Safety recommendation
HSSIB recommends that the Department of Health and Social Care includes the documenting of patient, family and carers’ wishes and preferences within the Mental Health Bill. This will ensure all patient, family and carer voices are considered in decisions relating to where the patient identifies they would like to be close to, for example the patient’s home or a family member, specifically when an out of area placement is needed.
Response:
The Mental Health Bill, which was introduced to Parliament on the 6th November 2024, contains a number of provisions that aim to ensure that the patient’s wishes and preferences, and those of their family and carers, play a more central role in decision making. Key examples include:
1) Care and treatment plans: Under the Bill, all patients, excluding those under very short-term sections, will receive a statutory care and treatment plans. The Bill requires that the patient’s clinician consults with the patient and those who care for the patient’s welfare (e.g. family and carers), among others, when preparing and reviewing the plan. The contents of the care and treatment plan should comprehensively cover what is needed to ensure that the patient’s needs are met during and after their hospital stay. We will set out details of the content required within the plan in regulations. We anticipate that this will include, information about a patient’s wishes and feelings regarding their care and treatment and details of any individuals with a relationship or other connection with the patient or individuals to whom the patient’s care and treatment plan is relevant. For example, relatives or those who may be providing care or treatment after discharge.
2) Advance Choice Documents/ advance decision making: The Bill puts ‘Advance Choice Documents’ (ACDs) on a statutory footing. These provide a place for people to set out their wishes, feelings, decisions, values and beliefs when they are well. This is so the ACD can later be used to inform practitioners’ decisions around their assessment, admission and treatment in mental health hospital, if they experience mental health crisis and are too unwell to express these things at the time. Wishes and preferences may include the treatments they want and don’t want, based on their past experience, and who they want to be consulted on their care and treatment e.g. family or carer, if they lose capacity or competence. To encourage individuals to make an Advance Choice Document, the Bill places duties on health commissioners to inform people of the opportunity to make an Advance Choice Document, while they are well, and to offer support. To ensure a person’s Advance Choice Document has impact, the Bill creates a statutory framework that gives weight to the contents of a person’s Advance Choice Document as well as any other advance statements or advance decisions.
3) Clinical checklist: The Bill includes a new clinical checklist that requires clinicians to take steps when deciding a patient’s treatment. For example, the clinician must, among other things, support the patient to take part in decision making about their treatment, consider their wishes and feelings - including those in an Advance Choice Document - and the relevant views of anyone named by the patient as someone to be consulted with e.g. family members or carers. The aim of this is to make clinical decision making more patient centred.
Actions planned to deliver safety recommendation:
- Delivery of the Bill. By when: Subject to Parliamentary timing. Organisational lead: DHSC. Resources in place to deliver actions: Dedicated Bill team.
- Delivery of revisions to the MHA Code of Practice. By when: 1- 2 years after Royal Assent of the new Act. Organisational lead: DHSC. Resources in place to deliver actions: Dedicated Bill and Implementation teams. Other dependencies identified: Dependent on passage of the Bill.
Response received on 24 February 2025.