Not many people up here may understand the situation where me as a locum enters a new job and inherits some 20 previously unknown patients following an absence of regular RC cover in weeks or months before. It’s worse in many places where there have been a string of a dozen or so RCs in short succession.
Scenario
Many of those patients would have been granted S17 leave (in custody or not in custody). And many of those patients and staff expect me to automatically honor leave previously granted by other RCs (a string of them in a patchwork of care). The most forceful demands come from patients (and their clamouring staff) who expect ‘fag leave’ a concept that was unknown to me prior to 4 weeks ago.
The law does not provide for any previous RC’s authority to have statutory weight when I take up a new post in transfer of legal duties via S34 [Words chosen very carefully]. Unbeknownst to most - apparently because they go ‘I’m not a lawyer’ - I am required to carryout 27.10 assessments for each patient (arising from Chapter 27 MHACOP). That includes consideration and balance of a number of factors that requires careful documentation to demonstrate such consideration. So, it’s not just the tickbox form to fill out on most electronic forms in an EPR. Sorry - I don’t cut corners following the findings of The Barrett Inquiry - John Barrett: A Preventable Homicide - Lessons Learned
So the task of properly evaluating patients for leave whilst trying to prioritise other clinical tasks such as confirming diagnoses based on evidence, consent to treatment, and medication reviews (inter alia) - creates an extremely difficult situation. It meant that many patients would be delayed in having leave granted. For some I may actually not grant leave if I find that smoking tobacco is an unacceptable risk to individual patients’ mental health (according to WHO research 2021). Those not in the know and wish to know can study this for over 20 hours: Nicotine Addiction: A Killing Mental Disorder [Caution: there is a risk of focalising on whether I can lawfully not grant leave to some patients who smoke tobacco and missing the much bigger issue. That’s a whole different debate.] It is minor relative to the big issue.
The big issue
The drum beat is that I have stopped all patients’ S17 leave. Well sorry - I can’t stop something that is not in force nor has any legal weight. It needs no explanation how those who are ‘not lawyers’ would come to such views. Now I am ‘the devil incarnate’; pedantic, probably labelled with OCD behind closed doors, and too legalistic apparently.
Tough - I did not invent the law. I have no authority to rewrite the law or bend the Will of Parliament.
This ‘big issue’ is apparently not an issue elsewhere in the country (absent me). Obviously my esteemed colleagues with their respective Trusts do something different.
So I’m feeling psychotic again because I am all alone in my interpretation and application of the law - when crowd sentiment is basically saying I am wrong.
I require assistance: not the type that suggests educating people, or explaining the situation of completing priorities when entering new jobs. Why - because I’ve done all that stuff. Staff see the law, nod their heads when I explain, but carry on to destroy my reputation when I follow the law and Good Medical Practice principles from the GMC. [Caution: I have not identified any persons or organisations and I take full responsibility for my appraisal of these situations. The GMC does not mention Section 17 - I know. It is more principled in its standards.]
I’m grateful for well considered opinions of the legalities, mindful that Statute trumps ethics in this sort of situation.