Just wondering what your views are on RCs undertaking, dialogue/discussion over the phone to help confirm whether a patient is consenting to their proposed treatment for purpose of a CTO12 or SOAD certificate for CTO11. RCs although penciling in outpatient appointments for this purpose find the patients always DNA - so there could be a long period where the patient is not seen but patients will still take their meds without the certificate in place which I know is unlawful and will generate an incident.
I should add I am fully aware of the all the barriers that would make it extremely difficult to truly ascertain capacity/consent over the phone and video assessment for the above purpose would always be preferable. We would always advise that the RC under takes a face to face assessment - as a remote assessment could always be subject to legal challenge - but it is difficult to push this when it is not clearly specified in the Act as a âmustâ.
This is an issue for us at the moment. Our stance is the discussion for a CTO12 must be done face to face and if patient DNA then recall could be used. We also have the issue where the patient is accepting depot from GP and next one will be due imminently without the authorisation being in place in time.
This is a personal response not a corporate one. Iâm not so sure that it is a requirement to do a face-to-face meeting to determine and certify that a CTO patient consents. The Devon case (Devon Partnership NHS Trust v SSHSC [2021] EWHC 101 (Admin) - Mental Health Law Online) that established judicial interpretation over face-to-face vs remote assessments hinged on the actual wording used in the MHA (sections 11 and 12) about assessments for detention. The MHA uses very different terms in those sections than in the sections of Part 4 dealing with CTO consent certification. At section 12 it is stated that a medical practitioner must have âpersonally examinedâ a patient before completing a medical recommendation and at section 11 the AMHP must have âpersonally seenâ the patient before making an application for detention. None of these phrases, or anything like them, appear in the MHA in relation to CTO consent certification. Section 64C(4A) merely states that the AC must certify that the patient has capacity to consent and does consent. CQC currently conducts remote SOAD assessments, so it would seem odd if it were unacceptable for an AC to do something similar. I canât see why it is impractical or in some sense unethical to determine the questions of capacity and consent by speaking to a person without meeting them face to face. Particularly if this would be that personâs preference: by contrast using coercive powers to recall someone to hospital just to discuss the fact they consent to treatment seems unnecessary and actually quite wrong.