Continuing the discussion from How do we help our brother as a Nearest Relative?:
Perhaps worth noting that in relation to the NR power of discharge, the page on that link acknowledges that “the term hospital managers is confusing terminology” which is right. However, it then backs up that acknowledgment by incorrectly describing the meaning of the term!
What’s the incorrection description of the meaning of the term? Explain to assist everyone. Thanks
Happy to, although I doubt that it will “assist everyone” as a large proportion of the people who clicked on the link may already know. Anyway this is the erroneous paragraph:
This notice must be delivered to the “hospital managers”. This term has a specific legal meaning in the Act:
It does not mean the day-to-day hospital operational managers.
The term “hospital managers” is a confusing terminology even for some people working in psychiatric services. They are a panel of people who are not themselves managers of the hospital or even employees.
Whilst the notice must be delivered to the hospital managers and this term does have a specific legal meaning, they are not “a panel of people who are not themselves managers of the hospital or even employees”. The statement appears to be describing the people who may exercise the power of discharge on behalf of the managers, as set out in section 23 and see specifically, subsections (4), (5) and (6).
The legal meaning of the managers is found in section 145 of the Act, according to the type of hospital. For the NHS in England, this generally means the relevant Trust.
Using a Trust as an example, by default this means the people who run/manage the organisation and it is the policies they produce, that dictate who has operational responsibility for ensuring that all the various powers and duties of the managers under the MHA, are carried out correctly (chapter 37 of the Code of Practice for England will assist you).
This includes how the nearest relative’s power of discharge is managed, but the process, including how and to whom the discharge notice is submitted, does not include the involvement of a ‘panel of non-employees’, unless and until a decision is subsequently made by the operational staff, that a review of compulsory powers is indicated as a result of the RC barring report.
The responsibilities in relation to the managers power of discharge will usually be set out in a stand-alone policy and chapter 38 of the Code assists with that.
I see. How can this be simplified into an explanation for ordinary peeps to understand.
I had a go at trying to explain it as simply as possible a few years ago and came up with:
It is the ‘hospital managers’ who ultimately hold the power to detain patients in their hospital. ‘The hospital managers’ actually means:
• for an NHS trust- the trust
• for an NHS Foundation trust- the board
• for an independent hospital- the person(s) registered with CQC relating to the assessment and treatment of mental disorder.
Hospital managers have various powers and duties, and they delegate these to specific members of staff via a ‘scheme of delegation.’ Nurses accepting a detained patent onto a ward on the basis of an application from an AMHP, for example, are carrying out that function because it will have been delegated to them by the hospital managers. The ’hospital managers’ panels’ which sit to review a patient’s detention are not ‘managers’ themselves, but people appointed by the hospital managers to carry out this function.
The usual conception of hospital managers are about people who supervise and control a healthcare provider organisation e.g. an NHS Trust. Let’s conceptualise that as ‘Administrative Hospital Managers’ (AHM) to avoid confusion.
‘Hospital Managers’ for MHA purposes are delegated certain powers of the AHMs. However, the AHMs have no powers to direct or control the MHA Hospital Managers. Nor do the MHA Hospital Managers engage in any part of administratively running a Trust (or other private sector healthcare organisation).
Whilst the AHMs are ultimately the detainers and hold responsibility for various things under the MHA, the MHA Hospital Managers may well independently counter the will of the AHMs (if for example they - the AHMs wanted to keep a patient detained but the Trust wanted to release the patient).
| Aspect | Administrative Hospital Managers (AHMs) | MHA Hospital Managers |
|---|---|---|
| Definition | The executive management team who run the day-to-day operations of the hospital or NHS Trust | A statutory function under the MHA vested in the legal entity (NHS Trust, Foundation Trust board, or registered persons) |
| Legal Status | Employees of the hospital with operational job titles including “manager” | A statutory role defined by the MHA, not a separate organisation but a legal function of the Trust/registered provider |
| Powers | Operational management, strategic planning, resource allocation | Statutory powers under the MHA including detention authority and discharge decisions |
| Role in MHA | Implement policies but don’t have direct statutory powers unless delegated | Hold the legal responsibility and authority for actions taken under the MHA |
| Connection to Panels | May appoint panel members but don’t sit on panels themselves | Review functions to appointed individuals (often called “Hospital Managers’ Panels”) |
| Delegation | Receive delegated MHA powers to implement specific functions | The source of delegation - they delegate MHA functions through formal schemes of delegation |
| Supervision and Control | Subject to organisational hierarchy, performance management, and Trust policies | Function independently for detention reviews and discharge decisions - guided by MHA provisions and Code of Practice, not by AHMs’ direction or Trust operational policies |
| Accountability & Discipline | Subject to employment contracts, disciplinary procedures, performance management | Not subject to typical employment disciplinary procedures; accountable to legal standards and MHA requirements; panel members can be removed from role but not “disciplined” as employees |
| Governance | Report to Board, NHS England, and other healthcare authorities on operational matters | Accountable for proper application of MHA statutory powers; their functions and duties are defined by legislation not Trust policy. |
| Primary Focus | Operational efficiency, performance targets, financial management | Ensuring lawful application of MHA powers and safeguarding patient rights. No business in running a healthcare organisation. |
I’m afraid that you have still not quite grasped it correctly, Russell and have mixed up things in both columns. Furthermore, introducing the abbreviation ‘AHMs’ to describe members of staff, is even more confusing, because a lot of organisations actually use that to describe the panel members considering the power of discharge under s.23; ‘Associate Hospital Managers’.
Taking mine and Nick’s explanations above, together with your two columns format; on the ‘left’ you have the organisation and its relevant staff exercising all the powers and duties under the MHA (as per chapter 37 of the Code) except for, on the ‘right’, you have the non-employed panel members (who could be non-executive directors of the organisation) whose only function is to consider the managers power of discharge on behalf of the organisation (as per chapter 38 of the Code).
The issue about panel members and disciplinary procedures is also not straightforward, following the Employment Appeal Tribunal case of Lancashire and South Cumbria NHS Foundation Trust v Moon [2024] EAT 4, where Ms Moon; a panel member, was ruled to be a ‘worker’ in respect of the Employment Rights Act 1996.
The table may be far from perfect. The table was an attempt to separate the roles, and a summary lacking full contexts.
The key issue is what separates ‘Hospital Managers’ for purposes of the MHA and ‘Hospital Managers’ as might be conceptualised in managing a hospital. People who manage hospitals have zero power at Tribunals.
The issue of being a ‘worker’ is not terribly relevant. ‘Worker’ does not mean employed. That was clearly played out in long running case of O’brien Judgment handed down in the case of O’Brien v Ministry of Justice — Cloisters
It’s the key issues that you have got wrong.
The key issue for me is whether the Hospital Managers for the purposes of the MHA are involved in Hospital Management as most ordinary people might think.
I’m satisfied that I have provided sufficient reasoning and evidence that Hospital Managers for purposes of the MHA are not involved in managing hospitals of any sort.
Best wishes.
The table above contains errors and I suspect was mostly AI-generated. Was it?
I guess AI is confused as the posts above from Guy and Nick are probably the first succinct explanations on the internet. Maybe it will learn from them!
I’m honoured to be mistaken for an AI. I am unable to prove a negative e.g. that there is no teapot orbiting the Earth. Obviously if I deny that my table was generated by AI, I can’t prove that it wasn’t. It’s well known as the ‘Kafka trap’. Those who have studied philosophy and read Franz Kafka’s novel “The Trial” will understand. Those who haven’t will not. I am unable to link to the book because that will be seen as an advertisement.
What statements are wrong and why in my table column on MHA Hospital Managers? But even if by focalism one or more are wrong the key issue has been evidently avoided.
The issue that has been clearly avoided is whether the Hospital Managers for MHA appeals have any part to play in managing Trusts or Hospitals. If the response to the above is affirmative, please supply evidence.
I have heard with my own ears, Hospital Managers at appeals panels declare that they have no part to play in running hospitals. If those were false statement made repeatedly then it is a serious matter. How? Because it would mean a false declaration i.e. they were running the hospitals and making false or dishonest statements.
In South Staffordshire and Shropshire Healthcare NHS Foundation Trust v The Hospital Managers of St George’s Hospital [2016] EWHC 1196 (Admin); [2016] M.H.L.R. 273, paras 26, 27, Cranston J. held that a panel of the hospital managers exercising powers under s.23 to discharge a patient was sufficiently separate from and independent of the Trust that appointed it to enable the Trust in “quite exceptional circumstances” to bring a judicial review challenge to its decision. [From Richard Jones] Obviously ‘a Trust’ can bring judicial review to its hospital managers - if it found it necessary to do so. I’ve not ever heard of a Trust bringing their employees to judicial review - but it may have happened in some neck of woods unknown to me.
Do MHA Hospital Managers manage Trusts? Yes or No.
Are MHA Hospital Managers employess of Trusts? Yes or No
You are not wrong about the people on appeal panels, Russell:
Panel members do not manage Trusts;
Panel members cannot be employees of the Trust.
So using your table format as a template (and leaving aside the role of non-executive directors):
| Aspect | Hospital Managers | Panel Members |
|---|---|---|
| Definition | As per s.145; the team/individual who run(s) the day-to-day operations of the organisation | As per s.23, a statutory function under the MHA vested in the legal entity (NHS Trust, Foundation Trust board, or registered persons). Sometimes referred to as Associate Hospital Managers or Mental Health Act Managers. |
| Legal Status | Employees of the hospital with operational job titles | A statutory role set out in s.23(4), (5) and (6), to carry out that one function on behalf of the organisation |
| Powers | Operational management, strategic planning, resource allocation | Managers power of discharge under s.23 of the MHA |
| Role in MHA | Implement policies to oversee statutory powers | As above |
| Connection to Panels | May appoint panel members but don’t sit on panels themselves | As above |
| Delegation | Delegate MHA powers to specific members of staff and appoint s.23 panel members | Appointed by the organisation to carry out managers power of discharge under s.23. Cannot delegate anything to anyone. |
| Supervision and Control | Subject to organisational hierarchy, performance management, and Trust policies | Function independently for discharge decisions, but guided by chapter 38 of Code of Practice and managed in accordance with some organisational policies |
| Accountability & Discipline | Subject to employment contracts, disciplinary procedures, performance management | Cannot be employees but are ‘workers’ so are subject to some Organisation policies and disciplinary procedures that can ultimately lead to removal from role |
| Assurance | Report to Board, NHS England, and other healthcare authorities on operational matters | Function and performance overseen by organisation |
| Primary Focus | Operational efficiency, performance targets, financial management | The managers power of discharge under s.23. No statutory role in connection with any other function of the Organisation; MHA or otherwise. |
Best wishes
I have had a long conversation with a philosopher who has read that novel and had never heard of a Kafka trap. It appears to be a concept much more recent than the novel, specifically in relation to a denial being treated as evidence of guilt. However, if you were to deny that your table was generated by AI, I would accept that at face value 
The error that Guy originally pointed out was that in the following text about nearest relatives you were confusing different people to whom different powers have been delegated:
This notice must be delivered to the “hospital managers”. … They are a panel of people who are not themselves managers of the hospital or even employees.
The dispute was not about the part which said: “It does not mean the day-to-day hospital operational managers.”
To know who the “hospital managers” are when delivering the nearest relative discharge order you’d need to see the relevant scheme of delegation. For instance, in Leicester Partnership NHS Trust’s scheme of delegation it states:
This authority is delegated to the nurse in charge of the ward or Band 4 and above administrative staff working within the MHA Office whichever is received first.
And Sheffield Health and Social Care NHSFT’s scheme of delegation states that the “Authorised Person(s)/Committee” is:
Mental Health Act Manager
Mental Health Act Administration
The “panel of people who are not themselves managers of the hospital or even employees” relates to something else entirely.
I had a long conversation with a consultant psychiatrist who read the MHA 1983 and its Code of Practice and was clueless as to what a MHA Manager was. Not anyone in these forums for sure.
No you won’t. I have made a finding of fact - based on the balance of probability i.e. 51% chance. 
I am unaware of a dispute but… but…if a majority say it’s a ‘dispute’ then it is - that’s how social media and the NHS works.
So now they are employees. Brilliant.
Thanks for amending the table. I’m yet to see a disciplinary policy or procedure applicabe to MHA Hospital Managers. Has it gone missing?
But some people will continue to be believe that they are employees of the Trust - which is fine because in free and quasi-democratic society, one is free to believe what one wants. I’m simply stating a fact.
I assert equality to feel free to believe that they have not one jot to do with managing hospitals or Trusts or private sector healthcare organisation.
If you do a search on Google for “power of discharge policy” you will see East London’s. Most other Trusts will also have a relevant policy that mentions disciplinary/investigation procedures in respect of panel members.
We need to be clear who “they” are:
I’ve never thought about the employment status of the “managers” as defined in s145. For an NHS Trust, or NHS Foundation Trust, it’s “the trust”, so I guess employment doesn’t come into it. The same would apply to the various bodies listed for Wales. For a registered establishment it’s “the person or persons registered” which is likely to be an employee of a company (e.g. one person is registered for every hospital in the CQC registration details for Cygnet Behavioural Health Limited).
I see. So ‘delegation’ of responsibility to employees means the MHA ‘Managers’ are employees.
I understand. If the delegated functions are to employees means that the MHA Hospital Managers are employees.
However, I am led to understand that employment status is irrelevant.
Receiving nearest relative discharge notices and discharging patients are both roles of the “managers” in the Act, but in practice these roles are delegated to different people. Those who receive NR notices are employees, and those who form panels to consider discharge are not employees. The important part, though, is that they are different people, which is what Guy was drawing attention to at the outset. See the quotation below.