I visited Elizabeth on Wednesday 6 March. There was a capacity lead (Tony Mansfield) there together with Dr Khokhar who was questioning Elizabeth’s capacity. There is no doubt she has capacity but does not want to go in a van to Sheffield where they have the Tesla 3 scanner but said she did not want to be filmed on the ward. I said that it would be best for everything necessary to be done under the Neurology Department. I had written to my MP (Victoria Atkin) questioning why ULHT did not have a Tesla 3 scanner but anyway it is most promising she can go to Sheffield and this was promised would definitely be happening hopefully soon. Once and for all finally after all this time Elizabeth will get proper pathological tests but no way should this have been made so difficult. Elizabeth’s visit was late, following this meeting and again she showed massive capacity by knowing what the date was and checking what the time was. She presented me with some sweets for Mothers Day and as usual asked questions about her cat. She had telephoned me prior to my visit saying how much she missed the sunshine and her cat.

Elizabeth has capacity, there is no doubt of that but when faced with meetings that have over 9 people it is no wonder she is put under pressure. Here is something useful to remember if anyone is put under duress to sign documents for instance:

“agreements signed under duress are voidable and not enforceable. Forcing a relative to sign an agreement on the consequences of not being able to visit loved ones is not only being obtained under duress but is simultaneously the exercise of undue influence:

Williams v Bailey (1866) LR 1 hl 200, Dent v Bennett (1839 4 My & CR 269 (Doctor patient undue influence).

This goes to anyone put under pressure to sign schedules: NO SCHEDULE SHOULD BE SIGNED WITHOUT INDEPENDENT LEGAL ADVICE EVER.

It is wrong when certain professionals do this in order to get decisions and this can amount to bullying. I attach an interesting article on research into brain injury below:

A New Biomarker of Brain Injury?

Pauline Anderson

March 05, 2024

Posttraumatic headache (PTH) is associated with an increase in iron accumulation in certain brain regions , notably those involved in the pain network, early research shows.

Investigators found positive correlations between iron accumulation and headache frequency, number of lifetime mild traumatic brain injuries (mTBIs), and time since last mTBI.

The findings come on the heels of previous research showing patients with iron accumulation in certain brain regions don’t respond as well to treatment, study investigator, Simona Nikolova, PhD, assistant professor of neurology, Mayo Clinic, Phoenix, Arizona, told Medscape Medical News.

“This is really important, and doctors need to be aware of it. If you have a patient who is not responding to treatment, then you know what to look at,” she said. 

The findings (Abstract #3379) will be presented on April 15 at the American Academy of Neurology (AAN) 2024 Annual Meeting. 

Dose Effect
The study included 60 people with acute PTH due to mTBI. Most were White, and almost half had sustained a concussion due to a fall, with about 30% injured in a vehicle accident and a smaller number injured during a fight.

The mean number of lifetime mTBIs was 2.4, although participants had sustained as many as five or six and as few as one. The mean time from the most recent mTBI was 25 days, and the mean score on the Sport Concussion Assessment Tool (SCAT), which measures postconcussion symptom severity, was 29.

Most in the mTBI group (43) had migraine or probable migraine, and 14 had tension-type headaches. Mean headache frequency was 81%.

Researchers matched these patients with 60 controls without concussion or headache. Because iron accumulation is age-related, they tried to eliminate this covariant by pairing each participant with mTBI with an age- and sex-matched control.

All participants underwent a type of brain MRI known as T2* weighted sequence that can identify brain iron accumulation, a marker of neural injury. 

Investigators found that the PTH group had significantly higher levels of iron accumulation in several areas of the brain, most of which are part of a “pain network” that includes about 63 areas of the brain, Nikolova said.

The study wasn’t designed to determine how much more iron accumulation mTBI patients had vs controls. 

“We can’t say it was twice as much or three times as much; we can only say it was significant. Measuring concentrations in PTH patients and comparing that with controls is something we haven’t don’t yet,” said Nikolova

Areas of the brain with increased iron accumulation, included the periaqueductal gray (PAG), anterior cingulated cortex, and supramarginal gyrus. 

Research suggests patients with migraine who have elevated levels of iron in the PAG have a poorer response to botulinum toxin treatment. An earlier study by the same team showed a poorer response to the calcitonin gene-related peptide inhibitor erenumab in migraine patients with elevated iron in the PAG.

Researchers discovered that those with more lifetime TBIs had higher iron accumulation in the right gyrus rectus and right putamen vs those with fewer injuries and that headache frequency was associated with iron accumulation in the posterior corona radiata, bilateral temporal, right frontal, bilateral supplemental motor area, left fusiform, right hippocampus, sagittal striatum, and left cerebellum.

Surprising Result
The investigators also found a link between time since the most recent mTBI and iron accumulation in the bilateral temporal, right hippocampus, posterior and superior corona radiata, bilateral thalamus, right precuneus and cuneus, right lingual, and right cerebellum. 

“The more time that passed since the concussion occurred, the more likely that people had higher iron levels,” said Nikolova.

It’s perhaps to be expected that the length of time since injury is linked to iron accumulation in the brain as iron accumulates over time. But even those whose injury was relatively recent had higher amounts of iron, which Nikolova said was “surprising.”

“We thought iron accumulates over time so we were thinking maybe we should be doing a longitudinal study to see what happens, but we see definite iron accumulation due to injury shortly after the injury,” she said.

There was no association between iron accumulation and symptom severity as measured by SCAT scores.

Questions Remain
It’s unclear why iron accumulates after an injury or what the ramifications are of this accumulation, Nikolova noted. 

The imaging used in the study doesn’t distinguish between “bound” iron found after a hemorrhage and “free” iron in the brain. The free iron type has been shown to be increased after TBI and is “the stuff you should be afraid of,” Nikolova said.

Iron’s role in the metabolic process is important, but must be closely regulated, she said. Even a small accumulation can lead to oxidative stress.

Researchers are investigating whether the findings would be similar in mTBI but no headache and want to increase the number of study participants. A larger, more diverse sample would allow them to probe other questions, including whether iron accumulation is different in men and women. More data could also eventually lead to iron accumulation becoming a biomarker for concussion and PTH, Nikolova said.

“If you know a certain person has that biomarker, you might be able to administer a drug or some therapeutic procedure to prevent that iron from continuing to accumulate in the brain.”

Chelation drugs and other therapies may clear iron from the body but not necessarily from the brain. 

Commenting on the study for Medscape Medical News, Frank Conidi, MD, director, Florida Center for Headache and Sports Neurology, Port St. Lucie , said that the study supports the hypothesis that concussion “is not a benign process for the brain, and the cumulative effect of repetitive head injury can result in permanent brain injury.”

He said that he found the accumulation of iron in cortical structures particularly interesting. This, he said, differs from most current research that suggests head trauma mainly results in damage to white matter tracts.

He prefers the term “concussion” over “mild traumatic brain injury” which was used in the study. “Recent guidelines, including some that I’ve been involved with, have defined mild traumatic brain injury as a more permanent process,” he said.

The study was supported by the US Department of Defence and National Institutes of Health. No relevant conflicts of interest were disclosed. 

Talking of conflicts of interest, this is something else I am looking into with the Trust Board of Executives as I have discovered with UHLT that there are two conflicts on interest on their Board. I then turned to the Board of Executives for the ICB and found the same. I am yet to thoroughly go through the Board of LPFT and have instead written to Care Concerns to speed matters up. I will let you know when I get a response.

Meanwhile I am waiting for the date for Sheffield for the once in a lifetime tests I have been trying to get for years and years.

It is very bad there is such a battle to get such tests that are needed in order to determine anything.

I told the capacity lead that nothing had been done properly and now I was a BI assessor myself and I pointed out that the cause of the “impairment” needs to be ascertained before any assumptions are made and also Principle 4 of the MCA 2005 had not been applied correctly – therefore the three capacity assessments were completely flawed so until Sheffield looks at everything properly under their Tesla 3 scanner no further assumptions could be made. I pointed out that it was quite shocking the way the MCA had been manipulated by LPFT in order to get a decision they wanted ie to get rid of me as the nearest relative. Everything they have done has been done incorrectly and needs to be rectified. I will keep you informed how everything goes.

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.   

2^nd 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 6^th 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

Trust Board Members

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.”

SCANDAL OF 2ND RATE MRI SCANNERS: “NORMAL?? LIVES CAN BE LOST DUE TO INADEQUATE 1.5 SCANNERS: LINCOLNSHIRE, ENFIELD, WESTON – WHERE ELSE??

Our Trust Board

The overall purpose of the Trust Board is to take responsibility for leading, governing and managing the organisation and all of its services.

Led by an independent chair and composed of a mixture of both executive and independent non-executive directors, the Trust Board shapes the strategic direction, vision and purpose of the trust and ensures it delivers value for money services. The Trust Board is also responsible for assuring that risks to the organisation and the public are managed and mitigated effectively.

Questions from the public at board meetings

Questions are welcomed from members of the public and these can be submitted to the Trust Board by emailing lhnt.lchsecomms@nhs.net or by completing the form below.

Trust Board meetings, whilst held in public, are not public meetings. This means that the public are very welcome to view the broadcast and our Chair will conduct a short item before the start of each public Trust Board meeting to acknowledge and where possible respond to questions from the public which have been submitted in writing in advance of the meeting. Questions can be accepted until the Sunday before each Trust Board meeting.

Subject matter for questions

The Chair reserves the right to refuse any written question that:

• is not within the powers and duties of the Trust to answer;
• is defamatory or offensive, or related to individual members of staff;
• would require the disclosure of confidential or exempt information;
• Is deemed to be overtly political;
• is substantially the same as a question that has been answered before.

The next Trust Board meeting will be held at 10am on:

Tuesday, 12 March

The meeting will be held in person. If you wish to attend, please contact: lhnt.lchsecomms@nhs.net or call the Chief Executive’s Office on 01522 308686.

---

By clicking on the link below, we will have your email address and may contact you to ask about your experience of the meeting.

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 Risk Appetite StatementBack to About Us Date Last Modified 19/02/2024

Subject matter for questions

The Chair reserves the right to refuse any written question that:

• is not within the powers and duties of the Trust to answer;
• is defamatory or offensive, or related to individual members of staff;
• would require the disclosure of confidential or exempt information;
• Is deemed to be overtly political;
• is substantially the same as a question that has been answered before.

Meeting date	Venue
Tuesday, 9 January	Click here to watch a recording of the meeting.
Tuesday, 12 March	Virtual (link to be added soon)

Please submit a question for our Trust Board

Name RequiredEmail Address RequiredTelephone Number RequiredPlease submit your question RequiredPlease type the letters and numbers shown in the image. Click the image to see another captcha.

“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.”       YES I DO AND I WANT TO DISCUSS THIS IN AN OPEN TRANSPARENT MANNER. I HAVE ENORMOUS CONCERNS REGARDING ELIZABETH AND SCANS AS YOU DO NOT HAVE AN ACCURATE SCANNER. I HAVE HAD A LETTER FOR SCREENING AND WISH FOR BOTH HER AND MYSELF TO BE REFERRED TO SHEFFIELD FOR THE ACCURATE TESLA 3. WHEN YOU TALK ABOUT NEW SOFTWARE – IT IS NOTHING TO DO WITH THE SOFTWARE. WHERE DID YOU GET THIS INFORMATION FROM AS IT IS TOTALLY WRONG AND INACCURATE. WHAT IS YOUR TECHNICAL KNOWLEDGE OF TESLA SCANNERS AND SOFTWARE TO WHICH YOU SPEAK? WHAT IS THE SOURCE OF YOUR INFOMATION AND WHO TOLD YOU?

“The new software allows comparative image quality and speed to a 3T without the additional risk.“

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. 

MY QUESTION ABOVE GOES TO JULIE FRAKE-HARRISON:

Julie Frake-Harris – chief operating officer

Julie joined LCHS as Interim Chief Operating Officer (COO) in July 2023, and recently became Interim Chief Operating Officer at ULHT alongside this role. Julie has worked in the NHS for over 25 years, during this time she has had the privilege to delivery services across London, Cambridge, Peterborough, and Kent. She has a passion for integrated community and mental health services and held COO roles in community and mental health settings and in an acute trust during the COVID-19 pandemic.

She held her first director role championing forensic and integrated prison services before moving to Cambridge and Peterborough to be the architect of the Neighbourhood Team model for Cambridge and Peterborough NHS Foundation Trust (CPFT). She has held system leadership roles and worked to develop with partners services closest to home across Kent and CPFT. She is committed to operational delivery for the communities we serve.

She lives in Cambridgeshire with her family and 4 dogs.

Malcolm Burch – trust board chair

Malcolm has had a career that spans universities, local government, policing and the NHS. Throughout his career, he has been focused on involving the public in service provision and supporting better performance and improved outcomes.

In the NHS, he was a non-executive director in Lincolnshire’s mental health trust for six years and before that spent four years as a commissioner as part of a Primary Care Trust in Peterborough and Cambridgeshire.

He has three degrees, including an MBA from the University of Birmingham, and works as the chief executive to the Lincolnshire Police and Crime Commissioner. He has lived and raised his family in the county for 15 years.

Andrew Morgan – group chief executive for LCHS and ULHT

Andrew has worked for the NHS since 1982. From August 2023 Andrew became the Group Chief Executive for LCHS and ULHT. He joined United Lincolnshire Hospitals NHS Trust as their Chief Executive in June 2019. Prior to this, Andrew was the Chief Executive of Lincolnshire Community Health Services NHS Trust from June 2014 to June 2019.

He has been a Chief Executive since 2004 and has held Chief Executive posts at East of England Ambulance Service NHS Trust, NHS Norfolk and Waveney, NHS Bedfordshire and NHS Harrow. His earlier NHS career included a range of director posts at NHS organisations around the country, including in commissioning, performance management, strategy and service improvement. Andrew is married and has a grown up daughter.

Executive directors

Professor Karen Dunderdale – executive chief nurse

Karen has held board level roles as a Chief Nurse, Chief Operating Officer, Deputy CEO and acting CEO. In addition, she held the role of vice chair of her local hospice for a number of years. Her more recent role as director of nursing was at Walsall Healthcare Trust where her leadership supported the Trust achieve Outstanding for Caring. Karen qualified as a registered nurse in 1991 and her clinical experience has been in cardiology. She became a cardiac nurse specialist developing cardiac rehabilitation and heart failure services. She has a PhD in Health Related Quality of Life in Chronic Heart Failure from York University, has contributed substantially to the development of cardiac nursing, and raised expectations nationally within the nursing profession. In 2017 Karen joined the National nursing team at NHS Improvement working for Dr Ruth May, Chief Nursing Officer for England contributing to the wider nursing and patient experience agenda. Karen is passionate about delivering high quality fundamental nursing care.

Claire Low – director of people

Claire joined the Trust in October 2023 in an interim role alongside her role at United Lincolnshire Hospitals NHS Trust where she has worked as deputy director of people and organisational development since December 2021 before starting work in the director position in October 2022. She has a long career spanning over 20 years of working in people services within the NHS and acute trusts and has worked in operational HR, recruitment, transformational projects and deputy director roles, and more recently acted as Director of People at Northern Lincolnshire and Goole Hospitals NHS Trust for a period of two years. Claire is passionate about the people agenda and investment in training and development of staff, she graduated from her part-time MBA, which she completed under the apprenticeship scheme at her previous Trust. Claire is also a Chartered Fellow of the CIPD and is embedding a ‘just and learning’ as part of the transformation agenda for the People Directorate.

Sam Wilde – director of finance and business intelligence

Sam joined LCHS as interim director of finance and strategy on June 1, 2018, having worked as associate director of finance for Norfolk Community Health and Care NHS Trust.

Sam graduated in 1996 having studied finance and accountancy before going on to complete an MBA at Durham University. He has worked in the NHS for six years interspersed with experience of working in the private sector for Rolls Royce PLC and Astra Zeneca.

 

Dr Anne-Louise Schokker – medical director

Dr Anne-Louise Schokker is the Medical Director and a Consultant Geriatrician. After completing her medical degree and post graduate training in London, she moved to the East Midlands as a consultant in 2007 where she gained extensive clinical experience in general medicine and geriatrics across secondary care and community settings. Her leadership journey began as a junior doctor and she has been passionate about compassionate, clinical leadership since. She has held divisional clinical director and deputy medical director roles where she delivered turn around improvements in nonelective care, successfully transformed integrated services across providers and advanced the quality agenda. She is also a regional clinical associate for the NHSE ECIST team. She lives locally in Lincolnshire with her husband, daughter and extended family.

Julie Frake-Harris – chief operating officer

Julie joined LCHS as Interim Chief Operating Officer (COO) in July 2023, and recently became Interim Chief Operating Officer at ULHT alongside this role. Julie has worked in the NHS for over 25 years, during this time she has had the privilege to delivery services across London, Cambridge, Peterborough, and Kent. She has a passion for integrated community and mental health services and held COO roles in community and mental health settings and in an acute trust during the COVID-19 pandemic.

She held her first director role championing forensic and integrated prison services before moving to Cambridge and Peterborough to be the architect of the Neighbourhood Team model for Cambridge and Peterborough NHS Foundation Trust (CPFT). She has held system leadership roles and worked to develop with partners services closest to home across Kent and CPFT. She is committed to operational delivery for the communities we serve.

She lives in Cambridgeshire with her family and 4 dogs.

Non-executive directors

Ian Orrell

Ian joined LCHS in February 2023, on an interim basis. Ian has a wealth of experience in the public sector, particularly with large and complex councils. He has experience of working within senior corporate leadership teams to help reshape and deliver quality frontline adult and children social care services, as well as delivering professional support services.

Ian also has over 30 years as a qualified accountant and previous experience in non-executive roles where partnership approaches were taken to improve service provision.

Gail Shadlock

Gail is a highly experienced director with a professional background in human resources and organisational development and extensive general and project management experience working in the UK and abroad. Gail has worked both as an executive director and as a non-executive director and has led and contributed to significant transformational change across the following sectors; private sector – FTSE 100 and FTSE 350 (major projects include mergers, acquisitions and flotation of a company on the London Stock Exchange); public sector – NHS, police, local government; third/not for profit sector – charity supporting people with learning disabilities and a housing association with a national footprint.

Murray Macdonald

Murray Macdonald has had a varied career across a number of sectors. He started in the commercial leisure sector managing a number of venues, before moving into regeneration and project management with local authorities.

Currently, Murray is Chief Executive of Boston Mayflower Housing Association, where he is responsible for all operational aspects of the company including housing management, asset management, regeneration, older peoples’ services and development.

Murray is an experienced Non-Executive Director, with posts currently also held with Lincolnshire Community Voluntary Service and Speedwell Homes.

Jim Connolly

Jim has a had a varied career in the NHS as a nurse, working in a range of clinical, managerial and executive roles. He worked as a Director of Nursing and was the National Director for Continuing Healthcare with NHS England. In addition he works with the Care Quality Commission as a specialist advisor on governance. Prior to joining LCHS he was a Non Executive Director at Lincolnshire Clinical Commissioning Group and is supporting the vaccination programme as a vaccinator at the Meres Clinic in Grantham. HOW EXACTLY ARE YOU INDEPENDENT??? IS IT NOT A CONFLICT OF INTEREST WORKING FOR THE CQC?

Rebecca Brown MBE

Rebecca Brown began her career in the NHS as a nurse in 1989.

From 2012 to 2016 Rebecca was Deputy Chief Operating Officer at Northampton General Hospital.  In 2016 Rebecca took on the role of Chief Operating Officer and Deputy Chief Executive at Kettering General Hospital. In 2018 She joined Leicester’s Hospitals as Chief Operating Officer and Deputy Chief Executive. She took on the role of Chief Executive in early 2020. Rebecca successfully lead the Trust during the pandemic, with Leicester Hospitals leading nationally on research and treatment of Covid.

Rebecca has played an integral role in the development of wider system and partnership working within the NHS and latterly with social care, local government and the independent sector.

In 2000, Rebecca was awarded the MBE by Her Majesty the Queen for Services to Nursing.

Rebecca also holds a Non Executive role for ULHT. Date Last Modified 29/02/2024

I managed to get to speak to my daughter who was passed her mobile phone kept locked away in the office right now which according to LINCOLNSHIRE PARTNERSHIP TRUST IS IN LINE WITH HUMAN RIGHTS.

I was worried for her safety the other day having heard she was having an episode.

I am going to write all about the injury my daughter is suffering and the frequent episodes and constant rapid tranquilisations Castle Ward are giving on virtually a daily basis. I now want all the scans re-looked at as nothing can be relied upon under Lincolnshire who only have a 1.5 scanner. In my previous blogs I have included some interesting research papers on 1.5 MRI as opposed to Tesla 3. A Tesla 3 is why the private scans I had done revealed details not visible on a 1.5 scanner and I am warning everyone to check on which scanner their Trust has.

The restrictions are supposed to have ended on 5 February but continue with phone locked away and visits heavily restricted 2-1 supervised. Elizabeth said she misses not being able to listen to music on her phone. I am going to invoice LPFT for the contract as it is not being used. It was during my conversation with Elizabeth that she mentioned Castle Ward want to film her on the advice of the Neurologist when she has an episode. How can this be accurate and I want things accurate and to be 100% sure and the only way for this is for Elizabeth to be referred under S17 leave to Sheffield where they have a Tesla 3 scanner and a proper ward for neurology. This would need to be granted by Dr Waqqas khokhar as currently she has no leave entitlement whatsoever. Elizabeth said she did not want to be filmed by the MH team but did not mind being monitored by the Neurologist team in Sheffield provided she was given a takeaway. I said I am sure this could be arranged. Elizabeth would need to be closely monitored but this is essential. She said she would be happy to be monitored by experts in Sheffield . I am now extremely concerned that the MH team will try and send her to a supported living to avoid any pathological tests that need to be done because of the frequent fits. This must be determined first and foremost in a specialist hospital. Elizabeth has said on numerous occasions she does not wish to go into supported living which has been tried and totally failed before especially when she has an independent bungalow and even a two bed static caravan in the back garden. I am appalled and disgusted at what LPFT are doing when all along they should have taken a strong interest in her physical health and I am disclosing some interesting information below and the disturbing facts.

Subject: Neuroplasticity and Rapid Tranquillisation!

Neuroplasticity & Concomitant Drug ADRs:     

Here are some potential explanations for the psychomotor ‘episodes’ Elizabeth has been experiencing.   

The reason the episodes are getting more frequent is explained below.  The frequency of the PRN is so short that the previous dose has not fully metabolised before they give her another one. 

There is also a possibility that the depot anti-psychotic medication concomitantly administered with rapid tranquillisation is causing psychomotor dysfunction. 

Chronic treatment with antipsychotic medications like Clopixol has been associated with alterations in brain structure and neuroplasticity, including changes in grey matter volume, dendritic spine density, and synaptic connectivity.

Benzodiazepines have also been shown to influence synaptic plasticity, albeit through different mechanisms. 

The concomitant use of Clopixol and benzodiazepines may potentially interact to modulate neuroplasticity.

Chronic benzodiazepine use, such as repeated PRN rapid tranquillisation may be associated with alterations in brain structure and function. These changes may include reductions in grey matter volume, alterations in neurotransmitter systems, and neuroplastic changes.  Neuroplastic changes will show up on a 3 Tesla MRI scanner.  Presumably that is why certain people might not want such a scan done.  

Neuroplastic changes can be detected using a 3 Tesla magnetic resonance imaging (MRI) scanner. A 3 Tesla MRI scanner is a powerful imaging tool that provides high-resolution images of the brain and has become the standard in clinical and research settings for studying brain structure and function.

Neuroplasticity refers to the brain’s ability to reorganize and adapt in response to experiences, learning, and environmental stimuli. These changes can occur at various levels, including alterations in synaptic connectivity, changes in neuronal morphology, and modifications in functional connectivity between brain regions.

With advanced imaging techniques such as functional MRI (fMRI), diffusion tensor imaging (DTI), and structural MRI, researchers and clinicians can visualize and quantify neuroplastic changes in the brain.

Here are a few examples of how neuroplasticity can be observed using a 3 Tesla MRI scanner:

1.     Functional MRI (fMRI): fMRI measures changes in blood flow and oxygenation levels in the brain, which reflect neuronal activity. By analysing fMRI data, researchers can identify changes in brain activation patterns associated with learning, memory, and other cognitive processes, providing insights into neuroplasticity.

2.     Structural MRI: Structural MRI techniques can detect changes in brain structure, including alterations in grey matter volume, cortical thickness, and white matter integrity. These changes may result from neuroplastic processes such as dendritic growth, synaptogenesis, and myelination, which can be visualized and quantified using high-resolution structural MRI scans.

3.     Diffusion MRI (DTI): DTI measures the diffusion of water molecules in brain tissue and provides information about the microstructural organization of white matter pathways. By analysing DTI data, researchers can map changes in white matter integrity, such as alterations in fibre density, orientation, and connectivity, which are indicative of neuroplastic changes in the brain.

Overall, a 3 Tesla MRI scanner is capable of detecting and characterising neuroplastic changes in the brain, providing valuable insights into the mechanisms underlying learning, memory, recovery from injury, and adaptation to environmental stimuli. These imaging techniques play a crucial role in advancing our understanding of neuroplasticity and its implications for brain health and function.

Repeated rapid tranquilization with benzodiazepines can potentially lead to psychomotor dysfunction, although the likelihood and severity of this side effect may vary depending on factors such as the specific benzodiazepine used, the dosage, frequency of administration, individual susceptibility, and concurrent use of other medications.

Psychomotor dysfunction refers to impairments in motor coordination, reaction time, and cognitive function, which can manifest as symptoms such as drowsiness, dizziness, confusion, ataxia (loss of coordination), and impaired judgment.  (this is what they mean by episodes) Benzodiazepines exert their effects on the central nervous system by enhancing the activity of the neurotransmitter gamma-aminobutyric acid (GABA), which can lead to sedation and relaxation.

During rapid tranquilisation, benzodiazepines are often administered to quickly alleviate acute agitation, aggression, or psychosis in emergency situations. While benzodiazepines can effectively reduce agitation and aggression, they can also cause sedation and other central nervous system depressant effects, particularly at higher doses or with rapid administration.

Repeated administration of benzodiazepines for rapid tranquilization may increase the risk of cumulative sedation and psychomotor dysfunction, especially if doses are given close together or if there is insufficient time for the drug to be metabolized and eliminated from the body between administrations. Additionally, certain factors such as age, medical conditions, and concurrent use of other medications may increase the susceptibility to benzodiazepine-induced psychomotor dysfunction.

Metabolism of benzodiazepines primarily occurs in the liver, where they undergo hepatic biotransformation mediated by various cytochrome P450 (CYP) enzymes, particularly CYP3A4, CYP2C19, and CYP2D6. Endocrine dysfunctions can affect the activity of these metabolic enzymes through various mechanisms, potentially leading to alterations in benzodiazepine metabolism.

It is essential for healthcare providers to carefully monitor patients who receive repeated rapid tranquilization with benzodiazepines for signs of psychomotor dysfunction and to adjust treatment accordingly to minimize the risk of adverse effects. Alternative strategies for managing agitation and aggression should also be considered, and the use of benzodiazepines should be limited to situations where the benefits outweigh the potential risks.

There is evidence to suggest that chronic benzodiazepine use may be associated with alterations in synaptic plasticity, which refers to the ability of synapses to strengthen or weaken over time in response to activity. Chronic benzodiazepine use has been shown to lead to changes in neurotransmitter systems, including alterations in GABA receptor expression and function, as well as changes in the density and morphology of dendritic spines, the small protrusions on neurons where synapses form.

These changes in synaptic plasticity may have implications for neuronal connectivity and brain function, although the extent to which benzodiazepines directly disrupt synaptic connectivity is not fully understood. Additionally, the clinical significance of these changes in synaptic plasticity in relation to the therapeutic effects and potential side effects of benzodiazepine use requires further investigation.

The increase in the frequency of the episodes you describe could indicate a condition known as dopamine supersensitivity psychosis.  This is seen both with typical and atypical antipsychotics.  The prolonged use of anti-psychotics that are not working due to her inability to metabolise anti-psychotics gives rise for concern.  Has it not crossed anyone’s mind in that ‘treatment team’ that in spite of being on Clopixol for years she has not shown any sign of it being efficacious.    

Since Elizabeth has never fully responded to the anti-psychotic medication they give her and they use PRN benzodiazepines for rapid tranquillisation far too frequently it is not surprising that she is having psychomotor problems.  In effect this is another form of TD.  If she is supersensitive then any dopamine antagonist could very well be causing this ADR.  

A high resolution scan will indicate inflammation in the meso-limbic pathway affecting the dopamine receptors.  The 1.5 Tesla scanner does not have sufficient resolution to do this. Inflammation can cause psychomotor problems as well as psychotic symptoms.  Perhaps if they took the time to look for this specific adverse reaction they might not conclude the rather odd idea that the scan is normal.    

By the way, the information I have on this is from The British Journal of Psychopharmacology just in case LPFT decide to dismiss this also.  

Why 3T is necessary for detecting lesions

· ■ In more than 500 follow-up images, only four of 1996 new or enlarged multiple sclerosis lesions would have been missed with 3.0-T MRI without the administration of contrast material.

· ■ With 3.0-T MRI, the assessment of interval progression did not differ between contrast-enhanced and nonenhanced images.

Introduction

Inflammatory lesions in multiple sclerosis (MS) are detected as focal areas of high signal intensity on T2-weighted MR images. By depicting newly occurring lesions, MRI reveals subclinical disease activity. Therefore, regular follow-up MRI is considered a mainstay of clinical care for patients with MS or clinically isolated syndromes.

Earlier studies have reported that the administration of contrast material is necessary to maximize sensitivity for detecting new lesions. However, these results date back more than 2 decades and were based on two-dimensional images obtained with 4–5-mm-thick sections at magnetic field strengths of 1.5 T and lower.

MRI units with higher field strengths have become widely available, especially for brain imaging. In addition, three-dimensional isotropic MRI sequences were introduced and were shown to outperform conventional two-dimensional sequences in lesion depiction; they are therefore part of recommended MRI standards in MS . Furthermore, the double inversion-recovery (DIR) sequence was introduced. Although this sequence is best known for its ability to depict cortical lesions, it is also useful for depicting white matter lesions Recently, longitudinal subtraction techniques have been developed that show new or enlarged lesions as bright spots while pre-existing lesions and normal-appearing brain parenchyma are canceled out.* Such techniques substantially improve the sensitivity in the detection of new or enlarged lesions in MS at follow-up imaging.

We hypothesized that the use of contrast material does not improve sensitivity in the detection of new or enlarged lesions at follow-up MRI when modern three-dimensional sequences performed at a field strength of 3.0 T are used together with longitudinal subtraction maps. We therefore performed this study to investigate whether the use of contrast material has an effect on the detection of new or enlarged MS lesions and, consequently, the assessment of interval progression.

*The private 3T scans are much more able to see the lesions that the inappropriate 1.5T scanner cannot see.

The higher resolution scans cancel out the distortions and signal noise that hide the lesion and make the scan look normal.

1.5T MRI scanners are not fit for purpose in discovering brain lesions and inflammation.

Brain lesions and inflammation, especially in the temporal lobe are responsible for poor drug response and in some cases for diagnosis.

1.5T scans are responsible for false negative (normal) brain images.

EXAMPLE OF MISDIAGNOSIS

A woman who was told she had anxiety was later diagnosed with Autoimmune Basal Ganglia Encephalitis, a rare brain condition.

When Evie Meg, 23, was a teenager, she began to suffer bouts of panic and psychosis, and was diagnosed with anxiety disorder by doctors.

Meg began experiencing seizures when she was 17, along with temporary limb paralysis that left her unable to walk for a month, but was still told that it was due to anxiety.

Frustrated with the diagnosis, the then-teenager began sharing her symptoms and experiences on TikTok, where she was reached out to by a concerned follower.

“I posted a video of me walking across my kitchen without crutches, just taking a few steps,” Meg explains. “That video went viral and the support from it was amazing. People were saying how proud they were that I’d learnt to walk again. It just went from there, really.

“In 2021, I started getting loads of messages from this girl who had been commenting on all of my TikTok videos, saying I should look into this condition. She had it and she was so convinced that I had it.”

Because of this interaction, Meg booked in to see a specialist who diagnosed her with the brain inflammation disorder.

“When I got the diagnosis, we’d had to go private to find a specialist,” Meg says. “The NHS just don’t know what to do with me, because it’s such a complex and unusual condition.

“I have daily seizure activity. I have really severe pain above my right eye, and I haven’t been able to walk properly since May 2023. I get a lot of tiredness. It affects my mood quite a lot as well, I can get really upset or angry for no reason.”

Meg says she was put on antibiotics and steroids upon diagnosis, which stopped her seizures.

“It was crazy how quickly things turned around. I couldn’t believe it,” she adds. “We stayed with the doctors in London for a while, but I started becoming resistant to the antibiotics.

“Because my condition was not diagnosed for such a long time, it was allowed to progress and get a lot worse. It means it’s much more difficult to treat now, so we had to look for more intense options.”

Meg adds that her mum began researching the infusions that she needed and found a clinic in Poland that offered them – but at at £20,000 price tag.

“Last year, when I went to Poland for tests, they found loads of other infections in my blood, which could be causing the brain inflammation,” she adds.

“The SOT I had in January was to treat one of the infections, but we’re very early days – we’ve got to treat each one individually. Because they found so many, they have to do it multiple times to treat each infection. The next year or so for me is looking like a lot more SOT infusions – but I’m taking it one day at a time.”

Meg and her family have begun a fundraising campaign to help her have the treatment she needs, and have raised over £16,000 so far.

“The support has been pretty insane,” she says. “We had a local fundraiser in a church hall, and we raised over £4,000 just doing tombolas and raffles in that one afternoon.

“It’s been incredible – very overwhelming but in the best way. I became a lot more passionate about raising awareness when I got my correct diagnosis, because it just showed how it can be missed so easily. I really want people to know that and see that so that other people don’t go through what I did.”

Autoimmune Basal Ganglia Encephalitis is estimated to affect just 1.5 in every 100,000 people in England, and is characterised by the rapid development of akinesia, rigidity, and tremors.

It is a form of Encephalitis, which the NHS says is “an uncommon but serious condition in which the brain becomes inflamed”. The very young and the very old are the age groups most at risk.

Some symptoms of Encephalitis include seizures and fits, confusion, disorientation, changes in personality or behaviour, difficulty speaking, and weakness or loss of movement in parts of the body.
It adds that causes are not always clear but, rarely, it can be caused by common viruses such as herpes simplex (cold sores), or chickenpox spreading to the brain; a problem with the immune system; or bacterial or fungal infections. And in Elizabeth’s case she contracted Covid twice at Ash Villa.

It is possible for some people to make a full recovery from Encephalitis, but the NHS says this can be a ‘long and frustrating’ process.

Additional reporting by SWNS.

Antipsychotics and the brain
Neuro-imaging research (MRI scans) of the brains of people under psychosis reveal changes in brain activity. Some of these changes may be linked to the psychosis vulnerability itself (or to environmental risk factors that increase psychosis vulnerability, such as trauma), but many of these changes are clearly also related to several non-specific, external, factors, such as antipsychotics, smoking, obesity and drug use.

Animal tests have confirmed that antipsychotics indeed contribute to changes in the brain. The question remains, however, whether the changes in the brain caused by antipsychotics can also be linked to the specific risks. Also unknown is in how far these effects are permanent.

Antipsychotics and negative symptoms
Antipsychotics work by making people somewhat indifferent. This lowers the ‘importance’ or ‘significance’ of their psychosis, sometimes to the point where the symptoms fade away completely. The problem is, however, that this medicine-induced indifference does not only affect the psychosis, but every personal emotion or experience. The suppressing of emotions makes the user of antipsychotics more numb and less active. The extent to which this happens is different from person to person, but some are seriously impaired by it.

This indifference is also called ‘secondary negative symptoms’. That term is confusing however, because it is impossible to make a distinction between the primary symptoms (caused by psychosis) and the secondary symptoms (caused by the antipsychotics).

In practice, the rule should be: negative symptoms (indifference, inaction) must be attributed to the antipsychotics unless proven otherwise.
In other words: these symptoms require treatment, and should not be regarded as a consequence of psychosis when the real cause is the medication.

Can antipsychotics make psychosis worse? Dopamine supersensitivity syndrome (DPS)
When taking antipsychotics over a long time, the body will try to compensate the effects of the medication. Because antipsychotics work by blocking the dopamine receptor D2 in the brain, the body responds by trying to remove this blockade some way or another. As early as in the 1960’s, the scientist Chouinard described how this can cause “supersensitivity” in the dopamine D2 receptor. As such, the eventual effect can be an increase of psychosis sensitivity instead of the expected decrease.

Symptoms of dopamine supersensitivity syndrome:
Abnormal movements – also called tardive dyskinesia
Increased psychosis vulnerability
Increase of the dosage required to suppress psychosis
More psychotic symptoms after stressful events.

Although the existence of DPS is not yet proven beyond doubt, it has become an issue of growing importance in practice. Some studies suggest that people who reduce medication, or quit altogether, have a higher risk of relapsing into psychosis in the first years (possibly due to the now ‘supersensitive’ D2 receptor). Yet on the longer term (when the ‘supersensitive’ receptor has returned to normal), they are better off than people who remain on their regular high dose.

Many psychiatrists are still unfamiliar with DPS
It is important to recognise DPS in an early stage. Otherwise people can end up with huge doses of antipsychotics, while still only highly increasing the risk of psychosis. T.

Conclusion: antipsychotics and dopamine
The perspectives on antipsychotics are rapidly changing. Anyone using antipsychotics, should in any case take the risk of DPS into account. Doctors prescribing antipsychotics should do the same. From the very first start of using antipsychotics, an accompanying strategy is required for reducing the dosage to its minimum, out of concern for the physical health and the effects on the brain. Sound alternatives are dopamine receptor partial agonists.

It is so disturbing the way the MH try to avoid essential scans and dismiss cancer and other neurological conditions without looking into it. Another shocking area is Enfield and also I am in touch with shocking cases in Weston – both areas only have a 1.5 Tesla by the way.

From: susan bevis
Sent: 29 February 2024 12:38
To: CARECONCERNS (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.careconcerns@nhs.net>
Cc: NEUROLOGYSECRETARIESLINCOLN (UNITED LINCOLNSHIRE HOSPITALS NHS TRUST) <ulh.tr-neurologysecs.lincoln@nhs.net>; Christopher Reid <Chris.Reid@parliament.uk>; Enquiries <Enquiries@cqc.org.uk>; CONNERY, Sarah (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <sarah.connery@nhs.net>

Subject: Re: EB – Update

I wish to address the serious threats made verbally by Dr WK.

“I am banning you indefinitely for inciting your daughter to attack members of staff on Xmas Day“.   I want an apology for that for a start.

You have no right to take away the phone we as a family pay a contract.  The matter of human rights will be address before the High Court.  You are in breach of Art 8, 5, 3, Equality Act and the Code of Conduct for the MHA / MCA.   Staff are acting ultra vires and you are treating my daughter like a restricted prisoner under the MHA 1983.  What you are doing is entirely unlawful.

The restrictions you claim to have ended are very much continuing.  You have no right to treat my daughter the way you are doing in the most degrading manner against all codes of conduct and the files will be requested by the court including all the notes being written behind my back by healthcare assistants who have been instructed to.

You are not using proper diagnostic scale PANSS and there is no proper scanner only a 1.5 Tesla and I am going to all the newspapers and TV stations to advise as this has cost someone their life before more lives are lost and Elizabeth will need to go to Sheffield to be re-tested under ultrasound for the cancer scare she had at Ash Villa since a Tesla 1.5 will not detect everything.

You had no right to ban the visits and now I want those comments made by Dr K and threats said to me verbally addressed and an apology.  I will continue to issue invoices because you are depriving my daughter of her phone so that she cannot play her music and readily have contact therefore LPFT are guilty of discrimination.   I will need all your reports Into your investigation of the alleged incident where Police were called on Xmas Day and to know that staff themselves who reported “concerns” have completed a Section 9 statement as we did.   I have contacted the NMC who are taking my complaint very seriously as nursing staff are in breach of their own code of conduct but acting on instructions from a combination of Management, Clinical Lead and of course the person with ultimate control Responsible Clinician Dr Waqqas Khokhar who is acting ultra vires.  Please do not assume Fridays as I am unable to visit on set days of the week.

You are acting totally unlawfully.

Yours faithfully

Susan A Bevis

Mother POA and Litigation Friend.   

---

From: CARECONCERNS (LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST) <lpft.careconcerns@nhs.net>
Sent: 29 February 2024 12:17
To: susanb
Subject: LB – Update

Dear Mrs Bevis,

We would like to communicate the following –

1. Ward round for E is at 12pm tomorrow, 1^st March 2024. The clinical staff involved in E’s care would like for you to attend, specifically to discuss the filming of E’s episodes of distress to allow for further investigation of this with ULHT staff.
2. To address your recent concerns around E’s access to her mobile phone, E’s phone access was limited for a fixed period of time as part of a comprehensive care plan that considered E’s human rights. This was to ensure the response to her phone use did not adversely impact her engagement with, or the efficacy of, her treatment plan. This was ceased on Monday 5^th February 2024 following a review of all of the relevant factors. To clarify this further, E’s phone is kept securely by ward staff, but E is able to request to use her phone at any time. In addition, ward staff regularly encourage E to use her phone to maintain contact with family.
3. Please be advised following your recent visit to Castle Ward that supervised visits to Castle Ward will be facilitated once a week, for one hour at a time. To request a time slot for visitation, please email the care concerns inbox. The inbox will confirm the date and time for the following week’s visit each Friday. All visits must be pre-arranged.

Kind regards,

The Mental Health Act Team.

Damning reports on patient care attached.  One states that “patient neglect is a breach of the most fundamental medical ethics of all ‘first do no harm’.

LPFT have denied Elizabeth the medical ethic of autonomy and benificence by not getting her fully examined and monitored.

Their obsession with what she might be telling me at the expense of her care is a gross breach of the most fundamental of all the Principalist ethics of Beauchamp & Childress.

Here are examples of abuse from both Enfield and Lincolnshire:

My daughter was abused in the former area under both hospitals and supported living which is why I moved as I wanted her to be in the right environment like I provided briefly under and to give her a fresh start in what I thought was the right environment. I had challenged care in the community in a supported living scheme where things went wrong. There was no honesty and no rectification of anything in the circumstances. Everything stemmed from there onwards. Elizabeth had been subject to institutional care on and off where not once when things went wrong did anyone raise their hands.

The Discharge Note stated “Abnormal Findings on Scan pointing to CNS twice. I have not been unable to get an explanation?

Upon moving we have been subject to extreme bullying because I have continually asked what the scans meant done by former area. When I discovered Dr Shahpasandy of Ash Villa did some fantastic research on the Limbic System I asked if Elizabeth could be included. I was then faced with no end of excuses. It was as though none of these doctors (Psychiatrists) wanted her to have the research that discovered that a former patient did not in fact have schizophrenia but inflammation of the brain and needed a different form of treatment and as a result of that became better. That is all I have ever wanted for my daughter to be properly pathologically tests since according to past file copies, it clearly says “Anterior Region Medial Temporal Compromise and so I checked what this meant and I was told “well done” by Headways that MH professionals training did not go nearly far enough to be able to conclude on neurological conditions, she was a former MH nurse. This puts into question the training for a start and that why isn’t training under MH more comprehensive and that it should in fact go much further in order that patients are not dismissed for underlying physical health conditions that may need a different kind of medical treatment.

Because I have dared to question I have been subject to bullying – extreme bullying. I was told “I am displacing you as NR” I thought not again as I have had a lifetime of this kind of treatment. It would appear all you have to do is to challenge in order to be the subject of bullying and various people including carers and former patients have tried to advise me that I should go along with everything but how can I when people are dying from being misdiagnosed and not having the right kind of treatment because the NHS is failing to look properly into neurological and underlying physical health conditions which could be autoimmune, could be endocrine dysfunction, thyroid, infection. It is very wrong to give someone a label for life and not be open to consider that there may be underlying physical health factors that need proper investigation.

Just now I have been on the phone to Ron Coleman. Both he and Karen Taylor through “Working-to-recovery provided wonderful care at their home on the Isle of Lewis. This care took my daughter to Spain and all over France and then to Australia, the account of this is on the Rightful Lives Website. She was in a terrible state before going away but came home unrecognisable. I will be forever grateful to Working-to-Recovery and thanked Ron Coleman for his wonderful care today and how the entire family took my daughter to the most wonderful locations and tried to work properly with her for the first time ever UNLIKE THE NHS. Unfortunately the NHS is rife with bullying and what I am finding right now is that staff are acting ultra vires. When my daughter returned home from Australia she wanted a job, she was totally unrecognisable as she had psychotherapy but because my shocking area of Enfield provided nothing she went downhill again. How I wish she had stayed forever in Australia. If I never saw my daughter again I would be happy in the knowledge she was in the right company and environment.

Via the NHS I have been described as someone who is controlling, abusive, aggressive – a vile person. I am not going to defend myself. I will leave it to my readers to decide.

Via the NHS upon moving I have been subject to severe bullying as follows:

First of all they declined to get the treatment up and running which was the clopixol depot leading to her going downhill – even I as just a mother knows that you cannot just stop these powerful drugs in one go.

Secondly they wanted the POA so they tried to make me look abusive – psychological abuse was mentioned. The Public Guardian Office had to investigate and found in my favour.

Thirdly they wanted the role of NR to be given to the social services, a conflict of interest. There followed months and months of litigation where I desperately tried to defend myself but there was no hope under this court because judges do not have the remit to challenge whether someone is really suitable or not. I was threatened constantly with costs as a result. That is known as SLAPPS.

“Suitability” should surely be a parent and carer who visits regularly and who cares. I have no say in anything in terms of treatment as this comes under doctors however I have gone by past file records. I have reports from other doctors who thoroughly dispute the diagnosis and I have noticed how Elizabeth has not been listened to so have done what any parent would do and stick up for her – defend her which has not made me popular. However no-one can dispute the fact that I have tried to help giving everything I have got to my disabled daughter and not expecting anything in return apart from the continuation of the former area’s medication whether I agreed with it or not. It is not that I am saying no-one else cares in the family but I happen to live the closest plus visit weekly. Anyway, the County Court Displaced me and all I will say is noone has effectively acted as NR and social services in any case are “a conflict of interest” and have done nothing to safeguard my daughter during the time at Ash Villa.

Anyway because I dared to challenge I was treated in the same way as present previously at Ash Villa:

phone restricted and visiting 2-1. No leave for months and months on end. Several flawed capacity assessments done not taking into account Principle 4, accident leading to possible injury and the start of the “epileptic fits” which noone knows really what is the cause. Today I have been asked whether Elizabeth agrees to be filmed during an episode. She disagreed. So what now? I personally think she needs to be assessed properly in Sheffield as an inpatient on a neurological ward and where they have the correct scanner ie a Tesla 3.

I am making everyone aware that there is a need for a Tesla 3 scanner at Lincs because a 1.5 does not pick everything up and has been known to miss tumours. All I want is an explanation of what is show on the MRI scans in certain images.

The treatment has been awful for my daughter. She is already held a prisoner but imagine how this would feel when denied basic human rights and proper pathological tests.

She has been treated in a degrading manner for far too long with phone taken away, visits restricted and medical pathological tests flatly refused.

I will add to this blog later to describe what treatment is given to patients under LPFT

https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-156/figures/1

BMC HEALTH SERVICES RESEARCH

Reader and Gillespie BMC Health Services Research 2013, 13:156

R E S EAR CH A R TIC L E

Patient neglect in healthcare institutions: a systematic review and conceptual model

Tom W Reader* and Alex Gillespie
Abstract Background: Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error.
Method: The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated:

(1) the definition of patient neglect,

(2) the forms of behaviour associated with neglect,

(3) the reported frequency of neglect, and

(4) the causes of neglect.
Results: Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients.
Conclusion: A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of

i) differences between patients and healthcare staff in how they perceive neglect,

ii) the association with patient neglect and health outcomes,

iii) the relative importance
of system and organisational factors in causing neglect, and

iv) the design of interventions and health policy to
reduce patient neglect.
Keywords: Neglect, Patient safety, Caring, Organisational culture, Systematic review
Background
Patient neglect, defined as “the failure of a designated care giver to meet the needs of a dependent”

1, has become an issue of concern in both North America and Europe

[2,3]. In the UK, this has been driven by media outlets

[4,5], charities

[6], and health regulators
[7]. Headlines such as “Want to know the NHS’s real problem? Ask a nurse for a bowl of cornflakes”

[8], “Shamed hospital accused of leaving dying patients to starve”

[9], and “Can patient neglect be a violation of
human rights?”

[10] capture concerns relating to patient neglect. They reflect public anxiety, with patients and
families making 22,845 complaints to the NHS in 2011on issues relating to staff attitudes, communication, and patient dignity

[11]. Senior politicians acknowledge the issue, and argue that neglect has been “hidden away”
[12] and that healthcare institutions must ensure “every
patient is cared for with compassion and dignity”

[13].Solutions include “reducing stifling bureaucracy” [14],
ensuring nursing staff talk to patients at least “once an
hour” [13], utilising legislation and regulation to ensure staff consider patient’ “wellbeing and dignity”

[15], and making staff sign-up to a “code of conduct” on dignity
and respect

[16]. The solutions reflect a belief that healthcare staff are responsible for instances of patient * Correspondence: t.w.reader@lse.ac.uk
Institute of Social Psychology, London School of Economics, Houghton
Street, London WC2A 2AE, UK
© 2013 Reader and Gillespie; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Reader and Gillespie BMC Health Services Research 2013, 13:156
http://www.biomedcentral.com/1472-6963/13/156
neglect, but they are also contradictory (e.g. reducing
bureaucracy to free staff from form-filling whilst simultaneously increasing bureaucracy to ensure staff care for patients properly), or involve regulating aspects of behaviour that are difficult to measure and assumed to be lacking (e.g. compassion). These contradictions reveal the lack of a clear understanding of the nature and causes of patient neglect.
High-profile scandals have made patient neglect a key issue for policy makers. Scandals have included patients being regularly physically (e.g. left malnourished, dehydrated, in pain, and unwashed) or emotionally (e.g. being ignored whilst in need, not shown compassion, loss of dignity) neglected by healthcare staff [17-20]. Linking patient neglect to specific metrics of patient harm or clinical outcomes is difficult due to the often complex conditions of patients and their treatment [21]. Furthermore, conducting research is challenging due to the toxicity of the subject (e.g. questioning the abilities, motivation and ethics of staff ) and a media narrative which seeks to blame rather than understand why poor care occurs [22,23]. However, cases such as the Mid-Staffordshire NHS Foundation Trust scandal, where routine and basic failings in care resulted in up to 1,200 patients deaths between 2005 and 2008, show the catastrophic implications for patient care when neglect becomes systemic across an organisation [21,24].
Researchers in medicine, health sciences, and psychology have for some time investigated how institutional processes, clinical environments, and the behaviour of healthcare staff influence patient safety [25]. These investigations have resulted in interventions (e.g. team-training, care bundles, skill validation) to reduce medical error and improve clinical outcomes [26]. Although they might be expected to reduce patient neglect, it appears necessary for practical (e.g. to meet public and political concerns)
and conceptual reasons (e.g. to develop suitable interventions) to distinguish patient neglect from unintentional error, or intentional abuse. This is because reports on neglect such as those cited above often refer to: i) staff behaviours that may not directly lead to patient harm (e.g. not aiding patients to go to the toilet), but are crucial for care and probably do not reflect a competency gap; ii) staff attitudes and behaviours towards patients that cannot be regulated or easily measured (e.g. compassion); iii) a mixture
of causal factors leading to patient neglect, some of which indicate neglect to be unintentional (e.g. due to a lack of resources) or alternatively not related to error (e.g. rudeness) [27]; iv) differing beliefs between patients, families, and staff as to whether neglect has occurred (e.g. for loss of patient dignity) and the causes of neglect; and v) breakdowns in institutional structures (e.g. communication between staff and management) that are a prerequisite to introducing interventions to improve care [26]. This article reviews the research literature on patient neglect, and interprets this work within the framework of organisational and social psychology. This structure is utilised in order to reflect the observation that patient
neglect emerges from a complex mixture of organisational (e.g. resources, management) and social factors (e.g. relationships between patients and healthcare staff ). In particular, the interactions and perspectives of staff and patients appear especially important for understanding when and why neglect occurs. The overall aim of the review is to contribute to the public dialogue and academic understanding of neglect. Its specific objectives are to:
1) Review what is meant by patient neglect, and
consider how it differs from other constructs
relating to poor patient care.
2) Describe the staff behaviours reported in studies of
patient neglect.
3) Examine how healthcare staff and patients perceive
neglect (and whether there are differences).
4) Identify the causal factors commonly cited as
leading to instances of patient neglect.
Method
This is the first literature review on the nature and causes of patient neglect. Accordingly no protocol exists to guide the review, so standard protocols for literature review were applied [28]. The eligibility criteria were articles or reports published in English reporting primary data, since 1990, on the occurrence or causes of patient neglect anywhere in the world. In the first instance, the search for articles on patient neglect was framed using Lachs and Pillemer’s [1] (p.437), widely used definition (in reference to neglect of
elderly patients) of “the failure of a designated care giver to meet the needs of a dependent”. From this perspective, patient neglect is behavioural (intentionally or unintentionally failing to meet the needs of a caregiver). The information sources, search terms used, and study selection procedure are outlined in Figure 1.
To evaluate the methodological quality of the research studies, we applied the SIGN system [29]. This provides ratings through which to assess the quality of data collected in quantitative and qualitative studies. The assessments for each study are reported in Table 1, with the quality ratings being the following:
1++: High quality meta-analyses, systematic reviews of
RCTs, or RCTs with a very low risk of bias.
1+: Well-conducted meta-analyses, systematic reviews,
or RCTs with a low risk of bias.
1-: Meta-analyses, systematic reviews, or RCTs with a
high risk of bias.
2++: High quality systematic reviews of case control or
cohort or studies. High quality case control or cohort
Reader and Gillespie BMC Health Services Research 2013, 13:156 Page 2 of 15
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studies with a very low risk of confounding or bias and
a high probability that the relationship is causal.
2+: Well-conducted case control or cohort studies with
a low risk of confounding or bias and a moderate
probability that the relationship is causal.
2-: Case control or cohort studies with a high risk of
confounding or bias and a significant risk that the
relationship is not causal.
3: Non-analytic studies, e.g. case reports, case series.
4: Expert opinion.
The following data extraction exercise was performed.
First, the meaning of neglect was reviewed in each paper. Second, behaviours identified in studies of patient neglect were identified. Third, frequencies of neglectful behaviours reported by healthcare staff, patients, and families were captured. Fourth, causal factors identified
by articles and reports as contributing to instances of patient neglect were extracted. This included the capture of both qualitative data (TR) and quantitative data (AG).
The extracted data were not amenable to meta-analysis due to a mixture of qualitative and quantitative studies being identified. Consistent with similar reviews of literature with mixed forms of data, a narrative analysis was used to synthesise the findings of the review [30,31].
Results
Figure 1 reports the results of the literature review. Ten
research articles were included, with data largely collected in Scandinavia, South Africa, and the US. The
majority of articles used survey methods to measure
staff, family, or patient observations of neglectful behaviours [32-39]. Two qualitative papers investigated staff
perceptions of patient neglect [40,41], and patient perceptions of neglectful behaviours were also of interest
[39,42]. Several studies were conducted in elderly care.
The hand search identified four qualitative UK government reports investigating patient neglect at both individual and unit/hospital level [24,43-45]. Many discussion articles (e.g. on legal issues) and studies of related topics (e.g. patient dignity, ethics) were also identified, and were informative in understanding what is meant by patient neglect. However, they were not included in the review due a lack of relevant primary data focussing explicitly on patient neglect. The number of studies and reports seems to be increasing rapidly, with 8/14 (57%) being published between 2009–2012.
In comparison to the other literatures linking behaviours and outcomes in healthcare (e.g. medical error) [46], the number of studies investigating neglect is limited, and data was mostly descriptive. Quantitati

Doing No Harm: Enabling, Enacting, and Elaborating a Culture of Safety in Health Care
Author(s): Timothy J. Vogus, Kathleen M. Sutcliffe and Karl E. Weick
Source: Academy of Management Perspectives , November 2010, Vol. 24, No. 4
(November 2010), pp. 60-77
Published by: Academy of Management
Stable URL: https://www.jstor.org/stable/29764991
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Academy of Management Perspectives
ARTICLES
Doing No Harm:
Enabling, Enacting, and Elaborating a Culture of Safety in Health Care
by Timothy J. Vogus, Kathleen M. Sutcliffe, and Karl E. Weick

Academy of Management is collaborating with JSTOR to digitize, preserve and extend access to
Academy of Management Perspectives This content downloaded from https://www.jstor.org/stable/29764991

Published by: Academy of Management
Stable URL: https://www.jstor.org/stable/29764991
Executive Overview
Medical error has reached epidemic proportions, and researchers have developed insufficiently sophisticated models of safety culture to match the complexity of the challenge of safety in health care. This has left providers and researchers with an inadequate conceptual toolkit for improving safety. To rectify the resulting crisis we consolidate fragments of management research into a comprehensive and integrative framework of how patient safety is produced and sustained through safety culture. Safety culture involves actions that single out and focus safety-relevant premises and cultural practices that reduce harm. This entails (a) enabling, which consolidates the premises for a safety culture; (b) enacting, which translates consolidated premises into concrete practices that prioritize safety; and (c) elaborating, which enlarges and refines the consolidation and translation. We close by discussing the implications of our framework for future research on key issues such as efficiency-safety trade-offs, interactions among components of the framework, and feedback loops. In the face of competing priorities (e.g., efficiency), organizations often inadequately prioritize safety relative to other goals (Perrow, 1984)* Although safety challenges plague many industries, the problem is especially acute in health care. Health care presents a challenging paradox by pairing the mandate to “do no harm” with mounting evidence that much harm is done in the course of delivering care. In 1999 the Institute of Medicine (IOM) released a report titled
To Err Is Human, in which medical error was citedas the eighth leading cause of death in the United
States (more than motor vehicle accidents, breast cancer, or AIDS), responsible for as many as
98,000 deaths annually (IOM, 1999). A 2002 report by the Centers for Disease Control (CDC)
stated that almost 2 million Americans acquire infections in the hospital, contributing to those
98,000 deaths each year. More specifically, 48,600 central-line bloodstream infections occur annu?
ally, with one third of those patients dying (Buerhaus, 2007). Additionally, an estimated 2% to 4%
of patients (between 670,000 and 1.3 million) fall during their hospitalization in the United States
annually, with 2% to 6% of those falls (13,000 to 78,000) resulting in injury. In sum, as many as 88
people out of every 1,000 will suffer injury or Timothy J. Vogus (timothy.vogus@owen.vanderbilt.edu) is Assistant Professor of Management at the Owen Graduate School of Management, Vanderbilt University.
Kathleen M. Sutcliffe (ksutclif@umich.edu) is the Gilbert and Ruth Whitaker Professor of Management and Organizations at the Stephen M. Ross School of Business, University of Michigan.
Karl E. Weick (karlw@umich.edu) is the Rensis Likert Distinguished University Professor of Organizational Behavior and Psychology at the Stephen M. Ross School of Business, University of Michigan.
Copyright by the Academy of Management; all rights reserved. Contents may not be copied, e-mailed, posted to a listserv, or otherwise transmitted without the copyright holder’s express written
permission. Users may print, download, or e-mail articles for individual use only.
We would like to thank AMP Editor Garry Bruton, Peter Cappelli, Ranga Ramanujam, Jen Vogus, and two anonymous reviewers for thoughtful and constructive comments that substantially improved the quality and contribution of this manuscript. We also thank Aidan Vogus for helping us see the importance of this work.

https://wordpress.com/post/revelationsuk.com/176053654

My blog on this subject is attached above, featured recently.

As regards the CQC’s SOAD that Ms Munro refers – as she cannot answer that question I will answer it myself. Never has a CQC SOAD looked into matters properly and even at times agreed with the Trust and Care Home when concerns are raised. They allowed the prescribing of Risperidone, prescribed at Reservoir House Supported Living despite allergy to this drug clearly pointed out to them. They allowed inaccurate prescribing ie 1.75 mg Risperidone which no-one, not even me could cut properly. They have allowed drugging of Elizabeth to enormous quantities whilst at Elysium which clearly did not work. They have ignored the fact she is “treatment resistant” which means poor/non metaboliser and not one of them recommended MRI scans or pathological tests to check for underlying causes when it was obvious none of the drugs worked. I do not feel they even bother to properly look at past file records. Most recently they have ignored the fact that LPFT do not use PANSS recommended by RCPSYCH. Most recently they have ignored or were uninformed that Elizabeth had private scans done which were NOT normal and need further verification OR, if they saw the recent scans done under Lincolnshire United Hospitals Trust they do not have a Tesler 3 which makes my private scans highly accurate. This puts everything in question because of the frequent episodes, stated to be partly blamed on myself.

No, I repeated that Elizabeth feels she is being abused and said this many times during supervised visits. These are Elizabeth’s words, not mine, but how can I disagree when she is being treated differently from everyone else and more like a restricted prisoner.

As for ward round meetings, I am supposedly allocated a 10 minute slot, whereas I should be invited to the whole of the ward round. Quite often I have sat there in front of the computer to no avail and no-one has let me into the Teams meeting or advised that this has been cancelled. I have been studying on a course for some weeks and so have not been able to attend lately but it is clear nothing has changed re the restrictions despite the comments of Ms Munro in her letter.

Yes I did state that the taking away of the mobile phone the family pay a contract on is a breach of Elizabeth’s human rights and ours – the family. The phone contract with Vodafone is only £13.61 pm but it is only right that LPFT should refund every penny whilst they continue to place the mobile into Elizabeth’s locker making it impossible at times for family to get through or for Elizabeth to enjoy listening to music or seeing the comforting pictures of her cat. This whole thing was done before under Dr Shahpasandy under Ash Villa run by LPFT. This carried on for weeks on end and no-one could get through on the phone. It most certainly is an infringement of everyone’s human rights and restrictions are very clearly still in place re supervision, no leave granted and only restricted visitors which does not allow for any quality time after all this length of time. At Ash Villa Elizabeth kept calling the Police in desperation. Don’t know if she has tried to do that here on Castle Ward but this punishment is all aimed at me. It is definitely punishment as I see it because the rest of the family/friends are not subject to any restrictions on visits but are still affected re the phone locked away. Because no impact assessment has ever been carried out as per NHS Guidelines this does not only have an impact on me but others in the family that LPFT have not even considered and Elizabeth herself. What has taking away the phone got to do with engagement with staff? From what I understand Elizabeth is asleep most of the day and up at night so it would not be affecting her ability to participate in any ward round meetings or activities on the ward. What treatment plan! They do not use the recommended PANSS. Elizabeth should be given a copy of her care plan. There is clearly no discharge plan of any kind and acute ward detention on a never ending section continues now for over 2.5 years with no end in sight. Now Ms Munro goes on to state the following:

“ELIZABETH’S PHONE ACCESS WAS LIMITED FOR A FIXED PERIOD OF TIME AS PART OF A COMPREHENSIVE CARE PLAN THAT CONSIDERED HER HUMAN RIGHTS. THIS WAS TO ENSURE THE RESPONSE TO HER PHONE USE DID NOT ADVERSELY IMPACT HER ENGAGEMENT PLAN WITH, OR THE EFFICACY OF THE TREATMENT PLAN. THIS WAS CEASED ON MONDAY 5 FEBRUARY 2024 FOLLOWING REVIEW OF ALL THE RELEVANT FACTORS.”

So, first of Elizabeth why is she still without her phone as it is held in her locker so that she cannot access at all times as she does not have the key. The ban (not limitation) has been ongoing for months now and it has been extremely difficult for all of us to contact her even the family members and friends were not put through immediately as a member of staff had to be available to go and unlock her locker and hand the phone to her or else in my case only for two members of staff to sit there listening in to all phone calls which is in breach of Art 8 HRA and the Equality Act 2010. I honestly truly do not know what on earth Ms Munro means by stating “care plan that considered her human rights”. This is absolute rubbish and I believe that not only do LPFT need to implement the Oliver McGowan Training Programme but it is no wonder there is no sign of that if they do not understand what basic human rights are and what is meant by acting ultra vires, relying on Bolam Law when it should be Montgomery – all hiding behind each other as regards decision making. Of course this is a breach of human rights as not having the phone or being readily able to access it whilst held under MHA 1983 and is an abuse of power and process as well as the law. What right do a public authority have to do this and this is NHS care. For a short while Elizabeth was sent to Cygnet Durham. At first she did not have her phone but then this was given back to her as at least Cygnet realised this was in breach of the law unlike the NHS. Under the MHA detention should be the least restrictive care. The most untruthful comment Ms Munro makes is that restrictions ended on 5 February. So what I did was take with me the letter to show Elizabeth. I was told by the two HCAs that I could not just give the letter so I said “why not”? They said they had to show the manager first (I then said Oh I see the Management are involved in all this?) The Manager to Castle Ward is Kashmir Moons. So they took the letter from me. I read the contents of the letter before I gave it to them. I asked that they hand the letter back to Elizabeth and will check she has it when I next have contact. Contact is only if Elizabeth asks for the phone but I get the impression she is asleep a lot during the day and up late at night. This would explain why meals continue to be missed.

Ms Munro then goes on to mention an “incident” on Xmas Day for which internal investigations and review of all relevant evidence was undertaken and following that re-establishing of prior arrangements.

This is NOT GOOD ENOUGH MS MUNRO. For a start there was no incident whatsoever but Elizabeth got upset with the second lady – a HCA told to sit in the small visitor’s room on Xmas Day of all days and write notes. It was the writing of notes that got Elizabeth upset and she reacted. I had also found out that the Clopixol depot had been reduced by 50mg and I was told to leave the ward when a crowd of about 5 staff gathered outside the visitor’s room including men which was very intimidating. When I left the visitor’s room all Elizabeth did was to shout and they grabbed her throwing her into seclusion and injecting her afterwards. Why inject when all someone needs to do is to calm down but they tend to do this after every ‘episode’ that looks like a fit. Why rapidly tranquilise when she has calmed down. Xmas Day was ruined and spoiled and I did not know they called the Police on me. When I found out I opted to complete a S9 statement but I doubt anyone from the Trust did that and they should have been asked to do after all to call Police out for no reason is very bad. All this is being done to intimidate and threaten using Police as a weapon when in fact Elizabeth trusts the Police more than MH professionals and regarded them as “friends”.

So this has justified the banned visits whilst internal investigations took place. Not one apology given in her letter.

Ms Munro goes on to explain about the Neurologist Appointment being unattended but what Ms Munro does not know is that I in fact attended with a copy of the private scans done on a Tesler 3 scanner. I knew about the appointment because Elizabeth told me and shared her letter with me. Again the MH were keen she did not attend by the looks of it. They have done everything to stand in the way of her Neurologist appointments but I met the Consultant Neurologist myself. I knew that scans were done in addition by the Trust in November 2023, Mine were done end of May 2023. What I did not know at the time was that they did not have a Tesler 3 but a 1.5 scanner so it is no wonder their scans are not accurate as opposed to mine. What I am concerned at was their response. The Clinical Lead Emily Scott said they had no knowledge of the Neurologist appointment and this was at 11.00 am so I bet Elizabeth was asleep and no-one got her up for it. Now they propose a further scan in Sheffield because they do not have the latest scanner when I have produced scans done privately under a Tesler 3. “This aspect of Elizabeth’s healthcare is ongoing”. Good – glad to hear it since all this should have been done upon arrival but the team were too busy trying to take away my role as POA and NR to consider physical health needs.

Regarding the telephone call where a new staff member had limited English, I only went by what Elizabeth said when I asked to speak to the new member of staff over the telephone. This might have been just an excuse on the other hand.

Concerns on Missing Meals – yes Adults safeguarding were supposed to look into this and the ward is supposed to keep daily food and fluid chart to document intake. At Ash Villa this was a frequent occurrence but I still think missing meals goes on as if Elizabeth is frequently rapidly injected then she is asleep during the day or cannot get up for meals and misses them and in the evening there is just a sandwich. I am not saying this is happening now on a daily basis like before however it still does occur and again laundry – this is what she was doing herself in her flat without support. This is the level of decline that now Elizabeth needs someone to help shower her, do her washing etc etc whereas before she was doing this herself and even using a bank card, going shopping, using buses whilst in her independent flat. Substantial decline because of her treatment worse than a restricted prisoner. These comments again came from Elizabeth who said she had run out of clothes but staff do not seem to understand autism. There is no sign of the Oliver McGowan Training and the other day when we visited she told me that Dr Khokhar said “you have not got autism” – I pointed out to the two staff supervising that autism was what Elizabeth had researched as her condition and should be respected – after all there is no end of evidence and every screening came out positive by other institutions and other doctors. I, on the other hand think there is brain injury which may have been present before under Enfield and covered up as it says on the discharge note “abnormal findings on scan pointing to cns”. Since then there have been 10 doctors (psychiatrists) keen to treat as a MH patient and ignore the discharge note and private scans up until the frequent life threatening episodes which resulted in A&E to the point this could no longer be ignored.

“We aim to provide high quality care and treatment to all those we support and are sorry you have had to escalate your concerns. We value opinions of those who use our service as it gives us vital insight into any care we provide and informs us when improvements are necessary. We thank you for raising these concerns.”

Taking the above into consideration here are the improvements:

Stop taking the phone away and using this and restricted visits and cutting of leave as an excuse unless someone fits the criteria of s11:15 MHA Code of Conduct. Elizabeth is an Adult and should not be treated this way and also you are in breach of Art 8, Art 5, Equality Act 2010 plus Art 3.

You should settle up with the phone bill and thinking about it the private scans that were accurate unlike those done under a 1.5 scanner.

You should allow leave/visiting rights to resume unrestricted and give the phone back to Elizabeth to keep in her handbag like everyone else.

You have discriminated against us as a family, not just Elizabeth that has impacted against even those not being punished ie other members of family.

Elizabeth misses her cat and wishes to come home to visit and to live. You have been looking at care homes in W Sussex and Yorkshire without any thought to rest of family.

I have had serious verbal threats of indefinite banning of visits at a Ward Round in December because of flawed allegations of some kind of incident when nothing happened except for police time to be wasted.

I have presented you with an invoice and would appreciate prompt settlement. I shall do either an additional or amended invoice to include the private highly accurate scans seeing as they were needed in the first place. It is therefore only fair that the Trust pays.

There is no sign of the Oliver McGowan Training? Where is this training?

There is no sign of proper diagnostic tool PANSS and why not when recommended by RcPsych?

The way you have handled everything has been a disgrace. To try to take away the POA. You failed at this.

To try to displace me you used County Court and did so in secret. Secret courts should be banned. This is of public interest as it is public money. The law needs to be tightened so that there is more accountability which could save vast amounts of public money at County Courts where Judges do not have the remit to properly look into matters.

To present papers and to keep getting HCAs to report negatively against me is bullying and I am entitled to see everything written against me.

It is wrong to treat me differently to rest of family and I should say this is clearly discrimination.

The ward is very noisy and this affects Elizabeth along with the very highly bright lighting.

The CQC should look into the legality of the Section 3. It is more like a Section 37/41. What right do you have to hold Elizabeth like this and treat her like a vegetable when each and every one of the capacity assessments are flawed. I should know as I have done the course. She was not even on a section in the former area so how do you explain this?

As for the MHA this needs urgent amended because Trusts and Councils like Lincolnshire and Enfield/Barnet Enfield and Haringey MH Trust have found a way to twist the law to their own ends and use social services against you and they abuse the MCA which I have studied thoroughly in order to take away a vulnerable patient’s autonomy when they have got capacity.

I now want all the files from both records and everything written about me so that I can correct everything which might take me years and years to do. How can you give decent care if your records are untruthful and inaccurate.

I have now highlighted the need for a new scanner in two areas – Lincolnshire and Weston. This is essential to ensure proper diagaosis.

The last thing I am going to point out is about Capita doing the assessments for PIP. I explained that Elizabeth was still in hospital, not in receipt of PIP and declining. If a vulnerable person got a call like this it would be extremely upsetting. I now have an appointment for an assessment coming up shortly.

It is important for anyone having an MRI scan to check which scanner their Trust has as I have wondered why the scans at Lincoln County Hospital have not shown up the same details as the scans I had done privately and now I know why. I have found out that they use a 1.5 Tesla scanner.

I immediately contacted my MP, Victoria Atkins to advise that Lincoln United Hospital Trust should be provided with the most accurate scanner which to my knowledge is the Tesla 3.

I am just warning everyone to check and question in order to ensure they receive highly accurate scans.

I have found out that the following:

Diagnostic imaging department at The Lincoln Hospital, Lincolnshire offers a wide range of diagnostic tests and imaging examinations.

All imaging is processed using electronic technology known as CR (Computed Radiography) and PACS (Picture Archiving and Communication System) which enables fast, electronic display of all images and reports. 

At The Lincoln Hospital diagnostic imaging equipment is used that includes a wide bore 1.5T MRI scanner, ultrasound and a mobile 64-slice CT scanner (available every other Tuesday).

The diagnostic imaging department at The Lincoln Hospital offers the full range of routine and specialist services including: 

• Abdominal Aortic Aneurysm Screening
• CT scanning
• Fluoroscopy – theatre 
• MRI scanning 
• Out-patient cardiology diagnostics including, echocardiograms, exercise ECGs and heart monitoring 
• Plain film radiography 
• Ultrasound 
• X ray

The main difference between a 1.5 Tesla (T) MRI scanner and a 3 Tesla MRI scanner lies in their magnetic field strength.

1.5 Tesla MRI scanners have a magnetic field strength of 1.5 Tesla, while 3 Tesla MRI scanners have a magnetic field strength of 3 Tesla.

Here are some implications of this difference:

1.     Image Quality: Generally, higher magnetic field strength (such as 3 Tesla) can provide better image quality compared to lower field strengths like 1.5 Tesla. This higher field strength can lead to increased signal-to-noise ratio, which results in clearer and more detailed images.

2.     Resolution: With higher magnetic field strength, there’s potential for higher spatial resolution, allowing for more detailed imaging of structures within the body.

3.     Scan Time: In some cases, higher field strength MRI scans may require shorter scan times to achieve comparable image quality to lower field strength scans. This can be beneficial for patients who may have difficulty remaining still for long periods.

4.     Cost and Availability: Generally, 3 Tesla MRI scanners are more expensive to purchase and maintain compared to 1.5 Tesla scanners. Additionally, they may not be as widely available as 1.5 Tesla scanners in all healthcare facilities.

5.     Clinical Applications: Both 1.5 Tesla and 3 Tesla MRI scanners have their own set of clinical applications. 3 Tesla MRI scanners are often preferred for certain types of imaging studies such as neurological imaging (brain and spinal cord), musculoskeletal imaging, and research applications where high-resolution imaging is crucial. However, 1.5 Tesla scanners are still widely used and may be preferred for certain clinical scenarios where higher field strength may not be necessary or may pose additional risks.

In summary, while both 1.5 Tesla and 3 Tesla MRI scanners serve the purpose of imaging internal structures of the body using magnetic resonance, the difference in magnetic field strength results in variations in image quality, resolution, scan time, cost, and clinical applications. The choice between the two depends on factors such as the specific imaging needs of the patient, availability of technology, and clinical judgment.

Surely the needs of the patient is paramount in terms of the provision by every Trust of the Tesla 3 scanner to ensure without doubt that they get the most accurate scans and I have therefore proven that the current 1.5 Tesla scan done by the hospital has missed vital details that need verification and checking out because I had a private Tesla 3 scan done for Elizabeth. I have told my MP that a Tesla 3 scanner is urgently required at Lincolnshire United Hospital Trust.

What makes this letter so untruthful is that the mobile phone is still held in the locker, locked away and only supervised calls and visits are allowed by the truly awful Lincolnshire Partnership Trust rated “GOOD” by the CQC. If restrictions had ended on the 5th February as Ms Ann Munro states then why are they still continuing on the ward in that case or why hasn’t this been relayed to the ward? Dr Waqqas Khokhar and team continue relentlessly with restrictions that are a complete infringement of Human Rights – breach of Art 8 and Equality Act 2010. The restrictions are ONGOING and it was threatened by Elizabeth’s doctor that the ban was indefinite. I have issued LPFT an invoice that is only £50 for the phone contract family pay to Vodafone monthly and the cake I brought for Elizabeth’s Birthday that got put in the bin. It seems like noone is doing anything about anything and all staff acting ultra vires. Yesterday as I have to be seen to be doing everything I can to resolve matters I chased up the investigations I called for under the NMC, GMC, ICO and HCPC – Adults Safeguarding have concluded their investigation but a couple of days ago Elizabeth phoned me and said she had missed meals and only had crisps to eat. This all goes to show that the “care” Elizabeth is receiving is not right or appropriate and that acute wards are totally unsatisfactory to anyone with sensory issues and those who claim or have been diagnosed to have autism, LD so in that case why are so many trapped for years and years on end.

The reason is not because there is nothing in the community but it is all down to funding. We did not ask for anything but had hoped for a better life in a new area. Inevitably the outcome is disablement and then that vulnerable person becomes institutionalised for the rest of their lives and placed under DoLs – another form of imprisonment. Stripped of their capacity, human rights do not apply.

Now there needs to be more done as what the NHS is providing is totally wrong and the way they go about bullying families with litigation lasting months and months in secret courts is totally and utterly wrong.

If Ms Munro claims that the restrictions have ended with the phone then this needs to be sorted out as members of staff were/are oblivious to this. There seems to be lots of bank staff supervising and they use HCAs and they are writing negative notes to build up a picture against me. It is the ultimate bullying. I now take a witness with me because they keep calling out the Police and wasting their time in desperation to portray me as a nasty person but I am being totally honest here revealing the truth and nothing but the truth. There is no way I would be going to these lengths publicly if I was not speaking the truth and from what I see I am not alone with others writing about the shameful care provided under MH in the UK that has no accountability. They have also gone out of their way to stand in the way of pathological tests and referrals to Neurologist which was on 3 January but I was told by the Clinical Lead Emily Scott that they knew nothing about this appointment. Oh yes they did! I attended instead with the private scans done under a Tesler 3 scanner which Lincolnshire do not appear to have and which are highly accurate.

Here is the letter:

LINCOLNSHIRE PARTNERSHIP

FOUNDATION TRUST

Patient Experience Team

The Point

Unit 9

Lion’s Way

Sleaford

Lincolnshire

NG34 8GG

Tel: 01529 222265

 Email: LPFT.PALS@nhs.net

Our Ref: SER/23/2717

CQC Ref: ENQ1-18383246613;

ENQ1-17716124293

19th February 2024

PRIVATE AND CONFIDENTIAL

Mrs S Bevis Sent via email:

Dear Mrs Bevis,

I write to respond to the queries and concerns you shared with the Care Quality Commission (CQC) between 14th November 2023 and 28th December 2023; You said that the SOAD (second opinion appointed doctor) did not take account of Elizabeth’s allergy to a medication. We are unable to answer points related to the decisions made by the SOAD as they come under the remit of the CQC.

You said you are concerned that Elizabeth is being abused. Investigations into Elizabeth’s safety have been initiated and the trust are cooperating with these as requested.

You claimed that on occasions you had not been allowed into the ward round meetings.

The ward confirmed that you have the link to attend a designated slot for the weekly ward round meeting. They have noted occasions where you have not joined the meeting.

You have said that Elizabeth having her mobile phone removed is a breach of her human rights. Elizabeth’s phone access was limited for a fixed period of time as part of a comprehensive care plan that considered Elizabeth’s human rights. This was to ensure the response to her phone use did not adversely impact her engagement with, or the efficacy of, the treatment plan. This was ceased on Monday 5th February 2024 following review of all the relevant factors.

You claim that details recorded of the incident that took place on 25th December 2023 during your visit to Castle Ward are untrue and have resulted in your visiting arrangements being suspended. Visiting arrangements were temporarily suspended while internal investigations and review of all relevant evidence were undertaken and that visiting arrangements have now been re-established, as set out in letter dated 5th February 2024.

You said that Elizabeth was not able to attend the neurology appointment in January 2024. Elizabeth was not able to attend a neurology appointment in January 2024, however following discussions with professionals at United Lincolnshire Hospitals Trust, alternative provision was facilitated so that the relevant clinical staff could attend Castle Ward to see Elizabeth. This was organised to minimise any disruption to Elizabeth and maximise her potential engagement with the process. This aspect of Elizabeth’s healthcare provision is ongoing.

You described a telephone call to the ward where a new staff member had very limited English. Your feedback on this staff interaction has been passed on to the relevant teams to ensure any necessary reviews are undertaken. You expressed concern that Elizabeth was missing meals which was impacting on her behaviour.

The ward is continuing to keep a daily food and fluid chart to document Elizabeth’s intake. This also ensures any additional support can be provided to Elizabeth where appropriate. You said that Elizabeth had lots of washing and that she was not being supported with this. The ward has confirmed that Elizabeth is usually known to attend to her own laundry independently. Patients can access the laundry room at any time in the company of staff and Elizabeth can request support from staff for this purpose. We aim to provide high quality care and treatment to all those we support, and we are sorry that you have had to escalate your concerns.

We value the opinions of those who use our service as it gives us vital insight into any care we provide and informs us when improvements are necessary, and we thank you for raising these concerns.

Thank you for bringing your concerns to our attention. LPFT mental health services strive to deliver the best care to all our service users and their families/carers all the time and I regret this has not been your experience. NHS Complaints Advocacy is also available at every stage of the complaints process.

VoiceAbility can be contacted by calling their Helpline on 0300 303 1660 or via email helpline@voiceability.org If you are not happy with how we have dealt with your complaint and would like to take the matter further, you can contact the Parliamentary and Health Service Ombudsman. The Ombudsman makes final decisions on complaints that have not been resolved by the NHS, Government departments and some other public organisations. Their service is free to everyone. There is a time limit for making your complaint to the Ombudsman so you should do this as soon as possible.

To take a complaint to the Ombudsman, or to find out more about the service, go to https://ombudsman.org.uk/making-complaint or call 0345 015 4033. Yours sincerely, Checked and electronically signed to speed delivery.

Ann Munro Patient Safety Lead

 cc: Care Quality Commission (Central)

Citygate,

Gallowgate,

Newcastle Upon Tyne NE1