"Rights of patient and carer "

About: St John's Hospital / Old age psychiatry St John's Hospital / Trauma & orthopaedics

(as a carer),

My relative who has dementia was forced into hospital under a Short Term Detention Certificate. For 5 days I was denied access to her, following two incidents in which staff reprimanded me on the ward. (In both cases I was doing the same as other visitors who were not reprimanded, and when I asked to see rules or procedures stating that I was doing wrong I was told very unhelpfully to look on the NHS website.)

After 5 days, during which there was a Professional Concerns Meeting, I was allowed access again but far less than official visiting times which apply for everyone else. My visits are also fully supervised by 3 or 4 nurses. The hospital refuses to give any explanation, other than one which is, to me, obviously bogus, ie they said my relative gets agitated when I visit. However it seems that she is far more "agitated" (shouting, screaming) when the nurses take her to the toilet.

The compulsory detention arose because I had legally withdrawn her from hospital against medical advice. She had been into hospital for an operation and recovered strength but was not walking. Physiotherapy had been stopped because, due to my relative's dementia, she had not made progress. I had offered to help, but this was rejected, even after she had spontaneously walked more than 5m with my assistance and encouragement. The Discharge Planning Team refused even to consider the possibility of her being discharged into my care, even if I arranged suitable accommodation for her. They also said that their plan was that she should never be allowed to walk again, because of the risk of another fall.

Exasperated, I removed her earlier this month against medical advice. I had the legal right to do this because I am also her Welfare Guardian, and I did so after careful consideration of the options and the Principles of Guardianship. She spent one week at home before the Team, spitefully in my opinion, issued a Detention Certificate, compelling her return to hospital. (I am challenging this, but it takes time - a few weeks. ) During the 1 week she spent at home her mobility improved enormously. From not walking at all in hospital, she walked holding my hand and climbed up and down stairs. Several health and care workers visited to offer services or equipment, and none expressed any concern. My relative was happier and healthier, and she moved safely around the house under my full-time supervision (as before her admission).

Perhaps the Discharge Planning Team genuinely believe they are doing the best for my relative. But they have ignored completely the Principles of Intervention (=Principles of Guardianship) contained in the Mental Health Acts - such as seeking the least restrictive option (they considered no other options), considering her views (to stay at home) and those of her carer (myself). and encouraging her to retain existing skills (walking) and promoting her independence.

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Response from Dougie Brownlie, Patient Advice and Support Service (PASS) Marketing Officer, Citizens Advice Scotland

picture of Dougie Brownlie

Hi baz61,

I have seen your post and noticed that there hadn’t been a response as yet by the NHS. I am sorry to read of your and your relative's experience and that you were not supported by the relevant NHS staff, so I thought I would let you know about the Patient Advice and Support Service (PASS) which is an independent service which provides free, accessible and confidential information, advice and support to patients, their carers and families about NHS healthcare in Scotland.

You can access this service from any citizens advice bureau in Scotland by going to a bureau in person, or by telephone. The number is in the phone book. You can find more information about the service at www.patientadvicescotland.org.uk

We have specialist advisers in every health board area in Scotland and who will give advice on health related issues including the policies relating to visiting rights. If required, a specialist adviser can meet you and work with you to draft a written letter to the relevant NHS area which will then raise this issue with the NHS. The adviser can also explain the NHS complaints procedure and support you if you are asked to attend a meeting with the NHS.

Hope this helps

Dougie Brownlie

PASS Marketing Officer

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Update posted by baz61 (a carer)

Thank you for your response, Mr Brownlie.

It is not advice we required, but help. I had already contacted PASS, and made a complaint to the regional complaints and feedback team. But as with all previous complaints to the NHS, the response was to deny everything. I have also written to my MP and MSP, my mother's GP, a locum psychiatrist who had been involved in the case, Alzheimer's Scotland, the Mental Welfare Commission, the Scottish Human Rights Commission, and the Sheriff Principal (who had granted me Welfare Guardianship). None were willing to do anything to help. My MSP (who had some previous involvement in the case) sent me a very snotty letter. Only the Sheriff Principal expressed sympathy and gave a reasonable excuse - that it would be improper for her to intervene because this would by-pass the appeals system within Mental Health Act

I challenged the Short Term Detention Order, and the Compulsory Treatment Order which followed it, through the Mental Health Tribunal for Scotland. I was not able to obtain legal representation for this because a so-called "independent" psychiatric report was unfavourable - it accepted the word of the health professionals and gave no weight to the documentary evidence which I had offered. So I represented myself and put up a strong case at the three tribunal hearings. Nevertheless, my documentary evidence was again ignored in favour of the unsubstantiated opinions of the health professionals. Even the Curator ad Litem, who had been assigned to represent my mother's legal interests, sided with the professionals, probably because he considered this was in her best medical interests, but this was not his brief.

In each case the Tribunal "cherry-picked" evidence to support the decision which it felt it should make, in support of fellow professionals. It was probably influenced by the health and social work professionals' unsubstantiated allegations that I had "behaved inappropriately" towards my mother and other patients, and felt that it should support them. One such allegation was that I was being investigated by the police, but it was in fact the health and social work professionals who had asked the police to investigate me! The police took 4 weeks to start their investigation but concluded it within a couple of hours, and declared they could find no evidence of any "inappropriate behaviour".

I appealed against the Tribunal decisions and await a hearing before the Sheriff Principal on 10 July 2014. Despite having to represent myself, I am quite confident of success, because unlike the lay Tribunal the Sheriff Principal will look at all of the evidence without any professional bias. I won my last appeal to the Sheriff Principal, against social work opposition, which is how I obtained Welfare Guardianship.

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