Can someone explain this to us lay people please? Why is recall under a CTO more difficult or lengthy than a MHAA?
I am assuming that it related to allocating bed - it may be that the bed hub in this area priorities new MHA assessments over recalled CTO patients requiring a bed.
Hi Julian,
It shouldnât! The clinical team will often rely on the power of recall to get the patient back into hospital quickly. However, in this case, the RC said in her evidence that a MHAA would be quicker than recalling the patient back to hospital.
Itâs to do with the Trusts internal processes. Sometimes beds are prioritised for CTO patients, sometimes RCs are fighting for beds for CTO patients and priority is given to urgent MHAAs. Thereâs no consistency between different areas of the country and Iâve honestly given up trying to understand it.
The role of the bed manager is to prioritize admissions. Understandably, most will prioritize emergency S2/3 admissions over a CTO recall if the recall does not appear (to them) to be immediately necessary.
A complication is that the community RC canât issue a recall notice if the patient can only be admitted to a bed at a different trust. First, the new trust must accept it has become the âresponsible hospitalâ and has appointed a new RC who can then issue the recall.
A complication is that the community RC canât issue a recall notice if the patient can only be admitted to a bed at a different trust. First, the new trust must accept it has become the âresponsible hospitalâ and has appointed a new RC who can then issue the recall.
That might be the practice (I donât know), but itâs not actually the law. Section 17E(3) says expressly:
(3) The hospital to which a patient is recalled need not be the responsible hospital."
Obviously the RC needs to check that the new Trust will accept the patient, but thereâs no need in law to change RCs first.
Yes I see but I suspect in practice it is quite hard to persuade trust to accept a recalled patient for which they are not responsible. It would be interesting to know if anybody knows of such cases.
Bearing in mind of course that the criteria for recall and an application for detention, are different. Also, recall does not necessarily equal inpatient admission, hence why the need to exercise the power of recall is not measured against how quickly an application takes to arrange.
The main issue there is territoriality and in-fighting. Of course all that is related to shortage of resources caused by that entity that we are not allowed to name.
On of the key issues is in Section 17E â recall is exercised by written notice to the patient â âThe power of recall under subsections (1) and (2) above shall be exercisable by notice in writing to the patient.â
Each word in that is another source of in-fighting and misunderstanding, though it reads simple enough.
The part about âin writingâ came alive to me in a real case. âPeopleâ were really scared in a certain LD case who was drugged up to the eyeballs for god-knows-what. P was very brittle and costed about ÂŁ1 million to place in a purpose-built facility in âthe communityâ.
So the big issue is what would happen if on a Friday around 16:00 P kicks off and needed to be recalled. Who is transporting a recall notice âin writingâ. Same for Saturday or Sunday. One might have thought that a courier or Uber driver taking a photograph of delivery to the patients live-in carers would be enough. Nope. Massive debates about it being delivered to the patientâs hands etc etc. Row, row, row your boat - you know the song. Come on - sing along.
So in the end no CTO. It was straight discharge to the community. [Caution: I unable to give more details in case anyone wantâs to go down the âI would have thoughtâ route. I cannot give more details. To do so will make the Trust and the patient identifiable.]