Wishing all my readers a Happy New Year. 

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

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

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

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

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

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

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

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

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

DENYING FOOD PARCELS AND TO ORDER FOOD FROM OUTSIDE 

L v Board of State Hospital [2011] CSOH 21; 2011 SLT 233

The hospital had been ultra vires in denying patients the right to have food parcels and to order food from outside.

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

House of Commons House of Lords

Joint Committee on Human Rights

Protecting human rights in care settings

Fourth Report of Session 2022–23

Report, together with formal minutes relating to the report

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

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

HC 216 HL Paper 51

Published on 22 July 2022

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

This is a very interesting paper to read.

Joint Committee on Human Rights

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

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

Current membership

House of Commons

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

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

Florence Eshalomi MP (Labour, Vauxhall)

Angela Richardson MP (Conservative, Guildford)

Dean Russell MP (Conservative, Watford)

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

House of Lords

Baroness Chisholm of Owlpen (Conservative)

Lord Dubs (Labour)

Lord Henley (Conservative)

Baroness Ludford (Liberal Democrat)

Baroness Massey of Darwen (Labour)

Lord Singh of Wimbledon (Crossbench)

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

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

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

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

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

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

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

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

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

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

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

ARTICLE 3 HRA

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

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

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

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

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

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

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

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

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

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

DENYING VISITS IN HOSPITALS ETC

Visiting Report December 2023

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

DISCRIMINATION

Equality Act 2010: guidance – GOV.UK

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

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

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

1.1 treat people with kindness, respect and compassion

1.5 respect and uphold people’s human rights

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

4.4 tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care

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

Masterman-Lister v Brutton & Co 2003

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

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

Subject: Guidelines on Restricting Hospital Visits

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

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

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

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

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

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

CLINICAL CARE LPFT TRUST POLICY DOCUMENT

8. Admission to Hospital/Keeping an individual in hospital

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

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

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

 • Contact with others

• Movements within ward

• Privacy

• Discharge

• Day to day activities

• Personal care

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

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

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

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

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

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

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

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

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

1. A zero tolerance to all forms of abuse

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

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

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

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

 6. Respect people’s right to privacy

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

8. Engage with family members and carers as care partners

9. Assist people to maintain confidence and a positive

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

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

9.4 Privacy and Dignity

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

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

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

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

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

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

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

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

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

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

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

• Obtain informed consent before undertaking examinations or treatments.

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

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

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

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

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

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

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

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

• Monitoring compliance with this policy

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

• Investigating any reported non-compliance with this policy

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

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

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

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

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

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

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

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

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

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

9.9.4 All workers All workers are responsible for:

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

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

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

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

Associated Documentation

 1. NHS 13-14 Standard Contract

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

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

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

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

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

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

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

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