On Friday of last week, the Chief Medical Officer of Norfolk and Suffolk NHS Foundation Trust (NSFT), dodgy Dan Dalton, sent out this email:
Why is dodgy Dan Dalton demanding the involvement of the trust’s consultant psychiatrists with such urgency, with a same day change in admission policy? Dodgy Dan’s email tell us:
We need to implement this from today, given both significant pressure on our beds…
It is because of the beds crisis.
Until very recently, NSFT’s executives were claiming to have solved the beds crisis. Yet our graph shows the truth:
It is true that doctors did not object to dodgy Dan’s idea when he mentioned that consultants should be involved where possible in admission decisions but it certainly was not a decision driven by the trust’s consultant body – it was driven by dodgy Dan Dalton and the NSFT executive team, seemingly due to the beds crisis. The involvement of NSFT’s disgraceful appointment as Deputy Chief Operating Officer, Amy Eagle, who thought that community teams could move to Gateway House without any provision for facilities to meet patients, simply adds insult to injury.
Of course, this being NSFT, the stupidity is in the detail – which was not seen or agreed by the trust’s doctors. And, yet again, there appears to have been no consultation with service users or carers. What is the point of diverting more than £500,000 per year from patient care to so-called People Participation Leads?
This week another email went out with the details of implementation. After implementation the previous weekend, of course:
The intention is clearly to delay or prevent admissions without serious consideration of the impact upon quality, service delivery or listening to the voices of patients and carers.
We’ll focus on the second bullet point as it is the most ridiculous:
“All admissions for patients who are not under the care of a CMHT will require agreement from the consultant responsible for the inpatient ward where admission is proposed. This will be the ward where people from the patient’s normal area of residence are normally admitted (the patient’s ‘sector ward’). The consultant will liaise with the consultant in the patient’s ‘home’ CMHT to establish what treatments or assessments might be required in hospital before agreeing to an admission”
‘Agreement is required from the consultant psychiatrist for the ‘ward where people from the patient’s normal area of residence are normally admitted’ means that agreement is needed from a doctor who is unlikely to have met the patient or their carers and certainly hasn’t during this episode of poor health. Given that nearly all NSFT acute wards are full, the ward consultant is unlikely to be the doctor who will be treating the patient either as they will probably be yet another victim of transportation.
‘The consultant will liaise with the consultant in the patient’s ‘home’ CMHT to establish what treatments or assessments might be required in hospital before agreeing to an admission‘ means that two busy consultants will be diverted from their jobs treating patients, after an inevitable delay on top of the existing delays which can be days, to discuss the treatment or assessment which most likely neither of them will be involved in. As the patient is ‘not under the care of a CMHT’, the community consultant psychiatrist will most likely never have met the patient either.
So, two doctors who have most likely never met the patient or their carers will be responsible for formulating the assessment and treatment, the process considerably delaying or perhaps preventing any admission. The patient and their carers have no voice in this process. Neither do the mental health professionals who have seen the patient most recently. Whatever happened to no decisions about me, without me?
There are many more questions.
Can a decision by a patient to agree to an informal admission to avoid a section assessment under the Mental Health Act be overturned by two doctors who have never met them?
What happens to the patients who would have been treated while doctors are diverted into this futile activity?
Who is looking after the patient while these delays are taking place?
How would two doctors make this decision if the patient they had never met had been another Michael Knight and how would they react to the delay and potential rejection?
How would two doctors make their decision if the patient they had never met was another Thomas Kemp, accompanied by his wife, Katherine?
What will the coroners think if people die while waiting for this process?
What will the coroners think if people die having been refused admission by two doctors who have never met the patient overruling mental health professionals who have?
What will the Care Quality Commission (CQC) think of these dangerous delaying processes?
These are important decisions and delays and rejection can have fatal consequences.
The beds crisis is not a result of doctors admitting too many patients. It is a consequence of NSFT breaking its promise not to close beds until it was shown they were no longer needed (see below), commissioners breaking their repeated promises to stop transportation to out of trust beds, NSFT fiddling its bed numbers, failing to invest in front line staff and destroying morale.