NCP 19

HAMPSHIRE AND ISLE OF WIGHT MENTAL HEALTH SERVICES

Version1

NCP 19

Hampshire Partnership NHS Foundation Trust

POLICIES AND PROCEDURES PROFORMA

Subject and Version of Document: / Multi-Agency Transportation Protocol for Clients Assessed Under the Mental Health Act 1983 (as amended by the Mental Health Act 2007), Version1
Author: / Head of Service Development for AMH
Persons/Committee etc consulted whilst document in draft: / Hampshire County Council, Southampton City Council, Portsmouth City Council, Portsmouth City PCT, South Central Ambulance Service, South East Coast Ambulance Service, Hampshire Constabulary, Hampshire Partnership NHS Trust, Surrey & Borders Partnership NHS Trust, Isle of Wight PCT & Isle of Wight Council.
Date agreed: / Version 1 - June 2009
By whom agreed: / Hampshire & Isle of Wight Criminal Justice Liaison Group
Date of next review/update and by whom: / July 2010
Head of Service Development for AMH
Copy obtainable from and/or distribution: / Website
Date document issued: / Version 1 – August 2009 – Update 51
Responsibility for dissemination to new staff: / Trust and Locality Criminal Justice Liaison Groups
Principal Target Audience: / Multi-Agency Operational Staff
Training Implications: / Local arrangements for dissemination and awareness raising
Equality Impact Assessment Completed? / Yes

Amendments Summary:

Amend. No. / Issued / Page / Subject

1.INTRODUCTION

This new protocol replaces the existing Conveying Policy between Hampshire County Council, Southampton City Council, Portsmouth City Council and South Central Ambulance Service originally agreed in January 2008.

This new revised protocol sets out the roles and responsibilities of each agency in relation to the transportation of clients assessed under the Amended Mental Health Act 1983 or already subject to the provisions of section 7 or 37 Guardianship orders or Supervised Community Treatment (SCT) under section 17a.

2.JOINT AGREEMENT

THIS POLICY IS AGREED BETWEEN:

Name: Gill Duncan

Director of Adult Services

HampshireCounty CouncilDate: 28 August 2009

Name:Brian Parrot

Interim Director of Adult Social Service

SouthamptonCity CouncilDate: 9 July 2009

Name:Margaret Geary

Director of Social Services

PortsmouthCity CouncilDate: 20 July 2009

Name:Fizz ThompsonSignature

Director of Clinical Services

South Central Ambulance ServiceDate: 26 July 2009

Name:David Pryde

AssistantChief Constable

Hampshire ConstabularyDate: 28 July 2009

Name:Nick Yeo

Chief Executive

Hampshire Partnership NHS

FoundationTrustDate: 15 July 2009

Name:Jo Young

Director of Operations

Surrey and Borders Partnership NHS

FoundationTrustDate: 14 October 2009

Name:Kevin Flynn

Chief Executive

Isle of Wight NHSPCTDate: 26 August 2009

Inc. Isle of Wight Ambulance Service

Name:Mark Howell

Acting Director of Community Services

Isle of Wight CouncilDate: 20 August 2009

Name:Diane Wilson

Associate Director of Adult Care Group

NHS Hampshire Date: 21 August 2009

Name:Amy Hobson

Associate Director of Commissioning

NHSSouthamptonCity Date: 16 July 2009

CONTENTS

INTRODUCTION / 3
JOINT AGREEMENT / 3
1. / GENERAL CONSIDERATIONS / 6
2. / DUTIES OF PARTICIPANTS / 7
2.1 / Responsibility / 7
2.2 / Conveying the Patient / 7
2.3 / Contacting the Ambulance Service / 9
2.4 / Non-compliant/Non-violent Patients / 11
2.5 / Con-compliant & Violent, Aggressive or Potentially Violent Patients / 11
2.6 / Decision Making and Conveyance (Mental Capacity Act (2005) / 11
2.6.2 / Conveying Patients under S17a and Recall / 12
2.7 / Documentation / 13
2.8 / Authority to Convey / 13
2.9 / Application for Legal Detention by Nearest Relative / 13
3. / DUTIES OF AMBULANCE SERVICE / 14
3.1 / Contact and Communication / 14
3.2 / Conveying the Patient / 14
3.3 / Offer Support in the event of Police Conveyance / 15
4. / DUTIES OF HAMPSHIRE/SURREY POLICE / 15
4.1 / Responsibilities / 15
4.2 / Contact and Communication / 16
4.3 / Procedure / 16
4.4 / Escorting Officer / 18
4.5 / Charging for Out of CountyTransportation / 18
5. / DUTIES OF SECTION 12 APPROVED DOCTOR / 18
5.1 / Mental Health Act Code of Practice: Professional Responsibilities / 18
6. / DUTIES OF MENTAL HEALTH TRUST / 19
7. / GAINING ACCESS / 19
8. / DISPUTES / 20
9. / COMPLAINTS / 21
10. / REVIEW / 21
11. / MONITORING / 21
12. / EXPLANTION OF TERMS / 22
APPENDIX 1 – Delegated Authority to convey a Patient – document / 24
APPENDIX 2 – Legal framework for authority to convey / 25

1.GENERAL CONSIDERATIONS

(as per the MHA 1983 Code of Practice)

1.1 Patients should always be conveyed in the manner which is most likely to preserve their dignity and privacy consistent with managing any risk to their health andsafety or to other people.

1.2 This applies in all cases where patients are compulsorilyconveyed under the Act, including:

a)taking patients to hospital to be detained for assessment or treatment;

b)transferring patients between hospitals;

c) returning patients to hospital if they are absent without leave;

d)taking supervised community treatment (SCT) patients or patients who have been conditionally discharged to hospital on recall;

e)taking and returning patients who are subject to guardianship to the place their guardian requires them to live;

f)taking patients to and between places of safety; and

g)taking patients to and from court.

1.3When deciding on the most appropriate method for conveying a patient, factors to be taken into account include:

a)the availability of different transport options;

b)the distance to be travelled;

c)the wishes and views of the patient, including any relevant statement of those views or wishes made in advance;

d)the patient’s age;

e)any special needs the patient has (e.g. a physical disability that requires the use of a bariatric vehicle);

f)any risks to the health and safety of the patient and any need for support, supervision and clinical care or monitoring during the journey. This is particularlyimportant where sedation has been, or may be, used;

g)the nature of the patient’s mental disorder and their current state of mind;

h)the likelihood of the patient behaving in a violent or dangerous manner;

i)the health and safety of the people conveying the patient and anyone else accompanying them;

j)the likelihood that the patient may attempt to abscond and the risk of harm to the patient or other people were that to happen;

k)the impact that any particular method of conveying the patient will have on the patient’s relationship with the community to which they will return;

l)the effect on the patient of who accompanies them, for example, whether the presence of the approved mental health professional (AMHP) or one of the doctorsinvolved in the decision to detain them may have a detrimental effect;

m)the availability of transport to return those who accompany the patient.

1.4Patients who have been sedated before being conveyed should always be accompanied by a health professional that is knowledgeable in the care of such patients, is able to identify and respond to any physical distress which may occur and has access to the necessary emergency equipment to do so.

1.5A person removed to a place of safety under section 135 or section 136 may be moved to a different place of safety before the end of the maximum 72-hour period for which they may be detained. The maximum period of detention begins from the time of the person’s arrival at the first place of safety to which they are taken and cannot be extended if the person is transferred to another place of safety.

1.6A record of the person’s time of arrival must be made immediately when they reach the place of safety. As soon as detention in a place of safety under section 135 or 136 ends, the individual must be told that they are free to leave by those who are detaining them. The organisation responsible for the place of safety (where there is one) should ensure that proper records are kept of the end of the person’s detention under these sections.

2.DUTIES OF PARTICIPANTS

DUTIES OF APPROVED MENTAL HEALTH PROFESSIONALS(AMHPs), RESPONSIBLE CLINICIANs (RCs) or RESPONSIBLE SOCIAL WORKERs (RSWs)

2.1Responsibility

The patient and the coordination of an assessment remains the responsibility of an AMHP until Section papers have been accepted by the admitting Hospital. Elements of this responsibility may be delegated. Likewise Responsible Clinicians (for patients subject to SCT) or Responsible Social Workers (RSWs – for those subject to Guardianship) may also authorise others to convey the patient to the appointed place. Where a patient requires transport between hospitals, it is for the managers of the hospitals concerned to make sure that appropriate arrangements are put in place. The managers of the hospital from which the patient is being transferred remain responsible for the patient until the patient is admitted to the new hospital.

2.2Conveying the Patient

(see duties in “Code of Practice” – Chapter 11)

When making arrangements to convey a patient to Hospital or other designated place, the AMHP, RC or RSW should ensure that:-

a)A joint risk assessment between those parties involved should be completed

b)when the patient is to be admitted to Hospital, a bed has been arranged by a Doctor and the ward staff informed of the expected time of arrival

c)the patient is conveyed in a lawful, humane and least restrictive manner

d)consideration is given to the potential impact of the mode of conveying the patient will have on the patient’s relationship with the community to which he/she will return

e)where practicable, the views of the patient and involved relatives/carers are taken into account

f)the views of other professionals involved in the process or who know the patient are taken into account

g)where a section 135 warrant is used, the AMHP, the hospital managers or the LSSA (as appropriate) should ensure that an ambulance or other transport is available to take the person to the place of safety or to the place where they ought to be, in accordance with a locally agreed policy on the transport of patients under the Act

h)thought should be given to the choice of the place of safety before a warrant is applied for under section 135(1). Proper planning should mean that it is almost never necessary to use a police station as a place of safety for people removed under section 135(1)

i)where appropriate the patient is escorted either by the AMHP, RC or RSW; or a member of the Ambulance staff other than the driver; a responsible relative; or another professional, taking into account the potential risk factors (to both patient, staff, carers and relatives) and the patient’s care needs

j)Consideration should be given to the possibility that in some cases the patient may be particularly angry with the AMHP, RC or RSW. In these cases the decision about who should act as an escort should take into account the health & safety of the AMHP/RC or RSW

k)TheAMHP will not routinely accompany the patient in the Ambulance and will instead follow the Ambulance to hospital in their own vehicle. If the AMHP is of the opinion that the risks would be reduced by themselves, a relative or another professional travelling in the ambulance they will facilitate this in consultation with ambulance personnel

l)The appropriate level of Police assistance has been obtained where AMHP, RC or RSW believes the patient will be aggressive or potentially violent (to self or others). In some cases Police assistance may be required before and during the journey, e.g. forcible removal and restraint. (See 2.5for further details). AMHPs/RCs or RSW’s in consultation with Police will determine whether police assistance is necessary

m)If the patient is likely to be unwilling to be moved, the applicant should provide the people who are to convey the patient (including any ambulance staff or police officers involved) with authority to convey the patient. It is that authorisation which confers on them the legal power to transport the patient against their will, using reasonable force if necessary, and to prevent them absconding en route. (see S6, S137)

n)People authorised by the applicant to convey patients act in their own right and not as the agent of the applicant. They may act on their own initiative to restrain patients and prevent them from absconding, if necessary. However, when they are the applicant, AMHPs retain a professional responsibility to ensure that the patient is conveyed in a lawful and humane manner and should give guidance to those asked to assist

o)In most circumstances the AMHP will not transport a patient who is subject to an application for admission under the Act by car. However in some circumstances where the assessed risks are low, the client is not objecting to going to hospital, where an escort (or escorts) is/are available and where transportation by car will lesson the stigma of being transported to hospital via ambulance (or police) – it may be appropriate to use a car. The AMHP as the applicant has to be sure that if the person is to be transported by car that in addition to the points above - the driver of the car must be confident that other road users, pedestrians, or the patient will not be put at additional risk by doing so. If the AMHP is not confident that transportation by car would be safe – then an ambulance should be requested. If a car is to be used, in these circumstances there should be an escort for the patient other than the driver

p)If the AMHP is using their own car for transporting patients they must ensure that their car insurance covers them for this type of business use

q)Police transport will only be used as a last resort e.g. where as a result of a joint risk assessment an ambulance has been deemed as not the most suitable means of transport

2.3 Contacting the Ambulance Service

When contacting the Ambulance Service to arrange for a patient’s transport to Hospital (section 2, 3, 4 admissions or informal admission under s131), or other designated place stated in the Section 7 or 37 guardianship orders or section17A/E Community Treatment Order, the AMHP, RC or RSW will:

a)Make a definite booking for an ambulance when it is known that an ambulance is likely to be required via:

  • South Central Ambulance Emergency Operations Centre (EOC) (All Hampshire localities except North-East Hampshire – Aldershot/Farnborough area) on: 08440903333
  • South East Coast Ambulance Control (For North-East Hampshire) on: 01737353333
  • Ambulance Communication Centre (Isle of Wight Ambulance Service) on 01983 534102

This request should be made giving as much notice to the Ambulance Service as is possible.

b)Advise of the need to make an “Urgent psychiatric admission”. (This term should be used to obtain an ambulance; it does not in itself denote hospital admission)

c)Provide the following information to Ambulance EOC/Control/Communication Centre:

  • Name, role and agency (i.e.AMHP, RC, RSW etc)
  • Mobile telephone or other contact number
  • GP or Psychiatrist authorising transport (if applicable)
  • Patients name, address, telephone number (if appropriate), age
  • Patients psychiatric condition (e.g. manic; deluded)
  • Presentation (e.g. agitated; suspicious)
  • Risks (e.g. passive; threatening)
  • Patients’ physical condition (e.g. diabetic; asthmatic; disabled, obese)
  • Medication (if known)
  • Police involvement (if applicable)
  • Police incident Ref No if involved
  • Section of Mental Health Act
  • Receiving Hospital/Ward/Designated place
  • Agreed post-assessment pick-up time
  • Type of vehicle required (i.e. front line ambulance)
  • Useful information (if applicable)

d)Obtain “Incident Reference No” from Ambulance EOC/Control/Communication Centre

e)If in the opinion of the AMHP, RC or RSW the patient’s condition has deteriorated to a life threatening extent, the option of the 999 facility should be considered. If an arrangement has already been made to obtain an ambulance via AmbulanceEOC/Control/Communication Centre the AMHP, RC or RSW must inform the 999 control room of:

  • His or her name, agency and mobile number
  • Patients name and address
  • Existing “Incident Reference No” from earlier request for an ambulance
  • Other relevant information

f)In the event of changing events NO LONGER requiring an ambulance as arranged, the AMHP, RC or RSW must inform the Ambulance EOC/Control/Communication Centreimmediately that the situation becomes apparent, quoting “Reference No”.

g)Mobile telephones used for 999 calls close to the County boundary may be routed to neighbouring services. It is important to identify the correct Ambulance Service that is required (South Central Ambulance for all localities in Hampshire except North East Hampshire where South East Coast Ambulance Service is required and Isle of Wight Ambulance for the Isle of Wight).

2.4Non-compliant/Non-violent Patients

When a patient refuses admission to Hospital following the completion of legal documents, ambulance personnel are able to convey non-compliant but non-violent patients.

Ambulance personnel must be given written authority to do so.(see Appendix 1)

Ambulance and AMHP personnel are trained to withdraw should they feel they are in danger from threatened or actual physical violence and must engage Police assistance.

2.5Non-compliant & Violent, Aggressive or Potentially Violent Patients

When a patient refuses admission to hospital (to be taken to or returned to designated place as specified in their section 7 or 37 Guardianship orders or 17a (Supervised Community Treatment) and is aggressive, violent or in the opinion of the professionals involved is potentially likely to become violent or aggressive when transportation is attempted then the AMHP will seek assistance from the Police.Given the risks involved, an ambulance service (or similar) vehicle should be used even where the police are assisting. Police Transport will only be used in exceptional circumstances, e.g. the Police cannot safely restrain the patient from using violence within the confines of an ambulance.See Section 4 below.

2.6 Decision Making and Conveyance (Mental Capacity Act (MCA) 2005)

2.6.1Sometimes, people who lack mental capacity to make a decision about whether they should be receiving help or intervention from Mental Health Services are referred in order to address risk situations, emergencies or non-emergencies. The result of an assessment in these circumstances may require the person to be admitted to hospital.

Individuals who lack capacity to make a decision about being admitted to hospital and who are not objecting and are compliant, might be conveyed to an admitting ward ‘in their best interests’ (s5 MCA 2005).