Read the profiles of our Associate Hospital Managers and find out about their roles in the Trust.
A Message from Dr Janet Bailey DProf LLM MSc -RMN RNLD
Non-Executive Director and Chair of Associate Hospital Managers Group
For Mental Health patients in hospital, or those subject to Community Treatment Orders under the Mental Act, there is a statutory requirement for the Trust to enable all eligible patients the right to appeal or have their section renewal reviewed. The power to independently review a case cannot be exercised by persons employed by the Trust, so Associate Hospital Managers are appointed to act on behalf of the Non-Executive Directors of the Trust who have an additional duty to ensure that the Executive Directors and staff of the Trust are carrying out their responsibilities towards patients.
Associate Hospital Managers are a safeguard built into the Mental Health Act to guard against wrongful detention or unnecessary use of Community Treatment Orders. They review statutory legal criteria to fulfil a legal test, if this patient was presented to a panel of well-selected, but non expert members of the local community, would they agree that the powers of the Act were necessary in this case, at this time? Is continued detention maintaining the five overarching principles of the Code of Practice; of efficacy and equity; purpose and effectiveness; respect and dignity; empowerment and involvement; and least restrictive option.
Reviews can be held at any time; however, they are usually held following an appeal by the patient or at renewal of their detention. Where there is a case for discharge the Responsible Clinician sometimes discharges the patient in the run up to a hearing, something that is very much part of this safeguarding process.
I have been an Associate Hospital Manager for 15 years, and have Chaired or been on the Panel for around four hundred hearings across the NHS and Independent hospitals. Each patient is unique, and I have learnt something new at every Panel. Our Mental Health Administrators usually send out written reports from the Responsible Clinician, Named Nurse, and Care co-ordinator a few days before the hearing to enable appropriate preparation. The panel meet half an hour beforehand to review questions or points of clarity we may require before the professionals, patient, and the patient’s solicitor arrives. Hearings last around one hour, and the role of the AHM is to ensure continuing detention is legal and appropriate by asking questions of the clinical care team. At the end of the hearing the panel adjourn to discuss the outcome and reach a decision which is then explained to the patient. This decision is then written up formally by the Chair of the Panel and placed on the patient’s file.
We have a wonderful team of very committed and bright AHMs in this Trust, Responsible Clinicians who are excellent at explaining quite complex cases, and an excellent Mental Health Act Team. Advice and support are always readily available from our Head of Mental Health Legislation and Chief Medical Officer.
Carol Hurley: My experience of being an Associate Hospital Manager
"I have been an Associate Hospital Manager for 17 years, first with Wolverhampton PCT, then for the Black Country Partnership Trust when Wolverhampton merged with Sandwell Mental Health Trust. I then conducted the same role with Dudley and Walsall Mental Health Trust. All of which are now one organisation, Black Country Healthcare NHS Foundation Trust.
It is a responsible but rewarding position which I conduct in semi-retirement, having spent my main career in education then sitting as a Board member on a Primary Care Trust, a Social Housing Board, and a central Voluntary Association. The AHM role carries the huge power and responsibility of discharging patients who have been detained under the Mental Health Act. My colleagues and I take this responsibility very seriously. We of course process the paperwork presented by each Responsible Clinician, Social Worker/CPN, Nurse, Psychologist, and support workers from community housing establishments. We then listen to these professionals as they present their reports verbally, update details and highlight reasons for their recommendations.
If a patient is appealing a section or contesting its renewal, there may be a solicitor representing them. Chairing a hearing is a skilful job with another two AHMs making up the panel. The training I have had over the years has been invaluable and keeps me up to date, most significantly on legal matters and in relation to the latest review of The Mental Health Act. However, the most critical issue is to recognise the individual needs of each patient and to act in their best interests with the least restrictive principle at the forefront. I hope I can be empathic with each patient who may present as quite unwell at a hearing, may have an Independent Advocate or a family member to support them or may be quite alone in a room full of professionals – intimidating for anyone. Empathy combined with professionalism are always my aims.
We have criteria to follow but the person at the centre of it all is our concern. The paperwork can be quite time consuming, and we continually strive to suggest changes for improvement to the process via our AHM Forum and other committees. I am always impressed by the dedication of my AHM colleagues in making the right decision for the patient. My hope is that patients with the right support, will not remain in the mental health arena for any longer than is necessary. It is sad to see patients who are in the system for much of their lives. AHMs must work within a legal remit but do ask questions and explore the issues which help with their decision making.
Siddique Hussain: My experience of being an Associate Hospital Manager
We are as independent as possible and the reason for our existence is to be an added level of scrutiny (or ‘checks and balances’ if you like) in order that the patient is not detained unnecessarily and that risk levels determine the type and duration of the detention.
I have been an Associate Hospital Manager for over 25 years. First with Dudley Health Authority and then the Dudley & Walsall Trust Mental Health Trust, and now following merger in 2020 Black Country Healthcare NHS Foundation Trust. In addition, I have also been doing the same role for a large private mental healthcare provider.
In all these years, I have seen many changes in procedures and processes as well as the nature of the trusts we work with, but the overriding factor has always been, ‘what is in the best interest of the patient.’ It is with this mind that I continue to work in this field and learn from it year in year out. To this end I also sit on the Trust’s Mental Health Legislation Scrutiny Committee as one of two representatives of the Associate Hospital Managers. But that's a story for another time…