Trust lockdown and access to acute services - covid and non covid period

Dear Camden and Islington NHS Foundation Trust,

Written with advocacy support

NHS lockdown commenced on March 2010.

Please provide details of the following:

1. Copies of ALL memos and communications to ALL 3 crisis houses and both Camden and Islington crisis teams sent from 23rd March onwards regarding ANY changes to referral and access routes and ANY changes to assessment and support of pts on a face to face basis.

2. Provide the date that the MH Trust closed face to face access to pts in crisis via either/ both crisis teams.

3. Please also provide numbers of how many pts were being supported through face to face visits at their place of residence on the following dates ( it is presumed the MH Trust knows how many pts are on the books at any one time in this context):

23rd March 2020
30th March 2020
6th April 2020
1st May 2020
31st May 2020

4. 're all 3 crisis houses.
Provide the dates for each crisis house when self referrals were refused from.

5. 're Drayton Park women's crisis house.

Provide the admission criteria in place in from October 2019 to December 2019.

For each of these 3 months how many referrals were made and how many admissions were there.

For this period of time, and for each month how many referrals were refused.

Provide a copy of the admission criteria as of 23rd March 2020 - if it was the same as the dates above please state.

Between March 23rd 2020 and 31st May 2020 how many self admissions were there, how many community admissions by any other route were there, how many admissions direct from hospital were there.

Given the NHS has been told to enter in to phase 2 of return to usual level of service provision and the Trust has not yet done so please provide a copy of the operational transition plan in place and being used to gatekeep acute services as of 31st May 2020

All requested information is required to be provided as part of datasets to both CCGs and NHS England therefore should be readily available.

Excel spreadsheet response is acceptable.

Yours faithfully,

Alea

Dear Information, Freedom,

Written with advocacy support

Thank you for your email.

This is the typical predictable and wholly obstructive response of a MH Trust who knows FULL well who the requester is given you claim I am a current MH Trust patient.

Your team have also had to handle SARs and have extremely detailed formalised arrangements with cross agency agreements in place to try and block access to legitimate data that were confirmed only 2 months ago. Your manager sits in said meetings. Yet you claim there is an identity issue?

Plus of course the issues of on going investigations and being subject to legal action.

So, please do not again claim there is an issue about identity.

My name is Alea.
You have responded to me on this site by that name and that name only.

For the purpose of this request ,and because as a MH Trust positive communication is so difficult and obstructive,my full name is Alea Iacta Est as changed by deed poll whereby YOUR team have been sent deed poll and id information 3 times in 4 yrs.

Let alone the fact there is NO legal basis to your assertion that someone requires a surname.

If you dispute this then please refer me to the relevant section and paragraph in primary legislation that demands a surname. And if you continue to block this request you will be referred YET AGAIN to the ICO who have had to threaten or actually serve notice on the Trust 4 times in relation to requests from me.

Your team blocks all and any requests that may be considered sensitive from myself or anyone. It would really really help your reputation to be transparent and open and to act lawfully.

Please read the full ICO statutory guidance on identification including whereby someone has a non traditional name or non English name.

Furthermore you have a standing statement that you may not be able to respond within 20 days despite lockdown being eased and all NHS Trusts now being in to phase 2 of operations.

Please advise exactly where in the Coronavirus Act 2020 and all subsequent guidance up to 1st June 2020 easement is given to not complying with the DPA

Yours sincerely,

Alea Iacta Est

Dear Camden and Islington NHS Foundation Trust,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Camden and Islington NHS Foundation Trust's handling of my FOI request 'Trust lockdown and access to acute services - covid and non covid period'.

're Question 2 which is a question 're between what dates crisis teams stopped seeing people in mental health crisis.

You have stated the following:
'
Camden and Islington NHS Foundation Trust can confirm face to face access to patients was
never closed. Staff were requested to consider which service user appointments could be
conducted over the phone rather than face'

This response is considered deliberately evasive and obstructive as it seemingly ONLY relates to either those already under the care of said crisis teams and / or under the care of community teams where decisions were made whether or not to see existing pts.

By definition it can't relate to those attending A&E not ever seen for assessment of whether face to face support more appropriate.

In these cases referred to above please review your response given that anecdotal reports are overwhelming that ALL Trust staff were telling existing pts ( and STILL are) that they are not seeing pts at all face to face even though the rest of the NHS now is. And in the case of emergency always has.

Please also confirm whether figures provided were solely for those ALREADY UNDER THE CARE OF THE CRISIS TEAMS RATHER THAN NEW PTS TAKEN ON DURING PANDEMIC PERIOD HIGHLIGHTED.

Q2 is NOT solely about existing pts who were under crisis team care at 23rd March. It also relates to those pts the Trust is duty bound by law to assess, including see, who present at any of the 3 A&Es in the Trust.

Agreed normal protocol and procedure in the acute division pathway ( confirmed by MH Trust and all acute Trust documentation) is that when a pt presents at A&E in severe mental distress - very often life threatening - they are assessed by the crisis team.

A&E acute staff are NOT considered qualified to assess mental health. Assessment by qualified mental health staff on premises is confirmed in ALL policy documents as being the ONLY safe option in clinical care.

Camden and Islington NHS Foundation Trust continued to place information on it's own website for those whose lives were at risk, to present at A&E after 23rd March.

From 23rd March ALL 3 A&Es refused to see those presenting solely with an emergency mental health condition. Stating Camden and Islington NHS Foundation Trust crisis team staff were no longer seeing pts at A&E and were not attending .

THIS IS IN DIRECT CONFLICT WITH WHAT YOU HAVE STATED.

They could treat associated physical harm or illness only ie if someone had taken an overdose or self harmed.

These pts were, at best, told to ring the crisis line single point of access. Whose staff were stating the same as ALL staff referred to above - that NO pts were being seen face to face. And who aren't open after 8 pm.

NHS 111 were also continuing to direct pts in tne Trust area ,with mental health emergency, to go to A&E from 23rd March in the Trust's area.

The 999 service were also told to take pts in Trust area to all 3 A&Es.

Your own figures given in this response are so low that they back up the contention that crisis team staff withdrew from all 3 A&Es BEFORE ANY OTHER ADEQUATE SAFE LAWFUL PROVISION WAS SET UP.

So, whilst the NHS across other sectors were continuing to see and assess face to face those with life threatening physical illness the Trust shut down the front line crisis team assessment duties at A&Es?

Obviously it is clinically inappropriate and unsafe to give someone in a life threatening condition a telephone number to call with NO other support. If this was safe the 3 A&Es would have closed to all physical care emergencies and just given out telephone numbers to those with cardiac concerns, head injuries, renal failure, sepsis etc etc .

They didn't because refusal to assess and provide suitable care in a safe manner is unlawful as is sub standard care and pts are both harmed and die.

VERY OBVIOUSLY FOR THOSE PRESENTING TO A&E IN MENTAL HEALTH EMERGENCY, INCLUDING THOSE ALREADY ASSESSED BY NHS 111 ,PARAMEDICS AND POLICE ATTENDING THE HOME AS NEEDING MENTAL HEALTH EMERGENCY, A TELEPHONE SUPPORT LINE THAT DOESNT EVEN OPERATE AFTER 8PM IS AN INADEQUATE CLINICALLY UNSAFE RESPONSE.

So, in order to clarify please actually respond the the question in totality as it obviously includes those who crisis teams would normally have seen in A&E.

The Coronavirus Act did NOT give easement to NHS mental health services closing down emergency care. Emergency care includes face to face assessment using the very same PHE guidance on PPE that ALL NHS staff were expected to follow.

Given the above and so that the request is responded to in full in the internal review please confirm the following so that there remains no confusion:

Q2 also relates to pts presenting at A&E as described above. Given the discrepancy between anecdotal accounts and emergency service accounts and the Trust's response please confirm how many pts were seen across all 3 A&Es by crisis team workers week commencing 9th and 16th March and how many were seen week commencing 23rd March., 30th March and 6th April.

A 'hub' is now opened in St Pancras hospital for mental health pts to attend. However they are told not to present in person but to ring ahead for assessment and appointment.

Confirm EXACTLY what date the hub was opened AND fully staffed. FULLY staffed includes having psychiatrists in situ as would be the case in A&E where the mental health liaison teams are based.

Given the above emergency services and NHS 111 were still diverting to A&E please confirm what date NHS 111/ NHS England / CCG was informed of alternative arrangements in place. This can be considered as a seperate FOI combined with below.

Physical health pts with life threatening conditions are NOT expected to ring A&E for assessment or permission to attend or for an appointment that fits in with clinical team availability. And to only be in life threatening danger within certain hours.

Camden and Islington NHS Foundation Trust are commissioned and funded and expected under the law to provide EMERGENCY care.

By your own guidelines and advice on the website the hub is clearly NOT providing care on parity with those with life threatening physical health conditions as these pts are NOT expected to go through the process of what at best can be described as an urgent care service the 'hub' apprars to be opetating at..

The Coronavirus Act did not provide for easement of the Equality Act. In fact statutory bodies were told to ensure the most vulnerable were NOT discriminated against and refused emergency care.

Given this, and that this is now 4 months on from when NHS lockdown started, please confirm what date an Equality Impact assessment was done of the reduced access 'emergency' service at the hub. Including how the Trust assessed need of those unable to use or access a telephone.

Please provide a copy of this - I understand this request may be considered a separate FOI request.

Please also confirm at what date a minicom number was provided for the hub .

're why crisis teams refused to see pts requesting face to face support - please confirm if at any point in or before lockdown, staff groups or their representatives , managers or unions raised formal concerns with the Trust re either lack of PPE or inadequate PPE. No date is required. Just if ANY formal representation was EVER made.

There is a very significant discrepancy between what the Trust has stated in this FOI response and first hand accounts of 'other's. ' personal and professional experience.

Hopefully you will now provide accurate figures and dates so this can be addressed.

A full history of my FOI request and all correspondence is available on the Internet at this address: https://www.whatdotheyknow.com/request/t...

Yours faithfully,

Alea

Dear Information, Freedom,

This is an FOI request.

Not a complaint.

If it was a complaint it would be written to your complaints team.

Comments made are solely in response to what you stated when replying, given anecdotal ,reported or actual evidence to the contrary.

Including PHE and NHS England own guidance to NHS Trusts on how to respond to, and manage services safely given covid threat.

Including widespread media reports and speculation across the region regarding availability of PPE resulting in staff in MH refusing to, or being directed not to, see pts /would be pts face to face.

Including what has been, and what is currently stated on your own website.

And to clarify given that the data on those presenting in crisis after 23rd March appears to omit those without physical injury or ill health or covid symptoms who needed face to face assessment by a MH professional and prior to 23rd March would have been offered that in A&E .

Or would have been offered that in another setting if referred. An obvious eg. being those referred by GPs.

Diverting an FOI request through a complaints procedure where no complaint is made is both inappropriate and unlawful .

And could be considered a deliberate contrivance in order to avoid responding to an FOI in a manner compliant with statute.

Now that we have cleared that up please can the Trust just provide accurate information in the response even if it takes significantly longer than the time limits normally allowed, even with amended guidance from ICO .

It is preferred that accurate data is provided rather than time limits are met .

So, I am willing to extend the deadline to 1st October.

Yours sincerely,

Alea

Dear Information, Freedom,

It was perfectly clear.

Glaringly so, in fact.,

Yours sincerely,

Alea