in front of other people at a meeting.  I told him I have no concerns about my so called MH and that he should be concerned about my physical health instead as this is most important.  I have to keep up my strength in this dreadful situation to keep going and my dream would be more places like Simons Trust where parents are valued not abused. I have been told I am not allowed to speak to the carers champion any more. There are all these things going on for carers such as Education but I have educated myself and I have concluded that there is a massive problem under LPFT and that problem is bullying and abuse towards anyone who so much as dares to challenge what they are doing which is very wrong and there is NO ACCOUNTABILITY.

I have now had to go down the ultimate route without support or backing from solicitors.

First the Post Office scandal but there is one scandal left to be challenged and that can only be challenged in a court where there is justice. There is no way I would have wanted to challenge at County Court a decision that would have put me up against my younger daughter however I do wish to challenge matters on behalf of my daughter in the High Court and I hope this will be possible.

Both Elizabeth and I want publicity over this and I have proof. Please do whatever you can to get me out of here.  That is what I intend to do somehow.

Wishing all my readers a Happy New Year. 

I can only hope 2024 will be better than the last.

Xmas was the worst I have known for a long time.  Elizabeth was not allowed home and wanted to see her cat but this was not allowed not even for one day. She is still held under heavy restrictions by Lincolnshire Partnership Trust on a never-ending section with phone taken away.  The phone restriction has been going on for some time along with visiting restrictions said to be an MDT decision but we know that this is not the case. Restrictions commenced every two weeks, then a further two weeks and then increased to every four weeks up until 26 January. Even more restrictions seem now to be in place because when I have phoned following New Year since I had not spoken to Elizabeth for some time, several staff appeared reluctant to even hand the phone to her. The Clinical Lead, ES, stated the phone would only be given if Elizabeth specifically asked for it, others said “I will see if she wants to speak to you”.   I know for a fact rest of family not treated the same but taking the phone away is very nasty and very restrictive and this is NHS not private sector care. Taking the phone away and locking it in the office or wherever makes it difficult for everyone in the family to keep in touch with Elizabeth who is cut off from the outside world and held a virtual prisoner after 2.5 years. It is not easy to get through to the ward. This is cruelty and I see it as punishment no doubt aimed at me but inflicting upon Elizabeth.  Also, Elizabeth is deprived of playing her music on her phone and seeing pictures of her cat who she misses so much. She no longer has a life and neither do I, our lives ruined by the decision I made to move to what we thought was a lovely area.  I have made a huge mistake moving here as although the immediate area is lovely I had not bargained for how ruthless the NHS is under MH care or the fact provision in the community is poor. Having said that, there is so much going on in the local area, things that Elizabeth would enjoy but instead she is locked up by a group of strangers(MDT) who think they know best and could not care less about the impact their punishment is having on the family, even those who are not under restriction are affected by taking the phone away yet there is no consideration whatsoever towards anyone. It is also forgotten about values, medical ethics and duty of care according to their individual Code of Conduct. They are in fact acting ultra vires by depriving s17 ground leave to the shop as a means of punishment for instance as instructed.

Xmas Eve, rest of family visited and reported Elizabeth “not so good”.

Xmas Day could not relax, cook a nice dinner or have people over this year.  I had just 45 minutes with a member of staff supervising in the small visitor’s room.   Elizabeth was OK at first but when the second member of staff took over she became upset by this person then a group gathered outside the visitor’s room and I was told to leave.  I had heard through Elizabeth that she had a reduction in her medication and I wanted to know what reduction she had and it was very upsetting that so many staff outside grabbed hold of her and that is when she tried to defend herself but so many of them involved and all she did was shout at them. Police were called to the ward yet again by staff told to report concerns yet these concerns were nothing like I was accused of.   It is alarming how many times Police have been called, as if they do not have enough to do for no reason.  Always there has been nothing to report and no evidence whatsoever recorded on CCTV, only members of staff who are told to report adversely so as to make me out to be someone who is hostile, aggressive, etc.  I now do not ever visit alone as I feel I am up against so many who are against me.  So Xmas was awful.  I had no idea Police had been called after I had left the premises that day.    The first I knew about this was on the 28th December at on line ward round.  I was told I was banned indefinitely by the RC for inciting Elizabeth to attack staff which was totally untrue.    I have since received another unsigned letter from the MHA legal office stating the ban is four weeks until 26 January. They are not following NHS Guidelines and have no regard to the latest Government paper on hospital/care home visits or Code of Conduct of the MHA. It seems like a never-ending ban just like Elizabeth’s never-ending section – an imprisonment for life by LPFT. I have just been told I must no longer contact the carers champion.  I must only write to one designated email address.   Since moving, I have had no carer’s assessment and was actually told previously I was not entitled to this.

Most disturbingly of all, the Neurologist appointment on the 3 January was not attended by Elizabeth and when I questioned why, I was told by ES, Clinical Lead that nothing was in the diary and no one knew anything about it.  Again this is totally untrue.  It is obvious LPFT did not want her to either have an MRI scan all along or see a Neurologist or Endocrinologist in the first instance. It seems the most important thing is the drugs they force and the law they twist to suit themselves re MHA and MCA.  All her physical health appointments were cancelled as unnecessary upon our move.   I am also banned from taking Elizabeth to any physical health appointments.   Our treatment has been even more appalling than the former area and I thought that was bad.

There does not seem to be any regard for human rights or Codes of Conduct/Guidelines.

For anyone else going through hell as we are I am going to share with you some points of law as what I am seeing is a whole group of professionals sticking together, totally disregarding their own code of conduct and ignoring the law. There seems to be no accountability.  Some of these professionals are responsible for health and wellfare of the most vulnerable patients but what has happened is several have acted ultra vires relying on colleagues and MDT backing, going along with what they are instructed to do regardless of what is correct and according to law and medical ethics and they are in breach of their own code of conduct.  Already restrictively detained under s3 MHA , Elizabeth is excessively deprived of any kind of liberty whatsoever, treated like a object not a person. It should be the least restrictive care under MHA but under LPFT, detention is more like what you would expect a restricted prisoner to have and no one seems to care less or to give a thought as to how they would feel if they were treated in this most degrading and undignified manner as Elizabeth is:

“It is no longer adequate for a medical practitioner to invoke the opinions of colleagues as authority for a decision. That mechanism known from the case of Bolam v. Friern Hospital Committee [1957] WLR 582

There is very strict policy as regards takeaways and Elizabeth loves Saturdays on the ward when patients are allowed to order a takeaway.  Whilst I would agree that takeaways are not good on a daily basis, there have been occasions where Elizabeth has been so tired she has missed all her meals and been in bed most of the day.  This is because of the huge amount of drugs prescribed have taken away every bit of quality of life leaving her with no energy and nothing but tiredness. I have drawn to attention of staff that missing meals is very bad and can affect behaviour but any sign of hostility is met with punishment and deprival of ground leave like one nurse did.  Even though she was instructed, she still went along with it and this is surely not part of her role to dish out punishment, therefore she is acting ultra vires.  On another occasion when without warning I was banned we thought we were going to the Carlton Shopping Centre but this was cancelled on the spur of the moment without warning by the RC of Castle Ward and Elizabeth was visibly upset. I had promised a meal for her and brought food to the ward and was told by a nurse that it was not permitted and to take that away along with gifts a friend brought.  It was totally undignified as Elizabeth was looking through a slit in the glass door and could see we had arrived and we were told to leave the premises and that it was an Executive decision.  I was told to get away from the door by another nurse as it was upsetting to Elizabeth. Again acting upon orders by banning a visitor to see a vulnerable patient who was excited and expecting our visit in her non existent life and these nurses stood in the way in the course of doing their job yet they acted ultra vires. It is not part of their job to ban visitors and then say it is an MDT or an Executive Decision not theirs when in fact they are the ones acting against their own Code of Conduct and even Trust Policy states about dignified care. Their actions along with the other nurse was totally undignified and degrading.

DENYING FOOD PARCELS AND TO ORDER FOOD FROM OUTSIDE 

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.

Whilst I agree ordering of takeaways every single day is not good or healthy but neither is missing meal times and there should always be exceptions but such is the environment, more restrictive than any prison this verges on abuse.

House of Commons House of Lords

Joint Committee on Human Rights

Protecting human rights in care settings

Fourth Report of Session 2022–23

Report, together with formal minutes relating to the report

Ordered by the House of Commons to be printed 13 July 2022

Ordered by the House of Lords to be printed 13 July 2022

HC 216 HL Paper 51

Published on 22 July 2022

by authority of the House of Commons and the House of Lords

This is a very interesting paper to read.

Joint Committee on Human Rights

The Joint Committee on Human Rights is appointed by the House of Lords and the House of Commons to consider matters relating to human rights in the United Kingdom (but excluding consideration of individual cases); proposals for remedial orders, draft remedial orders and remedial orders.

The Joint Committee has a maximum of six Members appointed by each House, of whom the quorum for any formal proceedings is two from each House.

Current membership

House of Commons

Harriet Harman QC MP (Labour, Camberwell and Peckham) (Chair)

Joanna Cherry QC MP (Scottish National Party, Edinburgh South West)

Florence Eshalomi MP (Labour, Vauxhall)

Angela Richardson MP (Conservative, Guildford)

Dean Russell MP (Conservative, Watford)

David Simmonds MP (Conservative, Ruislip, Northwood and Pinner)

House of Lords

Baroness Chisholm of Owlpen (Conservative)

Lord Dubs (Labour)

Lord Henley (Conservative)

Baroness Ludford (Liberal Democrat)

Baroness Massey of Darwen (Labour)

Lord Singh of Wimbledon (Crossbench)

“We were also concerned to hear about ongoing issues with Deprivation of Liberty Safeguards (DoLS), the check that is put in place to ensure that detention in care settings is within the law and in line with the prohibition of torture and inhuman or degrading treatment under Article 3 ECHR, and the right to liberty and security, under Article 5 ECHR. There are often unacceptable delays in authorisation of DoLS and there is often no access to legal aid if care users wish to challenge their deprivation of liberty in court. Whilst the DoLS system is going to be replaced by a new Liberty Protection Safeguards System (LPS), there is no timetable for this to be rolled out. We ask that the Government must work with the regulator and all stakeholders to ensure that providers fully understand the functioning DoLS and comply with statutory requirements, and that access to legal aid for those who wish to challenge is widened. The Government should also set a timetable for rollout of the LPS system and keep us updated on progress.

We have reported before on the visiting arrangements for those in care settings during the pandemic. Evidence submitted to this inquiry showed that through and beyond the pandemic problems persisted with providers following guidance. We also believe a lesson learnt from the pandemic was the harm caused by blanket bans on visiting. We have called in the past for the Government to legislate and do so again here. The Government must introduce legislation to secure to care users the right to nominate one or more individuals to visit and to provide support or care in all circumstances, subject to the same infection prevention and control rules as care staff. The Government must also legislate to give the CQC the power to require care settings to inform them of any changes to their visiting status, and to report live data on levels of visiting and restrictions. The CQC must make compliance with visiting restrictions a key consideration when undertaking its regulatory and monitoring roles.

Under the HRA, public authorities must act compatibly with ECHR rights. Those providing care services in care settings, however, are not all public authorities. Unless care legislation, such as the Care Act 2014, contract law, or consumer standards provide equivalent protections, there is no way for privately funded individuals in private care settings to enforce human rights on the same basis as for those in publicly funded care settings. This can mean that two residents in the same care home might have different legally enforceable rights. We recommend that the Government should consult on extending the protections of the HRA to those receiving care and support from all regulated providers, and suggest a way this could be done through an amendment of the Care Act 2014.

When something goes wrong, the users of a service should have access to an effective complaints mechanism that is capable of investigating those complaints, and putting things right, in a way that is transparent, fair, and proportionate. However, the complaints system for care users is confusing, time consuming and too often does not result in effective resolution. The system needs to become easier to navigate. Care users must not be frightened of retribution if they complain. We recommend changes to streamline the process, with the roles of the CQC, the Local Government and Social Care Ombudsman (LGSCO), and the Parliamentary and Health Service Ombudsman (PHSO) clarified and with all three organisations operating a “no wrong door policy”.

The right to life (Article 2 ECHR, Article 10 CRPD).

Freedom from torture and inhuman or degrading treatment or punishment (Article 3 ECHR; Article 15 CRPD).

• The right to liberty and security (Article 5 ECHR; Article 14 CRPD).

• The right to family and private life (Article 8 ECHR; Articles 22 and 23 CRPD).

• Freedom from discrimination in the enjoyment of human rights (Article 14 ECHR; Article 5 CRPD).

• The right to the highest attainable standard of health (Article 12 International Covenant on Economic, Social and Cultural Rights (ICESCR); Article 25 CRPD).

ARTICLE 3 DEGRADING TREATMENT WHICH APPLIES TO ELIZABETH WHO IS HAVING FORCED INJECTIONS VIRTUALLY ON A DAILY BASIS.

ARTICLE 3 HRA

The failure to give her appropriate treatment for a condition she has been diagnosed as having creates a situation where she is subjected to inhumane and degrading treatment.  Elizabeth has complex PTSD which is totally ignored by LPFT along with her physical health.

Constant Restraint and frequent RT is in breach of Art 3.

Deprivation of family rights is a consequence of this.  They say she is dangerous but have done nothing to address that, apart from to subject her to close surveillance at all times.Elizabeth likes animals and adores her cat and pigeons. She is totally misunderstood by these professionals and I would say her treatment at times has been that of cruelty and abuse.  

This is in violation of her rights under Art.3 ECHR and represents inhumane and degrading treatment as in  Sławomir Musiał  v.Poland (2009) & Raffray Taddei v. France (2010)

 Incidentally the ECHR has ruled that whatever obstacles the patient may have put in front of the treatment team that did not dispense the state from its obligations to protect their human right to being protected from inhumane and degrading treatment, Claes v. Belgium (2013).  

Right to take legal proceedings, ECHR Article 5(4) Storck v. Germany (Application No 61603/00), 16 June 2005.

Article 5(3), which deals with the rights of a person who has been detained.

“Everyone arrested or detained in accordance with the provisions of paragraph 1(c) of this article shall be brought promptly before a judge or other officer authorised by law to exercise judicial power and shall be entitled to trial within a reasonable time or to release pending trial. . . .”

The difference between a right to “take proceedings” and a right to “be brought promptly before a [court]” must be deliberate. It stops short of requiring judicial authorisation in every case. 

It leaves to the person detained the choice of whether or not to put the matter before a court. MH (by her litigation friend, Official Solicitor) (FC) (Respondent) v. Secretary of State for the Department of Health (Appellant) and others.

DENYING VISITS IN HOSPITALS ETC

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

DISCRIMINATION

Equality Act 2010: guidance – GOV.UK

https://www.gov.uk/guidance/equality-act-2010-guidance

Code of Conduct from the Nursing Midwifery Council and would comment on one or two points here:

1 Treat people as individuals and uphold their dignity To achieve this, you must:

1.1 treat people with kindness, respect and compassion

1.5 respect and uphold people’s human rights

3.4 act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care

4.4 tell colleagues, your manager and the 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

iv) A person is not to be treated as unable to make a decision merely because he or she makes a decision that is unwise (see Heart of England NHS Foundation Trust v JB [2014] EWHC 342 (COP)at [7]). The outcome of the decision made is not relevant to the question of whether the person taking the decision has capacity for the purposes of the Mental Capacity Act 2005 (see R v Cooper [2009] 1 WLR 1786at [13] and York City Council v C [2014] 2 WLR 1 at [53] and [54]);[2]

Masterman-Lister v Brutton & Co 2003

The leading case is Masterman-Lister v Brutton& Co [2003] 3 All ER 162 in which Lord Justice Chadwick stated at paragraph 75: the test to be applied….is whether the party to legal proceedings is capable of understanding, with the assistance of such proper explanation from legal advisors and experts in other disciplines as the case may require, the issues on which his consent or decision is likely to be necessary in the course of those proceedings. If he has capacity to understand that which he needs to understand in order to pursue or defend a claim, I can see no reason why the law – whether substantive or procedural – should require the imposition of … a litigation friend and at paragraph 79: a person should not be held unable to understand the information relevant to a decision if he can understand an explanation of that information in broad terms and simple language; and … he should not be regarded as unable to make a rational decision merely because the decision which he does in fact make is a decision which would not be made by a person of ordinary prudence. The Court of Appeal re-considered the Masterman-Lister test in Bailey v Warren [2006] EWCA Civ 51. At paragraph 126 of her judgment Lady Justice Arden concluded: The assessment of capacity to conduct proceedings depends to some extent on the nature of the proceedings in contemplation. I can only indicate some of the matters to be considered in accessing a client’s capacity. The client would need to understand how the proceedings were to be funded. He would need to know about the chances of not succeeding and about the risk of an adverse order as to costs. He would need to have capacity to make the sort of decisions that arise in litigation. Capacity to conduct such proceedings would include the capacity to give proper instructions for and to approve the particulars of claim, and to approve a compromise. For a client to have capacity to approve a compromise, he would need insight into the compromise, an ability to instruct his solicitors to advise him on it, and an understanding of their advice and an ability to weigh their advice Capacity to conduct proceedings was further considered by the Supreme Court in the post-MCA case of Dunhill v Burgin (Nos 1 and 2) [2014] UKSC 18. At paragraph 13 of her judgment Lady Hale noted: The general approach of the common law, now confirmed in the Mental Capacity Act 2005, is that capacity is to be judged in relation to the decision or activity in question and not globally. Hence it was concluded in Masterman-Lister that capacity for this purpose meant capacity to conduct the proceedings (which might be different from capacity to administer a large award resulting from the proceedings). This was also the test adopted by the majority of the Court of Appeal in Bailey v Warren[2006] EWCA Civ 51, [2006] CP Rep 26, where Arden LJ specifically related it to the capacity to commence the proceedings (para 112). It would have been open to the parties in this court to challenge

that test, based as it was mainly upon first instance decisions in relation to litigation and the general principle that capacity is issue specific, but neither has done so. In my view, the Court of Appeal reached the correct conclusion on this point in Masterman-Lister and there is no need for us to repeat the reasoning which is fully set out in the judgment of Chadwick LJ.

Subject: Guidelines on Restricting Hospital Visits

Visits from friends and relatives are considered crucial in the recovery and welfare of patients and research carried out on the severe restrictions imposed during the Covid pandemic indicates a clear detrimental effect on patients who missed visits from loved ones and friends. The impact on visitors has also resulted in an increased incidence of depression and anxiety being recorded. Elizabeth had once enjoyed my visits and especially on just one occasion the two hour leave unescorted at the Carlton Centre just around the corner from the hospital.  

Excluding or restricting visits should therefore be imposed only in exceptional circumstances where there are reasonable ground for believing that a visitor may have a detrimental effect on the patients therapy. I have been told I am indefinitely banned by the RC but in order to do that surely an application should have been made by LPFT to the Court of Protection to get rid of me for good.  What they are doing is very wrong.

A decision to exclude visitors on the grounds of his or her behaviour or propensities must be fully documented and explained to the patient and where possible the appropriate person concerned.  In the case of psychiatric patients the nearest relative should be informed of any visitor exclusions and supervision decision and if it is they who are excluded or supervised an explanation in writing is to be provided to them. Nothing has been done properly.  The nearest relative who I became nearest relative to has most certainly not been informed and no proper explanation has been given other than I am said by the RC to be a “bad influence”.  I am even said to be partly the cause of the episodes that look like fits but most of these have taken place when I have not been around.  The real reason is that they want to send her far away from home and family and cut contact altogether and they are doing this by isolating Elizabeth from her family already.

A visitor may be excluded or restricted to visits under supervision if the visit is considered to be anti-therapeutic (in the short or long term) to an extent that a discernible arrest of progress or even deterioration of the patient’s mental state is evident or can reasonably be anticipated if contact is not restricted.   It is the MDT of so many, none of whom take individual responsibility who do not want me to visit and why?    It has been said “why do you think Everyone ….……..   everyone agrees with his decision, everyone of practically 30 who are invited to MDT meetings agree and every one of them going along with EXECUTIVE decision made by one or two who do not want me on the premises because they do not want information shared. That is the real reason.

An impact assessment should be carried out in consultation with the patient to assess the impact of any denial or restriction of visits on the patient’s welfare.  Where a patient lacks capacity or is impaired as to their capacity an assessment by a suitably qualified best interests assessor should be carried out to assess any negative impact that denial or restriction of visits may have on the patient.   

Here is the impact these professionals are having on my daughter as stated on Xmas Day  “I no longer wish to live”.   This is the effect of the so called “care” by LPFT rated good by the CQC.   It is the worse experience we have ever encountered.

CLINICAL CARE LPFT TRUST POLICY DOCUMENT

8. Admission to Hospital/Keeping an individual in hospital

8.1 Policy Statement Care in a residential or hospital setting should be provided at the lowest level of security and restriction based on an individualised assessment of need, risk and capacity. Alternatives to residential or hospital care such as home treatment and crisis intervention should be considered as a less restrictive alternative to hospital admission where possible.

8.2 Consent to Admission to Hospital/Keeping Someone in Hospital If the individual has the capacity to decide whether to come into hospital or remain in hospital, then informed consent should be sought in all cases. This means that the individual is given information about the environment, routine and purpose of the inpatient setting / admission. If the individual does not consent, then consideration should be given to assessment and admission under the Mental Health Act (MHA) see MHA Policy 6a. If the individual does not have capacity to consent to hospital admission, then the MHA should be considered or the Mental Capacity Act (MCA) utilised as per Policy 6b. Any restrictions should have an accompanying care plan.

 Examples of restrictions include: • Ability to leave the ward (should remain on ward for first 24 hours minimum).

 • Contact with others

• Movements within ward

• Privacy

• Discharge

• Day to day activities

• Personal care

 If an individual lacks the capacity to consent to admission and the admission is completed using the best interest framework then this should be recorded as per policy 6b and an urgent authorisation for a Deprivation of Liberty should be submitted to the Supervisory Body as per the MCA Policy 6b.   After 2.5 years held like a restricted prisoner with no respect towards family with one goal and that is to send away – far away from home and family.  Best Interest is theirs not my daughter’s and every single capacity assessment is flawed.   “Go away my Mum is the NR”   “I am not going to engage”   –  It was their wish to get rid of me as NR only for me to become NR again lol!

Advocacy should be considered and advised to the patients / carers as appropriate upon admission and discharge.   

8.3 Consent to Admission for Under 16s’ (Also refer to Chapter 18 (18.3) of the clinical care policy)

Section 131A of the Mental Health Act (1983) requires hospital managers to ensure that patients age 18 or under are admitted to an environment suitable for their age (subject to their need). This duty applies to both detained and informal patients. It is not an absolute prohibition on the admission of such patients. If the young person is deemed competent (Gillick Competency or Fraser Guidelines) and consents to admission it can proceed. Parents and guardians should be kept informed (see chapter 13 of Clinical Care Policy).   Total breach of MHA and its Code of Conduct 11:14-11:16.

Where the young person objects to information being shared with a parent or guardian who has parental responsibility then further advice should be sought from the Trust’s safeguarding or legal team.   Elizabeth is sharing information such as the assessment that took place for a care home a very long distance away from home.

In cases of a dispute, priority should be given to the ‘parent’ with whom the young person lives or to the court involved. Advice should always be sought from the Trust’s legal team where there is dispute or a lack of clarity.     Nothing but court after court and investigation after investigation since I have moved.

Information should be provided to the patient and appropriate family/carers about visiting times, mealtimes, school hours etc.      Was told I could only visit evenings but Elizabeth told me other parents were visiting during the day.  Now I am completely banned.

8.7 Visitors to LPFT Premises LPFT considers the safety and dignity of all visitors to its premises as extremely important. The link below provides guidance and procedures regarding the management of all visitors to Trust premises and includes process for managing visits by children: Please refer to visitors process within safeguarding policy 11  What they have not done is offer any alternative.  If you ban someone from visiting there should be alternative arrangements

In November 2006 the Department of Health launched a ‘Dignity in Care’ campaign with an aim to put dignity and respect at the heart of care services, which extended into Mental health Services in 2007; and is now applicable in all health and social care settings. This campaign, led by the National Dignity Council, identified a 10 point Dignity Challenge to organisations which remains fully applicable today as follows:

1. A zero tolerance to all forms of abuse

2. Supporting people with the same respect you would want for yourself or a member of your family

3. Treat each person as an individual by offering a personalised service

4. Enable people to maintain the maximum possible level of independence, choice and control

5. Listen and support people to express their needs and wants

 6. Respect people’s right to privacy

7. Ensure people feel able to complain without fear of retribution

8. Engage with family members and carers as care partners

9. Assist people to maintain confidence and a positive

10. Act to alleviate people’s loneliness and isolation.

9.2 Purpose and scope of this policy 9.2.1 To provide clear information to workers, enabling them to provide care and treatment that respects and maintains patients (service users) rights to privacy and dignity.

9.4 Privacy and Dignity

9.4.1 Privacy refers to freedom from intrusion and relates to all information and practice that is personal or sensitive in nature to an individual.

9.4.2 Dignity refers to how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as a valued individual. In care situations, dignity may be promoted or diminished by the physical environment, the organisational culture, by the attitudes and behaviour of the care team and others; and by the way in which activities are carried out. Dignity applies equally to those service users (patients) who have capacity and to those who lack capacity.

9.4.3 Maintaining a service user’s (patient’s) privacy, dignity and respect is central to the delivery of effective health and social care, working in partnership with service users (patients) and where appropriate their carers / families.

9.4.4 Since July 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. Meeting the standard requires workers across the Trust to ensure people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand with support, so they can communicate effectively with health and social care services.   Sensory issues in Elizabeth’s case who cannot stand crowds, noise and bright lights which makes the current environment totally and utterly unsuitable.  She would be better off in a care farm where there are animals, a natural environment but the MDT and commissioners do not see it that way.

9.4.5 The following are examples of how to maintain a service user’s (patient’s) privacy and dignity:

Always ask a service user (patient) which name or title they prefer to be addressed by; and ensure all staff respect the service user’s (patient’s) expressed wishes.

• Ensure the Accessible Information Standard is consistently applied so all patients (service users) and carers where appropriate, are able to effectively access Trust (LPFT) services.

• Ask a patient (service user) if they wish their carer to leave for specific conversations or procedures which may compromise their privacy or dignity.

• Maintain a patient’s privacy when asking or assisting them to dress or undress.

• Close curtains or screens in areas where patients are expected to undress.

• Close observation windows in bedroom doors unless they are being used for observation at that time.

• Obtain informed consent before undertaking examinations or treatments.

• Ensure privacy and confirm the boundaries of confidentiality when discussing any confidential and sensitive issues such as diagnosis, symptomatology, sexual orientation and gender identity.

 • Respect privacy and dignity at all times, such as during the delivery of personal care, when undertaking all observational duties, when entering treatment rooms, single sex rooms or bedroom areas, toilets and bathrooms.    And do not give prone restraint by several men!

• Always knock or make your entry clear through announcing entry and waiting for a reply before entering* (* except where there is a clinical or care rationale not to do so, which includes during night periods when service users (patients) are sleeping).

• Don’t discuss worker or patient personal information with co-workers whilst carrying out care or within hearing distance of service users (patients), carers and visitors.

Ensure a service user’s (patient) choice is adhered to in respect of the gender of the staff member carrying out intimate care, such as assisting with washing or undressing.

Ensure reasonable adjustments are made to support a service user (patient) to function at their highest level possible. This may include ensuring a service user (patient) receives timely assessments, such as by a Physiotherapist or Occupational Therapist, and that related prescribed care and / or equipment is provided in a timely manner.

9.9.1 Board of Directors The Board of Directors are responsible for the Trust having policies and procedures in place which meet national and local requirements and / or legislation in order to provide a service which is based on best practice. The lead Director responsible for this policy is the Director of Nursing and Quality   Quite frankly what is the point of a Policy when no one takes any notice of it.   LPFT would do well to consider OPEN DIALOGUE.

9.9.2 Divisional Managers, Quality Assurance Leads and Team Leaders for in-patient services Divisional Managers, Quality Assurance Leads and Team Leaders for in-patient services are responsible for:

• Monitoring compliance with this policy

 • Ensuring timely reporting of any non-compliance of this policy through the DATIX incident reporting system.

• Investigating any reported non-compliance with this policy

• Implementing any actions required following audits, incidents or patient / carer / worker feedback relating to Privacy, dignity and mixed sex accommodation. This may include individual worker development where there is evidence of failure in respect of related practice.

9.9.3 In-patient Ward / Unit Managers and their Deputies In-patient Ward / Unit Managers and their Deputies are responsible for:

• Ensuring workers are aware of this policy, its content, where to access it; and their individual related responsibilities.

 • Ensuring timely reporting of any non-compliance of this policy through the DATIX incident reporting system.

• Ensuring timely recording in the service user (patient) record of the date, time and reason for the breach occurring.

• Ensuring service user/s (patient/s) and their carers (where appropriate) receive an apology and an explanation of the reason for the breach.    

• Ensuring patient safety is maintained during the period of the breach.

• Ensuring risk assessment/s, care plan/s and observation level/s are closely monitored and reviewed during the period of the breach.

• Ensuring timely escalation within service management structure where support or resource is required to ensure patient safety during the period of the breach.

• Investigating any reported non-compliance with this policy, including taking corrective action to prevent any recurrence.

9.9.4 All workers All workers are responsible for:

 • Actively promoting the service user’s (patient’s) privacy and dignity at all times.

 • Ensuring that all service users (patients) are cared for with privacy, dignity, and in single sex accommodation (as defined within Section 8.5 of this policy). Page 28 of 642

 • Ensuring they are aware of their role to support privacy and dignity including when carrying out practice such as observational work.

• Timely reporting of any breaches of this policy, including those reported to them by service users (patients), carers or other workers through the DATIX incident reporting system.

Associated Documentation

 1. NHS 13-14 Standard Contract

2. PL/CNO/2010/3, Professional Letter, Department of Health

3. DSSA Principles, September 2009, Department of Health, Gateway Reference: 12610

4. DSSA in Mental Health and Learning Disabilities, December 2009, Department of Health, Gateway Reference: 12940 5. Assessment of Same Sex Accommodation. Brief Guide for Inspection Teams (CQC 2015). 6. Accessible Information Standard Specification (NHSE 2015).

Staff must be mindful of the impact of mental health conditions on the wider family and support network, not just identified carers and next of kin, ensuring that information is shared as appropriate and wider family members are given the opportunity to seek advice, information and express any concerns they may have. Although it is recognised that the sharing of information may sometimes be difficult, it is crucial to the ongoing wellbeing of both the service users and their carers.

Staff must acknowledge that the carer is frequently the person who knows the service user best, often having regular contact over many years throughout many changes in mental health well-being, social networks and professional support.  Not recognised one bit.

The carer is often the person who has to offer support during out-of-hours crises, which can be stressful. By involving the carer in the development of the care plan and crisis plan where appropriate, or ensuring they have a copy of it, the carer can feel supported in assisting the service user to follow it.

Some service users will have entitlement to Section 117 after-care. The elements of the care plan which are provided under this entitlement must be clearly and separately articulated (see Mental Health Act Policy 6a) Help and guidance on assessment and care planning processes can be obtained from the Team Coordinator – Assessment & Care Planning. Application of the Care Programme Approach – CPA Whilst the expression Care Programme Approach was first introduced in mental health services in 1991, since the publication of Refocusing the Care Programme Approach (DoH 2008) the term Care Programme Approach is now specifically used to describe the approach used in secondary mental health care to assess, plan, review and coordinate the range of treatment and support needs for people in contact with secondary mental health services who have complex characteristics as defined below. CPA care and support must be discussed and agreed with the service user and the practitioners involved in the care. Where there is disagreement within the Multi-Disciplinary Team about the level of support from CPA, advice should be sought from relevant clinical leads or managers within the service, such as the Team Leader, Divisional Manager, Quality Lead or Clinical Director. Where there is a disagreement that cannot be resolved, the service user can appeal against the decision

This may be the last blog for some time on my part. What I would like to see is choice and there is none. There is no care in the community and we live in a District where provision is poor although there is a wonderful charitable sector and a lovely community. This would have all benefitted Elizabeth greatly. Like so many other parents and carers I have turned to social media but now I can see I could be doing this for the rest of my life and getting nowhere whatsoever. I am now taking a different route as there is no more choice and also I am one of many affected. It is not right or fair for parents to have to fight fo their sons and daughter’s because of organisational abuse by powerful public bodies.

<MHAEnquiries@cqc.org.uk>

CQC MHA Complaint Ref: ENQ1-17716124293

Dear Ms Bevis

We are writing to you from the Mental Health Act complaints team at the Care Quality Commission (CQC).

We have now received a copy of the letter summarising the outcome of the investigation into your complaints. We believe that a copy of this letter dated 14 November 2023 and signed by Dr T G the C Psych at Peter Hodgkinson Centre has already been sent to you, but please let us know if this is not so.    Not even touched on my complaint.You are in breach of human rights and every law.

The Mental Health Act grants the CQC a discretionary power to investigate complaints where they are about the use of the powers and duties in the Act. If you are not satisfied with the response provided to you by the service, you could request that the CQC consider reviewing your unresolved concerns.   No way am I satisfied.  All this time and nothing has been investigated properly.

We do sometimes receive complaints about matters that we are not able to investigate because they are not within these powers. The CQC complaints process cannot make any recommendation about matters that can only be decided by a court of law. For example, we cannot rule on whether a detention is lawful, nor would we be able to provide any clinical opinion re diagnosis.  Your investigation has been going on now for 2.5 years now I want some kind of resolution as I am losing my patience. You can investigate the bullying and appalling treatment of my daughter and myself.

Before we could decide if there is a role for us, we would need a clear statement from you outlining what you are unhappy with in the provider response, any outstanding issues and your desired outcome.  EVERYTHING!  I want the phone handed back for a start, s17 resumed, visiting resumed off ward preferably. s17 leave resumed in immediate vicinity.  Then I want leave resumed so that Elizabeth can see her cat at home without members of staff writing nasty notes behind out backs and calling the Police all the time. Wasting Police time. I want Elizabeth to have all her physical health appointments deemed unnecessary under LPFT.

Alternatively, you can contact the Parliamentary and Health Service Ombudsman Office (PHSO) within the next twelve months, saying why you are not satisfied. Their address is: –   WASTE OF TIME!Not interested in investigating.

The Parliamentary and Health Service Ombudsman for England

Citygate

Mosley Street

Manchester

M2 3HQ

From: susan bevis  
Sent: 04 January 2024 15:23
To: CARECONCERNS (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.careconcerns@nhs.net>
Cc: L A <l.a@voiceability.org>; r.a@voiceability.org <r.a@voiceability.org>;

Subject: INDEFINITE BAN ON VISITING AND ONGOING PHONE RESTRICTIONS

Please see attached.

Myself and ***** waited for half an hour to be let into the Teams meeting.  We were excluded.

L A has said she cannot talk to me due to Elizabeth not giving consent but Dr K had asked me to liaise with L A (Advocate) from Voiceability.   I assumed that this was some kind of go between – mediation of whatever he had in mind.

I today phoned Voiceability to express my concerns at what Elizabeth had told me during the last supervised phone call.  

So here are the questions we would have asked if we would have been let into the Teams meeting:

Why did Elizabeth miss her appointment on the 3 January 2024 with Dr C S?

Why are LPFT not doing things correctly –  to get rid of someone indefinitely should be done through CoP – why is Dr K taking it upon himself, acting ultra vires to ban me as a visitor indefinitely.  This is what he said verbally at the ward round on 28 December 2023.  So far there have been 3 x letters banning me and this is ongoing isn’t it so please confirm in writing.  This is totally unlawful.

I need confirmation that my calls are not banned either as I called twice this morning to ask to speak to my daughter on her phone we pay a contract on?   I spoke first of all to D T (OT from another ward) who said he needed to check something out.  Then I spoke to R who said “I will see if Elizabeth wishes to speak to you or not”.   

In the current situation I need to be seen to do everything I can to avoid XXXXXXXX but may well have to apply for an interim order unless I hear from yourselves that you have made alternative arrangements elsewhere off the ward so I can see Elizabeth and visit her and also that her phone is handed back.  The pre XXXTION states XX January 2024 so hope to hear from you by then.

The other thing is both myself and XX have completed s9 statements to the Police.  These are very serious allegations made by Dr W K that I incited ********* to attack staff.   That is not what happened –  please see attached. THIS IS BULLYING!

The day before our visit we heard Elizabeth was “not too good“.  Elizabeth shared with us that there was a change in her medication and we wondered what exactly what was going on in this respect.  

As you can see from the attached note Elizabeth becomes distressed at the way she is being constantly scrutinised and every move watched with phone supervised, visits excluded.   This is in breach of human rights, MCA and MHA and code of conduct.  Plus Art 8 and Art 5 HRA.  Equalilty Act 2010 and NHS Guidelines.

Look forward to hearing from you and hope some alternative arrangement can be made for visiting and that my daughter’s phone is handed back to her with immediate effect.

Regards

Susan Bevis

Mother POA LF and LIP   Tel

dhsc.publicenquiries@dhsc.gov.uk

Today I have been waiting for half an hour to be let into the Teams Ward Round meeting held by Dr W K supposed to have started at 10.40 am.  I was not let in to the meeting.    I have been banned for over a month now, NOW INDEFINITELY  Dr K said verbally my ban was indefinite for inciting my daughter to attack a member of staff on Xmas Day. she did not do this.    This is in breach of the MHA, mca, Human Rights act

Yesterday I know for a fact my daughter did not attend her Neurologist appointment.

Today we wanted to raise a few questions and were completely ignored.  

Myself and a friend have completed S9 statements for the Police as I am obviously being accused of something very seriously criminally and this has been a campaign of bullying since we arrived in Lincolnshire by certain professionals now escalated to ban me from having any contact whatsoever with my daughter.    

Phone calls supervised, visiting banned indefinitely.  I thought the correct procedure was to contact the CoP and get me banned indefinitely that way but nothing seems to be done correctly through LPFT.   

I want the phone handed back to my daughter we pay a contract on.  

I want to be able to visit my daughter off the ward.

Can something be done about this urgently?

I am very concerned for my daughter’s  wellbeing right now.

Regards

Susan Bevis  (Mother, POA, LF to L R E Bevis)

From: susan bevis <
Sent: 01 January 2024 20:49
To: WHATELY, Helen <helen.whately.mp@parliament.uk>; QUINCE, Will <will.quince.mp@parliament.uk>
Subject: Banned Indefinitely from Visiting my Daughter

I have been banned from visiting my daughter indefinitely by Dr W K RC, who is held under S3 MHA for over 2.5 years and my ban has so far been over a month now including  Xmas Day.  My daughter who had her phone taken away under Lincolnshire Partnership Trust, Castle Ward became upset with a lady supervising my visit.  I am now being accused by the Responsible Clinician of inciting her to attack members of staff and getting members of staff to phone Police on me.  not true at all.  The Police came to the ward but I had left and I feel uncomfortable visiting even if I could because I am being bullied by this XXXXXX.  I have issued a XXXXXXXXX XXXXXXXXl letter for XXXXXXXX but I am wondering when the legislation will come into effect because I am in touch with other cases.

I am concerned for my daughter’s wellbeing and that Lincolnshire Partnership Trust seem not to care.   They say they are taking my complaint seriously but allowing a doctor to act ultra vires in banning all leave, taking away my daughter’s phone.  It is cruel and disgusting the way some of these people abuse their power and when I visited on Xmas Day I had just one hr supervised and could only see my daughter for 1 hr and was told to leave when she became upset and then am being blamed for everything with Police called by a member of staff when there was nothing to report and the only time my daughter reacted was in self defence when they all grabbed hold of her on Xmas Day and threw her into seclusion for 6 hours injecting her once she was allowed out.

I have never seen such bad treatment as under LPFT and my daughter is not being treated the same as everyone else and neither am I.

So when can I look forward to the new law coming into effect to put a stop on the behaviour of some of these professionals who act above the law?

Regards

Susan Bevis    Tel

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.