“12. As yet, therefore, given that a suitable hostel has not been identified, despite the endeavours of the clinical team, and other appropriate conditions are not in place, I would respectfully suggest that B is granted a deferred Conditional Discharge in order that the above conditions can be implemented. In addition, he will require overnight leaves to an identified hostel to further to test his stability in the community before it can be considered appropriate to complete his discharge.”
“If discharge from hospital is considered, B would require the following to be in place prior to discharge: • Adequately staff supported accommodation. On interviewing him, B stated that he would like a small hostel with ensuite facilities, a maximum of six other residents and low levels of noise. In addition, he would prefer a placement that permits smoking. • A discharge process with encouragement to develop and create normal patterns as well as positive social contacts other than professionals. • Close monitoring of treatment plan with regular contact with allocated Community Consultant as well as Care Coordinator. • A clear treatment management and crisis response plan.”
“ In view of the above needs B needs regular contact with a • Community mental Health Team that would review and monitor treatment as per agreed care plan. • Care manager who would continuously review placement needs. • Meaningful daytime activities as well as attendants (sic) to a suitable community mental health resource centre such as day and a walk-in centres.”
“The establishment of a suitable care package as soon as possible, such a package to include: A. Suitable hostel accommodation to be identified and willing and able to accept [the Claimant] within six months. B. Identification of a Community Consultant Psychiatrist to act as RMO. C. Appointment of CPN and Social Supervisor. D. Patient’s compliance with all proper requirements of the supervisory team. E. Patient’s continuing to take prescribed medication. F. Patient’s continuing to abide by restrictions on alcohol consumption and to comply with requests to submit to drug screening and alcohol testing if required.”
“Richard Hutchinson, Camden Social Services, Camden Town CMHT completing comprehensive assessment regarding funding community placement. Attended ward round to obtain further details. I visited hostel with B, enjoyed visit. Allowed to smoke in room at hostel. Manager to contact Avesbury House to arrange an assessment of B. B met with Richard Hutchinson last week, dealt with some challenging questions. Information given to Richard Hutchinson at ward round regarding level of functioning and needs requirements. Brokerage team will assess Holtwhites Villa. To attend next CPA meeting.”
“It was confirmed that Holtwhites Villa had de-registered in April 2003 and was now a housing service, funded by the London Borough of Enfield Supporting People Service. As such, it is no longer a service provided by social services, subject to registration and inspection which ensures standards of care. There was concern as to whether a social services department could purchase accommodation at such a place or whether it would be appropriate to do so. It was also agreed that a possible alternative registered care placement be identified.”
“… Mr Jackson confirmed that B had been assessed by the Adviser Patricia Shanahan. In broad terms that they have considered B to be a suitable candidate for their placement. There were a number of key areas which will need further work to address them. … Mr Jackson confirmed that B had been formally accepted by the hostel and all costings for his stay had been forwarded to the appropriate person at the London Borough of Camden. It was noted, however, that Holtwhites Villa has not yet been recognised by Enfield Council as a supporting people provider placement. It would appear that this lack of recognition has been based on a technicality and that Enfield Council were due to visit in the very near future to address this issue and it was likely that they would recognise the hostel as an appropriate resource. It has also been noted, however, that Enfield Council are likely to want clients from the local area to access this resource in the first instance rather than clients from outside the Borough. Mr Richard Hutchinson confirmed the position in relation to the social services in the London Borough of Camden. There was no disagreement that B will require out of area funding given his inability to return to the area of Camden as result of his index offence. Mr Hutchinson was shortly due to complete the community care assessment, but on the basis of the information he has obtained thus far and in discussions with B, it would appear that his needs could be appropriately met by a supporting people provider placement rather than a residential care home. If this was the case, placements for supporting people are generally required on a block contract and not individually which will have implications in relation to B’s particular needs. Further liaison was required between the appropriate people in the Supporting People department in Camden to liaise with Enfield Council to solve the specific difficulties in relation to B’s needs. Mr Hutchinson confirmed that he had spoken to Keesia Crew, the manager of the Supporting People department in Camden who was due to liaise with Pauline Ketlass in the Enfield Council department. All those at the meeting agreed that B’s needs could be appropriately met by the resources available at Holtwhite’s Villa and that this was B’s first choice in relation to a community placement. Some of the issues raised by Mr Jackson could be addressed during periods of increased day and overnight leaves to the hostel prior to his formal discharge. It was confirmed that further high level discussions between Camden and Enfield Council Offices needed to occur. The meeting agreed that specific time scales should operate in relation to these discussions to ensure that B was not kept waiting unnecessarily, and to adhere to the timescales imposed by the Tribunal which was next due to meet in approximately mid March 2004. It was, therefore, agreed that any information pertaining to B’s case should be forwarded to the clinical team at Avesbury House by16th February 2004 . CARE PLAN CARE PLAN 1. Continue his current Care Plan to remain in place whilst he resides at Avesbury House, including monitoring of his mental state, compliance with medication, occupational therapy progress and community leaves. 2. Mr Richard Hutchinson to complete the community care assessment and forward it to the appropriate brokerage team, Camden Social Services. 3. Mr Hutchinson to communicate with the Manager of Supporting People Department in Camden, Keesia Crew, to ensure that she liaises with her opposite number in Enfield Council. Information regarding this to be fed back to the Avesbury House clinical team by16th February 2004 . 4. Ensure Camden Outreach have assessed B prior to reconvened Mental Health Review Tribunal in March 2004.”
“… B was granted a conditional discharge in October 2003 and the clinical team at Amesbury house are currently pursuing accommodation for him. B cannot return to live in the Borough of Camden due to the Home Office imposing an exclusion zone and is therefore requested to reside in Enfield. A placement has been identified at Holtwhites Villa in Enfield and my colleague, Martin Pankhurst and I have visited this unit. The manager of the hostel has assessed and accepted B and all parties agree that this would be an appropriate placement in meeting B’s care needs, however, we cannot proceed with this referral without the involvement from your department. B had a Care Program Approach Meeting on the 19/1/04. Your colleague Richard Hutchinson attended and explained that funding had not yet been agreed. I am aware that Mr Hutchinson was due to visit the unit to assess its suitability in order to report back to Camden's brokerage department, but unfortunately has been on sick leave. It would be helpful to know whether another social worker could be allocated to complete the work that Mr Hutchinson had started in the event he remains on leave.”
“In November 2003, the Community Mental Health Team in Camden were made aware that a potential hostel placement in Enfield had been identified. Since then, my colleague, Martin Pankhurst and I have been in liaison with both Camden and Enfield brokerage departments to ascertain who will be responsible for funding this placement. It is of concern to hear that the providers have now indicated their intention to withdraw the offer of a placement due to this funding not being resolved. Consequently, this will result in a further delay to B’s discharge from hospital, as a new placement will need to be sought.”
“3.5 The Camden CMHT were notified about the suitability of the placement in November 2003. A further Community Care Assessment was made by Camden in December 2003, once again confirming that B requires a ‘Supported Housing’ placement (not residential care) and that in all likelihood, Holtswhite Villa could meet B’s needs. A joint visit was arranged for Richard Hutchinson (Camden Care Manager) and Martin Pankhurst (NLFS Student Social Worker) to visit Holtswhite Villa for the purpose of Camden further assessing the placement suitability. However, this visit failed to occur due to Mr Hutchinson becoming ill. 3.6 The following three months has seen little progress in establishing further inroads into the Care Plan. This appears to be due mainly to a technicality over funding regulations. 3.7 To summarise, Holtswhite Villa is funded via ‘Supporting People’ monies (a government initiative to redirect housing benefit funds into Local Authority control as a way of funding and monitoring more appropriately the housing and support needs of vulnerable adults). B, if he were free to return to Camden, would have no difficulties accessing these monies and moving into a ‘Supporting People’ placement. However due to not being able to return to Camden, he has to seek accommodation elsewhere. Camden is unable to fund an ‘SP’ placement out of Borough as there are apparently no current protocols that would allow this. Camden has suggested that B register with Enfield Housing Department in the hope that he could then access LB Enfield ‘SP’ finances. 3.8 An application for housing registration in Enfield has been made and we are awaiting a response. There is however, a further complication in that Holtswhite Villa itself may not qualify for Enfield ‘SP’ funding support as it is a new project and missed a registration deadline with Enfield to access these monies. 3.9 All of this of course is of no help to B, who no longer needs to be residing in hospital. In trying to find a way round this, we have approached the Supporting People team (Pauline Ketlass) in Enfield who recognise that the Management Team at Holtswhite Villa (Patricia Shanahan) are “good providers with good outcomes”
“I remain supportive of the Tribunal’s decision in September 2003 that B fulfils the criteria for a deferred Conditional Discharge. However, I consider that B is appropriately detained in hospital at the current time, whilst the process of facilitating his discharge by meeting the conditions required for a community placement, as set out in the Tribunal decision, is completed. The imposition of the exclusion zone, necessitating B being found suitable hostel accommodation with a vacancy outside his original catchment area, has undoubtedly contributed to the time scales involved. At the current time, a suitable hostel placement, namely Holtwhites Villa, Enfield has been identified and a vacancy is available at present. There is, as yet, no agreement for the funding arrangements for this placement. B is due to be assessed by the Enfield Forensic Outreach team for his suitability for community supervision in the very near future. It is anticipated that should the team accept him, provision of a CPN and Social Supervisor can be facilitated. Should any additional information be forthcoming, this can be provided in oral evidence at the Tribunal hearing.”
“The Tribunal expressed its concern at the delay in implementing their decision of the 11th of September 2003 which was attributable to the absence of the funding agreement. And we note that suitable accommodation has been kept available since December 8, 2003 and will shortly be used for overnight leave following the authorisation of the Home Office. We hope that all conditions will have been complied with before the21 June 2004 .”
“In the particular circumstances of this case I consider it to be arguable that the claim for damages should be allowed to keep the application for judicial review in being. It may be that Anufrijeva is not an impediment.”
“(1) This section applies to persons who are detained under section 3 above, are admitted to a hospital in pursuance of a hospital order made under section 37 above, or transferred to a hospital in pursuance of a hospital direction made under section 45A above or a transfer direction made under section 47 or 48 above, and then cease to be detained and whether or not immediately after so ceasing leave hospital. (2) It shall be the duty of the Primary Care Trust or Health Authority and of the local social services to provide, in co-operation with relevant voluntary agencies, after-care services for any person to whom this section applies until such time as the Primary Care Trust or Health Authority and the local social services authority are satisfied that the person concerned is no longer in need of such services; but they shall not be so satisfied in the case of a patient who is subject to after-care under supervision at any time while he remains so subject.”
“(a) a health authority has the power to take preparatory steps before discharge of a patient; (b) it will normally be the case that, in the exercise of its discretionary power, an authority should give way to a tribunal decision, and should use reasonable endeavours to fulfil the conditions imposed by such a decision, in so far as they relate to medical care; (c) failure to use such endeavours, in the absence of strong reasons, would be likely to be an unlawful exercise of discretion.”
“(1) …, where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of such services, the authority— (a) shall carry out an assessment of his needs for those services; and (b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services. … (5) Nothing in this section shall prevent a local authority from temporarily providing or arranging for the provision of community care services for any person without carrying out a prior assessment of his needs in accordance with the preceding provisions of this section if, in the opinion of the authority, the condition of that person is such that he requires those services as a matter of urgency.” (a) shall carry out an assessment of his needs for those services; and (b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services. … (5) Nothing in this section shall prevent a local authority from temporarily providing or arranging for the provision of community care services for any person without carrying out a prior assessment of his needs in accordance with the preceding provisions of this section if, in the opinion of the authority, the condition of that person is such that he requires those services as a matter of urgency.”
“It will be for relevant health and social services staff to decide whether the resources available to them can enable acceptable arrangements to be made for treating specific patients in the community.”
“In my judgment section 117 imposes on health authorities a duty to provide aftercare facilities for the benefit of patients who are discharged from mental hospitals. The nature and extent of those facilities must, to a degree, fall within the discretion of the health authority, which must have regard to other demands on its budget.”
“68. Mr Jay submits that even if there was a breach of Article 5 on the facts Mr Gordon is shooting at the wrong target in seeking to recover damages from the Respondent. He submits that the hospital detaining W could not have acted differently under domestic law. It is not logical, he argues to be unable to proceed against the detaining authority and yet recover damages against a third party. The true remedy against a s.117 body is judicial review and not damages. He further submits that the Martin v Watson does not extend to false imprisonment: see Davidson v Chief Constable of Wales and another[1994] 2 All ER 597 . Just as the claimant in that case was imprisoned without a remedy, so it would be with W. 69. I can see the force of these arguments. I do not think that W is able to identify the respondent as a public authority liable for his detention under Art 5. But I do not think the case ever gets as far as this because in my view the respondent did nothing to cause the unlawful detention of W. It neither knowingly tried to nullify the decision of the tribunal nor failed to use its best endeavours to implement the conditions it had directed.”
“The detention of a person suffering mental disorder in a hospital constitutes an interference with the patient’s right to respect for private life protected by Article 8(1), in that it may adversely affect his ‘physical or psychological integrity’, his right to personal development and his right to establish and develop relationships with other human beings and the outside world: see Pretty v United Kingdom,(2002) 35 EHRR 1 , §61”
"It is acknowledged, and always has been, that the significance of this case arises from the importance of the issues it raises, not from the level of compensation that then might be obtained."