Date of Board meeting:27th July 2011

Title of report:Mental Health Act Managers’ Committee Annual Report

Title of director:Chair of Mental Health Managers’ Committee

Paper number:WL2109

For decision For discussion For information

Purpose of the report:

This is an Annual report on the work of the MHA Managers’ Committee setting out its terms of reference, hearing, visiting and training activities and delegation of duties under the Mental Health Act 1983.

Action required:

The Board is asked to ratify the list of MHA Managers wishing to continue in the role and note the activities undertaken and the delegation of duties under the Mental Health Act 1983

Summary of key issues

  • Increased hearing activity
  • Successful implementation of appraisal system
  • Improved training for the role

Relationship with the Assurance Framework (Risks, Controls, and Assurance):

Trust Objective: To provide a safe and effective service

Care Quality Commission Registration Regulations:

Outcome 4: - Care and welfare of people who use services

Summary of Financial and Legal Implications:

Increased MHA activity relating to increases in Community Treatment Orders will require a budgetary review.

Equality & Diversity and Public & Patient Involvement Implications:

This Committee is charged with activities that impact significantly in terms of promoting patients’ and carers’ rights.

WEST LONDON MENTAL HEALTH NHS TRUST

MENTAL HEALTH ACT MANAGERS’ ANNUAL REPORT

1 APRIL 2010 – 31 MARCH 2011

A REPORT FROM THE COMMITTEE CHAIRMAN

The Board is asked to note and endorse the current activity and training of MHA Managers and to ratify the continuing involvement of Managers listed at appendix 1.

1 INTRODUCTION

1.1 The Mental Health Act Managers’ Committee, is a sub-committee of the Trust Board and is chaired by Geoff Rose (since May 2011) and previously by Ann Chapman.

1.2The revised and updated terms of reference of the MHA Managers Committee (attached at appendix 2) require that an annual report is submitted to the Board. This paper provides a report on the work carried out by the MHA Managers during the financial year 2010/11.

1.3The revised terms of reference, previously approved by the Board require that one of the Managers shall be elected annually to act as Vice-Chair to the Managers’ Committee.

2 TERMS OF REFERENCE

2.1As the Committee’s terms of reference make clear, the primary work of this Committee is focused on the lawful detention of patients under the MHA 1983 (as amended by the Mental Health Act 2007). When the criteria for continuing detention are not met, or at their discretion, the Managers have powers to discharge patients from detention or compulsion under Supervised Community Treatment. Whilst MHA Managers must hold statutory reviews for unrestricted patients on renewal of detention or extension of a community treatment order as well as hearings on appeal, restricted patients may also request a review of detention although discharge can only be effected with the consent of the Secretary of State for Justice.

2.2Many of the duties of the MHA Managers are delegated to officers (staff) of the Trust. The revised scheme of delegation to officers of the Trust is attached at appendix 3.

3MEMBERSHIP OF THE COMMITTEE

3.1All Non-Executive Directors are members of the Committee. In practice, only two Non-Executive Directors regularly attend the quarterly meetings and actively participate in MHA Managers’ Panels.

3.2A number of lay MHA Managers are appointed by the Trust to fulfil the statutory duties of review of detention and compulsion in the community. Throughout 2010/11, there were 33 lay MHA Managers. Subject to appraisal, serving Managers are asked to confirm each year that they wish to continue in the coming year. 5 Managers have stepped down during the year.

3.3A recruitment exercise in early Autumn 2011 has been agreed by the Committee to replace those who have left the current cohort. This was originally 3, now likely to be 5 new Managers from a group of high calibre candidates who have expressed an interest during the year.

3.4A list of all 28 people wishing to continue to serve the Trust as lay MHA Managers in 2010/11 is attached at Appendix 1 and requires ratification by the Board.

4PERFORMANCE REVIEW FOR LAY MHA MANAGERS

4.1At the start of the current year, the Trust successfully implemented a formal performance review process for MHA Managers in accordance with the requirements of the revised terms of reference. In July 2010, the Board recognised this as a key target for the remainder of 2010/11 as the increasing complexity of the role and greater scrutiny of the conduct of, and decisions made at Managers’ hearings requires formal appraisal of each Manager’s contribution. Continuation in the role (other than for NEDs) is entirely subject to satisfactory performance review without exception. All those listed at Appendix 1 have been appraised by a panel of 2, in most cases, including a NED.

4.2The Committee has agreed to invite a number of very experienced Managers to contribute to performance review and observation of peers during the coming year.

5REMUNERATION OF LAY MHA MANAGERS & CURRENT BUDGET

5.1The allowance structure and travel expenses were reviewed and amended in January 2007. The lay Managers’ attendance allowance is £50.00 for a half day session and £100.00 for a whole day. Travel expenses are paid in line with Trust rates. Extra time is allowed within the session rate to read the hearing papers. This level of remuneration continues to compare favourably with other London Mental Health Trusts so it has not been uplifted.

5.2The Committee has recently decided to review and curb the maximum travel claim for Managers to the distance between TrustHQ & BroadmoorHospital. A number now live at significant distance from either or both sites.

5.3There are significant pressures on the current budget due to greatly increased hearing activity as well as ward visits and training events. The Board is asked to note the impact of significantly increased statutory activity.

6QUARTERLY MEETINGS

6.1Committee meetings are held quarterly. In the reporting period, meetings were held on: 27 May 2010 in Ealing, 9 September 2010 in BroadmoorHospital, 25 November 2010 and 24 February 2011 in Ealing and the meetings have all been well attended, providing training sessions in addition to the general discussion of Managers’ work and Trust activity.

7PATIENTS’ APPEALS & HEARINGS

7.1Appendix 4 provides a summary of hearings held in 2010/11. It should be noted that paper reviews are only held when the patient clearly states that they do not wish to contest their detention. Most paper reviews are held at BroadmoorHospital. The patient is visited on the ward by a MHA Manager before the review of detention takes place and the process is explained in some detail. The patient is given the opportunity to have a full hearing though this is sometimes declined, particularly when a Mental Health Review Tribunal is in progress.

7.2There has been a significant (anticipated) increase compared to the previous year’s activity. There has been a Trustwide increase of 24% compared to activity in 2009/10 most significantly in Hounslow and Ealing/WLFS.

7.3As noted in last year’s Annual Report, the impact of CTOs has been the main reason for the significant increase in hearings although completion of Korner KP90 returns for 2010/11 shows an upward trend in use of the Mental Health Act on previous year. Apart from a huge increase in recorded use of police powers under s136 across the three Boroughs, which may be partly due to underreporting in previous years, there has been a significant increase in detention under section 2 following admission.

7.4Although not directly affecting the role of members of this Committee, Trust staff have been affected by an approximate increase in Tribunal activity of approximately 20%. This has been reported in detail to the Trust’s Quality Committee. Of 869 listed hearings (i.e. date set), 474 took place across the Trust (100 in Broadmoor and 374 in London).

8TRAINING OF MENTAL HEALTH ACT MANAGERS

8.1Presentations were given on Quarterly Meeting days on the following topics:

  • 27 May 2010 An Introduction to Medication in Mental Health, Trudi Hilton, Chief Pharmacist, Productive Wards/Patient Experience Tracker, Una Kallis, Project Lead, Mental Capacity Act 2005, KevinTowers
  • 9 September 2010 Assessing Risk and understanding a risk assessment report, Dr Richard Church, Specialist Registrar
  • 25 November 2010 The Value of Psychological Care, Estelle Moore, Lead Psychologist, BroadmoorHospital
  • 24 February 2011 Advance Decisions and Advance Statements, KevinTowers

8.2A full-day training session ‘back to basics’ was agreed for the next financial year for all managers to be run twice to maximise attendance. These will be led by SheenaEbsworth & KevinTowers and will include role-play. These will compliment continuing presentations on Quarterly meeting dates.

8.3The Managers are regularly provided with legal briefings (e.g. the Capsticks Mental Health Law Newsletter) and details of relevant case law related to detention under the MHA. The Managers are kept informed of legal challenges or Judicial Review proceedings in relation to the Managers discharge powers, particularly those arising within the Trust.

9 MANAGERS’ VISITING ACTIVITY

9.1 MHA Managers began to undertake unannounced visits to wards in pairs from April 2010. They visited 41 wards between April 2010 & March 2011. Their visit schedule and emerging themes have been reported to the Trust’s Quality Committee.

10KEY DISCUSSION ITEMS

10.1The Managers have been provided with regular updates on progress of the Trust’s application for Foundation Trust (or FTe equivalent) status and key actions in the Care Quality Commission Action Plan.

10.2Other topics discussed during the year included training needs, recruitment and induction of new Managers as well as implementation of an appropriate appraisal programme. Additionally, there have been quarterly briefings on any significant new appointments and restructures.

11LONDON MHA NETWORK/LONDON MENTAL HEALTH LAW LEADS MEETING

11.1The Chairman of the Committee attends the quarterly meetings of the London MHA Network, a forum bringing together non-executive and executive managers having a leading role for MHA Managers within their Trusts, and sits on the Network’s steering group. The Trust’s two senior managers working in this area also attend these meetings when possible. Good practice across the London Mental Health Trusts is shared. This year there has been much discussion related to the processes used by Trusts for the recruitment, training and performance review of Managers, as well as the conduct of hearings. This work has been brought together in the form of a best practice guide for the use of the contributing Trusts. Further discussion has focussed on the impact on patient legal representation of changes to legal aid, the role of Independent Mental Health Advocates and the impact of Community Treatment Orders.

11.2Following the implementation of the Amended Mental Health Act, Quarterly meetings of the London Mental Health Law leads from NHS and Independent sectors have continued to address ongoing implementation issues and new initiatives. These are now facilitated on an Informal basis by the Trust hosting the London Mental Health Act Network. They provide a forum for discussion of technical issues ranging from Approved Clinician status, through to new absence without leave reporting mechanisms. The Head of Mental Health Law & Clinical Records (London sites) or Manager Mental Health Act & Health Records Office (Broadmoor) attends on behalf of the Trust.

11.3BroadmoorHospital agreed to facilitate both of the above meetings for the first quarter of the new financial year. This would include an opportunity for Non-Executive Directors and Managers of other London Hospitals to visit a high secure service.

12EXECUTIVE & ADMINISTRATIVE SUPPORT

12.1During the year, the Committee has been supported by the Executive Director of Nursing & Patient Experience, a Deputy Director of Nursing, Head of Mental Health Law & Clinical Records (London sites) and the Manager of the Mental Health Act & Health Records Office (Broadmoor) as well as Senior Mental Health Act Administrators. Where the Executive Director has been unable to attend, he is always represented by the Deputy Director of Nursing to ensure that opportunity continues for dialogue with Trust senior management.

12.2Both the Trust Chairman and Chief Executive have attended in the past and have committed to at least one of them attending a committee meeting during the coming year. Managers have fed back to the Committee Chairman that they welcome their periodic attendance and noted a positive contrast over previous years.

12.3Due to changes in reporting in London sites, administrative support for the Committee is under review.

13RECOMMENDATIONS

13.1The Board is asked to:

(i) note and endorse the current activity and training of MHA Managers, and

(ii) ratify the continuing involvement of Managers listed at appendix 1.

Geoff Rose

Non-Executive Director

Chair of Mental Health Act Managers’ Committee

July 2011

Appendix 1

West London Mental Health NHS Trust

List of Managers willing to undertake the role of MHA Manager for the year 2011/2012

Mrs Mary Ballin

Mr Glen Barnham

Mr Peter Benmax

Mr Robert Boles

Mrs Julia Bowen

Mr Gordon Burlinson

Mr Richard Collins

Mr Michael Coombe

Mrs Robin Fleming

Mrs Sally Friend

Mr Alex Gerlis

Ms Emma Hormoz

Mrs Rebecca Jones

Ms Eve Kontos

Mr Michael Lewis

Mrs Satinder Maan

Dr Barrie Mair

Mrs Ann Martin

Mrs Susan Nath

Mrs Denise Newlands

Mr Anthony Pearson

Mr David Rawley

Mrs Deirdre Seachoy

Mr John Starmer

Mrs Betty Sutton

Mrs Mercy Umeh

Mr Robin Webster

Mrs Patricia Wilbourn

Ex officio Managers:

All Non-Executive Directors of WLMHT

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