This is displayed by LPFT – what is a just culture exactly? This is completely ridiculous and biased. Just mention a “just culture” to all the parents and carers affected right now and particularly all the patients stuck on wards for years on end whilst Trusts such as this act dishonestly. When you dare to challenge you can expect a response as follows from the likes of Ms Munro who is as unfit to write complaint responses as the doctors who carried out the flawed capacity assessments.
Here is what Elizabeth has described her experience as: “hell on earth”. This is also how parents and carers view matters, those who are affected and those who are ignored. How can there be any accountability whilst those at the top have connections with the Care Qualilty Commission? How can any members of the public have faith in the Care Quality Commission who have produced some very dismissive responses even calling themselves a “business”. I have featured this on a former blog.
CQC Ref MHA-01217-X6F7TO
Date 4th April 2024
Patient Experience Team
Unit 9
The Point
Lion’s Way
Sleaford
Lincolnshire
NG34 8GG
Tel 01529 222265
Email: LPFT.PALS@nhs.net
Dear Mrs Bevis
The Care Quality Commission (CQC) have asked us to respond to requests you have raised with them and clarify the Trust’s position on a number of points:
You have requested an apology for the verbal threats made by Dr Khokhar where she said “I am banning you indefinitely for inciting your daughter to attack members of staff on Xmas Day”.
Following the incident on Christmas Day 2023, the Trust followed the usual incident reporting and investigation processes, as well as complying with instructions and communication from the Police. During this period of investigation, your visits to the ward to see Elizabeth were suspended in line with the Mental Health Act Code of Practice 2015 and to ensure the effective delivery of Elizabeth’s care and treatment could be prioritised. Dr Khokhar accepts that he used the word “indefinitely” and that this could be seen as inflammatory. It was used to reflect that at the point, an end date to the restrictions could not be confirmed. However, the letter sent dated 29th December 2023 confirmed that the situation would be reviewed on 25th January 2024. After subsequent review of the relevant documentation, the visiting restrictions were lifted from the 5th February 2024.
You asked about your invoice for £50 for Elizabeth’s ‘wasted’ phone contract.
As previously explained in an email on 29th Februay 2024, 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, her treatment plan. This ceased on the 5th February 2024 following a review of all of the relevant factors. Elizabeth’s phone continues to be kept securely by ward staff and Elizabeth is able to request to use her phone at any time. In addition, ward staff regularly encourage Elizabeth to use her phone to maintain contact with family.
We monitor and document Elizabeth’s phone use to ensure that she has fair and reasonable access to her phone. This details the occasions when she has been supported to use her phone and make calls and evidences that Elizabeth continues to be able to use her phone on request . On the basis that Elizabeth does continue to use her phone, we would not provide any reimbursement for her phone contract.
You said that Elizabeth’s birthday cake was thrown away.
To ensure that the limited storage space for fresh food brought onto the ward by visitors is fairly available to all patients on the ward, a new process has been put in place. This is clearly communicated to patients and their friends and relatives when they visit to manage expectations. The ward also adheres to Trust wide infection prevention and control (IPC) policies relating to food storage and consumption to ensure patient safety. Elizabeth’s birthday cake did have to be disposed of on 15th February 2024 as the expiry date had been exceeded.
You raise concerns about the size of the visitor’s room and that it was cramped which upset Elizabeth
The family room on the ward is used for visits as it affords privacy and has CCTV available which can be used to review the area, if necessary. This room is the largest room on Castle Ward used for visitors.
Subject Access Requests
In relation to the Subject Access Requests (SARs) received both for personal data relating to yourself and requesting a copy of Elizabeth’s rapid tranquilisation healthcare records, the Trust’s position remains the same as detailed in the email sent on 11th December 2023. This is because we are of the view that your request is “manifestly unfounded or excessive” as detailed in Article 12 (5) of the GDPR.
Our Records Management team did note that you subsequently attached a consent form from Elizabeth. However, this was not the correct consent form to support your Subject Access Request. Further, we continue to have concerns regarding Elizabeth’s capacity to consent, which has historically remained interchangeable with regards to information sharing. We also have continued concerns that any information shared may, in turn end up within a public forum which is outside the scope of any consent that we may gain.
We ;have provided a copy of this letter to the CQC.
Yours sincerely
Ann Munro
Patient Experience Lead
Cc Care Quality Commission (Central) Citygate, Gallowgate, Newcastle Upon Tyne
NE1 4PA
EXTRACTS FROM MY RESPONSE EMAIL TO MS MUNRO’S LETTER.
Yr Ref MHA-011217-X6F7T0
Dear Ms Munro
CEO (Sarah Connery) on the Trust’s Executive Board also works/worked as a Specialist Advisor for CQC or The Director of Operations (Chris Higgins) who works/has worked as an Executive Reviewer for CQC
Thank you for your letter of 4 April.
When you mention “The Care Quality Commission” asked you to respond. Who might that be? Could that be either of two LPFT Board Executives mentioned above by any chance? To think, all this time so it would appear LPFT have been answering on behalf of the Care Quality Commission in a defensive, almost threatening manner. What a conflict of interest! No wonder why none of my complaints have been dealt with satisfactorily and with Mr Higgins as Executive Reviewer for CQC it is also no wonder why you are rated “good”.
How can you have a CEO (Sarah Connery) on the Trust’s Executive Board who also works/worked as a Specialist Advisor for CQC or The Director of Operations (Chris Higgins) who works/has worked as an Executive Reviewer for CQC however I am talking about LINCOLNSHIRE PARTNERSHIP TRUST WHO APPEAR TO HAVE THEIR OWN LAW TO SUIT THEMSELVES.
I would like your opinion on this conflict of interest, Ms Munro.
Regarding your third paragraph I would point out this was the third time Police were called unnecessarily, all done for the purpose of threatening and intimidation however Section 9 statements were done to back the truthfulness of events on Xmas Day to cover our backs. What a waste of Police time. It is obvious that the restrictions are still ongoing with HCA’s/nurses writing notes during visits (no doubt of an adverse nature). This is bullying to the extreme to stop visits and threaten to do so indefinitely but still continue with restrictions. You might like to write a statement t explaining exactly what you mean by “suspension in line with the MHA Code of Practice”: Please also explain why I am being treated differently to everyone else which is discrimination.
Here is the MHA Code of Practice relevant points which were not even quoted in full as a reason to ban my visits.
MHA CODE OF PRACTICE
Restrictions or Exclusion on Clinical Grounds
11.14
From time to time, a patient’s Responsible Clinician may decide, after assessment and discussion with the MDT, that some visits could be detrimental to the safety or wellbeing of the patient, the visitor, other patients or staff on the ward.
In these circumstances, the Responsible Clinician may make special arrangements for the visit, impose reasonable conditions or, if necessary, exclude the visitor. In any of these cases, the reasons for the restriction should be recorded and explained to the patient and the visitor, both orally and in writing (subject to the normal considerations of patient confidentiality). Wherever possible 24 hour notice should be given of this decision.
Restriction Or Exclusion on Security Grounds
11.15
The behaviour of a particular visitor may be disruptive in the past, to the degree that exclusion from the hospital is necessary as a last resort. Examples of such behaviour include:
- Incitement to abscond
- Smuggling of illicit drugs or alcohol into the hospital or unit
- Transfer of potential weapons
- Unacceptable aggression
- Attempts by members of the media to gain unauthorised access
11.16
A decision to exclude a visitor on the grounds of their behaviour should be fully documented and explained to the patient orally and in writing.
Where possible and appropriate the reason for the decision should be communicated to the person being excluded (subject to the normal considerations of patient confidentiality and any overriding security concerns.
LPFT ARE IN BREACH OF THE MHA CODE OF CONDUCT RE: THE FOLLOWING POINTS:
“may make special arrangements for the visit” : No special arrangements were ever made and contact severely restricted by taking the phone away that affected the entire family and was detrimental to Elizabeth – depriving her of her phone deprived her of contact with everyone else in the family and was done primarily to punish me and deprived Elizabeth of listening to her music. This is in breach of human rights and totally degrading and undignified to Elizabeth..
“the reasons for the restriction should be recorded and explained to the patient and the visitor, both orally and in writing”.: None of this was done properly explaining the grounds mentioned below for banning visitors. No Impact assessment carried out as should have been.
“subject to the normal considerations of patient confidentiality). Wherever possible 24 hour notice should be given of this decision” This was not done. The pre-arranged visit was cancelled on the spot whilst Elizabeth stood the other side of the door – absolutely degrading and totally cruelty to do this without any notice. Nursing staff acting ultra vires upon orders at Executive level and against their own code of conduct.
None of the above was done properly and also LPFT failed to carry out an Impact Assessment which LPFT is supposed to do under NHS Guidelines and this should have been done on myself, on Elizabeth and a copy sent to the Nearest Relative. LPFT are therefore in breach of NHS Guidelines. Here below in bold are the justified reasons to completely ban visitors according to MHA Code of Conduct.
- Incitement to abscond
- smuggling of illicit dugs or alcohol into the hospital or unit
- Transfer of potential weapons
- Unacceptable aggression
- Attempts by members of the media to gain unauthorised access
None of the above apply in my case.
Dr K cannot very well deny threatening me with an indefinite ban as this was witnessed. Having such a ban has had a detrimental affect on my health. Elizabeth’s face is covered in marks where she is distressed and has been self harming and has said on more than one occasion she no longer wishes to live which in turn affects my health. The missing of meals has continued beyond the last safeguarding and had happened constantly at Ash Villa in the past yet nothing was done. It is bullying to the extreme to ban visitors and that is the tactic that LPFT adopted. My visits were suspended on none of the grounds above. Elizabeth’s care and treatment has been atrocious. She has been missing meals, isolating in her room because she cannot stand the noise. She has been deprived of proper pathological tests and nothing has been arranged as regards Sheffield as I have checked. There is no way a MH team can do proper pathological observations and have been filming my daughter when she is having fits against her wishes. This is an absolute disgrace. The way the MCA has been abused is another disgrace on the part of LPFT who enlisted the assistance of the council in this respect at County Court that lasted months and months on end. Human rights are non existent under LPFT and have never taken into account of. My daughter’s human rights are being dreadfully abused. It is not true when you state visiting restrictions were lifted from 5 February 2024. Restrictions are very much ongoing and visits are not of quality time but intrusive and degrading due to constant supervision. I am being discriminated against because other family members do not have 2-1 restrictive visiting with members of staff writing notes. The restrictions still very much in place clearly have a detrimental affect on my daughter who is treated like a prisoner. She reacted on Xmas Day to staff taking notes constantly. Even on Xmas Day, human rights were ignored by LPFT. How would any of you like this kind of treatment? It is breach of Art 8, Art 5 and Art 3 HRA. Police time was wasted on Xmas Day and Elizabeth was thrown into seclusion and rapidly tranquilised when she became upset by a crowd of “professionals” waiting outside the visitor’s room who grabbed hold of her because she had shouted at the lady writing notes because it was totally distressing to her.
There have been two accidents apparently according to Elizabeth, one at Ash Villa and another on Castle Ward where she lost balance or hit her head badly. Why wasn’t anyone in the family notified?
Because we pay a phone bill each month and Elizabeth hardly gets any use of the phone it is only fair that LPFT compensates for this. The bill now stands at £60 for your information and I request settlement of this amount to Elizabeth as already advised. Every month she is restricted with her phone I am adding on to that bill. Also under Ash Villa the phone was taken away for weeks on end making it difficult for the entire family to get through and for Elizabeth to be able to speak to family members. The reason for this was because Elizabeth kept calling the Police in distress. It says so in file papers.
“Elizabeth’s phone continues to be kept securely by ward staff and Elizabeth is able to request use of her phone at any time.” That is in breach of human rights. Totally degrading treatment – shame on you LPFT! Is this care? or rather is it abuse of a vulnerable person and their rights – it should be the least restrictive care under the MH LPFT are abusing patient’s rights and if this is just my daughter then this would also come under the Equality Act 2010. No other patient is being treated in such a degrading manner as my daughter. It is not the point that she is encouraged to use her phone. She is not at risk from anyone in her family and therefore the restrictions are excessive and the kind of thing that would apply to a restricted prisoner not a patient under the MHA.
LPFT haven’t got a clue when it comes to human rights and this is why I am copying in the British Institute of Human Rights. To keep the phone locked away constantly is a disgrace and still ongoing to date. Elizabeth does not like the phone being monitored and she expressly said she did not want to be filmed so why has this just gone ahead?
You clearly do not know the meaning of “fair and reasonable” . Elizabeth is a grown adult of 37 years of age and does not need support to use her phone.
The Birthday cake was not given to Elizabeth on her Birthday and should have been given to her immediately as I specially came back to the ward. It was her Birthday and no respect was given to this special occasion. Elizabeth did not even know I had brought her the Birthday cake so once again there was no communication. At Ash Villa all her presents were just dumped in a storage room. She did not know they existed. I brought another cake to make up for this and again Elizabeth was not given it. The second time it was not fresh cream and I assume thrown away.
Yes, the visitors room is cramped when 2 people are listening to every word and crammed into the room. It is undignified and unpleasant to say the least. How can you possibly say the visitor’s room affords privacy in the circumstances. You just have no insight into the situation. The rooms are all small in nature – not much difference in size but because of the restricted visiting and note taking going on (no doubt adversely against me), it is an unpleasant degrading experience that even a prisoner does not have to endure. In a prison, warders walk up and down but give respect to prisoners at visiting times to have privacy to see their families. The ward is worse than prison and the treatment is degrading, abusive and aimed no doubt as punishment towards me, but inflicting upon my vulnerable daughter.
Subject Access Requests.
I know LPFT do not want me to see any records especially not the copy of the CP11 rapid tranquilisation log. All the files and notes being taken will be requested through ICO. You have no right to refuse such request from both of us.
Your capacity assessments are totally flawed. I want full safeguarding done externally because in the past safeguarding under LPFT resulted in “I am satisfied” response. The safeguarding should be especially looking into the flawed capacity assessments. I am now a BI assessor – everything LPFT has done is wrong. Your capacity assessments are not fit for purpose. LPFT have abused the MCA. It is most certainly of public interest that everything is addressed openly and transparently.
Finally, please ensure that my daughter gets all the pathological tests she needs under Sheffield as soon as possible as this is another area of safeguarding that needs to be thoroughly looked into. I believe safeguarding should be done on the deprival of medical referrals to my daughter for her physical health and referrals need to be made to spend a full week under Sheffield for everything she needs, including Endocrinology
I have to say, I have never encountered such bullying in all my life and such dishonesty. You have been rating yourselves as good yet there are tremendous conflicts of interest I have witnessed at Executive level.
The capacity assessments are useless without referral to Sheffield and according to Professor Keith Brown everyone should be included (including myself) with the capacity assessments undertaken. My daughter most certainly has capacity and she is being abused and no-one cares otherwise this situation would not have been left to continue for so very long.
Here are the guidelines to filming patients against their wishes:
Here below is the book you read on Mental Capacity that LPFT have chosen to ignore.
Demystifying Mental Capacity: A guide for health and …
Amazon UKhttps://www.amazon.co.uk › Demystifying-Mental-Cap…
Keith Brown. Editor. Demystifying Mental Capacity: A guide for health and social care professionals (Post-Qualifying Social Work Practice Series). First …
Mental Capacity Act 2005 :
(Section 4): Requires that patient to be regarded as having capacity until evidence ascertained as to how that capacity is impaired.
(Section 4) (1) (a) and (b): “The Prohibited Step” Decision maker should not draw conclusion on capacity from patient’s age, appearance or on a condition of his/hers or an aspect of behaviour which might lead others to make unjustified assumptions on what might be in his/her best interests.
(Section 4) (2): Decision maker should try to identify all issues most relevant to the individual relating to particular decision (para 3, Main Code of Practice).
(Section D): inconsistencies of witness statements on capacity. Capacity assessments not conducted as required by S1 MCA 2005
Masterman-Lister v Brutton & Co [2003] 1WLR 151
“a party to legal proceedings is capable of understanding, with the assistance of such proper explanation (in broad terms and simple language) from legal advisers and other experts as the case may require, the matters on which their consent or decision was likely to be necessary in the course of those proceedings.”
Dont bother providing a copy to the CQC as LPFT are the CQC defending yourselves and rating yourselves as good when in actual fact you should be rated as “Requires improvement” or “inadequate” and you can’t even offer an apology for the shocking abuse of my daughter and her family in terms of human rights which you clearly have no insight of.
My final question to you is have LPFT applied for DoLs and in the meantime waiting to hear from the court because your intention is to dump her into a care home out of area in say Yorkshire and restrict contact forever? Why is she still held without leave under the MHA for over 2.5 years deprived of family contact and proper physical healthcare? I would like to hear from any of you in this respect as this is absolute abuse and breach of the law and the question needs to be asked about the validity of the entire section that is ongoing and the dishonesty in arriving at such decisions to hold her a prisoner indefinitely. My daughter is one of thousands trapped under the MHA by appalling Trusts such as LPFT and dishonesty too on the part of Councils who do not wish to provide any support whatsoever in the community. In fact I was not asking for anything of this area which brings me to the question of residency status and whether that responsibility still remains the responsibility of Enfield?
Yours sincerely
Susan A Bevis
Psychiatric Abuse UK 