BLOCKING PHONE CALLS/DENYING CONTACT BY CASTLE WARD PETER HODGKINSON UNIT, LINCOLN COUNTY HOSPITAL, LINCOLN LPFT “I NO LONGER WISH TO LIVE” – ELIZABETH’S WORDS ON XMAS DAY AND MY WORDS ARE “I AM NOT GOING TO BE BULLIED ANY MORE”

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. 

2. 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

3. 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 altogether and 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

Kind regards,

Karen Blackwell

Customer Relations Executive

Customer Service

Viatris

Building 4, Trident Place, Mosquito Way

Hatfield, Herts

AL10 9UL

productenquiries@viatris.com

Telephone: 44.0.1707.853100
Fax: 44.0.1707.261803

Viatris.com

  Hospital Orders – hospitalorders@viatris.com
  Wholesale Orders – UKorders@viatris.com
  Fax – 01707 261803 (please note this is a shared business fax so email is likely to reach us quicker)
 

Our Customer Services direct phone number is 01707 853100 and our Customer Services direct email is UKcustomer.services@viatris.com

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.