Healthcare Features
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Staff at an NHS Trust left patients’ medical information in public rubbish bins on two separate occasions, an investigation by the Information Commissioner’s Office has found.
The first incident involving University Hospitals Coventry & Warwickshire NHS Trust took place in February 2011, when records relating to the treatment of 18 patients were found in a communal waste bin at a residential apartment block.
According to the ICO, the information had been taken home by a member of staff and accidentally disposed of in a public bin along with other rubbish.
The second incident, which took place in May, saw a member of the public discover details relating to a patient’s sensitive medical procedures and test results. These were “allegedly found in a bin outside Coventry University Hospital”, the ICO said.
The ICO concluded that the NHS Trust’s policies and procedures on the use of personal information were not sufficient. Concerns were also raised during the watchdog’s investigation about the delivery and collection point for patient notes at one of the Trust’s hospitals.
"Although each separate incident did not involve a large quantity of personal data, they occurred with a two month period suggesting that the data controller did not take sufficient measures to safeguard the personal data it held," the watchdog reported.
"The Commissioner has taken into account the fact that a proportion of the personal data in question related to medical conditions and could potentially result in distress being caused to the individuals concerned."
The NHS Trust's chief executive, Andrew Hardy, has signed an undertaking in which it has agreed to review its policies on the protection and disposal of personal information. Staff will be trained to follow the updated guidelines and new procedures governing the handling of clinical data, while the Trust will also monitor compliance on a routine basis.
Sally Anne Poole, Acting Head of Enforcement at the ICO, said: “The fact that the trust lost sensitive personal information on two separate occasions within the space of two months is clearly not acceptable. Organisations across the health service must recognise that they hold some of the most sensitive personal data available and that it must never be disposed of in the same way as routine household waste.”
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The first-ever Mental Health Tribunal to sit in public has ruled that the patient concerned should not be discharged.
In what also represents the first time a determination has been published, the First-tier Tribunal today (26 October) revealed that the detention of Albert Laszlo Haines, 51, was still necessary for his own health and safety and for the protection of others.
Haines has been detained under s. 37/41 of the Mental Health Act 1983 since October 1986. He was initially at Broadmoor Hospital, then between 1992 and 2008 at Three Bridges, and from early 2008 at Broadmoor again. The responsible authority is West London Mental Health Trust.
The index offences were of attempted wounding, which occurred when Haines tried to attack a doctor and nurse at the Maudsley Hospital with a machete and a knife. He was returned to Broadmoor in 2008 after an incident at Three Bridges when having been placed in seclusion after arming himself with a fire extinguisher as a weapon he climbed into a roof space.
The patient had been found to be suffering from both mental illness and psychopathic disorder. However, in 2008 under the law as it then stood, he was reclassified as suffering only from psychopathic disorder. More recently it was suggested that he did suffer from a mental illness, as well as from a personality disorder, but that was the subject of dispute.
Haines, who had successfully waged a lengthy legal battle to have the hearing in public, asked the Tribunal for an absolute discharge. It was also submitted on his behalf that in the alternative the Tribunal should grant a conditional discharge, which would have to be deferred. Mr Haines asked to be discharged to his brother’s house or failing that to a hostel.
In his “detailed and very articulate” statement Mr Haines said he did not want a conditional discharge because he would find it very difficult to comply. However, he said he would comply if that were the only alternative to remaining in detention. He did not accept that he had either a personality disorder or a mental illness.
Rejecting Haines’ application for discharge, the Tribunal found that:
- Haines was suffering from a mental disorder, namely a personality disorder. “This was the unanimous evidence of all the psychiatrists whose written or oral evidence we considered, and their conclusions were based on the very extensive and detailed history of physical and verbal aggression”. The index offences, although 25 years ago, were correctly described as a very violent and dangerous event, albeit one that did not lead to serious injury. There had been numerous incidents since
- There was insufficient evidence at this stage from which it could be safely concluded that Haines also suffered from a mental illness. There had been a divergence of views among the witnesses
- The unanimous evidence – which the Tribunal accepted – was that Haines’ mental disorder was of a nature that made it appropriate for him to remain liable to detention in hospital for treatment. “The frequency and intensity of the incidents of irrational, hostile, abusive and aggressive behaviour cannot simply be explained by understandable frustration at the length of detention or by a reaction to ward moves.” Haines could plainly be settled and pleasant, but this was almost invariably with those whom he sees as being on his side and doing what he wants
- Detention in hospital remained necessary for Haines’ own health and safety. “It is correct to say that any suicidal threats are now historic, but we noted that they occurred while he was in a less structured environment, including at a time when he was having a considerable amount of leave,” the Tribunal said. “We also concluded that outside hospital there would be a considerable indirect risk to his own safety due to retaliation by others caused by Haines’ behaviour towards them.” The provocation of others was so much a current feature of his presentation that it would inevitably be repeated outside hospital
- Unless Haines was detained in hospital for treatment he would be unable to contain his anger or aggression. Detention in hospital was therefore necessary for the protection of others.
- Appropriate medical treatment was available for Mr Haines in Broadmoor. This included medication and therapy.
The Tribunal said: “Mr Haines has not progressed enough in being able to control his anger and aggression not to require detention, and he is unable to recognise the need for continuing treatment.
“In the community there would in addition be a clear risk of a misuse of alcohol and drugs. He is incapable of coping with anyone perceived to be in authority. In his own evidence Mr Haines very frankly acknowledged that he would have great difficulty in complying with conditions, and would be likely to fail: we are satisfied that in his current presentation he would be unable to comply.”
The Tribunal added that it was “in nobody’s interest” that Haines be detained – whether in high or medium security – for a day longer than absolutely necessary.
“In our judgment detention does remain necessary, and we conclude by observing that it is likely to remain so unless the treating team are able to find a way of engaging Mr Haines, and that this will require an equal commitment by Mr Haines himself.”
A copy of the determination can be downloaded here.
The hearing took place on 27-28 September 2011.
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The government will create a new duty for NHS employees to report bad practice or patient mistreatment and provide new protections for staff that do so, the health secretary Andrew Lansley has announced.
The proposed changes follow the poor care uncovered by the Care Quality Commission this month after unannounced inspections of 100 NHS hospitals.
The changes will also make it clear that it is the duty of all NHS workers to report bad practice or any mistreatment of patients receiving care from the health service. The changes will be added to the NHS Constitution and associated guidelines in early 2012,
They will add:
• an expectation that staff should raise concerns at the earliest opportunity;
• a pledge that NHS organisations should support staff when raising concerns by ensuring their concerns are fully investigated and that there is someone independent, outside of their team, to speak to; and
• clarity around the existing legal right for staff to raise concerns about safety, malpractice or other wrong doing without suffering any detriment.
Andrew Lansley said:“The first lines of defence against bad practice are the doctors and nurses doing their best to care for patients. They need to know that they have a responsibility to their patients to raise concerns if they see risks to patient safety. And when they do, they should be reassured that the Government stands full square behind them.“We are determined to root out the problems in the NHS. That is why I requested a series of unannounced hospital inspections by the Care Quality Commission. Its latest reports showed there are long standing problems and we now want to do all we can to tackle them.”
The proposed changes are currently the sibejct of a consultation process, which can be accessed at the following link: http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_1305512.
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Communities Secretary Eric Pickles has unveiled plans to pilot two “localist” approaches to integrating services.
One pilot will see two areas invited to design and run a ‘neighbourhood level’ Community Budget. The second will see two more areas invited to put together a ‘whole place’ Community Budget. This would set out in practice what a single budget comprising all funding for local public services, or options for pooling and aligning resources, would look like.
The two whole-place pilot areas will be tasked with taking forward a "proof of concept". However the government also wants ten areas to act as "friends of the pilots" through a challenge and learning network.
The four pilot areas will receive support “to break through Whitehall’s bureaucracy”, with the government suggesting the projects could be up and running by April 2013.
Details of the pilots, which will be selected by the end of the year, are contained in a Community Budgets prospectus. A copy of the prospectus can be downloaded here.
Writing in the foreword, Eric Pickles said: "Open Public Services set out how Community Budgets are being used to re-design services for troubled families. They put control in the hands of those who are best placed to shape public services around the needs of local people – public service leaders and local people themselves.
"But we want to go further and to test how local places can make best use of all the money that is spent in their area on public services on a wide range of problems. The pilots set out in the prospectus provide a real opportunity to overcome the long-standing barriers to real local design and leadership of services."
In a speech to the Local Government Association today, the Communities Secretary said: “This is your opportunity to change the future of the way public services are funded and be the thumping heart of your community".
He added: “Test your ambitions to the limit. And the old hands in Whitehall won't realise they've lost control until it's too late.”