Can a doctor trained and registered to act as an RC who is not the patients RC and are not in writing as an acting RC for them still grant the patient leave? If not what happens with duty consultants - I know when I call a Duty Consultant for an emergency section 17 form it is almost never my patients RC and these people seem to change daily in our trust - Surely an RC doesn’t have to sit there and sign forms everyday transferring his powers to and from his collages for each of his patients? I am sure there is a blindingly obvious answer to this question I just cant find it!
In a similar way dose an RC saying to a nurse (in person or on the phone) that a patient has s17 verbally count as s17 or dose it need to be written down before the leave can start (i.e. the nurse lets P of ward)?
I think a covering RC can prescribe a section 17 leave in the absence of patients RC. They only need to be abreast with the risks and presentation of patient.
Then again, i think a section 17 leave cannot be authorised over the phone without proper documentation to show.
It is certainly possible to authorise leave over the telephone. Hospitals have (quite rightly) developed their own s.17 leave forms, because there is no statutory form for authorising s.17 leave. In law, that authorisation can be verbal, by email, by carrier-pigeon or whatever… the law is silent about that. The mistake people make is then to treat their local s.17 form as if it were a statutory form and worry about whether it needs to be physically signed or completed by the RC authorising leave, and so whether an RC can grant leave remotely etc. It is better, I think, to treat the s.17 form for what it is in law - it is simply a record of an authorisation given by the RC. As such, there is nothing legally wrong with someone other than the RC completing the form, on the basis of having spoken with the RC over the telephone, and recording that they are doing so on that basis (I’d usually suggest making a note against the point where most forms require a signature). Of course ideally the RC authorises leave whilst being not only on the ward but in conversation with the patient, so I’m not advocating the use of the telephone at all times, but when needs must it is fine.
On the other question of who is the RC at any particular point: again this is an area where practicality has to skip over any gaps that a very rigid reading of the law creates. If it is practicable to contact the patient’s normal RC, then I’d recommend doing that. If it is impractical to contact that RC, then in practice another clinician must be acting as RC at that time and can make the authorisation instead. (The idea that clinicians who are covering RC duties might have to redo all the extant leave authorisations for patients is I think partly a symptom of treating s.17 leave forms as though they are statutory documents rather than records).
Mat Kinton (CQC National MHA Advisor, personal capacity)
On the second part of the question, it helps to remember that, legally, who is the RC is a matter of fact, not title. It is whoever is actually, at the time in question, in overall charge of the patient’s case (see s34(1)(b) of the Act).
For very good practical reasons, hospitals have policies for allocating the role of “normal” RC to a particular clinician in each case. But just because they’ve done that doesn’t mean they are necessarily the RC for legal purposes at any given moment.
For a duty clinician to exercise an RC’s power (like granting s17 leave) for a patient whose normal RC is absent, they become the patient’s RC, by temporarily assuming overall responsibility for the patient.
Whether there needs to be any paperwork associated with this temporary status is a matter for the hospital. But I believe most hospitals just have a policy which says that, when necessary, on-call approved clinicians can (and should) fulfill the function of RC for the limited time required.
So apply this principal if a patient has a community consultant who is against Ps detention and who is on the duty rota for Ps ward - on there night of cover filled in the trust section discharge form and then called the ward and told them he had just discharged P is P legally discharged