Missing Hospital Managers Reviews

We have received legal advice that the absence of an Associate Hospital Managers Review within a period of detention would render the whole detention invalid, even if there have been subsequent renewals and hearings held and the required tribunal hearings.

The CoP refers to this in 38.12 must undertake a review if the patient’s responsible clinician submits a report to them under section 20 of the Act renewing detention or under section 20A extending the CTO.

Has anyone else had this advice or had transfers refused on the basis that the required review did not happen?

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Hi Amy. Yes have experienced this one! In the absence of a HM review taking place with a renewal of detention, then process as prescribed by law has not been followed. In turn that period of renewal and from then on is invalid was the legal advice I received. That was on the basis of a very clear one wasn’t arranged - not on inability to locate decision paperwork.

I think a little pragmatism is needed. Has the persons detention been considered by the MHT? Did they contest the renewal of detention? Did the person participate in subsequent reviews? There are likely more questions but i think taking a full view of the whole case is worth considering before making a decision.

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Is there any case law pertaining to this, or was it just advise and the view of the legal team?

Good news. But the CQC may have an alternative view.

Not seen it but then again, I don’t see lots of things. But even when I see things, nobody believes me.

Look at the Notes in the MHA Manual to section 20(3). It is the process of completing the renewal/extension form H5/CTO7 that extends the authority to detain not the HM Hearing. There also makes provision regarding transfers and the new Hospital Managers needing to undertake a review if the transfer happens prior to a hearing being arranged. I would be interested to read you legal advice on this matter as we have had an issue regarding a CTO Extension and being unable to hold a HM Hearing prior to the new period.

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38.14 says that it is desirable that the panel considers a report under section 20 or 20A but it is the RC report itself that provides authority for continued detention even if a manager’s panel has not yet considered the case or reached a decision.

Hi moira, so my interpretation of this is that this refers to the review prior to the detention period or CTO coming to an end rather than the actual holding of the hearings itself which goes back to 38.12

Agree, this is what our advice was based on, the absence of the hearing taking place rather than absence of documentation. If we are able to confirm the hearing did take place however the decision is unavailable we are considering this on a case by case basis, however if there is no hearing at all, this is what is invalidating the detention.

I’ve been mulling this over and here are my thoughts (for what they’re worth). This does not constitute legal advice and I’m setting out my interpretation, which could absolutely be wrong.

Taking a purposive approach - parliament clearly set out certain requirements that applications and renewals must meet for detention to be valid. The Code of Practice is a helpful extension of regulations but it doesn’t create the law.

What does the MHA say?

Section 20(8) states that the authority to detain continues on the completion of the renewal of the section.

Section 23(2)-(6) confers a power of discharge to the ‘hospital managers’ which may be delegated to associate managers.

Section 118 provides the duty for the Secretary of State to provide a Code of Practice.

So what does the CoP say?

At 38.50 it recognises that “If a responsible clinician or the hospital manager, as appropriate, does not hold a review before the period of detention or CTO expires, this should be considered a very serious matter that should be urgently reviewed (see paragraphs 32.10).”

Para 32.10 states the RC not renewing makes subsequent detention unlawful (as we know from S.20(8) MHA 1983), and refers to the procedure that should be followed to ensure this does not happen again.

Note that 32.10 explicitly states “not renewing shall make this section unlawful” whilst 38.50 only states “this is a serious matter and the following review should take place.” I think 38.50 in mentioning 32.10 is referring to how such a failure should be documented & reviewed, not the lawfulness.

Final thoughts

Hospital Managers are an important safeguard, but the MHA itself is completely blank about managers reviews, as the authority to detain comes from the furnishing of the S.20/S20A report, not the subsequent review. The CoP is “guidance and not instruction” (see: Munjaz) and “does not have the binding effect which a statutory provision or a statutory instrument would have”, although departing requires “cogent reasons”. The Code of Practice cannot, in itself, dictate the validity of a section.

I think the most likely outcome of all of this is that not holding a review is bad practice and might attract the ire of the CQC, but does not invalidate a section.

Failure to follow the Code could be the basis of a judicial review case - remedies could compel a hearing to take place, provide a declaration that the Code was breached absent cogent reasons, or quash an unlawful policy. However, it’s unlikely that a failure to hold a managers review could even lead to a HR claim because the managers aren’t a “court” for the purposes of Art 5(4). That issue is resolved by s.68 references (which are dictated by statute).

“Too Long Didn’t Read”

  1. The MHA makes clear that the RC furnishing a report makes a valid renewal. There is no statutory requirement for a subsequent managers review.
  2. The Code of Practice makes a review obligatory in policy terms and its breach is serious, but under Munjaz the Code cannot create binding law as to section validity (although not following could be unlawful on public law grounds).
  3. Therefore - on what basis is the section invalidated? MHA makes no mention and CoP doesn’t (and can’t) give a legal view.

Thoughts are welcome. Sorry for the long post - I was trying to parse through as I was writing.

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Thanks Zac, this is really helpful. In the past we have worked on the basis of a deep dive into why it wasn’t done and then a file note but then we received this fresh legal advice.
It seems that the interpretation of what is actually required is very mixed and the wide range of school of thought has been really appreciated.

I think alot of the problem is actually the ambiguity and interpretation. From my perspective at the time as a MHAA…when you seek legal advice from your trust that you have to take as gospel. Each trust advises differently.
I hope it all works out for the individual at question here!

I’d be interested to see the wording of the advice and/or to know the source, if you’d be happy sharing.

You might be interested in these two previous topics: S3 Renewal & managers hearing and Hospital Manager's renewal meeting after section changed.