M ental I llness C oncerns A ll	Chapter 6 RECOMMENDATIONS For the North Staffordshire Health Authority 1. The strategy for the development of mental health services in North Staffordshire should explicitly ad This is the group of people, illustrated by the story we have told, whose symptoms lead to much reduced social and occupational functioning and who need a wider range of services, beyond the purely medical, which are provided by several health disciplines and, indeed, by agencies other than the NHS. We therefore recommend that the Health Authority together with the service providers should examine the purchasing plan for this group of people to see if the required skills and training are available and whether the lines of communication, both internal and to other agencies, are effective. 2. The Health Authority in discussion with service providers should expedite the development of an integrated local service for the-care and treatment of people who are mentally disordered and who commit offences. This service should be cast at a level below that of specialist forensic psychiatric services, include Court diversion schemes and liaison with rehabilitation, the probation service, the police, the magistracy and social services. 3. The plans for the continuing development of a broad range of mental health services in the District should be accelerated to ensure that rapid progress can be made towards a fully staffed community-based pattern of care provision. For the forth Staffordshire Combined Health Care NHS Trust 4. Patients who attend the psychiatric outpatient clinic regularly should be subject to a periodic multidisciplinary discussion to revise or refresh their care plan. 5. A near relative or friend should be involved in the monitoring of long term care and also in the formulation of contingency plans. 6. The Trust should establish meetings between clinical staff and probation officers to resolve matters of mutual interest in the continuing care of the mentally disordered offender. 7. In the near future, the clinical audit process should address the issue of long-term outpatient attenders, focusing upon the numbers involved, the reasons for continuing attendance and how their care is monitored;- such an audit would provide the basis for the development of a system of continuing review for these patients. 8. An agreed protocol should be constructed covering the process of internal audit of serious incidents. Audit should be conducted on a multi-disciplinary basis even where only one discipline has been involved in the case. For the Department of Health 9. As our contribution to the debate on the granting of firearms certificates we recommend that a comprehensive redrafting of firearms licensing application and renewal documentation is undertaken as a matter of urgency. This redrafting should aim:- (i) to reduce the risk of misunderstanding on the part of applicants and countersignatories which may give rise to false declaration on health matters. lii) to establish more effective screening procedures in relation to health matters. 10. The Department should discuss with the Prison Service how to ensure continuity of care for mentally disordered offenders who are serving prison sentences or who are about to leave prison. 11. Conduct of Independent Inquiries under HSG(94)27:- (i) Independent Inquiries should not be expected to start, hearing evidence until criminal proceedings have been completed and permission to inspect confidential medical notes has been obtained. (ii) Written records of internal investigations and relevant clinical audit, whilst bound by confidentiality against publication or public disclosure, should be available to the Independent Inquiry as a means of efficiently planning their work, at an early stage. (iii) There should be a preliminary phase in which the members of the panel of Inquiry decide what documents and information they will require, the witnesses they may wish to interview and in what order, full information about the service under investigation and any necessary background reading. (iv) Evidence given to the Inquiry should be recorded verbatim and given to witnesses to check. Whilst this evidence is confidential, relevant parts may be quoted in the report, after the witness has agreed the content and been given the opportunity to correct or clarify the evidence. (v) We are of the opinion that there should be a preliminary screening by a refereeing 'system, of cases in which an Independent Inquiry is proposed under HSG(94)27. This is because such inquiries may be disruptive, prolonged and cause much distress to patients, professional staff, potential witnesses and relatives. If there is a more effective means of satisfying the interested parties, it should be followed. back to Inquiry link column go to Home Page Home Page   back to Inquiry Link page       E-mail reaction is welcome mica@didgy.freeserve.co.uk