Operational Manual for
ASSOCIATE HOSPITAL MANAGERS (AHM)
Review Hearings
NUMBER:VERSION NUMBER: /
V11
AUTHOR: /Non-Executive Director,
Mental Health Act Administration Manager
Consultant Social Work PractitionerCONSULTATION: / Executive Directors and Non-Executive Directors,
Associate Hospital Managers (AHM’s),
Mental Health Act Office Administrators,
Operational Directors,
Human Resources Department, Workforce Development and Training department,
Compliance team
IMPLEMENTATION DATE: / 1ST August 2013
AMENDMENT DATE(S): / October 2014; April 2015
LAST REVIEW DATE: / New document
NEXT REVIEW DATE: / April 2017
APPROVAL BY CORPORATE GOVERNANCE MANAGEMENT TEAM:
This operational manual will be monitored and reviewed by
Executive Director of Corporate Governance
SOUTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST
ASSOCIATE HOSPITAL MANAGERS (AHM) Operational Manual
1. Introduction
1.1 Background and Context
1.1.1 Hospital Managers (AHMs) have a central role in operating the provisions of the Mental Health Act 1983 (hereafter known as the Act). The following chapters more fully discuss the legal framework within which the Hospital Manager power to discharge is carried out, drawing mainly upon the Act and the Mental Health Act 1983 Code of Practice, and referring to the various procedures that are not necessarily legally required but must be followed by Associate Hospital Managers within the organisation in compliance with the agreed local policy and as a matter of good practice.
1.1.2 Section 23 of the Act gives the Hospital Managers the power to discharge most detained patients and all patients subject to Supervised Community Treatment (SCT).
1.1.1 The Mental Health (Amendment) Act 1994 changed the definition of ‘the Managers’ under Section 145 (1) of the Mental Health Act 1983 from ‘the directors of the trust’ to ‘the trust’. The Hospital Managers are therefore the organisation, whether in the NHS or in the independent sector, and each organisation must therefore decide how it will delegate the extensive duties of the Hospital Managers as they are set out in the Mental Health Act 1983 and Code of Practice (2015), including the power of discharge.
1.1.2 The Hospital Managers can discharge patients from detention under sections 2, 3, 4, 37, 47, 48 and from compulsion under 17A (SCT) as well as unrestricted orders under section 5 of the Criminal Procedure (Insanity) Act 1964[1].
1.1.3 They can also discharge patients who are subject to special restrictions, but only with the consent of the Secretary of State for Justice. These sections are 37/41, 45A, 47/49, 48/49 and restricted orders under section 5 of the Criminal Procedure (Insanity) Act 1964[2].
1.1.4 The Hospital Managers may not discharge patients who are subject to short-term holding powers such as sections 5(2), 5(4), 135 and 136.
1.1.5 They also may not discharge patients subject to remand or interim orders; found in sections 35, 36 and 38.
1.1.6 The Mental Health Act does not set out a mechanism as to how a patient’s application for discharge to the AHMs should be considered. Neither does the Act state when the AHMs should consider exercising the power of discharge.
1.1.7 However the Code of Practice at 38.12 gives guidance on when a review should or might take place:
Hospital Managers:
§ May undertake a review of whether or not a patient should be discharged at any time at their discretion;
§ Must undertake a review if the patient’s responsible clinician submits a report to them under section 20 of the Act renewing detention or under section 20A extending SCT;
§ Should consider holding a review when they receive a request from (or on behalf of) a patient; and
§ Must consider holding a review when the responsible clinician makes a report to them under section 25 barring an order by the nearest relative to discharge a patient.
1.2 Delegation by the Hospital Managers of the Power to Discharge
1.2.1 Section 23(4) authorises any authority except a Foundation Trust to exercise the power of discharge by any three or more members authorised by that authority or body or by three or more members of a committee or sub-committee of that authority or body which has been authorised by them, providing they are not also officers of the authority within the meaning of the National Health Act 2006.
1.2.2 In the case of NHS Foundation Trusts under section 23(6) the power may be exercised by three or more persons authorised by the Board each of whom is neither an executive director of the board nor an employee of the Trust.
1.2.3 The position is set out more simply in the Code of Practice Chapter 38 sections 38.3 to 38.7
1.3 Standards
1.3.1 Every authority (NHS Trust or Independent Hospital) that is responsible for patients who are subject to the relevant compulsory powers – the Hospital Managers – should have a policy setting out how the power of discharge under Section 23 is to be carried out on its behalf by ‘Managers Panels’ and who should be members of such panels.The SEPT Manual comprises the following:-
a) The expected sequence of events;
b) Ensuring a fair hearing;
c) A clear procedure for renewal hearings, including how to deal with so called ‘uncontested renewals’ (Code of Practice 38.41 to 38.46); and
d) A clear procedure for CTO reviews and renewals to ensure that the legal criteria are properly addressed and that patients receive a fair hearing, in particular when they do not wish to attend or to be represented.
e) Confidentiality of patient information;
f) Note taking arrangements at the hearing including who takes notes and whether the notes are retained or destroyed after reaching a decision;
g) The role of advocates at the particular hearing bearing in mind the Code of Practice reference which sets out the various roles of advocates[3];
h) How to seek advice on legal and procedural matters including when the hearing is held outside of the hospital;
i) Reaching a decision, in particular ensuring that the statutory criteria are properly considered;
j) Communicating decisions in a safe and sensitive way, whether in the hearing room or in a ward or other area;
k) Recording decisions, so that there is a full account of reasons and supporting evidence;
1.3.2 Guidance is provided to Managers’ Panels on the approach to be taken to handling ‘restricted cases’.
1.3.3 AHMs cannot discharge a patient on a restriction order. However they can review such cases, either at the patient's request or at their initiative. If, having reviewed the case they feel that discharge is appropriate they can report their observations to the Secretary of State at the Ministry of Justice. See Appendix B- Hearing Restricted Cases
2.0 ROLE
2.1 Background and Context
2.1.1 Chapter 38 of the Code of Practice sets out the role of the Associate Hospital Manager (AHM).
2.1.3 In essence, the role is to undertake the function of the Hospital Managers in considering patients’ requests for discharge from detention under certain sections of the Mental Health Act in accordance with S23 of that Act, (including from Supervised Community Treatment) and reviewing detention following renewal of such sections or following the barring by the Responsible Clinician of an application for discharge by the patient’s nearest relative.
2.1.4 An AHM is a part-time appointment by the organisation of a lay person who may not be an officer (i.e. an employee) of the organisation or have any financial interest in it. Non-Executive Directors may fulfil this role. AHMs are not therefore independent of the organisation in the way that the panel of the Tribunal Service[4] is, but they are independent of the management and of the clinical teams assessing and treating detained patients.
2.1.5 The precise status of the role remains a matter of some debate and discussion. Its status may differ for purposes of employment law or tax status. Traditionally, it has been seen as a volunteer role but of a special kind, exercising as it does a statutory function. In some respects it may be seen as analogous to the lay magistrate.
2.1.6 Managers will be expected to perform their role displaying the Nolan principles of public life:-
· Selflessness
· Integrity
· Objectivity
· Accountability
· Openness
· Honesty
· Leadership
2.1.7 AHMs carry out reviews of certain categories of detained patient in panels comprising three or more members[5].
2.2 Information
2.2.1 SEPT will consider the representation and balance of their Associate Hospital Managers in terms of age, gender, ethnicity and disability. This will be audited.
2.2.2 SEPT clarifies the terms under which they are appointing AHMs in a letter of appointment. These include details of:-
a) remuneration by way of an allowance for undertaking reviews,
b) the required number of training events or meetings to be attended
c) the payment of travelling and any other ancillary expenses
d) the issue of indemnity cover
e) the requirements for any minimum or maximum number of hearings to be undertaken and,
f) other requirements in respect of training and attendance at meetings.
These matters are covered in Appendix C10
2.2.3 SEPT ensures the requirements of HM Revenue & Customs are met in that AHMs are required to be responsible for their tax returns and in the cases of allowances paid by account payable the trust records details of HMRC Unique Tax Number.
2.3. Standards
2.3.1 A competency set is attached at Appendix C for AHM and panel chairs.
2.3.2 SEPT commits to ensuring that their staff, and especially all members of clinical teams caring for detained patients, understand the role and function of AHMs and offer them the cooperation and support that they need to fulfil their responsibilities. Details of the role and relevant procedures are detailed on the SEPT website. SEPT staff mandatory and induction training contain an input on AHM hearings and the role of Associate Hospital Managers (AHMs).
2.3.3 To avoid confusion, the term Associate Hospital Manager (the term used in the Code of Practice) should be used to describe people who undertake this role in preference to the term ‘Mental Health Act Manager’ which is often used to describe an employed manager who is in charge of Mental Health Act administration and services within an organisation.
3.0 RECRUITMENT AND SELECTION
3.1 Background and context
3.1.1 As previously explained, Associate Hospital Managers are lay people appointed by health organisations to undertake reviews of certain categories of patients detained under the Mental Health Act.
3.1.2 The title does not convey their role accurately and the term ‘manager’ (a legal term in the Act) is misleading to the general public (and indeed to patients). This complicates the recruitment process and any associated publicity.
3.1.3 SEPT is committed to ensuring that the representation of AHMs reflects the make-up of the detained population and the local community, in respect of gender, age, ethnicity, social and economic background. Consideration is also given to include people who are in full or part-time work and people who may themselves be or have been users of mental health services.
3.1.4 SEPT serve large and diverse conurbations and have made special efforts to recruit more widely, for example from BME communities. Equality audits will be undertaken by the MHAO Manager and reported on at the AHM Committee Meetings.
3.1.5 The advertising/recruitment of these voluntary roles is to be managed by the SEPT Recruitment Service.
3.1.6 The management of the Associate Hospital Manager roles will remain with the Mental Health Act Office Manager.
3.1.7 A Job Profile Appendix C1 and Person Specification Appendix C2 will be held by the Recruitment Service and the MHAO Manager which will outline the purpose of the role and the minimum requirements for selection process.
3.1.8 A template Advert will be held by the Recruitment Service and the MHAO Manager to be used for purposes of advertising, Appendix C3.
3.1.9 The MHAO manager will be required to complete a Request to Advertise Form, Appendix C5 (Recruitment control form checklist) each time they wish to place an advert for an Associate Hospital Manager. The Recruitment Service will retain the Job Profile, Person Specification and Advert and will use this when they receive a request to advertise (should these documents change during processes then it will be the responsibility of the MHAO Manager to ensure that the recruitment service are provided with updated documents).
3.1.10 On receipt of the request to advertise form, the Associate Hospital Manager role will be placed on suitable websites and journals as a Voluntary Role with a closing date for applications of 2 weeks (unless specified otherwise).
3.1.11 Candidates will be expected to apply on and agreed application form. Appendix C4.
3.1.12 The day following the closing date, all applications will be sent to the MHAO Manager for them to shortlist, using the person specification and on line shortlisting process.
3.1.13 At the same time the manager will be sent an Interview Schedule by email, Appendix C6 for them to complete for all shortlisted candidates and to include interview details i.e. venue, times etc. The Mental Health Act Office Manager will keep a list of volunteer service users and clinicians who are in agreement to participate on interview panels and will select the interview panels.
The interview panel for AHM roles will comprise the Mental Health Act Office Manager, a Non-Executive Director, Service User and Responsible Clinician.
When interviewing for the Chair role the interview panel will consist of the Mental Health Act Office Manager and 2 Non-Executive Directors.
3.1.14 Invite to interview letters will be sent by email from HR to the candidates.
3.1.15 Following interviews the MHAO Manager will be required to complete the interview record forms Appendix C7 and a successful candidate appointment details form, Appendix C8.
3.1.16 The relevant checks will be undertaken for the successful candidate and once complete, they will be sent a letter outlining the terms of their volunteer agreement and the requirements of the role.
· Letters of appointment (Appendix C10) should state clearly the length of appointment, the required performance in terms of the minimum number of hearings to be undertaken over what period, attendance at training and other events. Further the arrangements for performance review, resignationand termination of appointment in the event of unsatisfactory performance together with anycomplaints andappeal procedures. See Appendix C9.