Agenda item: 7 Ref: cm/10/01/04 board meeting – 11 febrary 2010




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Agenda item: 7

Ref: CM/10/01/04



BOARD MEETING – 11 FEBRARY 2010
MENTAL HEALTH ACT 1983 AND MENTAL CAPACITY ACT 2005

PURPOSE


  1. This is a short paper to alert the Board to key aspects of our work in relation to the Mental Health Act (MHA) and Mental Capacity Act (MCA) and refer to the accompanying slide pack. Separate papers are also to be tabled at the Board meeting, one of which describes the proposals in respect of modernising the mental health act function at the Care Quality Commission and the second provides a more detailed account of our work in relation to monitoring the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS).


RECOMMENDATION


  1. To note the actions in respect of Community Treatment Order Second Opinion Appointed Doctor request and to specifically comment on the proposals in respect of the CQC’s Annual Report on the implementation of the MHA and the reporting of our monitoring of the MCA. DoLS


BACKGROUND


  1. The CQC has specific statutory duties in respect of the MHA 1983 and the MCA 2005 as amended by the MHA 2007.




  1. CQC’s duties in respect of the MHA include the provision of the Second Opinion Appointed Doctor (SOAD) service. In November 2008 Community Treatment Orders (CTO) were introduced under the MHA 2007. These orders are designed to help patients to maintain stable mental health outside hospital, and to promote recovery. All patients subject to a CTO are required to be seen by a SOAD within 28 days of the order. The Department of Health’s forecast for the number of CTO’s in the first year was 450. The actual numbers have far outweighed the forecast with over 4,000 patients having been placed on a CTO within the first year. This has created an unplanned pressure on the SOAD service which we have been actively working to manage, however we recognise that there are significant practical difficulties, some outside of our control, around implementing this policy which we are continuing to highlight to the Department of health.




  1. CQC is required to provide an annual report to Parliament on the implementation of the MHA. This report should follow as close to the end of the financial year to which it relates. The report is separate to the State of Care report and therefore requires a separate set of governance arrangements. These are set out in the accompanying slide pack. The report will need to contain performance information in relation to our monitoring activity and comment on the findings from this. In particular the report should comment on some of the key changes that were introduced through the Mental Health Act 2007, in particular our findings in relation to Community Treatment Orders, patient access to Independent Mental Health Advocates and the provision of information about a patients rights where they are subject to the MHA. We would welcome guidance from the board about these proposals and other issues which they feel the report should pay attention to.




  1. CQC has specifically been given a duty to monitor practice under the Mental Capacity Act Deprivation of Liberty safeguards from 1 April 2009. It is required to report the findings from this monitoring function.

We monitor the practice in ‘managing authorities’ (care homes and hospitals), and in ‘supervisory bodies’ (local councils and PCTs). CQC has no powers to enforce compliance with MCA requirements, and therefore, monitoring is not regulatory inspection and enforcement activity, as we normally understand it, but the code of practice and safeguards are fairly well aligned with Care Standards Act and Health and Social Care Act regulations, standards and guidance. Our reporting function and duties relate to reporting on this practice in our service, commissioning and national reports and to advise the government about changes that might be needed. Again we would welcome the Boards guidance about any particular issues they feel CQC should seek to comment on as part of this report.


KEY ISSUES


  1. The detail around key issues is contained in the separate papers and slide presentation that accompany this paper. However, in summary they include;

  • The need to comment on our ongoing action in respect of SOAD CTOs

  • Governance arrangements for and content of the annual MHA report and the MCA DoLS report.

  • Comment on the proposal for modernising the MHA function at the CQC.


LINK TO STRATEGIC AND CORPOATE PRIORITIES


  1. The activity is a core part of CQC’s statutory duties with a clear link to each of the five strategic priorities and our manifesto.



EQUALITY, DIVERSITY AND HUMAN RIGHTS IMPLICATIONS


  1. We need to ensure that the outcomes of the any proposed activity contained in this and accompanying papers are subject to an equalities impact assessment. The work covered by this suite of information directly impacts on our actions to promote equality, diversity and human rights for people with mental health needs and people who may lack capacity.



NEXT STEPS


  1. See detail in accompanying papers.

  2. Provide an update to the Board in March in respect of the actions taken



RECOMMENDATION


  1. To note the actions in respect of Community Treatment Order Second Opinion Appointed Doctor request and to specifically comment on the proposals in respect of the CQC’s Annual Report on the implementation of the MHA and the reporting of our monitoring of the MCA. DoLS



ANNEXES

15. Powerpoint presentation



Anthony Deery
Head of Mental Health Operations
26 January 2010


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