This seminar covered delayed transfers of care from hospital, a Mental Capacity Act/DoLS landscape update and claims arising from Human Rights Act 1998.
This seminar covered delayed transfers of care from hospital, a Mental Capacity Act/DoLS landscape update and claims arising from Human Rights Act 1998.
Shari McDaid - The Mental Health Act 2001: Issues from a Coalition PerspectiveDarius Whelan
Dr Shari McDaid - The Mental Health Act 2001: Issues from a Coalition Perspective
Dr Shari McDaid is the Director of Mental Health Reform.
Presented at Mental Health Law Conference 2015 - Centre for Criminal Justice & Human Rights, School of Law, University College Cork and Irish Mental Health Lawyers Association.
25 April 2015
http://www.imhla.ie
#mhlaw2015
Maria Morgan: The Mental Health Act 2001 from a Clinician's PerspectiveDarius Whelan
Dr Maria Morgan, Consultant Psychiatrist
The Mental Health Act 2001 from a Clinician's Perspective
Presented at Mental Health Law Conference 2015 - Centre for Criminal Justice & Human Rights, School of Law, University College Cork and Irish Mental Health Lawyers Association
25 April 2015
http://www.imhla.ie
#mhlaw2015
The document discusses advance care planning, lasting power of attorney, and advance medical directives. It provides information on:
- What advance care planning involves and its benefits in reducing crisis decision-making.
- The process of completing a lasting power of attorney, including appointing a donee to make decisions on one's behalf if mental capacity is lost.
- What an advance medical directive is and the process of completing one to inform doctors of wishes regarding life-sustaining treatment for a terminal illness.
- Challenges that can arise with implementation of these plans in real clinical situations.
Mental Health Act 2001: Involuntary, Intermediate and Voluntary Categories: t...Darius Whelan
This document summarizes the changing landscape of involuntary, intermediate, and voluntary categories under mental health law. It discusses legal cases that established definitions and protections. Key changes proposed in an expert report include adopting a rights-based approach, new detention criteria focusing on treatment benefit, and categories for those with/without capacity to consent to admission. Involuntary patients would be detained while intermediate patients lack capacity but do not meet detention criteria. The report recommends support for decision-making and oversight of re-grading or overriding treatment refusal.
Debbie Lombardi Hill presented information on recent CMS rule changes and their implications. Key points included:
1) CMS is proposing to remove certain stroke quality measures for FY2018 and include stroke in bundled payments and hospital readmission reduction programs.
2) The two-midnight rule for inpatient vs. observation status remains, requiring physicians to determine whether a patient's expected length of stay will cross two midnights.
3) Hospitals are focusing internally on documenting and auditing physician decisions to ensure compliance with the two-midnight rule.
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
- Acute liaison services provide mental health support to patients in acute hospital settings like emergency departments and inpatient wards. They address the high rates of undiagnosed and untreated mental illness in these physical health settings.
- Mental and physical health are closely linked, and acute liaison services help integrate treatment by detecting and treating co-occurring conditions. This can improve outcomes, reduce costs from shorter hospital stays, and support the quality and productivity goals of the NHS.
- Current provision of acute liaison services varies greatly across the country. Services are often commissioned separately from acute hospital care despite the benefits they provide within physical health settings. Most services provide assessment, brief intervention, and referral but capacity is
Dr Derek Thompson: Building a caring futureNuffield Trust
In this slideshow, Dr Derek Thompson, GP and Medical Director at Northumbria Healthcare Foundation Trust, on reducing the length of hospital stay and building a caring future.
Dr Thompson spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
This seminar covered delayed transfers of care from hospital, a Mental Capacity Act/DoLS landscape update and claims arising from Human Rights Act 1998.
Shari McDaid - The Mental Health Act 2001: Issues from a Coalition PerspectiveDarius Whelan
Dr Shari McDaid - The Mental Health Act 2001: Issues from a Coalition Perspective
Dr Shari McDaid is the Director of Mental Health Reform.
Presented at Mental Health Law Conference 2015 - Centre for Criminal Justice & Human Rights, School of Law, University College Cork and Irish Mental Health Lawyers Association.
25 April 2015
http://www.imhla.ie
#mhlaw2015
Maria Morgan: The Mental Health Act 2001 from a Clinician's PerspectiveDarius Whelan
Dr Maria Morgan, Consultant Psychiatrist
The Mental Health Act 2001 from a Clinician's Perspective
Presented at Mental Health Law Conference 2015 - Centre for Criminal Justice & Human Rights, School of Law, University College Cork and Irish Mental Health Lawyers Association
25 April 2015
http://www.imhla.ie
#mhlaw2015
The document discusses advance care planning, lasting power of attorney, and advance medical directives. It provides information on:
- What advance care planning involves and its benefits in reducing crisis decision-making.
- The process of completing a lasting power of attorney, including appointing a donee to make decisions on one's behalf if mental capacity is lost.
- What an advance medical directive is and the process of completing one to inform doctors of wishes regarding life-sustaining treatment for a terminal illness.
- Challenges that can arise with implementation of these plans in real clinical situations.
Mental Health Act 2001: Involuntary, Intermediate and Voluntary Categories: t...Darius Whelan
This document summarizes the changing landscape of involuntary, intermediate, and voluntary categories under mental health law. It discusses legal cases that established definitions and protections. Key changes proposed in an expert report include adopting a rights-based approach, new detention criteria focusing on treatment benefit, and categories for those with/without capacity to consent to admission. Involuntary patients would be detained while intermediate patients lack capacity but do not meet detention criteria. The report recommends support for decision-making and oversight of re-grading or overriding treatment refusal.
Debbie Lombardi Hill presented information on recent CMS rule changes and their implications. Key points included:
1) CMS is proposing to remove certain stroke quality measures for FY2018 and include stroke in bundled payments and hospital readmission reduction programs.
2) The two-midnight rule for inpatient vs. observation status remains, requiring physicians to determine whether a patient's expected length of stay will cross two midnights.
3) Hospitals are focusing internally on documenting and auditing physician decisions to ensure compliance with the two-midnight rule.
Guidance for commissioners of liaison mental health services to acute hospitalsJCP MH
- Acute liaison services provide mental health support to patients in acute hospital settings like emergency departments and inpatient wards. They address the high rates of undiagnosed and untreated mental illness in these physical health settings.
- Mental and physical health are closely linked, and acute liaison services help integrate treatment by detecting and treating co-occurring conditions. This can improve outcomes, reduce costs from shorter hospital stays, and support the quality and productivity goals of the NHS.
- Current provision of acute liaison services varies greatly across the country. Services are often commissioned separately from acute hospital care despite the benefits they provide within physical health settings. Most services provide assessment, brief intervention, and referral but capacity is
Dr Derek Thompson: Building a caring futureNuffield Trust
In this slideshow, Dr Derek Thompson, GP and Medical Director at Northumbria Healthcare Foundation Trust, on reducing the length of hospital stay and building a caring future.
Dr Thompson spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
This document summarizes the annual meeting of Healthwatch Stoke-on-Trent from 2017-2018. It includes welcome remarks, a presentation on transforming health and wellbeing in the area, and an annual report. Key highlights from the past year are noted, including work on drug and alcohol services, audiology, and homeless access to GPs. Priorities for 2018-2019 include community hospitals, the sustainability transformation partnership, and mental health. A case study on the rollout of care navigation is presented, along with volunteer activities over the year. Attendees are encouraged to get involved in future engagement activities.
This document discusses the admission and discharge of mentally ill patients. It defines admission as allowing a patient to stay in the hospital for care and discharge as releasing a patient. Admission can be voluntary if requested by the patient or guardian, or involuntary if requested by others against the patient's will. Discharge includes releasing patients admitted voluntarily based on doctor approval, releasing involuntary patients to caregivers with bonds, and releasing prisoners based on fitness for trial. The roles of nurses include intake assessments, discharge planning, and ensuring legal and ethical standards are followed.
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements for the services. This preventive care coverage requirement, which generally took effect for plan years beginning on or after Sept. 23, 2010, does not apply to grandfathered health plans.
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
The document describes efforts to improve psychosis care through the Treatment and Recovery In PsycHosis (TRIumPH) program. The key points are:
1) A working group was established between Southern Health NHS Foundation Trust and Wessex Academic Health Science Network to improve assessment and treatment for people experiencing psychosis based on understanding gaps in existing care.
2) The program developed and implemented a standardized care pathway across four Early Intervention in Psychosis teams, improving access to assessment and treatment.
3) Feedback from service users, carers, and clinicians informed the work, which aimed to provide more compassionate, holistic, and recovery-focused care.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
This document discusses optimizing patient flow through emergency care by segmenting patients into categories based on length of stay and clinical needs. It advocates using expected date of discharge and clinical criteria for discharge as goals to coordinate care and discharge planning. Key steps include allocating patients early to specialty teams, standardizing care pathways, minimizing handovers, and conducting daily board rounds to focus on constraints and moving patients smoothly through their care. The overall aim is to get patients home safely and faster while improving outcomes.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
Browne Jacobson - Elderly Care Conference 2016 - Workshop Stream A, Capacity ...Browne Jacobson LLP
Britain's ageing population has created distinct legal issues and liabilities. This annual conference brings together leading experts to discuss and explain:
• inquests and serious investigations
• mental capacity and decision making
• medical treatment; and
• the role of the commissioner/provider in an integrated care environment.
These issues, and more, are covered in streamed workshops and plenary sessions by leaders within Care England, Candesic, NHS Litigation Authority as well as Senior Coroner for the City of Birmingham and Solihull Districts, specialist barristers and experts from Browne Jacobson.
Aimed at senior management from across the NHS, local authorities and the private health and social care sector, this one day national conference helps you to understand and plan for the increasing legal risks associated with an ageing population, and how you can protect yourself, your organisation and your service users.
https://www.brownejacobson.com/health/services/elderly-care
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of mental health services for people with learning...JCP MH
This guide is about the commissioning of mental health services for people with learning disabilities, enabling them to live full and rewarding lives as part of their local communities.
This guide is aimed at all commissioners responsible for mental health services for people with learning disabilities including young people in transition to adulthood. The guide will also be helpful for providers of mental health services and for family carers.
This guide describes what we know about mental health services for adults with learning disabilities, and what effective and accessible services look like based on current policy, the law and best practice.
While this guide does make reference to autistic spectrum disorders and ‘behaviours that challenge’ (which people with learning disabilities who have mental health problems may also experience), the primary focus of this guide is on people with learning disabilities who have mental health problems.
This document discusses advance healthcare directives (AHDs) in Ireland. It notes that only 6% of people in Ireland have written an AHD. It defines AHDs as documents where a person can write down medical treatments they do not want if they lose decision-making capacity. For an AHD to be legally binding, the person must have had capacity when writing it and it must apply to their current medical situation. The document outlines the requirements for making a valid AHD in Ireland and implications for healthcare professionals, including that they have no liability for complying with a valid AHD or not complying if there are doubts about its validity.
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Guidance for commissioners of perinatal mental health servicesJCP MH
This document provides guidance for commissioners on perinatal mental health services. It discusses:
1) The importance of perinatal mental health services for both mothers and infants, covering prevention, detection and management of mental health problems during pregnancy and the postpartum period.
2) What constitutes good perinatal mental health services, including specialized inpatient mother and baby units, outpatient perinatal mental health teams, and ensuring access to care across settings from primary to specialized care.
3) Key recommendations for commissioners around ensuring regional strategies, pathways for care, training, data collection, and collaboration across maternity, adult mental health, pediatric and primary care services to meet the mental health needs of
Guidance for commissioners of community specialist mental health servicesJCP MH
This guide is about the commissioning of specialist community mental health services. It explores the role of Community Mental Health Teams (CMHTs), Assertive Outreach Teams and Early Intervention Teams among others.
East Midlands corporate governance network, February 2017, NottinghamBrowne Jacobson LLP
This seminar covered the new Integrated Support and Assurance Process, a background into the General Data Protection Regulation requirements coming into force on 1 April 2018, and the implications of Brexit on the NHS.
This seminar covered delayed transfers of care from hospital, a Mental Capacity Act/DoLS landscape update and claims arising from Human Rights Act 1998.
This document summarizes the annual meeting of Healthwatch Stoke-on-Trent from 2017-2018. It includes welcome remarks, a presentation on transforming health and wellbeing in the area, and an annual report. Key highlights from the past year are noted, including work on drug and alcohol services, audiology, and homeless access to GPs. Priorities for 2018-2019 include community hospitals, the sustainability transformation partnership, and mental health. A case study on the rollout of care navigation is presented, along with volunteer activities over the year. Attendees are encouraged to get involved in future engagement activities.
This document discusses the admission and discharge of mentally ill patients. It defines admission as allowing a patient to stay in the hospital for care and discharge as releasing a patient. Admission can be voluntary if requested by the patient or guardian, or involuntary if requested by others against the patient's will. Discharge includes releasing patients admitted voluntarily based on doctor approval, releasing involuntary patients to caregivers with bonds, and releasing prisoners based on fitness for trial. The roles of nurses include intake assessments, discharge planning, and ensuring legal and ethical standards are followed.
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements for the services. This preventive care coverage requirement, which generally took effect for plan years beginning on or after Sept. 23, 2010, does not apply to grandfathered health plans.
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
The document describes efforts to improve psychosis care through the Treatment and Recovery In PsycHosis (TRIumPH) program. The key points are:
1) A working group was established between Southern Health NHS Foundation Trust and Wessex Academic Health Science Network to improve assessment and treatment for people experiencing psychosis based on understanding gaps in existing care.
2) The program developed and implemented a standardized care pathway across four Early Intervention in Psychosis teams, improving access to assessment and treatment.
3) Feedback from service users, carers, and clinicians informed the work, which aimed to provide more compassionate, holistic, and recovery-focused care.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
This document discusses optimizing patient flow through emergency care by segmenting patients into categories based on length of stay and clinical needs. It advocates using expected date of discharge and clinical criteria for discharge as goals to coordinate care and discharge planning. Key steps include allocating patients early to specialty teams, standardizing care pathways, minimizing handovers, and conducting daily board rounds to focus on constraints and moving patients smoothly through their care. The overall aim is to get patients home safely and faster while improving outcomes.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
Browne Jacobson - Elderly Care Conference 2016 - Workshop Stream A, Capacity ...Browne Jacobson LLP
Britain's ageing population has created distinct legal issues and liabilities. This annual conference brings together leading experts to discuss and explain:
• inquests and serious investigations
• mental capacity and decision making
• medical treatment; and
• the role of the commissioner/provider in an integrated care environment.
These issues, and more, are covered in streamed workshops and plenary sessions by leaders within Care England, Candesic, NHS Litigation Authority as well as Senior Coroner for the City of Birmingham and Solihull Districts, specialist barristers and experts from Browne Jacobson.
Aimed at senior management from across the NHS, local authorities and the private health and social care sector, this one day national conference helps you to understand and plan for the increasing legal risks associated with an ageing population, and how you can protect yourself, your organisation and your service users.
https://www.brownejacobson.com/health/services/elderly-care
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of mental health services for people with learning...JCP MH
This guide is about the commissioning of mental health services for people with learning disabilities, enabling them to live full and rewarding lives as part of their local communities.
This guide is aimed at all commissioners responsible for mental health services for people with learning disabilities including young people in transition to adulthood. The guide will also be helpful for providers of mental health services and for family carers.
This guide describes what we know about mental health services for adults with learning disabilities, and what effective and accessible services look like based on current policy, the law and best practice.
While this guide does make reference to autistic spectrum disorders and ‘behaviours that challenge’ (which people with learning disabilities who have mental health problems may also experience), the primary focus of this guide is on people with learning disabilities who have mental health problems.
This document discusses advance healthcare directives (AHDs) in Ireland. It notes that only 6% of people in Ireland have written an AHD. It defines AHDs as documents where a person can write down medical treatments they do not want if they lose decision-making capacity. For an AHD to be legally binding, the person must have had capacity when writing it and it must apply to their current medical situation. The document outlines the requirements for making a valid AHD in Ireland and implications for healthcare professionals, including that they have no liability for complying with a valid AHD or not complying if there are doubts about its validity.
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Guidance for commissioners of perinatal mental health servicesJCP MH
This document provides guidance for commissioners on perinatal mental health services. It discusses:
1) The importance of perinatal mental health services for both mothers and infants, covering prevention, detection and management of mental health problems during pregnancy and the postpartum period.
2) What constitutes good perinatal mental health services, including specialized inpatient mother and baby units, outpatient perinatal mental health teams, and ensuring access to care across settings from primary to specialized care.
3) Key recommendations for commissioners around ensuring regional strategies, pathways for care, training, data collection, and collaboration across maternity, adult mental health, pediatric and primary care services to meet the mental health needs of
Guidance for commissioners of community specialist mental health servicesJCP MH
This guide is about the commissioning of specialist community mental health services. It explores the role of Community Mental Health Teams (CMHTs), Assertive Outreach Teams and Early Intervention Teams among others.
East Midlands corporate governance network, February 2017, NottinghamBrowne Jacobson LLP
This seminar covered the new Integrated Support and Assurance Process, a background into the General Data Protection Regulation requirements coming into force on 1 April 2018, and the implications of Brexit on the NHS.
This seminar covered delayed transfers of care from hospital, a Mental Capacity Act/DoLS landscape update and claims arising from Human Rights Act 1998.
New World Hadoop Architectures (& What Problems They Really Solve) for Oracle...Rittman Analytics
Most DBAs are aware something interesting is going on with big data and the Hadoop product ecosystem that underpins it, but aren't so clear about what each component in the stack does, what problem each part solves and why those problems couldn't be solved using the old approach. We'll look at where it's all going with the advent of Spark and machine learning, what's happening with ETL, metadata and analytics on this platform ... why IaaS and datawarehousing-as-a-service will have such a big impact, sooner than you think
From resilient to antifragile - Chaos Engineering Primer DevSecConSergiu Bodiu
Can we inject failure scenarios into deployed systems to reduce platform risk? During this talk, demonstrations of the Simian Army, Chaos Lemur and Locust.io tools will be presented. We will go beyond reliability, stability and availability to help your platform operations team build a continuous process improvement program which will prepare your production systems for the unexpected.
92% of catastrophic system failures were the result of incorrect handling of nonfatal errors.
It is simply not possible to fully reproduce the entire architecture and run an end to end test.
Don't trust claims systems make about themselves & their dependencies. Verify by breaking.
Like us on Facebook! Does your FB content build your brand?Michael Paredrakos
My presentation in_AllThingsFacebook '17 http://allthingsfacebook.boussiasconferences.gr/ slightly changed because my gifs unfortunately don't play here from my keynote :-( All the images are stolen from the internet if one is yours pls let me know. The info is also from all over the Internet check the sources at the end for further reading. As always I have dyslexia if you find a spelling mistake pls don't kill me :-) Enjoy!
Este documento presenta la información sobre el Centro de Prácticas Profesionales 2015-2016 en la Fundación Centro El Portal en Caracas. La fundación tiene como objetivo transmitir valores a la comunidad y contribuir al desarrollo integral de los niños a través de la educación, cultura, deporte y capacitación. El programa de prácticas profesionales tiene como objetivo fortalecer las relaciones familiares mediante el diagnóstico de dificultades, el acompañamiento de procesos familiares y la generación de espacios de diá
Este documento describe un plan de integración académica para una escuela de trabajo social. El plan consta de cuatro niveles de integración que conectan las asignaturas, prácticas profesionales, investigaciones y comunidades. El objetivo general es brindar una oferta académica de calidad centrada en las necesidades de las comunidades a través de la presencia, implicación e investigación-acción de los estudiantes.
El documento define y describe tres tipos de escritos académicos: el resumen, el informe y el ensayo. El resumen provee una breve representación de las ideas principales de un documento sin interpretación crítica. El informe informa sobre los resultados de una investigación y recolección de datos. El ensayo interpreta libremente un tema sin necesidad de citas y con el objetivo de estilo.
Este documento describe el proyecto de prácticas profesionales de una estudiante de trabajo social en el Consejo de Protección de Niños, Niñas y Adolescentes del Municipio Bolivariano Libertador en Venezuela. El objetivo es contribuir a mejorar la calidad de vida de los niños a través de estrategias como la asignación de casos familiares, apoyo a programas comunitarios y participación en un equipo multidisciplinario. La estudiante realizará actividades iniciales como entrevistas sociales, revisión de evaluaciones, seguimiento de casos
Este documento trata de la informática, la cual es la prioridad en este pleno siglo 21 ya que la tecnología esta muy avanzada y debemos tener una cercanía con ella que sea mayor a la de años pasados.
Este documento describe un proyecto para crear un periódico escolar impreso y digital. Los estudiantes de 5to grado investigarán y diseñarán las secciones de un periódico, recopilarán noticias, y publicarán el periódico final en línea y de forma impresa. El proyecto contará con la colaboración de socios externos que aportarán su experiencia en áreas como ingeniería, música, trabajo social y educación.
CPP Niños, niñas y adolescentes - Luz y Vida - MariselaTrabajoSocial.tk
Este documento describe un modelo comunitario desarrollado por UNICEF para prevenir la violencia contra niños, niñas y adolescentes. El modelo evalúa varios factores en la comunidad como las leyes, actitudes, conciencia, servicios de apoyo y monitoreo del gobierno para abordar la violencia. El objetivo es fortalecer las redes de protección en la comunidad a través de la participación y estrategias para prevenir la violencia y defender los derechos humanos de los niños.
Foro Trabajo Social en el ámbito judicial-penal N. Rojas y M. A. PérezTrabajoSocial.tk
Presentación de la lic Belky Henríquez en el Foro "Trabajo Social en el ámbito judicial-penal: caso Venezuela", realizado en la ETS de la UCV el martes 7 de abril de 2015
Este documento describe la enseñanza de las matemáticas en educación infantil. Explica las características del pensamiento infantil, los contenidos matemáticos que se trabajan como el pensamiento lógico, numérico y espacio-temporal, y cómo se abordan estos contenidos de forma indirecta y a través de situaciones significativas para los niños. También destaca la importancia de transmitir a los niños las matemáticas como una herramienta funcional para resolver problemas de la vida cotidiana.
Análisis del cuento el viaje carmen botelloveronicaria
El resumen describe el encuentro entre Rosa y un hombre desconocido en la estación de tren. Al cruzar miradas, Rosa descubre un recuerdo turbador de su niñez en el que se refugiaba en unas alas para escapar del caos exterior. Este encuentro la lleva a reflexionar sobre decisiones que tomó en el pasado respecto a elegir entre la seguridad o arriesgarse a la incertidumbre.
Este documento describe los proyectos y actividades realizados por el Centro de Prácticas Profesionales del Consejo de Protección del Municipio Bolivariano Libertador. Se detallan tres proyectos implementados en el período 2014-2015 para atender las necesidades de niños, niñas y adolescentes. También se proponen nuevas actividades para el equipo de prácticas profesionales, incluyendo el diagnóstico de casos, elaboración de informes y la organización de charlas formativas.
La película retrata la dinámica de un aula en un instituto de un barrio marginal de París. Muestra las interacciones entre el profesor François y sus alumnos de orígenes diversos, quienes enfrentan problemas personales y de convivencia. A través del diálogo y la sinceridad, François busca fomentar la reflexión en sus estudiantes. Sin embargo, su exceso de franqueza a veces genera conflictos. La película ganó la Palma de Oro en el Festival de Cannes de 2008.
Personal Health Budgets and Continuing HealthcareMS Trust
This document provides information about personal health budgets and continuing healthcare. It begins with an overview of personal health budgets, including findings from a national pilot that showed benefits for quality of life, wellbeing and cost effectiveness. The document then discusses the case of "Dave", who has multiple sclerosis and received a personal health budget, and how it improved his independence, care consistency, social activities, pain control and more. It also provides details on the process for personal health budgets and continuing healthcare assessments and eligibility. Breakout session examples discuss cases and whether individuals would qualify for continuing healthcare assessments.
Independent review of the Mental Health Act summary of interim reportBrowne Jacobson LLP
In this webinar Rebecca Fitzpatrick looked at the recently published interim report of the ongoing independent review of the Mental Health Act chaired by Sir Simon Wessely, former president of the Royal College of Psychiatrists (link to report here: https://www.gov.uk/government/publications/independent-review-of-the-mental-health-act-interim-report)
In May 2017, Theresa May stated that, if elected, her government would replace the "flawed" Mental Health Act “in its entirety” with a new Mental Health Treatment Bill including:
• revised thresholds for detentions
• new Code of Practice
• more safeguards for those with mental health problems who have capacity so that "they can never be treated against their will".
The review is due to report in Autumn 2018 and on 1 May 2018 published its interim report identifying priorities for the review’s work giving a flavour of its initial thoughts.
Working together for Better Care in Richmond HW_Richmond
Presentation from Richmond CCG, Healthwatch Richmond, Hounslow and Richmond Community Healthcare, Kingston Hospital, West Middlesex University Hospital and the Richmond GP Alliance on the changes happening to community services in Richmond.
The document discusses Ontario's Health Link program which aims to improve care for patients with complex conditions by encouraging local health providers to better coordinate care. It provides an overview of the Health Link model, including key features such as a focus on a defined region and inclusion of primary care, hospitals, and home care providers. The document then outlines Champlain's Health Link implementation process, including how the region was divided into 10 Health Link areas and the criteria for readiness assessments, which will be used to approve individual Health Links.
Medical Documentation Improvement InitiativeOmer Khan
The document proposes an initiative to improve medical resident documentation at SBAHC. It outlines a 4-step plan: 1) demonstrate the purpose of good documentation; 2) conduct a needs assessment; 3) engage physicians in a clinical documentation improvement program; 4) develop documentation tools. The initiative aims to address deficiencies in documentation, which impacts patient care and outcomes. Good documentation is important for quality care, legal protection, and demonstrating the care provided. The proposal also includes policies and procedures for house physician patient care responsibilities, including conducting assessments and documenting findings.
The document discusses the current high demand for urgent and emergency care services in the UK healthcare system. It notes there are over 100 million calls or visits to urgent and emergency services annually, placing strain on the system. It proposes developing community-based integrated care as an alternative to reducing pressure on hospitals. This would involve coordinating various services like general practice, nursing, social care, and hospitals to provide more coordinated care outside of the hospital setting. It also discusses challenges in implementing such a system, like payment reforms, information sharing across organizations, establishing measures of an integrated system, and shifting some workforce skills to this new model of care.
This session covered:
- seclusion
- the new law Commission proposals for changes to Deprivation of Liberty
- case law update on conditional discharge/CTO and DoL (MM & PJ)
The concept of advance care planning outlined. The Assisted Decision Making (Capacity) Act 2015. Using Think Ahead as a tool to engage with advance care planning and with advance healthcare directives
This document summarizes a presentation on emergency management for healthcare for the homeless programs. The presentation covers the principles of emergency management including mitigation, preparedness, response and recovery. It reviews key HRSA policy guidance and outlines roles health centers can play in emergencies. It stresses the importance of planning for this vulnerable population and provides resources to help programs and patients prepare.
PowerPoint Presentation giving a brief history of care and support and the context for the current changes to the social care system. Presentations was delivered by Simon Medcalf and Kevin Kitching at the 'Personalisation and the Care Act consultation events' hosted by TLAP, Department of Health, the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) on Monday 21st July 2014 in London and 23 July 2014 in Manchester.
Simon Medcalf is Deputy Director of Social Care Policy and Legislation at Department of Health and Kevin Kitching is Personalisation Policy Manager Social Care, Local Government and Care Partnerships Directorate at Department of Health.
The document discusses admission and discharge policies and procedures for intensive care units (ICUs). It defines ICUs and other critical care levels. Admission depends on likelihood of benefit from intensive care and availability of beds. Scoring systems like APACHE II are used to predict outcomes but not for individual patients. Discharge occurs when intensive care is no longer needed or further treatment is deemed futile. Senior staff involvement, documentation, and family agreement are important for difficult discharge decisions.
This document discusses the CMS Final Rule on home and community-based services (HCBS). It covers three main areas: person-centered planning, developing a conflict-free HCBS system, and transitioning HCBS settings to be fully compliant with the rule. It provides an overview of the rule's requirements and best practices for states to establish a conflict-free system, including separating eligibility and assessment functions from direct service provision and establishing safeguards for any exceptions. The document also discusses mitigating conflicts of interest in areas like guardianship and targeted case management.
Sian Davies & Suzanne Robinson: Functions and mechanisms of priority settingNuffield Trust
Here are some suggestions for each scenario:
CCGs developing priority setting:
1. Engage all key stakeholders including public/patients
2. Establish transparent decision making processes
3. Build strong clinical leadership and ownership
4. Ensure sufficient resources and expertise are available
5. Collect and use high quality data and evidence
Department of Health developing national policies:
1. Provide guidance on minimum standards for priority setting processes
2. Support development of tools and methods for priority setting
3. Ensure adequate public health expertise is available locally
4. Allow flexibility for local decision making and innovation
5. Develop mechanisms for sharing best practices across areas
Actions for David Nicholson at the NHSCB:
1
Transforming Urgent and Emergency Care: Safer, Better, Fastermckenln
Rick Stern is the Director of the Primary Care Foundation, which has done extensive work examining urgent and primary care systems. This includes reviewing urgent care services, primary care in A&E, and potential ways to reduce bureaucracy and avoidable appointments in general practices. General practices currently feel under significant pressure due to increased workload, expectations, and a declining share of NHS funding over the last decade. The Primary Care Foundation has identified ways that practices can improve their urgent care response, reduce unnecessary contacts, and keep processes simple. Their work found that 27% of GP appointments could potentially be avoided and that integrated IT systems could help reduce workload.
The document discusses issues facing the UK NHS healthcare system including rising costs, an aging population creating greater demands, antibiotic-resistant superbugs, and a need for improved long-term management of health problems. It notes the NHS spends over 80% of GDP but will need £65 billion more by 2030. Current issues include overloaded A&Es, a disconnect between health and social care, and a failure to implement past reforms to transform the delivery model. Proposed changes center on prevention, personalized services, reducing inequalities, and integrating health and social care.
This document provides an overview and summary of Virginia's public behavioral health system challenges and opportunities presented by James M. Martinez Jr., Director of the Office of Mental Health Services at DBHDS, to the Virginia Rural Health Association on December 11, 2014. The presentation discusses the current environment of behavioral health reform in Virginia, new laws affecting behavioral healthcare in the state, and DBHDS's vision, mission and transformation process. Key points include the drivers of recent reforms, current demand and utilization of services, new laws on emergency custody, temporary detention facilities, and the psychiatric bed registry.
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Josh Luke, PhD, FACHE, Founder, National Readmission Prevention Collaborative, Interim Chief Executive Officer, Memorial Hospital of Gardena at the marcus evans ACO Payer Leadership Summit Spring 2015 held in Las Vegas, NV
Employment law update - Browne Jacobson Exeter - 06 February 2020Browne Jacobson LLP
These seminars are aimed at anyone who deals with employment law on a day to day basis, including HR Managers and HR Directors.
At these events we will present an overview of what we consider to be the most significant developments in 2019, and what they teach us about managing your workforce – together with our practical tips.
You will also hear about what is coming up in 2020, and how you can get ready for what will be another busy year in employment law.
This document discusses school exclusions and provides guidance on the topic. It begins with an overview of the exclusions landscape and key documents related to exclusions. It then outlines prospective changes being made to exclusions policy, including recommendations from the Timpson Review. The exclusions process is explained as a multi-stage process involving the head teacher's decision, governing board review, and potential independent review panel. Finally, tips are provided to avoid common pitfalls in the exclusions process related to issues like SEND, documentation, and timelines.
Procurement workshop training slides - Birmingham sessionBrowne Jacobson LLP
Managing procurement risks and challenges aims to increase understanding of procurement processes and risks, and knowledge of risk mitigation strategies. The document outlines several procurement stages and associated risks, including pre-market engagement, selection, tendering, contract award, and modifications. Key risks include challenges from bidders, non-compliance with regulations, undisclosed evaluation criteria, and substantial contract changes. Mitigation strategies include transparency, equal treatment of bidders, thorough documentation, and compliance with regulations.
Local authority acquisition and disposal of land - July 2019Browne Jacobson LLP
Ongoing austerity requires authorities to “sweat their assets” and land holdings are a significant focus for the generation of revenue and capital. These slides cover commercial and public law considerations in relation to:
- Powers to acquire land
- Powers to invest through land acquisition including investment purchases
- Potential barriers to disposal
- Powers to appropriate land
- Planning permission
- Powers to dispose of land
- Pre-conditions relating to disposal of land
- A capital receipt or a revenue stream
- Development vehicles and options
- Who do you need to be able to satisfy as to the legality of land transactions
Your employees, their future employers, and your intellectual property - July...Browne Jacobson LLP
Innovation and creativity is driven by your people. How do you as a business encourage innovation, capture the relevant IP assets and reward your innovators? What happens when a key individual leaves the business – how do you ensure that your R&D crown jewels remain legitimately protected? In a market of ever increasing competitive collaboration, setting up the right strategy to ensure the appropriate safeguards are in place and are communicated to your employees is important.
At this Public Sector Planning Club we reviewed:
- Recent developments in planning law, including cases and guidance
- Consideration of the use of planning conditions, including the appropriate use of pre-commencement conditions
- The powers available for stopping up and diverting highways, when these may be used, and points to consider
Browne Jacobson, Deloitte and DoctorLink are pleased to invite you to our first joint health tech seminar with leading industry thought leaders. This will be a practical session, sharing experience from across the NHS and beyond to inform options on how to improve services, break down silos and focus on population health outcomes.
This event is exclusively for Commissioners, GPs, and Policymakers keen to understand how new integrated care systems and models of care can meet the needs of their local population and can be implemented pragmatically and affordably to drive improvement goals and achieve better health, better care and better value.
Education Law Conference Manchester - Monday 10 June 2019Browne Jacobson LLP
1. Implement a clear, well-publicized complaints procedure that outlines appropriate steps and timelines.
2. Address social media issues promptly by controlling the narrative and responding diplomatically or ignoring depending on the circumstances.
3. Understand when the law can help, such as the Protection from Harassment Act for addressing vexatious complaints.
4. Escalate complaints appropriately and clarify the desired outcome to resolve issues efficiently. Stand back when complaints are really about private disputes rather than the school.
Designed to inform, challenge and enliven your perspectives, our packed agenda was designed to provide innovative ideas and fresh perspectives. With a headline session on the management of transgender children needs within a school setting, we aim to provide you with the advice and guidance that the sector currently lacks.
Other topics included:
learning from child death inquests
good governance – so much more than compliance
managing difficult parents and their complaints.
The IICSA has a number of investigative streams, and one of its areas of focus is Accountability and Reparations. It has already recommended that the Government sets up a Payment Scheme for former Child Migrants, and the Government has acted upon it.
Is a redress scheme the way forward for abuse claims? How might it impact your organisation? We are helping more and more organisations explore the pros and cons of redress schemes so that they can decide whether a scheme is right for them and what the longer term impacts might be.
Our Birmingham Claims Club event will cover the following:
- Civil Liability Act 2018
- Freedom of Information Act requests - including 'Information Law, why is it relevant?'
- Brexit and local government
Our London Claims Club event will cover the following:
- Civil Liability Act 2018
- Freedom of Information Act requests - including 'Information Law, why is it relevant?'
- Brexit and local government
Our Admin and Public Law seminar, chaired by Sir Robert Devereux, former Permanent Secretary for the Department for Work and Pensions was held on Thursday 4 April, covering the following topics:
- 'wearing two hats' - managing the legal risks of conflicts of interest and allegations of pre-determination/bias
- information law update session - freedom of information (FOI) cases, General Data Protection Regulation (GDPR)
- case law update
- judicial review - tactics for dealing with judicial review and case law
In this webinar recording, Selina Hinchliffe, Alex Kynoch, Nick Smee and Helen Jones hold a panel discussion covering some of the key state aid concepts and how this impacts ownership and licensing of intellectual property, both from a commercial partner, public body and university perspective.
Whilst you’ve been distracted with Brexit and what that means for your business, you’ve probably missed some significant changes in the law. In our March forum we covered:
- contract changes (what they mean to your supply chain, customers and suppliers)
- data protection (the challenges of becoming a 'third country')
- legal privilege and internal investigations (practical tips following SFO V ENRC)
- employment law (changes to employment law you need to be aware of)
- banking - your banking covenants (what to be aware of - particularly in the event of a downturn ahead)
- property (end of lease issues for business owners).
For further training and resources visit our webpage - https://www.brownejacobson.com/sectors-and-services/sectors/in-house-legal
Every business, and every in house lawyer, will at some point be involved with an enquiry, an investigation, or potential litigation. During litigation, documents – including emails, attendance notes and reports – which are relevant to the litigation may have to be disclosed if they are not privileged.
So businesses need to know how it can assess litigation risk or conduct an enquiry without creating documents that it then has to produce and which may be detrimental to its position. The law on this issue has recently been considered by the Court of Appeal in two key cases: WH Holding Ltd v E20 Stadium LLP and SFO v Eurasian Natural Resources Corp Ltd.
In this webinar recording, our experts Mark Daniels and Helen Simm provide you with the key information you need to identify these issues when they arise and to know how you can best protect your position.
We are all waiting with bated breath for the Supreme Court decision in CN & GN, a case which will have a huge practical impact on service providers. Previously the Court of Appeal was dismayed about the damages claims, that had been litigated with little regard to, or understanding of, the law and reality of social care practice. Some of the team involved in the case discus what might happen next, and analyse the practical effect for you of the Supreme Court judgment.
Whilst that judgment has been awaited many claims have been on ice, but to fill that gap we are seeing many of our clients being affected by:
- pressure to consider Redress Schemes
- the Independent Inquiry into Child Sexual Abuse
- claims being brought directly against them as fostering agencies
- claims under the Human Rights Act
- issues following the implementation of GDPR.
For further information and training visit our webpage - https://www.brownejacobson.com/insurance
In this practical session we explored the legal duties of directors and the difficulties which they may face. The session focussed on individuals who are directors for public sector companies, including their role, obligations and competing interests which may arise.
At our February planning club we covered the following topics:
- planning performance agreements
- expert evidence in planning inquiries
- certificates of lawful use.
For further information and training visit our webpage - https://www.brownejacobson.com/sectors-and-services/sectors/public-sector
Mental health, capacity and deprivation of liberty case law update, February ...Browne Jacobson LLP
Rebecca Fitzpatrick looks at some of the most recent leading cases in relation to the Mental Health Act and Deprivation of Liberty, including the Supreme Court’s important decisions of 'MM' and 'PJ' which consider the interaction between the Mental Health Act and deprivation of liberty in the community. Rebecca also covered the subsequent case of 'AB' which focuses on the role of the High Court’s inherent jurisdiction in these types of cases, and the recent final report from the Mental Health Act independent review chaired by Professor Sir Simon Wessely.
Guide on the use of Artificial Intelligence-based tools by lawyers and law fi...Massimo Talia
This guide aims to provide information on how lawyers will be able to use the opportunities provided by AI tools and how such tools could help the business processes of small firms. Its objective is to provide lawyers with some background to understand what they can and cannot realistically expect from these products. This guide aims to give a reference point for small law practices in the EU
against which they can evaluate those classes of AI applications that are probably the most relevant for them.
Synopsis On Annual General Meeting/Extra Ordinary General Meeting With Ordinary And Special Businesses And Ordinary And Special Resolutions with Companies (Postal Ballot) Regulations, 2018
Business law for the students of undergraduate level. The presentation contains the summary of all the chapters under the syllabus of State University, Contract Act, Sale of Goods Act, Negotiable Instrument Act, Partnership Act, Limited Liability Act, Consumer Protection Act.
Matthew Professional CV experienced Government LiaisonMattGardner52
As an experienced Government Liaison, I have demonstrated expertise in Corporate Governance. My skill set includes senior-level management in Contract Management, Legal Support, and Diplomatic Relations. I have also gained proficiency as a Corporate Liaison, utilizing my strong background in accounting, finance, and legal, with a Bachelor's degree (B.A.) from California State University. My Administrative Skills further strengthen my ability to contribute to the growth and success of any organization.
Lifting the Corporate Veil. Power Point Presentationseri bangash
"Lifting the Corporate Veil" is a legal concept that refers to the judicial act of disregarding the separate legal personality of a corporation or limited liability company (LLC). Normally, a corporation is considered a legal entity separate from its shareholders or members, meaning that the personal assets of shareholders or members are protected from the liabilities of the corporation. However, there are certain situations where courts may decide to "pierce" or "lift" the corporate veil, holding shareholders or members personally liable for the debts or actions of the corporation.
Here are some common scenarios in which courts might lift the corporate veil:
Fraud or Illegality: If shareholders or members use the corporate structure to perpetrate fraud, evade legal obligations, or engage in illegal activities, courts may disregard the corporate entity and hold those individuals personally liable.
Undercapitalization: If a corporation is formed with insufficient capital to conduct its intended business and meet its foreseeable liabilities, and this lack of capitalization results in harm to creditors or other parties, courts may lift the corporate veil to hold shareholders or members liable.
Failure to Observe Corporate Formalities: Corporations and LLCs are required to observe certain formalities, such as holding regular meetings, maintaining separate financial records, and avoiding commingling of personal and corporate assets. If these formalities are not observed and the corporate structure is used as a mere façade, courts may disregard the corporate entity.
Alter Ego: If there is such a unity of interest and ownership between the corporation and its shareholders or members that the separate personalities of the corporation and the individuals no longer exist, courts may treat the corporation as the alter ego of its owners and hold them personally liable.
Group Enterprises: In some cases, where multiple corporations are closely related or form part of a single economic unit, courts may pierce the corporate veil to achieve equity, particularly if one corporation's actions harm creditors or other stakeholders and the corporate structure is being used to shield culpable parties from liability.
सुप्रीम कोर्ट ने यह भी माना था कि मजिस्ट्रेट का यह कर्तव्य है कि वह सुनिश्चित करे कि अधिकारी पीएमएलए के तहत निर्धारित प्रक्रिया के साथ-साथ संवैधानिक सुरक्षा उपायों का भी उचित रूप से पालन करें।
Defending Weapons Offence Charges: Role of Mississauga Criminal Defence LawyersHarpreetSaini48
Discover how Mississauga criminal defence lawyers defend clients facing weapon offence charges with expert legal guidance and courtroom representation.
To know more visit: https://www.saini-law.com/
Sangyun Lee, 'Why Korea's Merger Control Occasionally Fails: A Public Choice ...Sangyun Lee
Presentation slides for a session held on June 4, 2024, at Kyoto University. This presentation is based on the presenter’s recent paper, coauthored with Hwang Lee, Professor, Korea University, with the same title, published in the Journal of Business Administration & Law, Volume 34, No. 2 (April 2024). The paper, written in Korean, is available at <https://shorturl.at/GCWcI>.
The Future of Criminal Defense Lawyer in India.pdfveteranlegal
https://veteranlegal.in/defense-lawyer-in-india/ | Criminal defense Lawyer in India has always been a vital aspect of the country's legal system. As defenders of justice, criminal Defense Lawyer play a critical role in ensuring that individuals accused of crimes receive a fair trial and that their constitutional rights are protected. As India evolves socially, economically, and technologically, the role and future of criminal Defense Lawyer are also undergoing significant changes. This comprehensive blog explores the current landscape, challenges, technological advancements, and prospects for criminal Defense Lawyer in India.
Receivership and liquidation Accounts
Being a Paper Presented at Business Recovery and Insolvency Practitioners Association of Nigeria (BRIPAN) on Friday, August 18, 2023.
What are the common challenges faced by women lawyers working in the legal pr...lawyersonia
The legal profession, which has historically been male-dominated, has experienced a significant increase in the number of women entering the field over the past few decades. Despite this progress, women lawyers continue to encounter various challenges as they strive for top positions.
3. Contents
• Overview and context
• Main issues
• Common causes of delays
• Common issues
• Summary
• Case studies
4. Delayed Transfers of Care – An
overview
• Estimated cost to NHS of £900m per year (Carter
report, Feb. 2016);
• A mixed duty (legislation and common law);
• A joint obligation (health and social care);
• Importance of getting the basics right –
Implementing good practice, knowing your own
policy, and how/when to escalate
• What can we do?
5. Delayed Transfers of Care – An
overview
• Discharge isn’t an isolated event, but often the
transfer from one care setting to another;
• Often need to think in broader terms than the legal
and policy issues such as the impact on the Trust’s
reputation and staff morale.
6. DTOC – some context
Reason for delay Year to September 2015 Change from previous year
Awaiting further non-acute NHS care 327,638 +6.7%
Awaiting completion of assessment 306,450 +11.3%
Awaiting care package in own home 264,082 +62.1%
Awaiting nursing home placement 226,863 +21.4%
Patient or family choice 216,844 +2.2%
Awaiting residential home placement 182,944 +12.9%
Awaiting public funding 67,405 -2.7%
Housing 48,642 -10.8%
Awaiting community equipment
and adaptations 42,243 +2.4%
Disputes 19,418 +2.2%
7. DTOC – some context
• Traditionally discharge from hospital is seen as either “simple’ or
“complex”, with different care pathways for each. Most discharges are
“simple” and involve basic arrangements for P returning home, usually
where P has no significant post-discharge need for care and attention.
• Although much of the guidance in this area is now quite dated many of the
principles still apply (though be wary of outdated references to old
legislation):
• For “simple” discharges see: “Achieving timely ‘simple’ discharge from
hospital, 2004”
• For “complex” discharges need to consider a range of guidance, policy and
legislation depending on the context.
8. DTOC – some context
• For “complex” discharges may need to consider:
- “Discharge from hospital: pathway, process and practice” (DoH, 2003);
- “Definitions – Medical Stability and Safe to Transfer” (DoH, 2003);
- “Ready to go: Planning the discharge and transfer of patients from
hospital and intermediate care” (2010), DoH;
- Schedule 3 to the Care Act 2014 & Care Act 2014 Guidance
- Care and Support (Discharge of Hospital Patients) Regulations 2014 (Acute care)
- “Transition between inpatient hospital settings and community or care home
settings for adults with social care needs”, (NICE ,NG27, December, 2015)
- NHSE Guidance “Template Policy: supporting patients’ choices to avoid long hospital
stays”, 23 March 2016
• And ,of course, Trust’s own hospital discharge policy
9. Getting the basic right - PHSO Report May 2016
common issues
1) Patients being discharged before they are clinically
ready to leave hospital;
2) Patients not being assessed or consulted properly
before their discharge;
3) Relatives and carers not being told that their loved
one has been discharged
4) Patients being discharged with no home-care plan in
place or being kept in hospital due to poor co-
ordination across services
10. Issues which can delay hospital discharge
• Law has focused on discharge from acute care (defined as “intensive NHS funded
medical treatment provided by or under the supervision of a consultant which is
for a limited time after which the patient no longer benefits from that
treatment”)
• For example, the delayed transfer of care legislation which sets out certain
assessment and notification requirements, as well as allowing the NHS to recoup
money from Local Authorities, only applies to acute care settings. It does not apply
to maternity, mental health, palliative, or intermediate care settings.
• Regardless of the setting, or whether “simple/complex”, discharge should only
proceed where:
- 1) P is clinically/medically fit for discharge (a clinical decision)
- 2) Discharge will be “safe” (duty of care to P to discharge safely. Breaching this
duty could led to P being able to claim damages against the Trust).
11. Common delays: NHS
• Delays can be caused by:
- Awaiting CHC assessment (NB Framework and NHSE Guidance suggests CHC
eligibility should not generally be carried out in hospital setting as this
may distort accurate assessment of need – also suggests that CCGs can
fund care in interim pending CHC assessment in appropriate environment);
- CHC panel decisions (particularly if high-costs considerations);
- Not commencing discharge planning early enough;
- Poor communication within the Trust and with key partners in social care
and CCGs;
- Lack of understanding about who is responsible commissioner for post-
discharge (CHC eligible, s.117 MHA 1983 or Joint Funded);
- Misunderstanding the role of best interests under MCA 2005 and hospital
discharge.
- Lack of awareness of Trust policy and possible tools to facilitate
discharge.
12. Common delays: social care
• Delay in carrying out Care Act 2014 assessments
• Delay in finding suitable accommodation/care if eligible for
services following assessment
• Delays/waiting list for provision of re-ablement services
• Delays in provision of housing aids and adaptations
• Arguments about whether P has no recourse to public funds (NRPF)
13. Other common delays
• P/Family saying they won't be available on the
proposed discharge date;
• P/Family opposed to discharge to residential care;
• P/Family consider P not fit for discharge;
• P/Family refusing to agree to discharge until refusal of
CHC eligibility is reviewed;
• P lacks capacity to decide where to reside post
discharge.
14. DTOC - Key points
• Need to ensure that good practice discharge guidance is
followed, both in terms of clinical practice and process;
• Ensure P and/or P’s family properly consulted;
• Try to begin discharge planning as soon as possible;
• Ensure discharge planning is done via MDT where possible
• Ensure timely communication with care home/LA/CCG that
will be responsible for P post-discharge
• In difficult cases seek support as early as possible.
15. Discharge from acute beds
• Care Act 2014 schedule 3
• Care and Support (Discharge of Hospital Patients)
Regulations 2014
• Process no longer mandatory
• Assessment Notices from NHS to LA (s.1 Sch.3)
• Discharge Notices (s.2(1) Sch. 3)
• LA needs assessment (s.3(1) Sch.3)
• Delay: LA must pay NHS daily “specified amount” (s.4
Sch.3)
• Doesn’t apply to non-acute settings, MH, Maternity or
Palliative care
16. DTOC: Difficult Areas
• Mental Capacity Act and best interests
• Social care delays
• S.117 aftercare
• Responsible commissioner disputes
• No recourse to public funds
• CHC issues
17. Delays due to P lacking capacity
• Very important that robust assessment of P’s capacity is carried out as
early in discharge planning as possible and written record kept;
• P lacking capacity or questions about where it is in P’s best interests
to reside post-discharge should not prevent discharge as clinical
decision that does not depend on whether P has capacity or not;
• Where P should go post-discharge is a BI decision, but Trust can
discharge duty to P by ensuring that any discharge is safe and
appropriate;
• In most cases it should be possible for P to be discharged to interim
placement whilst dispute about long term BI is resolved – exception
may be where P would be too frail or ill to move twice in a relatively
short period of time.
• Consider application to CoP in appropriate cases for one off hearing
authorising P’s move to specific care home where P or family are
objecting
18. Common Issues: Delay in social
care
• LA under duty to assess under Care Act;
• Duty to cooperate with NHS under Care Act 2014;
• Wider “wellbeing” duties around housing etc.
• Key is early effective communication, and
appropriate local arrangements for escalation in
event of delay;
• Important that all involved are aware of respective
obligations on health and local authority
19. Common Issues: S.117 MHA Aftercare
• S.117 places joint obligation on CCG and LA to provide aftercare services
to P if under qualifying detention (usually s.3 MHA);
• Aftercare now defined by s.117(6) means (a) meeting a need arising from
or related to the person's mental disorder; and (b) reducing the risk of a
deterioration of the person's mental condition (and, accordingly, reducing
the risk of the person requiring admission to a hospital again for
treatment for mental disorder
• LA may say that not required to provide aftercare (as often appears local
arrangement between CCG and LA that LA would provide accommodation,
and CCG health services)
• Can resist this as s.117 can include accommodation if both a) & b) above
satisfied, and it is for CCG and LA to decide how to meet those aftercare
needs
20. Common Issues: S.117 MHA Aftercare
• Where P may be eligible for s.117 aftercare, and CHC, then CHC
Framework says s.117 takes precedence (so LA cannot insist that
only CCG has responsibility for P post-discharge as it remains joint
under s.117);
• Obviously, only applies to needs related to mental disorder – P
could be eligible for CHC (and so only CCG responsibility) if
physical needs are “primary health need”.
• When planning discharge it is important to ascertain as soon as
possible which statutory bodies will be responsible for P’s care
post discharge
21. Common Issues: S.117 MHA Aftercare
• Working out the relevant LA/CCG means applying s.117 and the
Care Act 2014 Guidance for LAs and responsible commissioner
guidance for CCGs
• Basic position is that for LAs the relevant test is where P was
resident when they were detained.
• In respect of P discharged after 1 April 2016 this is also the test for
determining which CCG is responsible for s.117 aftercare
• For P discharged between 1 April 2013 and 31 March 2016 the RC
for s.117 is to be determined by wherever P’s GP is located (or
where P is resident if no GP)
22. Common Issues: NRPF
• Delays often caused by statutory bodies saying that they are not
responsible for post-discharge care as P has “no recourse to public
funds”.
• Usually this means that P’s immigration status prevents them from
being able to access services such as social services support,
housing and benefits.
• These exclusions don’t apply to s.117 MHA to which P is entitled if
they meet the criteria irrespective of immigration status.
23. Common Issues: NRPF
• Social services still required to carry out assessment of someone who has
NRPF;
• Even if NRPF social services may still have an obligation to provide post-
discharge services (including accommodation) to P if failure to do so
would breach their human rights.
• Children are excluded from the general prohibition on accessing services
so children’s services may need to consider providing services including
accommodation to child or family of child in need
• Entitlement to health services (other than non emergency hospital
treatment) is currently not affected by P’s immigration status – it is no bar
to someone receiving CHC for instance;
• If P is NRPF then home office may have obligation to support them
(including the provision of accommodation) under ss.4 or 95 so called
“NASS Support”
24. Common issues: entitlement to CHC
• Framework says that hospital not usually the best place to assess CHC
eligibility, and that CCGs have power to commission services to facilitate
discharge and carry out CHC assessment in non-hospital environment.
• CHC determined by MDT considering whether P has primary health need
• If eligible for CHC, relevant CCG to be determined by where P’s GP is
registered (or where P resident if no GP);
• Note that if P already entitled to CHC, responsibility remain with
originating CCG even if P is admitted to hospital and reregisters with GP
elsewhere
• CHC assessment process has specified time limits (28 days from receipt of
checklist or other notification)
• Appeal can take 6 months – not appropriate for P to remain hospital
pending this
25. Summary - what can be done
1. Have a robust discharge policy that staff are aware of and can regularly refer
to.
2. Identify as early as possible if P will likely require support post-discharge.
3. If so, ensure that MDT considers what type of support may be required.
4. MDT should include social services and a representative of the CCG or CSU;
5. As early as possible, seek to ascertain which organisation(s) will be responsible
for commissioning P’s post-discharge care. This will depend on whether P will
be entitled to s.117 aftercare, CHC, joint packages between health and social
care or social care funding only. Discuss proposed discharge arrangements with
the patient and their family (if P consents) as early as possible (unless such
discussion would cause clear and demonstrable harm to P);
6. If there is a dispute or disagreement see if an acceptable resolution can be
reached informally. Ensure patients are made aware of the options available
to them and how to access these. If P vulnerable consider whether the LA
should be requested to provide a Care Act advocate to assist P.
26. Summary - what can be done
7. In cases of delay/potential delay, agree a timetable for specific actions to
be taken by the patient (or those advocating for the patient) after which
the matter may be escalated.
8. Ensure such timeframes take into account the needs and circumstances of
the individual concerned, including any support or assistance they may
require.
9. Where delays is in an acute setting are being caused by Local Authority
inaction, Trust can consider triggering the delayed discharge mechanisms
under Sch. 3 Care Act 2014.
10.Where a patient is unreasonably refusing to engage in the discharge
process, and efforts at resolution have failed, consider if it is appropriate
to exercise the powers under the Criminal Justice and Immigration Act
2008. This makes it a criminal offence for a person to refuse to leave NHS
property when requested to do so if the person has caused a nuisance or
disturbance and is not there to obtain medical treatment (s.119). There is
a power permitting the removal of such a person, using reasonable force if
need be (s.120).
27. Summary - what can be done
11. Guidance in this area suggests that refusing to leave hospital when
medically fit could constitute a nuisance, but this is untested, and the courts
may not accept that a passive and otherwise compliant P who is refusing to
leave hospital is committing the criminal offence.
12. Can’t use the powers where P still requires treatment, or there is a risk of
harm to P if the powers are used.
13.Where the refusal of a clinically fit P is accompanied by P being
verbally/physically abusive, or disruptive to the attempts to provide care to
others, the scope for using CJA powers in greater.
14.Before exercising such powers a Trust should write to the patient to put
them notice that it is considering this course of action and offering the
patient a further opportunity to engage with the discharge process.
15. Often the threat of using enforcement powers is sufficient to get P
and/or family to relent.
28. Summary - what can be done
16. If the patient lacks capacity around post-discharge care and residence
ensure the MCA is followed, but note that the decision to discharge is not
itself a best interests decision.
17. An application to the Court of Protection seeking a declaration that it is
in their P interests to be discharged to an alternative location pending
resolution of their long-term care may assist in resolving the issue.
18. The Trust should invite the relevant statutory body/bodies with
responsibility for P’s post-discharge care to make this application, but where
met with refusal/delay the Trust could make the application itself and ask
that the relevant body be added as applicant at the first hearing and the
Trust removed as a party.
29. Summary - what can be done
19. As last resort can consider serving formal notice revoking the licence
under which the patient occupies a bed, and ultimately seeking a court
order permitting that person’s removal from the hospital under the law
of trespass (Sussex Community NHS FT v Price (2016) and Barnet PCT v X
[2006].
20. Before taking this step the Trust should write to the patient putting
them on notice that it is considering this course of action.
21. In all discharge cases the Trust can only discharge P from hospital
premises where P is clinically fit, and it is safe to do so.
22. If the Trust is proposing to discharge P to somewhere else the Trust
(or whichever body will carry put the transfer) needs to have lawful
authority for this.
30. Summary - what can be done
23. In most cases this will be lawful because P has capacity and
has consented to be discharged home, or to a care home;
24. Where P lacks capacity, this will only be lawful where a
best interests decision has been made on P’s behalf
25. In neither case, unless they hold a valid welfare power of
attorney or deputyship, will the agreement of P’s family
provide authority to transfer P to somewhere else post-
discharge.
26. In all discharge cases, must consider the reputational risk
to the Trust
31. Sussex community NHS Foundation Trust
v Price (October 2016)
• Action for repossesion of room in health funded
intermediate care facility where “normal” stay is
14 – 28 days;
• P admitted in August 2015 and no medical needs
from November 2015
• Self-caring and refusing all attempts to engage her
in discharge planning
• Possession ordered “forthwith” as P was able to go
home, and ordered to pay £8,000 legal costs
32. Case studies – X & Y
• X & Y were married and had lived together in their home for over 50
years. There was some indication that X had a cognitive impairment and Y
was bedbound.
• Their home had fallen into significant disrepair, and X & Y were
considered by professionals to be hoarding significant amounts of items at
the property.
• After an emergency call X was taken into hospital and Y continued to
reside at the property alone. Y wasn’t coping and an ambulance was
requested which then took Y to hospital.
• Whilst in hospital a prohibition notice was placed on the property
preventing X and Y from living there until extensive remedial works were
carried out. Various professionals expressed differing views as to whether
X and Y had capacity to decide where they should reside post-discharge
from hospital.
33. X & Y case study
• When both X and Y were medically fit for discharge they refused to
leave on the basis that they would only agree to be discharged
home, which was not possible as a result of the prohibition notice.
• Security had to be called to deal wit X & Y’s behaviour on a
number of occasions.
• X & Y had started to hoard in the hospital, with rotten food
beginning to present a health risk.
• On discharge X and Y would be eligible for support from social
services, but both had refused to accept this offer of support.
• What issues arise in this case?
34. Case studies – X & Y
• In this case the Trust involved, insisted that it was the LA’s responsibility
to make an application to the CoP
• The Trust supported the Local Authority in an urgent application to the
Court of Protection.
• The Court concluded that there was evidence that X and Y may lack
capacity to decide where to reside, but that they should not remain in
hospital whilst this issue was resolved.
• An order was made authorising X and Y’s discharge to a care home in the
interim whilst the longer term care and residence issues were resolved.
• The order authorised the use of reasonable force to move X & Y, and the
court invited the police to attend as part of the order
• Trust was removed as a party to proceedings at that early stage.
• Imagine if the court had found that X & Y did have capacity? What options
would be open to the Trust and what issues arise?
35. Case Study – Mr A
• Mr A is 45 and lives with his wife. He is partially sighted, mobility
issues, significant breathing difficulties, and a mild cognitive
impairment as a result of a car accident when he was younger.
• Mr A fell and was admitted to A&E with a suspected broken leg
requiring surgery. He is reported to be muddled and confused.
• With the surgery completed Mr A is considered medically fit for
discharge. After the surgery Mr A’s wife says that she won’t agree
to his discharge until he receives a higher support package to help
her care for him at home as he is likely to be even more immobile
then before. She also feels that his needs have increased
significantly.
• What potential issues arise here?
36. Potential Issues
• Indication that may lack capacity but no
assessment;
• No indication of post-admission discharge planning;
• Mr A may need additional care. Need to contact LA
to ensure assessment is carried out;
• Needs may have increased so CHC assessment likely
to be required.
37. Case Study – Mr A
• Professionals in the hospital are concerned about Mrs A’s ability to
look after Mr A, and have decided that it would be best for Mr A to
move to residential care.
• His capacity is assessed and it is found that he lacks the capacity
to make this decision.
• The Trust have identified a care home that will take Mr A at short
notice, and the ambulance service will take him there.
• Mrs A opposes this and wants him to come home. It is explained to
Mrs A that she isn’t the decision maker under the MCA as this is
always the statutory body concerned and that the best interests
decision has been made.
38. Potential Issues
• No evidence of discussion with CCG/LA who will be
responsible for the care home placement;
• No proper consultation with P or Mrs A in making the
best interests decision.
• No indication that Trust has checked whether Mrs A has
LPA
• Case law indicates that where best interests are in
dispute, attempts should be made to resolve these
informally, but if not possible may require application
to Court.
39. Mr A Case Study
• The Trust decides not to discharge Mr A until the LA makes an
application to the CoP, but Mr A’s behaviour has begun to
deteriorate to the extent that, due to violence to others, he is
detained under s.3 of the MHA and transferred to the Trust’s
psychiatric in-patient ward;
• In the meantime Mrs A’s wife has herself fallen ill and is receiving
long term treatment in hospital.
• The property that Mr and Mrs A had been renting has been
repossessed due to rent arrears having accrued.
• Mr A’s treatment for his metal disorder is complete and he has
made a good recovery. He is also assessed as having regained
capacity to decide where to reside.
• The Trust contact the LA who say that they don’t have an
obligation to rehouse Mr A.
40. Potential issues
• Not necessarily the Trust’s responsibility, but shouldn’t
someone have considered Mr A’s tenancy and what to
do about the arrears (can in some cases claim HB for up
to 52 weeks if in hospital)? Would have meant his own
property was available on discharge.
• Mr A is entitled to s.117 aftercare which is not just LA,
but CCG also.
• Whether s.117 aftercare includes the need for
accommodation depends on the two part test earlier.
• Although s.117 takes priority over CHC for mental
health needs, he could still be eligible for CHC for
physical needs – assessment still not happened.
42. The MCA 2005 and Deprivation
of Liberty – An Overview
Emmett Maginn
43. What we will cover
• MCA 2005 Overview
• Advance Decisions and LPAs
• Court of Protection – When to go to court and why
• Deprivation of Liberty – the “acid test”
• DoLS
• DoL in hospital
44. Why does this matter?
• MCA is about capacity to make decisions for yourself
• Compliance/acquiescence is not the same as consent!
• Implications of getting MCA wrong:
– Assault (criminal and civil)
– Negligence claims
– Complaints and disciplinary action
45. Five Basic Principles
1) A presumption of capacity
2) All reasonably practicable steps to empower P to
make the decision.
3) Unwise decisions do not mean lacking capacity
4) If a person lacks capacity, decision made on their
behalf must in their best interest
5) Decision made in best-interest must be least
restrictive
46. The MCA Capacity 2 stage test
S2 - Does the person have an impairment of, or a disturbance in the
functioning of the mind or brain? Does that impairment mean the
person is unable to make a decision that they need to make?
s3 – P is “unable to make a decision for himself” if he is unable to do
any of these:
– To understand information relevant to the decision
– To retain that information
– To use or weigh that information in the decision making process, or
– To communicate his decision
47. “Maximise” P’s ability to decide
• Does P have all relevant information? - CC v KK
(2012)
• Could the information be presented in a way
that is easier for P to understand?
• Are there particular times of day when P’s
understanding is better?
• Can the decision wait if P will recover capacity
• Is a SALT referral needed? Is specialist input
required around behaviour, medication or
communication?
48. Some case law
• A competent patient can refuse treatment
– Re MB (1997)
– Re B (2002)
– Kings College Hospital FT v C & V [2015]
• Children – aged 16 & 17 (within MCA jurisdiction)
– NHS FT v P [2014]
• Mental Health Act
– Re C [1994]
49. Recording capacity assessments
• Capacity assessments should be recorded in the
patient’s notes or on file;
• Note should record why the patient is deemed to
lack capacity;
• Assessments of capacity should be proportionate.
• The more significant the decision for P the more
formal the assessment of capacity is likely to be
and the more extensive the record that will need
to be made.
50. What do you do if a person
lacks capacity?
• S.4 Any decision made, on behalf of a P who lacks
capacity, must be done in that P’s best interests
• That principle applies whether the person making
the decisions is a family carer, a paid care worker,
or a healthcare professional
51. How do you assess best
interests?
Under the MCA, the decision maker must consider:
• P’s past and current wishes and feelings –
particularly if previously had capacity
• Any beliefs and values (e.g.. religious, moral or
cultural) that would influence P if they had
capacity
• Advance Decisions to Refuse Treatment
• Wye Valley NHS Trust v B [2015]
52. Consulting others
• But, you must take into account, if practical:
– Anyone named by the patient as a person to be
consulted
– Anyone engaged in caring for the patient, including
close relatives
– Anyone with a Lasting Power of Attorney or a Court
appointed Deputy for personal welfare issues
– If appropriate, an IMCA
54. Best Interests decision making
• General position is that nobody can consent /
refuse on behalf of an incompetent adult (but see
Lasting Power of Attorney or Court of Protection
appointed Deputy)
• Best interests decision can be seen as a
collaborative process
• So Beware of thinking “the family have consented”
55. Advance Decisions
Valid Applicable
Made by P over 18, with capacity The patient lacks capacity at the time
of proposed treatment decision
No need to be in writing, unless relates
to life sustaining treatment
The treatment is expressly specified in
the advance decision
No subsequent relevant Lasting Power
of Attorney
There are no reasonable grounds for
believing circumstances exist which the
donor had not anticipated at the time
of the decision
No other “clearly inconsistent” act
Not subsequently withdrawn
56. Lasting Powers of Attorney
• Introduced by MCA 2005 s.9
• LPA can authorise donee to make decisions about:
– A donor’s welfare; and/or
– A donor’s property and affairs
• Must be made while donor has capacity
• Can include refusal of or consent to treatment,
providing express provision is made to that effect
• Welfare LPA applies only when the donor no longer has
capacity
• Must be registered with the Office of the Public
Guardian before use
• Cannot make decisions about life sustaining treatment
unless expressly stated in the LPA
58. COP – A forum for sharing risk
• Disputes over capacity
• Disputes over best interests – welfare and finance
• Deprivation of liberty where P lacks capacity
• S.21A MCA Appeals
• Some serious healthcare decisions must go to court
• Validity of advance decisions
• Removal of LPA
• Appointment of deputies
• High court inherent jurisdiction may apply if CoP
cannot deal with case
59. COP
• Briggs [2016]
“I have concluded that as I am sure that if
Mr Briggs had been sitting in my chair and
heard all the evidence and argument he
would, in exercise of his right of
self-determination, not have consented
to further CANH treatment, that his best
interests are best promoted by the court
not giving that consent on his behalf.”
• NB – procedural point re s15/16 & s.21A
60. COP
• SR v Bury CCG [2016]
• Daughter’s application re withdrawal of CANH – agreed by judge in
2015
• Usual rule in CoP is no order for costs but she sought her legal
costs back from the CCG – due to CCG’s conduct
• Hayden J awarded 50% of her costs against the CCG
62. Art 5 – Right to liberty and
security
“Everyone has the right to liberty and security of
person. No one shall be deprived of his liberty save
in the following cases and in accordance with a
procedure prescribed by law”:
• after conviction by a court;
• lawful arrest;
• lawful detention of a minor for educational supervision;
• lawful detention for the prevention of the spreading of
infectious diseases, of persons of unsound mind, alcoholics or
drug addicts or vagrants;
• lawful arrest to prevent unauthorised entry into the country
63. “Lawful detention”
• Everyone who is deprived of his liberty by arrest or
detention shall be entitled to take proceedings by
which the lawfulness of his detention shall be
decided speedily by a court and his release ordered
if the detention is not lawful (Art 5(4))
• Everyone who has been the victim of arrest or
detention in contravention of the provisions of this
article shall have an enforceable right to
compensation (Art 5(5))
64. Deprivation of Liberty Safeguards
• Bournewood - de facto detained
• Schedule A1 (2009) amendment to MCA - DOLS
65. “… human rights are for everyone, including the
most disabled members of our community,
and … those rights include the same right to
liberty as everyone else”
Lady Hale (para 1)
“… features consistently regarded as key in the [ECHR]
jurisprudence - that [P] was under continuous
supervision and control and was not free to leave”
Lady Hale (49)
Cheshire West
66. Excluding factors (previously) typically
relied on to say no DOL…
• P’s disability / ‘relative normality’
• P’s awareness / compliance
• reason or purpose behind the placement
• the quality / appropriateness of the care
• “A gilded cage is still a
cage”
Just as important…
67. Deprivation of liberty in hospital
LF v Coroner Inner South London (2017)
• Case is concerned with the application of DoL in an acute medical setting
• Maria, 45, Down’s syndrome was admitted to Hospital with pneumonia
19.11.13
• Deteriorated and moved to ICU 2/3.12.13, but died 7.12.13
• Coroner’s inquest but started without jury
• JR of that decision – jury is mandatory if not natural death and D was “in
state detention”
• Divisional court held not “in state detention” and no DoL as context of CW
was different to ITU and should not be “mechanistically” applied. Maria’s
family appealed.
68. Court of Appeal – 26 January 2017
• held that “in general” there will be no DoL in the context of
life-saving medical treatment because:
– context (distinguishing Cheshire West and disengaging
Article 5)
– non–discrimination
– not “not free to leave”
– resources
69. Context – No DoL
• “…any deprivation of liberty resulting from the administration of life-
saving treatment to a person falls outside Article 5(1) (as it was said in
Austin) “so long as [it is] rendered unavoidable as a result of
circumstances beyond the control of the authorities and is necessary to
avert a real risk of serious injury or damage, and [is] kept to the
minimum required for that purpose”.
The above quote would appear not to limit the court’s reasoning to ITU, but
to all settings where life-saving treatment is administered.
• “in essence…acute condition of the patient must not have been the result
of action which the state wrongly chose to inflict on him and…the
administration of the treatment cannot in general include treatment that
could not properly be given to a person of sound mind in her condition
according to the medical evidence”.
70. Non - Discrimination
• “The purpose of Article 5(1)(e) is to protect persons of unsound mind. This does
not apply where a person of unsound mind is receiving materially the same
medical treatment as a person of sound mind. Article 5(1)(e) is thus not
concerned with the treatment of the physical illness of a person of unsound mind.”
• The court reiterated that it is important that a patient of unsound mind with the
same physical needs as a person of sound mind is not treated differently as a result
of this – essentially a non-discrimination argument.
• If a patient is being treated differently as a result of being of unsound mind, then
Article 5 may be engaged, notwithstanding life saving context
71. P wasn’t “not free to leave”
• Court held that even if wrong that article 5 is generally not engaged in context of
life-saving treatment, the 2nd limb of “acid test” was not satisfied:
• “In the case of a patient in intensive care, the true cause of their not being
free to leave is their underlying illness, which was the reason why they were
taken into intensive care. The person may have been rendered unresponsive by
reason of treatment they have received, such as sedation, but, while that
treatment is an immediate cause, it is not the real cause. The real cause is their
illness, a matter for which (in the absent of special circumstances) the state is
not responsible. It is quite different in the case of living arrangements for a
person of unsound mind. If she is prevented from leaving her placement it is
because of steps taken to prevent her because of her mental disorder.”
• Whilst factually there was some dispute about whether Maria’s family were actually
asking if she could leave the CA (like the divisional court below) rejected the idea
that clinicians should be asking the hypothetical question of whether they would
stop P from leaving, or stop P’s family from taking her, if they were to attempt to
do so. Court questioned how often such a scenario would occur in practice.
72. Resources
• Of itself resources was not considered a basis for deciding that
there is in general no DoL in the context of life saving treatment,
but court found that there were sound public policy reasons for
avoiding the administrative and resource burdens that accompany
a finding of DoL in acute hospital settings:
• “Ultimately, this all detracts from the real priorities for ICU
staff; the investigation and treatment of critically unwell
patients, their recovery and rehabilitation, and the safe and
effective delivery of patient care”.
73. Conclusions
• A welcome result for Trusts and LAs? Reduced need for DoLS
authorisations in respect of those receiving life saving treatment?
• What is meant by “life-saving treatment”? How far removed does
the prospect of P’s life being in danger need to be before we can
say that DoL becomes a factor and can it apply outside ICU?
• What’s the rationale for not applying the CA’s reasoning to non-life
saving physical treatment if that treatment would be the same as
that which would be provided to a person with capacity to consent
to/refuse? What about hospice care, or other acute non-life
threatening settings?
74. Conclusions - continued
• What is the difference between “context” and “purpose”?
• Does the distinction between long term care settings (where DoL does
apply), and life saving medical treatment decisions (where generally it
won’t), rely on the purpose of P’s care – something which Lady Hale in CW
expressly said was irrelevant to determining whether P is DoL?
• CA said Maria “free to leave” thus no DoL in the context of ITU, isn’t the
court’s finding that Maria’s underlying physical condition was the real
reason why she could not leave capable of wider application? Could this
itself lead to discriminatory approaches based on who can and can’t
physically leave their care setting?
75. Conclusions - continued
• How does CA’s rationale that article 5 generally has no application
in the context of life saving medical treatment sit with CW that
“human rights are for everyone”?
• Is it important that CA probably felt justified in taking this
approach as ECtHR has never decided that article 5 applies to
medical treatment for physical disorder?
• SC may agree to hear appeal.
• NB Proposed amendment to Coroners and Justice Act 2009
79. ECHR
• ECHR Articles generally relied upon in cases
relating to Healthcare
• Article 2 – Right to life
• Article 8 – Right to respect for private and family life
80. Wording of Article 2
1. Everyone’s right to life shall be protected by law
No one shall be deprived of his life intentionally save in the execution
of a sentence of a court following his conviction of a crime for which
this penalty is provided by law.
2. Deprivation of life shall not be regarded as inflicted in
contravention of this Article when it results from the use of force
which is no more than absolutely necessary:
(a) in defence of any person from unlawful violence;
(b) in order to effect a lawful arrest or to prevent the escape of a
person lawfully detained;
(c) in action lawfully taken for the purpose of quelling a riot or
insurrection.
81. Interpretation of Article 2
• 4 distinct but related duties:
– A duty not to take life, except in exceptional circumstances
– A duty to conduct a proper and open investigation into deaths
for which the state might be responsible
– A duty put in place legal and administrative systems that will,
to the greatest extent practicable, protect life
– An operational duty, in certain circumstances, to take positive
steps to prevent the death of an individual who is under threat
• Relevant case law mainly concerns the operational
duty
82. Article 2 Case law
Osman v UK (2000) 29 EHRR 245
• Foundation of the operational duty
• Boy injured and father shot dead by the boy’s school
teacher.
• “Article 2 of the Convention may also imply in
certain well-defined circumstances a positive
obligation on the authorities to take preventive
operational measures to protect an individual whose
life is at risk from the criminal acts of another
individual”
83. Article 2 Case law
• “… such an obligation must be interpreted in a way
which does not impose an impossible or
disproportionate burden on the authorities.”
• “… it must be established… that the authorities
knew or ought to have known at the time of the
existence of a real and immediate risk to the life of
an identified individual or individuals”
• “…and that they failed to take measures within the
scope of their powers which, judged reasonably,
might have been expected to avoid that risk.”
• Breach of duty not found on the facts
84. Article 2 Case law
Powell v UK (2000) 30 EHRR CD362
• Applicants’ son died in hospital as a result of clinical
negligence.
• Applicants argued, following Osman, Article 2 places
a positive duty on the State to do, “all that could be
reasonably expected of them to avoid a real and
immediate risk to life of which they have or ought
to have knowledge”
• Applicants argued that as death was caused by the
negligence of State agents, there was a breach of
the obligation to protect life.
85. Article 2 Case law
• Osman was not relevant.
• Powell held: ‘Where the State had made adequate
provision for securing high professional standards
among health professionals and the protection of
the lives of patients, matters such as error of
judgment or negligent co-ordination are not
sufficient to give rise to an operational duty under
Article 2.’
86. Article 2 Case law
Savage v South Essex Partnership NHS Foundation
Trust [2009] 1 AC 681
• Detained MH patient absconded and committed
suicide
• Daughter brought action
• Judge – Claimant would have to establish gross
negligence. Summary judgment.
• Court of Appeal – allowed appeal.
87. Article 2 Case law
• Supreme Court in Savage held that Osman applied:
‘Where hospital staff knew or ought to have known
that a detained MH patient presented a real and
immediate risk of suicide, Art 2 imposed an
operational duty to do all that could reasonably be
expected of them to prevent the patient committing
suicide.’
88. Article 2 Case law
• Two lines of authorities:
– Powell line of cases – where a (non-psychiatric)
patient’s life is at real and immediate risk, even if
due to negligence, the operational duty does not
apply.
– Savage line of cases – where the patient is a
detained psychiatric patient and the Trust knew or
ought to have known that there was a real and
immediate risk to life, the operational duty applies.
89. Article 2 Case law
Rabone v Pennine Care NHS Foundation Trust [2012]
UKSC Civ 698
• Miss Rabone was admitted to hospital following a
suicide attempt on 11.04.05; informal admission
• Assessed as a high risk of further suicide attempt
• It was noted that if she attempted to leave she
should be assessed for detention
• On 19.04.05 home leave allowed (despite mother’s
concerns); 20.04.05 she hung herself
90. Article 2 Case law
Rabone v Pennine Care NHS Foundation Trust [2012]
UKSC Civ 698
• Parents brought CN claim and claim under Art 2.
• Settled CN claim £7,500 – funeral expenses and PSLA
damages
• Argued operational duty owed (Savage)
91. Article 2 Case law
Rabone v Pennine Care NHS Foundation Trust [2012]
UKSC Civ 698
Key issue: Did Powell or Savage apply?
Held:
• Trust assumed responsibility - Under its control
• Although not detained, if she had insisted on
leaving, Trust could and should have detained
• Difference between her situation and detained
patient – one of form not substance
• Operational duty WAS owed
92. Article 2 Case law
Rabone v Pennine Care NHS Foundation Trust [2012]
UKSC Civ 698
• Real and immediate risk?
• Risk of suicide was 5 – 10% = “real”
• “Immediate” = present and continuing
• Simple to avoid risk by refusing leave
• Operational duty was breached
93. Article 2 Case law
Rabone v Pennine Care NHS Foundation Trust [2012]
UKSC Civ 698
• Another issue – did parents lose “victim” status by
having settled the CN claim?
• Accepted lose victim status if:
• Public authority provided adequate redress; and
• Acknowledged breach of a Convention right
• Acceptance of sum in settlement of all claims
generally means no longer able to claim to be a
victim- Caraher v UK (2000) 29 EHRR CD119
94. Article 2 Case law
Rabone v Pennine Care NHS Foundation Trust [2012]
UKSC Civ 698
• Settlement in Rabone did not include any amount for
bereavement (adult child)
• No adequate redress
• Admission of a breach of the common law duty =
acknowledgement of breach of convention right (in
this case)
• Parents did not lose victim status by settling CN case
95. Expert Evidence in Rabone-type
cases
Psychiatrist will need to comment on:
• Whether there was a “real” risk of suicide
-“substantial or significant risk”
• Whether there was an “immediate” risk of suicide
-“present and continuing”
• Whether the treating psychiatrist knew or should
have known of any such risk
• Whether the steps that were taken (if any) to avoid
the risk of suicide were reasonable
96. Wording of Article 8
• Right to respect for private and family life
1. Everyone has the right to respect for his private and
family life, his home and his correspondence.
2. There shall be no interference by a public authority with
the exercise of this right except such as is in accordance with
the law and is necessary in a democratic society in the
interests of national security, public safety or the economic
wellbeing of the country, for the prevention of disorder or
crime, for the protection of health or morals, or for the
protection of the rights and freedoms of others.
97. Article 8 Case law
McDonald v UK (2015) 60 EHRR 1
• Applicant had incapacitating stroke 1999
• She needed to urinate several times per night, but
was unable to access a toilet or commode without
assistance.
• Assessed by the local authority as requiring carers at
night to assist with toileting.
• In October 2008 (without a formal re-assessment)
decision was taken to reduce care – use incontinence
pads at night
98. Article 8 Case law
McDonald v UK (2015) 60 EHRR 1
• Informed of decision Nov 2008
• Sought JR – unreasonably and unlawfully failed to
meet assessed needs and would cause indignity –
interference with respect for private life (Art 8)
• Holding compromise (5 nights/4 nights)
• March 2009 permission for JR refused
99. Article 8 Case law
McDonald v UK (2015) 60 EHRR 1
• Re-assessment of needs Nov 2009 – use of
incontinence pads most appropriate solution
• Ct of Appeal – no breach of Art 8
• Supreme Ct – no breach of Art 8
100. Article 8 Case law
McDonald v UK (2015) 60 EHRR 1
• During the period Nov 2008 (date of reduction in
care) to Nov 2009 (the date of the first care plan
review) the local authority had failed to provide
care in accordance with its own assessment of her
needs – reduction not “in accordance with the law” –
breach of Art 8
• After the care plan review – no breach
101. Article 8 Case law
McDonald v UK (2015) 60 EHRR 1
• After Nov 2009 the interference with the applicant’s
right to privacy:
Was in accordance with the law
Pursued a legitimate aim (economic welfare of the
State and the interests of other care-users)
Was necessary in a democratic society
Was proportionate to the legitimate aim
• Art 8 para (2)
102. Limitation
• Section 7 (5) HRA 1998 Limitation is
(a) 1 year
(b) Such longer period as the Court considers
equitable in all the circumstances
• Section 33(3) LA 1980 may provide some guidance
as to factors to consider
• Rabone – 4 months late, extension granted
• AP v Tameside Metropolitan Borough Council [2017]
103. Damages and Costs
Savage v South Essex
• Detained MH patient – suicide
• Range for non-pecuniary loss: €5,000 to €60,000
• £10,000 damages awarded
• Equaled bereavement award at the time
104. Damages and Costs
Rabone v Pennine Care
• Voluntary MH patient – suicide
• Lord Dyson – real force in the submission that £5,000
per parent is too low, but no appeal on this point
• £10,000 damages (£5,000 each) awarded
• Equaled bereavement award at the time
105. Damages and Costs
McDonald v UK
• Art 8 rights breached for 12m
- €1,000 damages
- £9,500 costs
- £9,822 was claimed in costs
- Entitled to costs and expenses only insofar as these
have been actually and necessarily incurred and are
reasonable as to quantum
106. Comment
• Very limited circumstances in which a HRA-based
health care claim will be successful.
• Art 2 – essentially limited to MH patients who are
either detained or would be detained
• Art 8 – in general, unlikely to be successful (rarely
pursued as stand-alone)
• Damages for a breach of an Art 2 operational duty
(Savage / Rabone) likely to be akin to a
bereavement award – currently £12,980
107. Comment
• If settling a CN case where there could possibly be
a HRA claim in addition – seek to settle:
– “all claims on the Claimant’s own behalf and on
behalf of the estate and dependents of the
deceased”
• If a claim is brought regarding a reduction in care
(McDonald) – care provider should ensure that a
formal re-assessment has been carried out
(preferably before the reduction)
108. Comment
• Almost 5 years since judgment handed down in Rabone
– no significant development in the law since then
• Many speculative case still being brought – they should
be defended
• NHSLA taking a case by case approach