West London Mental Health Trust Report for the period October 2007 - October 2008 Prepared by:

1. Mental Health Act Commission West London Mental Health Trust Report for the period October 2007 - October 2008 Prepared by: Simon Armson – Area Commissioner Presented by: Steve Klein – Regional Director

2. MHAC in West London Mental Health Trust • Area Commissioner: Simon Armson • Local Commissioners: Kuruvilla Punnamkuzhy Jane Barnes (part year) Louize Collins* Norman Hamilton* Steven Richards* (part year) Margaret Wall* (part year) • Regional Director: Steve Klein * Also working in other parts of NW London SHA

3. MHAC activity in 2007/08 • During the period October 2007 - October 2008, the Commission has: • made 67 formal visits to WLMHT which have included • Interviews with 321 patients patients • Visits to 54 wards together with Education Department, Sports & Leisure Services, Workshops, Kitchen Gardens, Patients’ Shop &c • Inspection of the records of 290 patients • Meetings with a wide range of individual clinicians, heads of departments and senior managers

4. MHAC activity in 2007/08 [cont] • In addition during this period the Area Commissioner has: • Attended meetings of SMARG at Broadmoor Hospital • Attended meetings of the Suicide Reduction and Serious Incident Monitoring Group • Attended meetings of the Broadmoor Hospital Development Stakeholder Group • Attended meetings of the Incident Monitoring and Review Group • Attended meetings of the Local and Forensic Clinical Governance Executives • Taken part in clinical review meetings for certain specific patients

5. General Themes There have been a number of general themes to emerge from the Commission’s report: • The continuing need to ensure that meaningful, quantifiable, time specific and delivered responses are provided to Commission visits and reports following death reviews. • The need to take particular care over preventing unlawful treatment in relation to consent issues. • The need to ensure that lessons learned from Serious Untoward Incident (SUI) and Critical Instance Review (CIR) reports and to identify and address any underlying themes or issues. • The need to give further consideration to the issue of patients’ access to electronic equipment. • The need to continue to pay attention to improving the cleanliness of patient accommodation. • The ongoing need to manage bed allocation and to prevent distress to patients caused by over occupancy.

6. Main findings The main findings of the Report include the following: • The impact of the changed regime in the Paddock Centre at Broadmoor Hospital • The impact of staffing shortages on the full implementation of s.17 leave entitlements • Consent to treatment [s.58] • Unlawful medication • The need to ensure that patients are properly advised of the outcome of second opinion consultations • Proper determination of capacity • The use of s.62 • The need for a smooth changeover to new documentation necessitated by the revised legislation • The need to prevent the coercion of patients to accept with medication

7. Main findings [cont] • Patients’ rights [s.132] • The need to advise patients of their rights in a timely and appropriate manner • The need to be aware of, and work to, the provisions contained with the new Code of Practice in relation to s.132 • The continuing need to communicate fully the changes in the law to patients: MCA 2005 and MHA 2007 • Care Programme Approach [s.117] • Tailored to suit individual needs of the patient • Full engagement of clinical team (including care managers) in CPA process

8. Main findings [cont] • Seclusion and safety • The need for seclusion only to be used as a last resort • The need to attend to the personal needs of patients whilst in seclusion • The need to attend to the challenge that ‘siesta’ period at the Paddock Centre equates to seclusion • Bullying • Cleanliness of patient accommodation • Bed occupancy • Smoking and the implementation of the Trust wide ban • Staff/patient interaction • The need to pay special attention to the findings of SUI &CIR reports, especially as they relate to patient safety and any implication of inappropriate staff behaviour

9. Main findings [cont] • Concern over catering arrangements • Deaths of detained patients • The need for timely action following the death of a patient especially in relation to appropriate liaison with bereaved relatives • The need to pay attention to reports from the Commission following a review of the death of a detained patient and to respond promptly to recommendations made • The need to be responsive to the therapeutic benefits to be gained by adopting a more imaginative approach to allowing patients access to certain electronic equipment

10. Looking ahead • During the forthcoming year the Mental Health Act Commission will join with the Healthcare Commission and the Commission for Social Care Inspection to form the Care Quality Commission. However… • ‘Business as usual’ • A smooth transition • Greater powers • A more ‘joined up’ approach to regulation and inspection • A desire to continue to work collaboratively with the Trust towards the fulfilment of the shared objective of enhancing patient care

11. In Conclusion • The Commission has been able to fulfil its statutory function and where necessary to identify concerns against the background of mutual respect between Commissioners and the Trust’s senior staff which has been almost invariably reflected at ward and unit level. • The Area Commissioner (in absentia) wishes to record his gratitude to the Trust for the constructive and collaborative relationship that has been the hallmark of the work that the Commission has undertaken with the Trust.

12. Mental Health Act Commission “Safeguarding the interests of all people detained under the Mental Health Act”