Minutes:
Further to minute 76 (Matters Arising Report—Report CSD 14038) of the meeting dated 4th March 2014, representatives from SLaM attended the meeting. SLaM is the South London and Maudsley NHS Foundation Trust. The representatives that addressed the Committee were:
1. Dr Martin Baggaley, Medical Director and Lead for Clinical Governance.
2. Ellie Davies, Service Director
3. Professor Tom Fahy, Clinical Lead
4. Dr Matthew Patrick, Chief Executive.
Dr Baggaley introduced the representatives, and gave a brief overview of the Bethlem Hospital. It was a “forensic unit” that had three hundred beds. It undertook a wide range of services, and also provided local services for Croydon. Approximately one third of the inpatients were “forensic” which meant that they were mental health patients that had committed crimes against the criminal justice system. They had been sectioned under the Mental Health Act. The Hospital had featured in the Channel 4 documentary—“Bedlam”.
The representatives from SLaM addressed the Committee specifically around concerns pertaining to the Bethlem Royal Hospital in Beckenham and the issues relating to the absconder incident of February 2012.
Dr Baggaley explained that the Hospital used a “Buddi” system of GPS tracking to monitor patients when they were outside of the Hospital. It was explained that a large part of the work of the Hospital was to facilitate the integration of patients back into the community. Leave was divided into two types, escorted and unescorted. Over the last year, there had been 16,000 cases of unescorted leave, and 6,000 cases of escorted leave. Patients were risk assessed before they went on leave, and the Hospital had the option to use the “Buddi System” when it felt appropriate; this provided real time tracking. It was stated that any issues of patients absconding should be put into perspective; out of 22,000 episodes of leave, there had been just 14 incidents, and only 2 patients had failed to return. Additionally, no episodes of crime were reported and there had in fact been no escapes from the Hospital grounds itself.
The Chairman enquired if all patients on escorted leave were tagged. The answer to this was no, approximately one third of those on leave were tagged. Ellie Davies explained that not all patients were tagged as part of their discharge plan. Ellie Davies outlined that there were planned phases of leave, some would be accompanied by two escorts, some by one escort, and then eventually the patient would be allowed unescorted leave. Each patient was assessed on a case by case basis, and were looked at by a team at the Hospital and also by the Ministry of Justice (MOJ). The Chairman asked if there had been any news regarding Daniel Salaco, and Ellie Davies responded that he was still missing. It was noted that the patient was not tagged in this case. The decision not to tag the patient at that time was based on clinical presentation. Ellie Davies stated that she was not able to discuss the specifics of this case in the public arena because of issues around confidentiality; it would be possible however, to update the Chairman privately if the Chairman required.
Councillor Peter Fortune enquired what the process was when a patient failed to return. Ellie Davies explained that if a patient failed to return on time, or went past a designated boundary, an alarm would be triggered. At this point Bethlem would contact the Chairman, the Portfolio Holder and Nigel Davies as well as the police. It was quite often the case that an absconder would return within twenty four hours. The case of the outstanding absconder was exceptional. It was noted by the Committee that in the absconder incident of 2012, the relevant ward councillor was not contacted as per protocol. This was the ward councillor for Kelsey Park; at the moment this ward councillor was Tom Philpott. Ellie Davies felt that it was probably the case that the protocol needed updating.
The Portfolio Holder pointed out that SLaM would need updating with new councillor details. This was a matter that would be followed up by Nigel Davies.
Councillor Botting asked how the patient in February 2012 managed to “escape”. Ellie Davies reiterated that this was not a case that could be discussed in public, but could be discussed with the Chairman privately. Ellie Davies stated that SLaM did not regard the matter as an “escape”, but that rather the patient had in fact absconded and run away from the escort. This was something that was not expected given the checks that were carried out beforehand.
Councillor Tom Philpott enquired what lessons had been learned from the absconder incident. Ellie Davies replied that lessons had indeed been learned, and that after such incidents, an Incident Review Panel is conveyed, chaired by the Clinical Director. The Incident Review Panel would look at various issues, including:
1. How was the patient reviewed?
2. Were there any lessons to be learned from the MOJ review?
3. How could staff training be improved?
4. Clothing checks to be undertaken before the patient leaves-to make identification/reporting easier in the event of an incident.
5. Photographic images to be taken of the patient before leaving the Hospital, which similarly can be circulated in the event of an incident.
Ellie Davies brought to the attention of Members that matters had to be put into a proper perspective. Bethlem Hospital had the lowest rate of incidents across London, and this was despite a high number of leave episodes. Dr Robert Hadley asked how patients would know what boundaries they could not cross. The response to this was that patients would be briefed on these matters before they left the Hospital.
A Member enquired what the logistics were after an escape or absconder incident was reported. Ellie Davies responded that it was important to note that the absconder may have already left the local area; the police would use what intelligence they had to locate the absconder. The family of the absconder would normally be contacted to see if they could assist. CCTV would be looked at—all parties would work together to get whatever leads they could.
Councillor Peter Fortune enquired what would happen to an absconder upon return, and if there were consequences /sanctions that would result. Ellie Davies responded that there would definitely be consequences, and that incidents of this nature were viewed seriously by both the Trust and by the MOJ. There would normally be a discussion with the patient and with the clinical team and the cause(s) for the incident would be ascertained. There were usually specific reasons for an absconsion. The consequences of an absconder incidence were severe, and there were normally sanctions imposed. Normally a patient’s leave would be curtailed. Absconder incidents would normally affect leave and would have an adverse effect on any planned discharge date. It would normally set the progress of the patient back adversely; the MOJ would usually undertake their own review.
The matter of “public perception” was referred to and the Committee was reminded of the Channel 4 programme-“Bedlam”, which featured Bethlem; the idea was to encourage a more positive public perception. The programme was an attempt to break down stigmas. The Committee were informed that the BBC had approached the Trust with a view to making a documentary about the work of psychiatric teams in police stations. In terms of managing public perception, SLaM were looking at ways to encourage the Public to use the site; the site has facilities to play football, undertake nature walks, and has a pool. Additionally the site has a museum. The Committee were also updated with respect to the Hospital’s “Sunfayre Day” which is taking place on the 5th July 2014, between noon and 5.00pm. The web link to this is: Bethlem Sunfayre.
The Portfolio Holder was very encouraged by the improvements in the general communication and relationship between the London Borough of Bromley, and SLaM, and noted that joint meetings were now being held four times a year.
Ellie Davies concluded by stating that SLaM would very much like to invite Members to a visit of the Hospital site.
RESOLVED that:
(1) the update from SLaM be noted
(2) a Members visit to Bethlem Hospital be facilitated