Deferred s23 discharge and CTO scheduled for exactly the same time


Wondered if we could get some advice?

We have a client who we have received a S.23 notice discharging them at 1pm, however we then received a CTO1 making the client subject to a CTO at 1pm on the same day. Does this make the CTO invalid?

I would describe the CTO as non-existent rather than invalid. If the s.23 discharge order was made before the CTO forms were made out, the s.3/37 had already ended so a CTO could not be made. If the s.23 discharge order came after the CTO was made, both the CTO and underlying s.3/37 were discharged.


I would have thought the CTO is OK if there is no gap? ie both 1pm?

No Julie; as above it’s the case that no matter when the order for discharge occurred, there can be no CTO.

Some Doctors think that once they discharge patients on CTO, they need to complete Section 23 order for discharge. I have on several occasions received both CTO1 and Section 23 order for discharge. On, asking, the Dr has said they thought they need to discharge the patient as they are now on CTO which is wrong. In all the cases, I have found that they were misinformed and had completed Section 23 in error. Otherwise if S23 is completed before the CTO, then CTO doesn’t apply as there is no underlying section. If Section 23 is completed after the CTO, then this ends the CTO. In your case, it seems the Dr completed both at the same time. Find out their intention…as I think this was done in error.


We had a previous discussion that involved the question of whether an RC can defer s23 discharge at all: Deferred RC Discharge - Can this be revoked?.

Assuming that the RC’s s23 discharge took effect immediately or on the future date, the outcome will be as described above: the CTO will either never exist or will end straight away. Alternatively, you could argue that a s23 discharge that purports to take effect on a future date has no effect and does not discharge the patient at all, in which the case the CTO would be all right… but the easier course would be to assume that there’s no CTO.

I’m not sure that the RC’s intention is relevant to the consequences of his or her decisions!

Thank you everyone. Having had a response from the MHAO, they are saying the S.23 was completed in error, however it was fully completed, signed and we’ve a copy of it. Does it therefore remain the case that the CTO is non-existent? Does it matter if the S.23 was completed in error?

Ha! Send a letter before claim to find out how strongly they believe that this makes it all right.

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