Queens Speech Oct 2019

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My Government will bring forward proposals to reform adult social care in England to ensure dignity in old age. My Ministers will continue work to reform the Mental Health Act to improve respect for, and care of, those receiving treatment“.

Even if the Government is able to get this through Parliament approval – what does it mean.We keep waiting!!

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World Mental Health Day

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Listening is one of our most important senses…

….the World Health Organisation recognises World Mental Health Day on 10 October every year. This year’s theme set by the World Federation for Mental Health is suicide prevention.



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What is CRITERIA FOR DETENTION when considering a Community Treatment Order?

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The responsible clinician (RC) may not make a community treatment order unless—

(a) in the RC’s opinion, the relevant criteria are met; and
(b) an approved mental health professional states in writing—
(i) that he agrees with that opinion; and
(ii) that it is appropriate to make the order.

 The relevant criteria are

(a) the patient is suffering from mental disorder of a nature or degree which makes it appropriate for that person to receive medical treatment;
(b) it is necessary for that person’s health or safety or for the protection of other persons that he should receive such treatment;
(c) subject to that person being liable to be recalled as mentioned in paragraph (d) below, such treatment can be provided without them continuing to be detained in a hospital;
(d) it is necessary that the responsible clinician should be able to exercise the power under section 17 E(1)  to recall the patient to hospital; and
(e) appropriate medical treatment is available for that patient.


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Section 17 Leave

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Section 17 leave is the power of a patient’s responsible clinician to grant, detained patients, leave from the hospital. A detained patient is only allowed to leave the hospital with this leave in place.A patient granted leave under Section 17 remains “liable to be detained” under the Act and is, therefore, subject to the same consent to treatment provision as if they were still in hospital.It is immaterial if the patient is escorted by hospital staff, whether the excursion is part of a specified treatment plan or even as a result of an emergency, without the consent of the RC, or with the authority of the Secretary of State for Justice if the patient is subject to restrictions, the leave is invalid and a breach of the law.Section 17 concerns leave of absence from hospital. This is the hospital which is named in the application or order which provides authority for the patient’s detention.

Leave of absence can be granted to any patient detained under sections 2, 3, and 37 of the Mental Health Act 1983. It is not legally possible to do so where a patient is subject to sections 4, 5(2), 5(4), 135 and 136.Patients detained under Sections 35, 36 and 38 cannot be granted leave of absence.Patients who are subject to a restriction order under Sections 41 or 49 cannot be granted leave of absence without the permission of the Secretary of State for Justice.

The authority for granting Section 17 leave cannot be delegated, so RC cannot delegate the task to a junior. Where the RC is on annual leave or otherwise unavailable, permission can only be granted by the approved clinician who is for the time being in charge of the patient’s treatment and who is, therefore, temporarily acting as the patient’s RC.

Section 17 leave should not be confused with discharging a patient subject to a Community Treatment Order (CTO) which is granted under section 17A of the Mental Health Act.  Section 17 leave may be used to grant shorter periods of leave from hospital in the build up to discharging patients on to a CTO, but they are distinct legal concepts.

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St Nicholas Gosforth

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The City of Newcastle upon Tyne and its’ neighbours at Durham, Northumberland, Cumberland and Westmorland were all authorities which were slow to respond to the 1845 Lunacy and County Asylums Acts which had obliged them to provide lunatic asylums. Until the new asylum was opened, Newcastle had utilised a number of private asylums in the Gateshead, Co. Durham area.The new asylum site was chosen in 1865.The asylum was designated as the County of Northumberland War Hospital by the military in 1914 and in addition to the medical and surgical cases accepted, 100 beds were also set aside for mental health patients. With the return of the civilian population the opportunity was taken to rename the asylum, which became the Newcastle upon Tyne City Mental Hospital.In line with surrounding authorities and the Mental Deficiency Act of 1913 the Newcastle Corporation purchased a site at Shotley Bridge in order to provide facilities for so called mentally defective persons. Shotley Bridge was evacuated at the start of the 1939 War to serve as an Emergency Medical Services Hospital. After the War, the creation of the National Health Service 1948 meant the transfer of the Newcastle upon Tyne City Mental Hospital to the newly formed Newcastle Regional Hospital Board. The new management resulted in a change of name to the St. Nicholas Hospital.

As the Government’s policy of winding down large mental hospitals continued into the 1980’s the former female wing, previously the original asylum was gradually vacated and patients were concentrated into the 1890’s extensions. The chapel was destroyed by fire in 1986 and subsequently demolished, part of its’ site being developed in 1994 as the Ashgrove Nursing Home. The hospital continues to operate from the refurbished former male wing and a number of newer detached units in the grounds. The majority of the hospital grounds south of the main buildings are occupied by housing development.


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The National Health Service Act 1946 (c 81) came into effect on 5 July 1948 and created the National Health Service in England and Wales. Though the title ‘National Health Service’ implies a single health service for the United Kingdom, in reality one NHS was created for England and Wales accountable to the Secretary of State for Healt, with a separate NHS created for Scotland accountable to the Secretary of State for Scotland by the passage of the National Health Service (Scotland) Act 1947. Similar health services in Northern Ireland were created by the Northern Ireland Parliament through the Health Services Act (Northern Ireland) 1948.The whole Act was replaced by the National Health Service Act 1977, which itself is now superseded by the National Health Service Act 2006 and the Health and Social Care Act 2012.

This piece of legislation was far ahead of its time. Slowly it appears to be under constant threat. Why is it that it is admired by the whole world, and the ordinary members of the public in the UK, but somehow demonised by our own Government. We should all remember the brave politicians who fought to get this legislation on the statute books in the first place. Do we really want a system where people with mental health issues are admitted quite unnecessarily just so that the hospital can benefit from exorbitant fees?

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Independent Review =are we moving forward on implementation?

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Following the final report of the Independent Review of the Mental Health Act 1983 last year the government has, so far, accepted two of its recommendations:

  • to replace the nearest relative role, in which a patient is allocated a relative to be involved in decisions about their care, with that of a nominated person that they would choose;
  • to allow people to make statutory advance choice documents setting out their preferences for inpatient treatment, which clinicians must honour unless there are compelling reasons not to.

Ministers accepted two of its 154 recommendations straight away and promised to respond more fully in the New Year. In June of this year, it promised a white paper before the end of 2019 setting out its plans for legislation.However, as a new act was an idea strongly associated with Theresa May, it is unclear whether the plan will survive now that there is a new prime minister.

AMHPs (approved mental health professionals), the vast majority of whom are social workers, have a critical role under the existing Mental Health Act, co-ordinating assessments for admission to hospital or for community treatment orders, and ensuring that safeguards for people’s rights are upheld, including that restrictions on them are minimised.

The inquiry report said that the role required practitioners to have the “time to make the appropriate, least restrictive decision for an individual; time to get to know them, to explain their options to them, to talk to family members and to come to a collaborative decision”.

There are an estimated 3,900 AMHPs practising in England, according to a Skills for Care briefing issued last year.However, the Association of Directors of Adult Social Services reported, also last year, that ratios of AMHPs to population  – 1:16,000 in November 2017 – were much lower than previous recommendations set out in 1991 (1:7,600 for inner city areas and 1:11,800 for other areas).The inquiry said the situation meant that the existing statutory provisions needed to be strengthened to require a statutory minimum number of AMHPs per head of population.

“The introduction of ratios with statutory force would support local authorities in gaining resources to meet need and ensure provision of more rights protective and consistent service. It would assist in workload management and staff recruitment and retention. It would also help to underpin successful partnership with NHS colleagues and organisations.”

The UK Social Workers: Working Conditions and Wellbeing research, co-commissioned by Social Workers Union (SWU) and the British Association of Social Workers (BASW) found that almost two-thirds (61%) of social work practitioners and managers surveyed were looking to leave their current position in the next 16 months. This compared to 52% in last year’s study. We seem to be in a state of paralysis watching all this happen whilst politicians generally seem to be so heavily involved in the Brexit process that they appear unable to appreciate the enormity of the problems facing everyday members of the public. When they wake from this slumber it may all  be too late!!

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