Winston Harris

Birmingham City Council
a

Private and Confidential

ore:
Your Ref: [EEE Winston Harris
Date: 24 August 2016

HM Coroner for Birmingham & Solihull Areas
Coroner's Court

50 Newton Street

Birmingham

B4 6NE

Dear Madam,

Re: Winston HARRIS — Deceased

Response of Birmingham City Council to Regulation 28 Report to Prevent
Future Death

1. Recipients of Report
1. Sandwell and West Birmingham Hospitals NHS Trust;
2. Kerria Court residential home
3. DoLs team at Birmingham City Council
2. Coroner’s Concerns
During the course of the Inquest the evidence revealed matters giving rise to
concern. In my opinion there is a risk that future deaths will occur unless action
is taken. In the circumstances it is my statutory duty to report to you.

3. The Matters of Concern — Birmingham City Council

(4) The application for DOLS order was not processed before Mr Harris's death.
| heard evidence that it often takes many months to process a DOLS

Please reply to: Ps

Assessment and Support Planning
People Directorate

PO Box 16466 Telephone : 0121 464 1105
Birmingham Facsimile : 0121 303 5761
B2 2DP E-mail :

www.birmingham.gov.uk

application. Given that these are extremely vulnerable people applications
should be processed more quickly.

4. Response of Birmingham City Council to (4) above.

Following the Supreme Court judgment in P v Cheshire West and Chester
County Council and Another; P and Q v Surrey County Council [2013] UKSC
19, [2014] COPLR 313, SC (referred to as Cheshire West and MIG and MEG),
there was an immediate eleven-fold increase in the number of applications for
Deprivation of Liberty Safeguards (DOLS) in England. Birmingham, as in every
other local authority area, experienced this increase and saw its referrals for
this work rise from 198 in 2013/14 to 3,278 authorised in the last 12 months. No
additional resources have been made available to local authorities to meet this
increase. In such circumstances, very large backlogs of assessments mounted,
and in Birmingham this was the case as in all other areas. Since these
assessments can only be undertaken by specially qualified Best Interests
Assessors and Consultant Psychiatrists, there has been a national shortage of
these, of the professional advocates routinely required, and of the other
resources needed to increase assessment activity. It is in this context therefore
that your finding “...applications should be processed more quickly’ has to be
seen.

In Birmingham great efforts and resources have been invested to address the
problem, which is now delivering significant results, with the waiting list for
assessment considerably reduced. Plans are therefore already in place to
ensure that in future applications will be processed more quickly.

In relation to the case of Mr Harris, his application for a DOLS had been
prioritised for action on receipt in February 2016, but by the time the lengthy
assessment process had been completed, he had been admitted to hospital.
Since a DOLS assessment is specific to each care setting, this could not then
be authorised. It was therefore the duty of the hospital to judge if his new
circumstances also constituted a deprivation of liberty and request the process
be started afresh. Indeed, had the DOLS been in place in the care home, this
would have had no legal power or application once Mr Harris was admitted to
hospital.

On a separate but related point, it may be helpful to note that the presence or
otherwise of an authorisation of a deprivation of liberty under the Mental
Capacity Act for a person who lacks capacity to make decisions (the process
referred to above) has no bearing whatsoever on the duty of care providers (be
it a care home or a hospital) to provide the level of care and supervision
necessary to ensure the person who lacks capacity is safe. Therefore whether
or not a DOLS had been in place at the care home, the duty of the home to
ensure adequate supervision was in place there (and to share the nature of his
care and supervision needs with the hospital ) would be unchanged.

Yours faithfull

Sandwell and West Birmingham Hospitals

NHS Trust

Trust Headquarters
Health & Wellbeing Suite
Sandwell Hospital

Lyndon
West Bromwich
B71 4HJ
27" September 2016
Mrs L Hunt
H.M. Coroner

Birmingham and Solihull Areas
50 Newton Street
Birmingham, West Midlands
B4 6NE

Dear Mrs Hunt,

Re: Regulation 28 Report — Winston Harris

!'am in receipt of your Regulation 28 Report following the Inquest and your ruling on 6 April
2016, in respect of the late Mr Winston Harris. The absence of an application for a Deprivation
of Liberty Safeguard on Mr Harris was of equal concern to me and to the Board. Given that we
have made significant efforts to alter our approach with the aim of ensuring we achieve a good
practice state by the start of 2017. This letter outlines what we have done and plan to do.

Current practice — September 2016

As you would expect we have the necessary policies and procedures in place. These provide
both advice and instruction to staff. Having re-checked that material it remains suitable and is
available to staff through our Intranet web site. What we have decided we need in order to
augment that approach is an aide memoire or prompt for staff. This will be in place by the end
of October.

The Trust is a national pilot site for work on Focused Care. Very commonly such patients are in
receipt of capacity assessment, which then drives their additional nursing and care needs.
These patients are registered centrally via our Safeguarding system. We have audited the
compliance with DOLS for such patients. That audit continues on a rolling basis and we would
expect to see the volume of cases rise among that cohort.

We have a well-developed training approach with staff. In recognising that the framework
around DoLS is in place, the focus of attention is on the need to raise awareness, rather than
revise the process. A programme of ongoing education and awareness is well advanced.. To
date it has included:

¢ Two workshop sessions which were well attended by 83 multidisciplinary staff, including
ward sisters, matrons, allied health professionals and doctors.

¢ Videoing one of the workshops so that it can be shared both with those staff who could
not attend, and as a training resource available on our Intranet. By the end of October
this video will have been widely publicised inside the organisation.

¢ Structured audit with ward sisters and Unit matrons across the Trust, as the majority of
the patients who may need a DolS will be in these inpatient areas, to obtain
confirmation that they have raised awareness of DoLS with all their staff and have
systems in place to support new starters and temporary staff.

e Strengthening the existing Safeguarding Level 2 staff training, which already includes the
Mental Capacity Act and DoLS, by using local scenarios and improving the content and
prioritising current training for those who may have more patients needing a DoLs.

¢ Targeting medical staff who carry out consent procedures with patients to promote
earlier consideration of the potential need for critical care in the event of a
complication. Also all Consultants will be required to share this with their team to
understand why DoLS may need to be applied and how treatments may impact on the
need for a DoLS.

© An e-learning DoLS module is in development for nursing staff (ready by the end of
November), and induction processes have been updated to include DoLS policy and
procedure requirements for new staff.

Partnership working
We are aware that both Birmingham and Sandwell Local Authorities are struggling to process

the volume of DoLS requests they receive. However, we are working with them to see if there
is a more streamlined approach to address the late responses to applications made by the
Trust. The response periods will be centrally monitored and reported to me. Clearly as our
volume of applications rises the resourcing issue will need to be faced.

Tracking success:

We will monitor the items listed above. But fundamentally we are looking to see:

¢ our application numbers rise
e clear evidence that in ‘expected cohorts’ like focused care volumes are rising
¢ applications are proceeded in a timely manner

These Key Performance Indicators will be displayed in our Integrated Performance Report
which is discussed at our monthly public Board and at a number of Executive meetings,
including our contract review with Sandwell & West Birmingham Clinical Commissioning Group.
We can use this information to refocus any further training requirements to particular groups
of staff, and it will feature in our ward dashboard system.

2|Page

We will use our continuing programme of in-house inspections to check what DoLS are in place
or required, feeding our findings back to the ward and unit managers. The next round of visits

take place on November 1* and 2" and are focussing on the wards. Awareness of DOLS will be
a key indicator in that process.

Work is in train to move towards an electronic patient record, due to be fully implemented by
Christmas 2017, which will further improve the monitoring of patients who may lack capacity
and require a DoLS application.

Taken together, | am satisfied that these actions will give us a strong likelihood of succeeding in
improving substantially the number of patients who are appropriately placed on DoLS. Our
Board-level Quality and Safety Committee will receive a bi-monthly progress report to check
that the actions described above have delivered the required improvements.

My colleague, PY Assistant Director of Governance, would be best placed to provide

advice to your office on the detail of our plans or indeed to provide such updates as are
required on our progress this year. She can be reached on

Yours sincerely,

Toby Lewis
Chief Executive

cc. Mr Harris’ family
Care Quality Commission
NHS England

HE Director of Governance

3|/Page