" 1. We do not agree, however, that this consequence follows. What takes a person outside the class of persons specified in section 117(1) to whom section 117 applies, and thereby terminates the duty under section 117(2), is not admission to hospital or detention simpliciter but detention under section 3 of the 1983 Act (or one of the other provisions mentioned in section 117(1)) for treatment for mental disorder. Further, under section 117(6) after-care services are directed at reducing the risk of admission to hospital for ātreatmentā and to admission to hospital āagainā for such treatment. This is clearly referring to further treatment under section 3 of the 1983 Act (or the other provisions referred to in section 117(1)). Where after-care services have not avoided that risk eventuating and there has been readmission for such treatment, there is no room for the continued provision of services which are aimed at reducing that specific risk. The same does not apply in relation to other admissions to hospital. It is wrong to suppose, therefore, that a voluntary admission to hospital or admission for assessment could lead to permanent loss of the right to receive after-care services.
So, if a person placed in area B, where area A holds an ongoing s117 responsibility, goes into hospital either voluntarily or under s2 in area B, could the Trust/ICB in area B recharge the cost of admission to the Trust/ICB in area A? They would have to be saying that the hospital admission is part of the personās aftercare, and is aimed at preventing the need for the use of a s3.
I believe youāre over-thinking this, Nick.
s117(6) talks about after-care reducing the risk of deterioration ārequiring readmission to hospitalā. This doesnāt differentiate between informal admission or detention, or between s2 and s3. Itās just admission.
Iām not sure why you say that this is clearly referring to further treatment under s3.
And if the person has been readmitted, then the need to prevent readmission has not worked for the time being. The āafter-careā will restart on discharge.
Hi Steve, I hope everyone takes your approach. Iāve seen some strange decisions over the years when it comes to ICBs deciding who is responsible for what. That can be OK as long as the discussions happen behind the scenes, with no impact on the person receiving the service.The most frequent nonsense Iāve seen is the āautomaticā transfer of detained patients back to wherever they have a GP registration. usually very vulnerable people who may be homeless, or who have moved around a lot. They register temporarily with a GP in one part of the country, then carry on moving around with no need to see another GP for years. Then, they have become as settled as they ever have been in an area and end up detained in hospital. An almost unstoppable bureaucratic process starts, and they can be transferred back to the place where they still have that GP registration- despite having no connection with that place. This can be very disruptive to the person concerned, and creates the risk of poor communication of immediate circumstances to the eventual hospital. For example: pfd (judiciary.uk)
Iām just trying to predict potential problems rather than advocate a new understanding of aftercare.
Also, to be fair to Nick, it is their Lordships not Nick saying that āThis is clearly referring to further treatment under section 3 of the 1983 Actā. I think they are wrong about that, for the reason Steve gives. Probably doesnāt matter all the sameā¦
I can see Nickās point: if the Supreme Court are right in their āfurtherā proposition involving the s117(6) aftercare definition then it seems to follow that aftercare services would include informal/s2 admissions to hospital. I agree that they are wrong, as the definition must be referring to any hospital admission. I think itāll fine to work on the basis that aftercare services do not include informal/s2 admissions, either because the bit we think the Supreme Court got wrong wasnāt really a necessary part of their reasoning (which is that once youāre detained again under s3 etc youāre no longer within the class of āpersons who are detained under section 3ā¦ and then cease to be detained and ā¦ leave hospitalā, and so the old s117 duty ends) or just because itās absurd to call inpatient treatment āaftercareā.
I agree that their Lordships didnāt quite get that bit right, presumably because they were anxious to confirm that informal/s.2 admission does not end the s.117 duty. I also agree that it makes no sense to claim that the subsequent s.2 admission is part of the personās aftercare. In which case, for the s.2, presumably you should disregard the underlying s.117 and treat the person as a new admission, applying normal NHS funding rules- but I can see Nickās point that this is not obvious and is likely to lead to ongoing confusion among commissioners. Maybe the next iteration of the āWho Pays?ā guidance should expressly address this?
I think I agree with Simon, though I donāt know exactly what the ānormal NHS funding rulesā areā¦ I guess that if the patient is admitted to hospital in Area B then that area would pay under those rules, whether the admission is under s2, s3, informal, or whatever. During s3 (or equivalent) admission no s117 duty exists (so it canāt be s117 that decides who pays) and I donāt think an ongoing s117 duty would be relevant during non-s3 admission either. I have to admit Iāve never got my head round the medical half of s117 funding, so maybe Iām barking up the wrong tree.