FLAWED CAPACITY TESTS UNDER LPFT AND CAPACITY MEETING WITH TONY MANSFIELD CAPACITY LEAD AND DR WAQQAS KHOKHAR
This below is my latest email I have received via Care Concerns inviting me to a meeting by LPFT to discuss capacity which is something LPFT have totally abused when 3 flawed in-house capacity assessments were done a year ago to achieve their ends. I am featuring my response how the MCA has been abused. I am now a BI assessor myself and I am quite appalled by this abuse. People have a right to know what is going on.
MY RESPONSE TO “CAPACITY” MEETING ON 6.03.2024 WITH DR WAQQAS KHOKHAR AND MENTAL CAPACITY LEAD TONY MANSFIELD
From: susan bevis
To: CARECONCERNS (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.careconcerns@nhs.net>
Subject: Fw: Wednesday 6th March 2024
Dear Ms Munro
Thank you for your email below.
I spoke to my daughter today and she told me about another accident that happened on the ward. Under Reg 14 HSCA The family should be informed of any accidents, especially ones where she hit her head in light of the fits she is suffering.
I am now a Best Interest assessor myself so I would know that the assessments done on my daughter are completely flawed and that goes for the Tesla 1.5. I am waiting to hear as regards Sharon Harvey’s promise to get done a completely independent capacity assessment as promised in our meeting on 2 October 2023. (HOWEVER HOW ANYTHING BE INDEPENDENT WHEN LPFT ARRANGE IT)
There is no doubt my daughter has capacity as she is able to relay to me exactly what is happening including the assessments/suggestions of her going into supported living against her wishes and that of the family out of area. Perhaps you can inform the family and nearest relative who I am copying in herewith.
Elizabeth does not agree to being filmed by the MH team on the ward re her fits.
Elizabeth did not have an advocate present at ward round today but was able to relay everything and the only reason she mentioned she did not wish to go to Sheffield was because of the transport. Elizabeth did not want to go in a van and she still remembers and is traumatised by the previous caged vehicle used to transport her from Lincoln Hospital to Ash Villa to this day. Elizabeth said she will be happy if family were present at Sheffield and I have written to Dame Pamela Shaw at Sheffield.
As regards Elizabeth’s Capacity she told me personally she did not wish to engage and that was because AM (AMHP) and certain shameful doctors were deliberately trying to coerce her into displacing myself as Nearest Relative. That has been the main objective focussed on and not the wellbeing and care of my vulnerable daughter.
LPFT’s abuse on capacity:
Case study: The diagnostic step and the causative nexus · 12 June 2023 Case Study, Mental Capacity in Practice
The diagnostic step is a simple but often misunderstood part of the Mental Capacity Assessment. One of the most common errors is to simply list a medical diagnosis without any explanation of how the diagnosis impacts upon decision-making. However, this link – also known as the causative nexus – is the vital point on which the rest of the assessment is based. It is therefore important to understand exactly why the diagnostic step is important and how to document it properly.
LPFT have ‘determined’ via faulty processes that Elizabeth lacks capacity. She frequently missed meals at Ash Villa and spent much of the day isolating in her room situated right next to the Seclusion Room knowing full well she had sensory issues. Her treatment was befitting of Panorama and Dispatches and several patients approached me in the grounds outside asking if I was Elizabeth’s Mum and stating they were doing the safeguarding and sleeping with their doors open at night. This is where the fits started and where the cancer scare originated but the tests for cancer will need re-doing as you do not have a decent scanner in Lincolnshire and this is about to be headline news hopefully and totally inadequate response below. The 1.5 scanner did not pick up what the Tesla 3 did that I paid for privately and a cancer patient has died in this area. I now want all the scans done properly under a Tesla 3 in Sheffield.
Julie Frake-Harris, Chief Operating Officer at United Lincolnshire Hospitals NHS Trust, said:
“Our hospitals offer the correct and appropriate equipment for medical imaging, including 1.5 Tesla MRI scanners, which allow our experienced clinical teams to scan all our patients to a high diagnostic quality. 3 Tesla MRI scanners would usually only be in place at specialist tertiary centres, where they have a specific need for neurosurgery or research. ULHT does not provide this type of specialist service.
“We are commissioning four new state-of-the-art 1.5 Tesla MRI scanners in Lincolnshire this year, which is more appropriate for the wide variety of patients we care for, is safer for their clinical needs and offers a more comfortable experience during a scan. The new software allows comparative image quality and speed to a 3T without the additional risk.
“If any patients or carers have any questions about their care, we would encourage them to discuss them with us so we can address any concerns they may have.”
That is totally wrong!
The acuity and resolution of the scanner is determined by the strength of the magnets measured in Teslas not by imaging software.
No amount of software can resolve an image that has not been picked up in the first place.
The analogy is the James Webb telescope. Its acuity and resolution come from it mirrors. They ‘find’ the image the software only cleans it up.
If you use sophisticated software with a low resolution image it will not allow you to see something the ‘lens, mirror or magnet did not see in the first place.
This is why Elizabeth was being referred by Dr S to Sheffield because my private scans showed much more detail and as my daughter’s “episodes” have ended up in A&E on more than one occasion with low blood oxygen levels and enormously high blood pressure – this could be life threatening ad someone has died as a result which makes this whole matter public interest.
Getting back to Capacity ………...
Why has a vulnerable patient such as Elizabeth, who by LPFT’s assessment lacks capacity being left unfed for large parts of the day? It was certainly negligent to leave anyone who lacked capacity to be not properly nourished.
Why was Elizabeth only fed when I called, in emergency to ensure that she was properly nourished?
Why was/is a patient judged as lacking capacity not properly monitored in respect of her sleep, especially as it is clear she suffers from sleep apnoea, most likely as a result of the overuse of neuroleptic medications administered via depot and prn?
Why was Elizabeth, who by LPFT’s evaluation (faulty) lacking capacity not given appropriate tests to determine what might be causing this lack of capacity?
If Elizabeth lacks capacity, as LPFT suggests, LPFT’s duty of care/standard of care in medical negligence is at a higher level. Why has/had she been neglected on the ward and prior to this Ash Villa to the extent that no one checked that she was being properly nourished?
The LPFT and LCC have abused the capacity assessment process to restrict/deny Elizabeth’s fundamental rights to patient autonomy to facilitate their own interests or convenience. This includes/ has included denying her rights to privacy and a family life by subjecting her to oppressive supervised visits.
The LPFT have/are abusing their powers under the Mental Health Act 1983 to deny Elizabeth and her family fundamental human rights, not in order to prevent or control risk but simply to benefit themselves and to obtain control to abrogate their actual responsibilities.
These are matters that will be referred to judicial review as ultra vires. The MHA 1983 was designed to protect the interest of the mentally ill, not provide a convenient set of excuses for clinicians, nurses and social workers.
Elizabeth was judged to lack capacity but the common law test as determined in Masterman-Lister v Brutton & Co [2003] 1WLR 1511 was not applied.
“whether the party to legal proceedings is capable of understanding, with the assistance of proper explanation from legal advisers 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… the threshold for capacity to provide instructions is not high, and people severely affected by a mental disorder may still be able to provide instructions if you explain matters simply and clearly.”
I contacted Dr Bob Johnson (former Expert Witness) regarding the capacity assessment and he said:
“I tend to agree with you about issues of capacity centring on the doc!”
Bob informed me that the ‘no comment’ interview makes no sense in terms of determining capacity.
“Either you don’t understand the question, in which case you say so, and your “micro-expressions” confirm it, or you do, and you’re dodging. The latter is rather too clever for no capacity”.
Bob of course has had enormous experience dealing with this kind of interview.
The decision that Elizabeth lacks capacity is contrived in the face of obviously conflicting evidence. In criminal law a ‘no comment’ interview can be put to the jury as an inference of guilt, i.e. that the suspect is evading the question while knowing the answer.
Elizabeth is using it as a defence mechanism against people she considers hostile. She is carefully calculating when it is in her interest to ‘cooperate with them and when it is not. That is not indicative of those who lack capacity.
What does happen with those who lack capacity is that they either confabulate or talk nonsense or that they are ‘interview suggestible’*, meaning that they say what they perceive the interviewer to want them to. That is why in police station interviews that need a responsible adult present.
Elizabeth was/is being evasive and dodging questions she is uncomfortable with. A classic evasion strategy that is quite the opposite of what would be expected from someone who really lacked capacity.
A proper examination applying the proper methods and following the Code of Practice correctly, instead of manipulating it would show that Elizabeth has capacity, albeit impaired. That is why they want to get me as far away from the treatment regimen as possible.
Research indicates that attitudes assuming guilt (or lack of capacity) actually reduces the effectiveness of interviews1
Interrogative Suggestibility. Gudjonnson (1984)
1. Baldwin (1993); Moston (1995), Pearse and Gudjonsson (1996), Shepherd (1993)
If it was/has been really concluded that Elizabeth lacks capacity then LPFT must have radically altered her care plan and her detention must now be under the deprivation of liberty criteria from the MCA 2005 rather than the MHA 1983. My suspicions are that no such variation has been made. This was possibly designed to do an end run around the section 3 review system just as much as it was to displace me as the NR.
Elizabeth used evasive answers that are logically selected and timed. She even used distraction techniques to what she perceived as her advantage. Refusal to engage and interrogation evasion techniques indicate complex insight, even if the patient is in other ways cognitively impaired. Elizabeth perceived the interrogator as a threat or even as an oppressor. No comment and noncommittal answers are exactly what one would expect in that situation. I would not expect a patient who truly lacked capacity to use ‘no comment’ answers.
She was being defensive and that is not a sign of lacking capacity.
The doctors describe choosing an interrogation technique that assumes in advance that Elizabeth lacks capacity in spite of that being contrary to section 4(1) MCA 2005 and the Code of Practice. Elizabeth is assumed to be educationally sub-normal and of low IQ (another discredited system of evaluating capacity) but Huntercombe – an entire team assessed her properly as being “High Spectrum Aspergers”.
The doctors talked of asking short simple questions but her answers indicate she is fully cognisant of what they are saying. They even interpreted her desire to go home as being delusional instead of a perfectly understandable aspiration.
This process was totally flawed and designed with a ‘no capacity’ outcome built in. It even assumed, again contrary to section 4 that she was not capable of regaining capacity. That, combined with the retractions was designed as an obstacle to any form of appeal or genuine objective second opinion.
The MCA2005 is used to take control from patients and their families. In most cases this really is in the best interest of the patient but is open to abuse as is everything else. The best interest of the institution are often ‘factored in’ even though that is entirely contradictory to the spirit of the legislation and code of practice.
Inadmissibility of Capacity Assessments
The capacity assessments carried out at Ash Villa are inadmissible as evidence.
Applicable Principles and Requirements
The capacity assessments are all seriously flawed in terms of the requirements and principles of the Mental Capacity Act 2005, the Code of Practice, and indeed in the very philosophy underpinning the legislation.
The concept of best interests is founded on the most fundamental principles of human rights. Those principles are centred entirely around the welfare of the patient and never in the interests or expediency of ward management or those carrying out assessments.
The Mental Capacity Act 2005 at Section 4 requires that the patient is to be regarded as having capacity until evidence is ascertained as to how that capacity is impaired.
No Proper Capacity Evidence
It is evident from the statements regarding Elizabeth’s capacity that:
(a) No proper, full, objective and admissible evaluation of capacity has been made at Ash Villa; and/or
(b) there was an over-emphasis of the goal of displacing myself as NR, which created a bias in assessment so materially affecting validity that none of the evidence on capacity is admissible.
Capacity Evidence Has No Relevance
There is in any event no relevance of any evidence, on capacity of the Elizabeth, to any aspect of the Claim, which is that her mother is unsuitable to continue to act as Nearest Relative.
It was not asserted why capacity evidence has been produced, nor shown – anywhere – any relevance of such evidence.
The very slight admissible evidence in the capacity assessments is not on capacity itself, but is only that which reinforces the evidence of the her mother that the position of the Elizabeth is very simple: she wishes to go home to live next to her mother, and that her mother is her Nearest Relative.
The Context for Elizabeth’s Responses
What is startling is that no account is taken of Elizabeth’s reaction to being, as she sees it, in an oppressive institutionalised situation in which she has virtually no right to privacy, family life or psychological and spiritual enrichment.
It is hardly surprising that any person so deprived of the most fundamental of human aspirations is not so much lacking capacity but is self evidently being deprived of it.
All of this is in breach of the letter and spirit of section 4, MCA 2005.
The Prohibited Step
It is never allowed that the decision maker on best interest draws conclusions on capacity from a patient’s age or appearance on a condition of his/hers or an aspect of his behaviour which might lead others to make unjustified assumptions about what might be in his/her best interests by section 4(1)(a) & (b). This is known generically as The Prohibited Step.
Failures: Identification of Issues
Section 4(2) MCA 2005 requires that the decision maker should try to identify all the issues that would be most relevant to the individual who is asserted to lack capacity relating to the particular decision (para 3, Main Code of Practice)
Failures: Framing of questions/suggestions
The framing of questions/suggestions in closed form gave Elizabeth no opportunity to explain or include detail in her answers.
It is a disturbing oversight on the part of those carrying out those interviews that the nature and framing of questions and suggestions, and their leading nature, made it impossible for her to express herself.
Failures: Elizabeth’s Clear Responses
There is no evidence from the interviews that there was any attempt to determine the actual meaning of Elizabeth’s clear responses to questions/suggestions made by the interviewer.
Failures to comply with Requirements
The content of the Section D witness statements on capacity is riddled with inconsistencies. The capacity assessments were not conducted as required by section 1 of the Mental Capacity Act 2005.
It is submitted that the capacity evidence is inadmissible as evidence of lack of capacity not only because of logical and factual inaccuracies in the statements, but also for failure to apply the meaning of the statute, and the failures to follow the required steps:
Submissions on the Required s.4 Steps
The required steps, in summary, in s.4 of the Mental Capacity Act 2005, and appropriate related submissions, are:
To consider the likelihood of the person gaining capacity. There is no evidence that this was even considered by either first or 2nd opinion assessor or in the ‘off record’ intervention by KS, and thus never taken into account at all.
To promote and encourage the participation of the patient so far as possible. There is no evidence that Elizabeth’s participation via appropriate dialogue was encouraged or ever taken into account at all. Indeed the first and second assessor treated her as someone with a severe learning disability rather than an educated woman with a chronic mental health condition. They make reference to talking to her in “little chunks of three sentences”. Nothing in Elizabeth’s diagnosis suggests that she is mentally retarded or incompetent and this approach is in clear violation of The ‘Prohibited Step’ described in section 4(1) of the Act.
To consider the persons wishes, beliefs and other factors the person would be likely to consider were they able to do so. Once again this is not taken into account at all by either of the first and second opinion assessors. None of Elizabeth’s wishes were considered in those interviews or were simply disregarded with scant attention. This is evident in the perfunctory treatment of her observations regarding the litigation. No attempt was made to understand why she may have taken those positions, including of course that the oppressive nature of the interview with no independent observer present may have seriously deprived of any ability to explain in detail. All contrary to section 4(2) and the main Code.
To take account of the views of named others. This is perhaps the most obvious complete failing of all the assessment interviews and is a cause for serious concern. The views of neither Susan Bevis, Elizabeth’s mother, or her sister, or her father were taken into consideration or even sought.
Conclusion:
The individual and accumulative effects of all of these failings make the statements by the assessors incapable of being relied upon at all.
Comments on the Section D Assessments of the 1st assessor and second opinion assessor in red.
Question 1. UNDERSTANDING: Does the person understand the information relevant to the decision?
Answer: No
She was happy to see me, and we (along with S/N GJ) used family rooms in order to promote her privacy. I explained that I would like to talk with her so that I can complete an assessment on her mental capacity to make decision in order to displace her mother as her NR. She asked me what that meant. I explained in simple language the rights and duties of the NR as summarised above in the salient information section, using slow and steady speech. I ensured I gave her the information in little chunks of three sentences and would go over it, if it seemed that she was not following. I explained that her mum is her NR and that there are steps to identifying a NR. I explained that her mum (NR) will be expected to fulfil those roles as above and also to act in her best interests – such as supporting her in staying well and making services aware should she start relapsing or stop taking her medications. I explained that there are times either the patient can ask to displace their NR or professionals can apply to do so. I added that usually it is when professionals do not believe that the NR is acting in the patient’s interest. In this case, that her mum is not acting in her best interest. Elizabeth frowned and stared at me. I added that according to her records,
Her mum does not believe that she suffers from the diagnoses listed. I explained that she believed that she had ‘autism’. She asked me what was going to happen about that diagnosis and I explained that she has been (or is going to be soon as we have agreed in last ward round) to be referred for a diagnostic interview but unfortunately, there was a long waiting time and when her turn comes up she would be assessed for it. I mentioned the pros and cons of not having her mum as her NR. I recapped my explanation above regarding the issue at hand of her capacity to displace the NR. I am of the reasonable belief that Elizabeth did not demonstrate understanding of the functions of the NR, pros and cons of the decision and the implications of displacing her mum as her NR.
She did not seem interested in NR displacement issue. Although, she said that she understood, she was not able to relay it back to me as if she did not want to discuss this issue anymore.
‘as if’ is entirely speculative and inconclusive of Elizabeth’s lack of capacity. It is also contradicted by Elizabeth’s response to the suggestion that her mother is displaced. “Elizabeth frowned and stared at me”. Such a response is self-evidently disapproval and indicates the capacity to make decision on this. If indeed Elizabeth was expressing a refusal to discuss the matter further that cannot be ‘reasonably’ regarded as a lack of understanding of the issues and would just as likely show an objection to the suggestion her mother was displaced as NR.
The erroneous beliefs of Elizabeth’s mother regarding the diagnosis is irrelevant to a capacity assessment. Elizabeth’s mother’s beliefs are not evidence of Elizabeth’s capacity or lack of it.
“I am of the reasonable belief that Elizabeth did not demonstrate understanding of the functions of the NR, pros and cons of the decision and the implications of displacing her mum as her NR”. This is indeed not a reasonable belief in the light of Elizabeth’s obvious disapproval of her mother being displaced.
“I mentioned the pros and cons of not having her mum as her NR. I recapped my explanation above regarding the issue at hand of her capacity to displace the NR”. This is a logical fallacy. It is effectively asking Elizabeth to acknowledge her lack of capacity. Logic clearly dictates that if she does not understand the information ‘given in little chunks’ she is not going to be able to determine her own lack of capacity.
Question 2. RETENTION: Can the person retain the relevant information long enough for the decision to be made?
Answer: No
I asked her if she had any questions to ask and she said “no questions”. It is my reasonable belief that Elizabeth was not able to recall the salient points given to her to enable her to make a decision on whether to displace her mum as her NR or not. It seems like she was able to retain the information for some time but she was not able to relay it back to me as if she did not want to discuss this issue anymore.
“I asked her if she had any questions to ask and she said “no questions”.”
“she was not able to relay it back to me as if she did not want to discuss this issue anymore”.
It is not a reasonable basis of belief that this indicates a lack of capacity and could just as easily represent defiance or resistance to a suggestion that Elizabeth found threatening or disagreeable. It is also logically inconsistent. If Elizabeth says “no questions” there is no reason at all why she would wish to relay back the discussion.
2nd Opinion Comments
1. UNDERSTANDING: Does the person understand the information relevant to the decision?
Answer: No
When I asked Elizabeth if she was aware that there was an ongoing court case she said “yes” but when I asked her if she knew what it was about, she said “not sure”. I explained to Elizabeth the purpose of court proceedings, stating that this was because LPFT were asking a judge to decide if her mum should be her nearest relative or whether someone else should act in this role. Elizabeth stated that she could not be involved in court proceedings because “my back is broken and I have got autism”. I did challenge Elizabeth on this stating that just because a person has autism (noting this is not a formal diagnosis for Elizabeth) does not mean that they do not have opinions or views about what they want to happen, and this includes who they want to be nearest relative or represent them in court. Elizabeth was still adamant that she could not be involved. I asked Elizabeth if she knew who her litigation friend is currently and she said no. When I told her it is her sister, she said “she can’t help me” but was unable to expand on why she felt this was the case, when I asked her why she thinks that, she said “not sure”. I have checked with the care team and have been informed that although there is a likelihood that Elizabeth had injured her back when in periods of high distress and volatility, this has not been to a significant degree beyond strain or sprain and she is not known to have ever broken her back or sustained a similar level of injury.
On the balance of probabilities, I consider that Elizabeth does not understand all the salient information needed to be able to make this decision. When I tried to explain to Elizabeth that she could instruct a solicitor or tell the judge what she wants, she was fixed in her view that she could not do this because of having autism. This evidences that Elizabeth does not understand all the options available to allow her to participate in the legal process regarding displacement of her nearest relative.
Elizabeth stated that she could not be involved in court proceedings because “my back is broken and I have got autism”. However Elizabeth asked to attend court but this was denied through a phone call from Solicitors to the Ward.
That is not conclusive or even persuasive evidence of a lack of capacity. Elizabeth’s erroneous belief in her condition is not indicative of an inability to choose her mother as NR or a failure to understand the questions put to her. As for the injury to her back, she has been subjected to numerous physical restraints including pinning her face down on the floor according to witnesses . It is entirely understandable that she may use hyperbole to describe her pain from injuries sustained by this restraint. That is not evidence of a lack of capacity.
2. RETENTION: Can the person retain the relevant information long enough for the decision to be made?
Answer: No
Elizabeth has demonstrated that she does retain some information relating to the court proceedings to displace her nearest relative. Having reviewed her notes, I can see there have been occasions when she has been emotionally distressed that she has expressed anger about the application to displace her mother as nearest relative without prompting and has stated that LFPT does not have a right to stop her mother being her nearest relative. She was also able to recall today that her mother is her nearest relative.
Although there is clearly a level of retention regarding this decision, I do not consider that Elizabeth is able to retain all the pertinent information required to be able to litigate in these proceedings. For example, after explaining to Elizabeth that her sister is her litigation friend and that she is representing her in the current proceedings, when I revisited this later in the conversation and asked Elizabeth if she could remember who I said was acting as her litigation friend, she was unable to recall that it is her sister.
After I finished my discussion with Elizabeth, deputy ward manager KS went to speak to her independently in her bedspace to see if she was willing to discuss this decision in more detail without me being present. Elizabeth asked K if I was going to be going to court. Elizabeth had asked me the same question approx. 10 mins earlier when I was talking to her and I explained to her that I was not a solicitor and was not going to be in the court hearing, but that I would be writing about our discussion today and the court would see it. As Elizabeth had asked K the same question 10 minutes after I had given her this information, this evidences difficulties with retaining all relevant information relating to the court proceedings.
“I can see there have been occasions when she has been emotionally distressed that she has expressed anger about the application to displace her mother as nearest relative without prompting and has stated that LFPT does not have a right to stop her mother being her nearest relative. She was also able to recall today that her mother is her nearest relative”.
All of that is indicative of a functioning capacity to understand the issues, not only at that point but on reflection of earlier events. This is fully supportive of her ability not only to recall but to maintain a position on the NR. In the light of this is cannot be stated that “on the balance of probabilities” Elizabeth lacks capacity. The MCA 2005 principles found at are at section 1 quite explicit that the capacity assessor should work on the basis that a patient has capacity ‘on the balance of probabilities” Those principles are as follows:
· Principle 1: A presumption of capacity. …
· Principle 2: Individuals being supported to make their own decisions. …
· Principle 3: Unwise decisions. …
· Principle 4: Best interests. …
· Principle 5: Less restrictive option.
Violations of principle 1: Elizabeth is presumed in the negative contrary to the principle of presumed capacity. Clear evidence in Elizabeth’s answers and attitude to the capacity assessment indicates a presumption of capacity and not the contrary.
Violation of Principle 2: Elizabeth has received no support to make her own decisions and was not supported at this capacity interview by an independent advocate. The clinical staff are seen by Elizabeth as intimidatory. Her responses to these capacity interviews show clear evidence of resistance to the questions and objections to the purposes of it.
Violations of Principle 3: Section 1 of the MCA 2005 and the Code of Practice are quite explicit that unwise decisions cannot be used as evidence of lack of capacity. Emphasis is placed in the interviews on irrelevant interpretations of Elizabeth’s mistaken beliefs in her diagnosis. It is very often that case, probably more often than not that a psychiatric patient will deny their illness. This is not evidence in itself of either delusion or lack of capacity. Elizabeth’s complaints about the back injury are quite explainable since she has been subjected to maximum physical restraint on several occasions. The use of restraint has been described as a method of dealing with “distressed” patients at Ash Villa and that is quite disturbing.
Violation of Principle 4: It was in Elizabeth’s best interest that this interview was conducted in the presence of an independent advocate or her NR. Neither was present and Elizabeth had no support. Elizabeth is used to being physically restrained and in the light of that far better safeguarding of her best interest should have been applied at these interviews.
Violation of Principle 5. Elizabeth is currently being held under a regime of restraint and it is difficult to see how she could be subjected to a more restrictive option. The two on one surveillance that has been employed at Ash Villa and the intrusive surveillance of family visits is more severe than many s.37/41 patients would encounter. There is every reason to believe that should Elizabeth be given a less institutionalised and restraint based treatment regime that she would display a much better degree of capacity than the current regime allows.
“I do not consider that Elizabeth is able to retain all the pertinent information required to be able to litigate in these proceedings”
Elizabeth is not required to litigate these proceedings she is represented by a litigation friend and has a right to a solicitor.
“As Elizabeth had asked K the same question 10 minutes after I had given her this information, this evidences difficulties with retaining all relevant information relating to the court proceedings”.
That presumption is fallacious. Elizabeth could just as likely have been seeking verification from someone she was more familiar with and it does not necessarily indicate she did not understand or retain the information. It is also indicative of a lack of trust, especially in the light of the stated reason for K S wanting to speak to Elizabeth independently. The suggestion that the capacity assessor was being mistaken for a solicitor is not made out. Elizabeth’s question regarding whether the capacity assessor was going to be in court is perfectly sensible since this person was discussing the litigation with her.
“Elizabeth demonstrates an ability to communicate her views to the extent that she chooses and is able to do so. She did offer a view regarding her involvement in the current legal application, stating “I don’t want any part in it”. Further to this, she has at times of distress spontaneously expressed her unhappiness that LPFT have instigated these court proceedings. Additionally, when deputy ward manager K S went to speak to Elizabeth alone 10 minutes after my assessment with her, she was able to express to K that she did not want me (meaning K F) to have anything to do with the court case”.
Although Elizabeth is guarded and refused to discuss her capacity to litigate in any great detail with me, I do not consider that a refusal to communicate a decision equates to an inability to do so and therefore on the balance of probabilities, I consider that L does have the ability to communicate in relation to this aspect of the capacity assessment”.
This element of the statement is riddled with contradictions when considered against the principles defined in section 1 of the MCA 2005. Elizabeth appears to have a full appreciation of the nature and purpose of the litigation and expresses strong and clear views on it and the NR process as currently conducted by LCC Adult Social Care. As stated a refusal to communicate is hardly any evidence of an ability to do so and is in realty much more likely to indicate a good range of capacity. Once again concluding otherwise falls foul of principle one of the Mental Capacity Act 2005. The entire process seems faulty and as such should not be admissible as evidence in these proceedings.
Subject: End runs and abuses of process
“The capacity red herring is being used solely to facilitate the LCC (acting as proxy) for the health trust being effectively unopposed in their application and represents a violation of article 6. ECHR.
The county court is unlikely to be able to deal with an argument on this level due to their perfunctory approach to this case to date. They have so far accepted evidence of questionable provenance and accuracy and failed to see the procedural errors and self-evident abuses of process.
So far no human rights issues have been put before the court for consideration and they are operating on process alone. This is giving them the advantage. The human rights matters will put a spanner in that works.
Unless a truly independent capacity report is presented Ash Villa is being allowed to act as a judge in their own cause and that is contrary to natural justice. The capacity report is obstructing everything here and while the county court is accepting it as justification for displacement in the most absurd and contradictory manner possible no progress will be made there.
It is utterly preposterous to suggest on the one hand that Elizabeth wants her mother to be displaced and on the other that she cannot decide where she might want to live. It is nonsense to suggest that capacity could be that selective. If Elizabeth wants to go to home that is an entirely separate issue to the NR case.
It strikes me the council are deliberately conflating these two separate issues to achieve a single aim. It is obviously not based on any fear of Susan applying for discharge. That is no threat in any case. This procedure is being used to ensure that discharge is to sheltered accommodation (out of area). What is ridiculous about this is that once discharged Elizabeth can leave any such accommodation unless a separate injunction is applied preventing it. There has been a case where the mother was injuncted from taking her son home for more than two days a week. Note that even in those extreme circumstances the son was still allowed to stay with his mother for part of the week.
The LCC and LPFT are trying to do an end run around the MHA 1983, the MCA 2005 and the very recent common law cases is order to have it all their own way. They should not be allowed to do an end run around the ECHR and Human Rights Act provisions on privacy and the family, the right to a fair hearing and the right to freedom expression. This is a blatant and quite startling disregard for human rights and the law right down to the most fundamental maxims of English law. Everyone knows that final decisions of any court cannot be made in secret or ex-parte and at the very best only interim orders can be made.
Once again these abuses of process are trying to do an end run even around that principle.
Two court of protection assessors visited Elizabeth at Ash Villa. According to the court papers she had fluctuating capacity. Her medication was increased from 400mg fortnightly to 400mg weekly plus 10 mg table form. This huge increase in “medication” was the cause of fluctuating capacity but still she was not deemed to have NO CAPACITY which was the result LPFT and Council were looking for.
All the time Elizabeth had to listen to “professionals” running down her mother (myself) using gaslighting and coercion to achieve their ends. At first it was working because she was approached so she told me during a time she had Covid and was very unwell. Then she changed her mind.
She has been treated appallingly and left to go downhill – how would anyone like to be treated this way? We did not ask for anything other than the depot to be provided and my former area are responsible for providing the care in any case. The former area (Enfield) have neglected my daughter in the community previously which was subjected to Judicial Review and solicitors were successfully appointed but then they sectioned her unlawfully in haste to avoid Judicial Review.
From the minute we moved was the time bullying commenced first with the POA which Public Guardian saw in our favour and then followed months and months on end.
There is no way I would wish to challenge the NR through the court for the role of NR back that is my younger daughter. However to do what they did is most certainly not out of kindness or care in any way. It is pure abuse of power.
All physical health appointments cancelled as unnecessary where former area were taking health very seriously.
“abnormal findings on scan” mentioned twice was why I had the private scans done under a Tesla 3.
As regards capacity you involved the Court of Protection to take away the POA which there followed months and months of investigation into us as parents for malicious allegations on “psychological abuse” and the Public Guardian Office found in our favour.
If LPFT wanted a decision on forcing my daughter into supported living and housing out of area LPFT chose not to go down the correct route ie Court of Protection – could this have been because the last Court of Protection case went in my daughter’s favour?
LPFT have cut me out consistently as a mother, treated me like a criminal, threatened me via the doctor in charge stating “I am banning you indefinitely for inciting your daughter to attack members of staff” – you have now concluded your investigation but we (myself and witness completed a section 9 statement even though we did not have to because of these serious threats which once again involved Police. This is bullying tactics.
Now LPFT wish to talk about capacity and my daughter’s capacity which she has had all along. LPFT had no advocate at this ward meeting and Elizabeth was able to relay everything in front of the supervising member of staff during my supervised phone call which is an infringement of human rights for a start.
The issue is: Does Elizabeth allow for staff on castle ward to film her and I understand she said “no” to that.
However, in the absence of an advocate: Does Elizabeth want to go to Sheffield? This question was unfairly sprung on her in the absence of any advocate present to support her. When Elizabeth told me she did not wish to go it was because she was concerned at the transport. She still is traumatised by being taken in a van – a caged van from Lincoln County Hospital to Ash Villa. That was her explanation. Secondly Elizabeth has made it clear that she wishes a member of her family to be present. Section 17 leave will therefore need to be facilitated. I see you are involving a MCA lead namely Tony Mansfield. It is a conflict of interest to carry out a capacity assessment by staff employed by LPFT as has been done at County Court.
Why hasn’t any fresh capacity assessment been done as promised by Sharon Harvey? (Then again if arranged by LPFT how can you trust anything they do. Elizabeth herself phoned to try to arrange this before LPFT took away her phone and locked it away in her locker making it impossible for her to make calls, receive text messages, listen to her music, see pictures of her cat. Anyway hopefully matters will eventually be resolved as this is all about human rights which LPFT have discounted all along.
The last thing I wanted was to challenge and be in this position of having to defend myself and my daughter. In the former area she was compliant with medication in the community and the former area were taking her physical health extremely seriously unlike here.
Clearly any capacity assessment needs to be done completely independently and Elizabeth called Mental Capacity Consult to arrange this herself privately and has tried to appoint solicitors before the phone was taken from her by staff acting against human rights and this is still going on currently when it is stated in Ms Munro’s letter that restrictions had ended which is NOT TRUE. That shows tremendous capacity for her to phone and try to arrange things herself that was before her phone was taken away.
I was supposed to visit on Tuesday but rather than go two days running I shall have to look to changing this to fit in with them because it is a long distance for me to travel there and back Instead it is suggested 3.30 pm on Wednesday.
Elizabeth has said she would go to Sheffield as long as she does not have to go in a van and she has asked if I can be present to support her or even her sister although she is working right now.
Yours sincerely
Susan A Bevis Mother and POA
Going to Sheffield is to be under specialist observation and we are keen for this to go ahead because of the frequent fits Elizabeth now suffers but our concerns are what Elizabeth has relayed a few days ago “I will not be here much longer”. So this meeting is to discuss what exactly??? as the correct procedure would have been for LPFT to seek a capacity assessment completely independently through the CoP or let her family arrange it. The issue at stake now is discharge to supported living once again when Elizabeth wants to be near to her family and come home. They want her to have no capacity so they can control and restrict contact for a lifetime no doubt placing her far away from home and family. There is no way anything can be classed as independent, true and honest if LPFT arrange or carry this out themselves as you can see from the above example of sheer dishonesty. This time, the decision will not be about getting rid of me but where THEY want to send her and so far a care home has visited situated far from home and family in W Sussex and even if it is Yorkshire or another area it will not make family relationships easy to maintain and under Art 8 Elizabeth is entitled to a family life. It is an absolute disgrace what LPFT and Lincolnshire County Council have done/are doing to the Elizabeth and this is affecting the family who have provided a nice independent home for her. There are other cases where sons/daughters have been sent far out of area which makes it difficult for them to see one another. I am in touch with such cases in this area and can see what damage this does to everyone. A total disgrace on the part of LPFT and the Council. It would be my former area of Enfield who would be paying for s117 aftercare and they have always wanted Elizabeth to be institutionalised for the rest of her life. We tried to provide a fresh start only to find even worse here in Lincolnshire. Supported living and housing has been tried and failed before and – this is just lining the pockets of wealthy business people who set up homes that are like an extension of hospital and their rigid prison style rules and restrictions just for the convenience of Lincolnshire Partnership Trust and Council combined so they can wash their hands of all responsibility.
This is going on all over the country and as a family. It is total abuse to send a vulnerable patient away from home and family in this way. This is all done to take control of everything and wash their hands. It has nothing to do with the wellbeing of the vulnerable patient.
From: CARECONCERNS (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.careconcerns@nhs.net>
Sent: 01 March 2024 14:51
To: susanb255
Subject: Wednesday 6th March 2024
Dear Mrs Bevis,
A meeting has been organised for you to meet with the Trust Mental Capacity Lead, Tony Mansfield, and Dr Khokhar on Wednesday 6th March at 3:30pm to discuss Elizabeth’s ongoing care and treatment, and Elizabeth’s capacity for decision making in relation to this.
This meeting will take place face-to-face at Peter Hodgkinson Centre and will last for a duration of 45 minutes.
Kind regards,
The Mental Health Act Team.
HERE ARE ELIZABETH’S WISHES:
FRIDAY 10TH NOVEMBER 2023 IN FRONT OF A HCA SUPERVISING:
“I WANT TO EVENTUALLY COME HOME TO LIVE WITH MY MUM IN THE ANNEX THROUGH COURT OF PROTECTION” “I MISS MY MUM GREATLY AND WANT TO GO HOME TO HER.”
MESSAGE TO LPFT: I WILL NEVER GIVE UP THROUGH THE LEGAL SYSTEM IN FIGHTING FOR MY DAUGHTER TO COME HOME. SHE HAS HAD NOTHING BUT ABUSE SINCE COMING TO THIS AREA AND WE HAVE ENCOUNTERED BULLYING FROM SOCIAL WORKERS. WHILST THE SYSTEM IS ROTTEN TO THE CORE AND YOU BOTH SHOW THIS BY EXAMPLE, THIS DOES NOT GIVE EXCUSE FOR DISHONESTY AND BULLYING. HERE IS WHAT I THINK:
“YOU ARE A DISGRACE AND NEED EDUCATING IN HUMAN RIGHTS”. YOU TREAT VULNERABLE PEOPLE LIKE DIRT AND YOU DO NOT RESPECT CARERS WHO QUITE RIGHTLY HAVE GOOD CAUSE TO CHALLENGE. THAT GOES TO MY FORMER AREA OF ENFIELD TOO BECAUSE WE WOULD NOT HAVE MOVED IF THERE WAS A GLIMMER OF THE BASIC NECESSITY OF CONTINUATION OF THE SO CALLED MEDICATION IN THE COMMUNITY. WE DID NOT EXPECT ANYTHING MORE THAN THAT.
YOU ARE IN BREACH OF THE LAW AND THIS NEEDS TO BE CHALLENGED BECAUSE IT IS OF PUBLIC INTEREST AS IT IS PUBLIC MONEY THAT HAS BEEN WASTED BY TRUST AND COUNCILS IN BOTH AREAS. I AM HAPPY TO FEATURE ALL OF THIS PLUS OTHER AREAS TOO.
MORE THAN THAT THE ISSUE OF THE TESLA SCANNERS NEEDS TO BE ADDRESSED IN EVERY TRUST NATIONWIDE BEFORE MORE LIVES ARE LOST.
REGISTER OF GOVERNORS’ DECLARATION OF INTERESTS 2023-2024 08.01.2024
Date of Disclosure
Constituency/Stakeholder
Organisation Name Political Party
Interests Other Interests
01.10.2023 Staff: Adult Inpatient Services (1) Debbie Judge TBC TBC
01.10.2020 Staff: Adult Inpatient Services (2) Helen Smith Nil Nil
01.10.2023 Staff: Adult Community Services (1) Dan Fleshbourne Nil • Nicola Fleshbourne works as a Peer Support Worker for the LPFT in the Community
Rehabilitation team.
- Currently working with @RAMOSGOMEZ,Carmen around Carers Rights Day ‘23
- Bank HCA (LPFT)
- Member of UNISON
- Co-opted at Unison Lincolnshire BEC as Joint EDI Officer, no affiliation to the funding of any
specific party. - 01.09.2022 Staff: Adult Community Services (2) Andrew Leaston Member of the
Labour party
Nil
01.10.2020 Staff: Corporate Services Laura Suffield Nil Nil - Staff: Specialist Services (1) VACANT – AWAITING NOMINATION
15.09.2017 Staff: Specialist Services (2) Lisa Norris Nil
Updated:
05.06.2020
Nil
Updated: 05.06.2020
1.3
2
Staff: Older Adult Services (1) VACANT – AWAITING
NOMINATION
10.10.2016 Staff: Older Adult Services (2) Jacky Tyson Nil Nil
Updated: 19.01.2022
01.10.2021 Public: Borough of Boston Marlene Fullwood Nil Nil
01.10.2023 Public: City of Lincoln Alexandra Chambers Nil • I work for Development and Community
Development charity and I am founder of project neurotopia. A new neurodivergent support hub.
01.10.2021 Public: East Lindsey Emma Slack Nil • Ongoing complaint against another NHS
Trust (outside of Lincolnshire) in relation to the care of a close relative and involving the Health Service Ombudsman.
Updated: 17.11.2021 - Current complaint with local GP regarding waiting times for medication, advanced through Healthwatch and referred to CCG.
Updated: 23.05.2022 - Current volunteer at RAF Association
Connections for Life
Updated: 19.07.2022
07.10.2021 Public: North Kesteven Carole Hagan Nil Nil
01.10.2023 Public: South Holland Reverend Jonathan Sibley
Nil Nil - 01.10.2021 Public: South Kesteven Debbie Abrams Nil • Trustee Restless Legs Syndrome UK
(charity)
Updated: 15.10.2021 - Husband is a volunteer with Healthwatch
Steering Group 3
Updated: 21.09.2022 - Virtual ULHT patient improvement panel
- Member of local surgery patient
participation group and as a representative
of this group attends Lincolnshire Patient
Participation group 4 times a year.
Updated: 24.10.2023
Public: Rest of England VACANT AWAITING –
NOMINATION
01.10.2021 Public: West Lindsey David Docherty Nil • Currently employed with East Midlands
Ambulance Service to provide NHS Estates advice and assurance. Attends ICS property
boards for Nottinghamshire, Derbyshire, Leicestershire and Northamptonshire.
Updated: 01.12.2022
06.08.2020 Service User (1) Rebecca Mezzo Nil • Suicide Intervention trained by Asist - Sleaford Dementia Support Trustee
- CEOP Ambassador
- Girlguiding leader- age group 10-14 years
- Dementia Friends Champion
- Sister works Peterborough City Hospital.
01.02.2020 Service User (2) Michael Regan Nil • Service veterans’ clubs in Sleaford and Lincoln
Service User (3) VACANT AWAITING –
NOMINATION
Service User (4) Alice Barton Nil Nil
Service User (5) VACANT AWAITING –
NOMINATION
4
Service User (6) VACANT AWAITING –
NOMINATION
Service User (7) VACANT AWAITING –
NOMINATION
28.09.2022 Carer: General (1) Amanda Whitehead Nil • Owner/ Health and Nutrition Coach –
Purposefully Nourished - Health & Wellbeing Director – The Wellness
Network CIC
Updated: 07.12.2022
01.10.2022 Carer: General (2) Sally Spencer Nil • Works in the Business Support department
at Lincolnshire County Council - Member of the LPFT Carers Council
- Member of the Carers Education Group
Updated: 21.12.2022
28.09.2022 Carer: General (3) Diane Fox Nil • Bank Midwife at Northern Lincolnshire and
Goole NHS Foundation Trust - Trainee Neuordevelopment Practitioner for Healios as of 17.10.2022
- Vice Chair of Maternity Autism Research
Group (MARG) – bringing researchers and health professionals together to improve care for autistic people in Maternity Care
Carer: Younger People VACANT – AWAITING NOMINATION
31.05.2023 Stakeholder: Lincolnshire
Integrated Care Board
Pete Burnett Nil • Wife is Director of Midwifery and Deputy Chief
Nurse at University Hospitals Leicester - Mother-in-law is a Primary Care Commissioning
Manager in Nottinghamshire ICB - Sister-in-law employed in a Project Management role for the East Midlands Academic Health Science Network 5
- Sister-in-law’s partner is a Finance Manager for NEMS Nottingham
- Brother-in-law’s partner is a technician in the Nottingham division of East Midlands Ambulance Services (EMAS)
Stakeholder: Healthwatch VACANT – AWAITING
NOMINATION
15.02.2021 Stakeholder: Lincolnshire County Council (LCC) (1)
Cllr Colin Matthews Member of the Conservative Party
(Conservative Party Councillor) - Poplar Farm Caravan site, shop, craft room
and tea room, Owner and operator. - Executive Support Councillor for NHS Liaison, Community Engagement,
Registration and Coroners - Member of Children and Young People Scrutiny Group
- Member of Corporate Parenting Panel
Member of Definitive Map and Statement
of Public Rights of Way sub-committee - Member of Gibraltar Point National Reserve Joint Advisory Committee.
- Member of Local Government Association – Coastal Special Interest Group.
- Member of Snipe Dales Joint Advisory Committee
Updated 26.05.2022
22.07.2022 Stakeholder: Lincolnshire County Council (LCC) (2)
Cllr Robert Kendrick Member of the Conservative Party
(Conservative Party Councillor) - Former employee of LPFT – Voluntary
Services Manager
Updated 22.07.2022
6
Stakeholder: Lincolnshire
Partnership NHS Foundation Trust
Volunteers
VACANT –
AWAITING
NOMINATION
10.03.2022 Stakeholder: Shine Lincolnshire Rachel Wright Nil • CEO of Shine Lincolnshire who hold a
contract with LPFT.
01.10.2023 Stakeholder: University of Lincoln Lesley Gratrix Nil Nil
31.05.2023 Stakeholder: Lincolnshire Police Chris Davison Nil • Assistant Chief Constable at Lincolnshire Police
19.07.2022 Director of Corporate Governance Jenna Davies Nil Ni
Psychiatric Abuse UK 