Guidance

Delays in Mental Health Casework decisions - update 29 January

Published 6 February 2018

1. Recovery plan

The recovery plan continues to ensure that the most critical decisions are made without delay. “Critical” decisions are those where delay could mean that a patient’s life or safety is at risk, or where the lives and safety of others could be at risk (for example prison transfers, remissions, recall decisions and urgent medical leave). Compassionate leave requests are also treated as critical.

Transfers between hospitals are now being dealt with alongside “critical” and all other types of work, meaning that community leave decisions are now the only decisions facing delays. We continue to fast track level transfers and medical leave.

MHCS is now in a better position, having filled some of its vacancies on a permanent basis and having engaged more agency staff. In consultation with NHS England, priority in the backlog (i.e. outside of critical cases) has been given to inter-hospital transfers, with the result that there is now effectively no backlog with respect to those decisions. Exceptionally, MHCS has been authorised to recruit temporarily above our approved staffing levels in order to eradicate the remaining backlog of community leave decisions at the earliest opportunity. As a result, we have now been able to create a temporary task force to focus on leave decisions, supported by administrators.

We cannot yet be confident about projecting a date by which the MHCS backlog of decisions relating to detained patients will be eradicated, but our current best estimate is the end of May 2018. This date is based on previous experiences of lead-in times to recruit and deploy agency staff, as well as the anticipated arrival of new permanent staff to fill vacancies. The task force focusing on leave decisions commenced on 8 January 2018 and we are carefully monitoring its progress.

2. Leave task force

As set out above, a leave task force has been in place since 8 January 2018. This taskforce is comprised of at least ten case workers and one senior manager, supported by administrators. The taskforce is tackling leave applications in chronological order of the date of receipt, while also considering requests for expedition in exceptional circumstances. Case workers on the taskforce are not responsible for any other work and telephones are being diverted to other numbers.

Clinicians may find that the work of the task force means that they are being asked for updates on patients, or for further information on applications that they made some time ago. I understand that it may be frustrating when further information is sought some time after the initial application, but we do have to ensure we have full and up to date information before we can make decisions on behalf of the Secretary of State. If there was insufficient information to come to a decision in the original application, it may be that further questions need to be asked. Clinicians are invited to confirm [by email to the relevant casework team address] that there have been no adverse developments in cases where they submitted a leave application prior to 1 December 2017, as this may help avoid some of the calls and enquiries we have been making.

3. Requests to prioritise/expedite decisions

As it will still take some time before we are able to eradicate the backlog of leave applications, the process to request expedition in exceptional circumstances continues. In order to make such an application, please write to the relevant MHCS casework team, setting out why you consider the decision should be expedited. For ease of reference, I repeat the examples below where exceptional circumstances might exist:

Exceptional circumstances to expedite an overnight leave request might include where a s47 patient has been deemed suitable for discharge by the Tribunal, but his Parole Board review has been adjourned to enable him to be tested on overnight leave and the Parole Board hearing is forthcoming. In hospital transfer cases, if the delay in transfer is causing a chain of patients to be delayed (for example where a transfer down from medium secure means that a prisoner awaiting transfer from prison can be moved), then this might constitute exceptional circumstances for expedition.

Applications to expedite can be considered from any interested party (for example clinicians, patients, patients’ families, legal representatives, MH advocates).

4. Medical leave – high and medium secure hospitals

In December, we wrote to the three high secure hospitals providing responsible clinicians with general consent to exercise their power to grant leave for medical treatment leave for most patients. This was done in order to reduce any delay in considering such applications and to enable more staff to focus on community leave applications.

Please note that this general consent to medical leave applies to patients on trial leave to medium secure units (as the authorisation lies with the responsible clinician at the high secure hospital).

As there are a number of medium secure units and the ability of staff in these units to use or carry handcuffs varies, rather than providing a similar general consent to all medium secure units, the Secretary of State invites each MSU to write to MHCS seeking general consent. MHCS will then be able to ascertain what that particular unit would be seeking as minimum escorting and security arrangements and consider the request accordingly. If any MSU wishes to apply for a similar general consent to allow medical leave, then they should write to MHCSqacs@noms.gsi.gov.uk

Further updates will be provided via https://www.gov.uk/government/collections/mentally-disordered-offenders.

5. Future plans

Flowing from the experience of the backlog, we are also reviewing our permanent and settled staffing position, in order to consider whether we might need more resources for the future, having regard to the significant financial challenges which face many public bodies.