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									    Draft Minutes of the Forensic Mental Health Services Managed Care
     Network Advisory Board meeting on Friday 1 December 2006 in
            St Leonard’s Pollock Room, University of Edinburgh

Present:        Mrs Andreana Adamson, Chief Executive
                Dr Ian Dewar, Royal College of Psychiatrists
                Dr Andrew Fraser, Scottish Prison Service
                Mr Geoff Huggins, Head of Mental Health Division (Chair)
                Mr George Hunter, CoSLA and ADSW
                Dr John McGinley, British Psychological Association

In Attendance:
Miss Vivienne Gration, Forensic Network Project Manager (Secretary)
Mrs Rosie Toal, Scottish Executive
Dr John Crichton, Consultant Forensic Psychiatrist, Orchard Clinic
Dr Fergus Douds, Lead Clinician, Learning Disabilities
Mr Martin Montgomery, Regional Lead, West of Scotland


1.     Apologies for absence and opening remarks
Apologies were noted from Dave Langton, Mary Weir, Ray Flint, Ian McMaster,
Colin Poolman, Willie McFadden, Annie Ingram, Stella Clarke, Margaret Morrison,

HDL (2006) 48 requires strengthened regional arrangements and the Forensic
Way Forward Group asked each region to review their structures. This means
that there will be some changes to the regional representatives to the Network
Board.

North
Annie Ingram remains regional lead.

SEAT
Ray Flint remains; addition Dr Stella Clarke as Lead Clinician

West of Scotland
Doug Adams will no longer attend, Anne Hawkins is Regional Lead, Martin
Montgomery, General Manager of Forensic Services in Glasgow and Clyde will
attend representing the West of Scotland.

Medical Director
Members heard that Dr Lindsay Thomson has been successful in her application
for the post of Medical Director.

2.     Minutes of the last meeting
The minutes of the last meeting, 2 June 2006 were agreed as an accurate record
with the comment that under matters arising the Scottish Executive will try to
fund further RMO training events.

3.   Matters arising
Members noted the written update.

CAMHS
Geoff Huggins updated members on CAMHS services in Scotland.               Following
discussion with colleagues in England the Health Department will refer     the issue
to Ministers to consider the provision within Scotland, including           whether
assessment or treatment facilities. Consideration will also be given to    how best




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to fund services including whether linking with Learning Disabilities services is
feasible.

Andreana Adamson informed the Board that a proposal for a National CAMHS
Network was discussed at recent Chief Executives meeting.           Andreana will
forward the paper to Geoff who will look into how this might fit with the Forensic
Network.
                                 Action: Andreana Adamson/Geoff Huggins

4.   Chief Executive’s Report
Members noted the written report and the additional comments.

Regional Arrangements
Papers outlining the new regional arrangements for the North and SEAT are
attached for information. It is likely that the Forensic Way Forward Group will
invite regional groups to strengthen Clinical Governance arrangements within
their regional structures.

IAFMHS 2009
The State Hospital and Forensic Network has won the bid to host the ninth annual
IAFMHS conference in June 2009.          Work will commence shortly in putting
together an organising committee and programme group as well as a wider
reference group. Andreana informed the Board that there has been some
discussion about whether to widen the conference to include the rest of the UK
but that given the differences in legislation it has been agreed to keep the focus
just on Scotland.

IAFMHS 2007
The seventh conference is in Montreal, 26 – 28 June 2007. The Forensic Network
will offer support to speakers from Scotland. Submissions are being made for a
symposium involving, Andreana Adamson speaking about the Network, Lindsay
Thomson speaking about Education and Training and Ed Finlayson about the
Mental Health Act.

Workforce Planning
There has been some initial work done looking at the implications of the interim
arrangements in Glasgow and the West. There is a particular issue around
recruitment for Glasgow and how this might affect other services.

Nurse Consultant Update
Members agree that there has been good work across Scotland and look forward
to a presentation at the next meeting.

Forensic Network Education Group
The materials for “New to Forensics” programme are being written by Lindsay
Thomson, Dave Langton, Ed Finlayson and Louise Ramsey as part of the
successful bid from Edinburgh University. They are expected to be completed by
March 2007.

Forensic School
There have been very positive meetings with the three universities interested in
collaborating on the development of a Forensic School. It has been agreed to
submit a bid to the Scottish Funding Council in spring 2007 to progress with
assessing demand.


Secure Services for Women



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It is confirmed that Rowanbank (Stobhill) Clinic will be the location of medium
secure services for women. There is ongoing discussion about collaboration
between the North and SEAT about low secure services.

Appeals against Excessive Security
Geoff Huggins explained that the Mental Health Tribunal for Scotland seem to be
processing appeals against excessive security most quickly. A meeting has been
arranged with MHTS involving Mental Welfare Commission to examine what the
likely impact will be if successful appeals move to Court of Session and Boards
have failed to find suitable accommodation.

5.   Interim Lead Clinician Report
Members noted the written report presented by Dr Andrew Fraser.

High and Low Secure Standards
Consultation period complete, very supportive comments received which require
some minor adjustment of the standards.

Community Services
The consultation period is also complete resulting in some minor adjustments
from social work perspective.

Care Standards
Now that all the care standards have been written and endorsed by the Forensic
Network Board it is intended to bring all together into one document, high,
medium, low and community standards. These will be presented at the next
meeting.

It is hoped that this will provide a framework for pulling together all of the
relevant pieces of work into a useful companion to the Memorandum of Procedure
including clinical governance.

Relevant Inquiries
Andrew Fraser brought two Inquiries to members’ attention, Michael Stone and
John Barrett. Both inquiries found issues with CPA practice and concerning
patients’ consent for sharing information. Members heard that it is hoped that
the CPA report will address these issues which have also been the subject of
recent parliamentary questions.

It was suggested that there needs to be some work done around providing
support for staff who deal with particularly difficult patients such as the ones
subject to these types of inquiries, for example patients with personality
disorders. Members agreed that this issue should be considered when Lindsay
Thomson takes up her new post.
                                                       Action: Lindsay Thomson

Section 136 TTDs
There are potentially ten patients trapped in the system due to this issue. The
Scottish Executive Health Department is currently discussing the issues with CLO
and it is hoped that it will be resolved shortly. It was suggested that there is a
need for some interim guidance and Geoff Huggins will keep members up to date
on progress.
                                                          Action: Geoff Huggins



Prison Inspections



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HM Inspector of Prisons is about to publish themed reports of which two thirds of
the intentions concern mental health and through care. These will be shared with
members as soon as they are available.
                                                            Action: Viv Gration

Integrated Case Management
This system has now been put into practice within SPS and has made some
improvement to internal systems; it will also link with CPA and MAPPA
arrangements.

Changes in SPS Personnel
Several members of SPS staff have taken up new posts; Kenny McGeachie is
working on a project working on routes out of prison; Sue Brooks has taken up a
policy post and John McGeach is now at Deputy Inspector of Prison.

The Board formally thanked Andrew for taking on the role of Interim Lead
Clinician for the past few months.

6.   Update on Psychological Therapies Working Group
Members noted the written report presented by Dr John McGinley.

Members heard that it is intended to present the first draft of the report to the
next meeting of the Board. The group are working on the basis of integration of
practice and disciplines in order to produce a framework for psychological therapy
services. The report will also support psychotherapy as part of the service.

The report will have sections dedicated to each of the different programmes
although does not include any work on depression. Members suggested that it is
important to include depression as it is included within the Mental Health Delivery
Plan and it will be important to link with the work being taken forward with that.
                                                            Action: John McGinley

It is expected that producing the protocols for psychological therapies will be
quite straight forward but that integration with risk and community services will
be more difficult. The Group hopes that the network will support a conference in
2007 to launch the proposed protocols.

Members acknowledged that this is an ambitious paper and look forward to a
further presentation in March. The Board asked that the group also consider the
immediate and short term implications of the services (2 – 3 years). Important
to include information about integration, training in community teams and
therapy community models and to make sure that there is liaison with NES.

The group should also consider as part of their report, what to do, how to get
there and how to deliver the services proposed.

7.     Revised CPA Guidance for Restricted Patients
Members noted the presentation from George Hunter, outlining the three streams
of work within the revised guidance, risk assessment and management,
integration with MAPPA and information sharing. The report recommends that the
guidance could easily be relevant for non-restricted patients and that it is
important to consider extension of the guidance to this group as there are many
patients, particular in the community that pose significant risk and would
therefore benefit from management within such a system.




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Members agreed that the report should be subject to a consultation period, until
mid February, before being shared with the Tripartite Group and ultimately
Scottish Ministers.
                                                          Action: Viv Gration

Following consultation The Scottish Executive will edit the report into actual
guidance and consider how the implications of CPA such as the number of red and
amber alerts will be dealt with in terms of clinical governance.

There have been a number of cases recently where patients’ views have differed
from CPA and it is important within this guidance to encourage CPA chairs to
solicit dissenting views from CPA members.

Members thanked George Hunter for this significant piece of work.

8.     Review of Critical Incident Reviews Procedures in Forensic Mental
       Health Care
Members welcomed this considerable piece of work and thanked John Crichton for
his overview presentation. The following comments were made:

o    A pilot of the new guidance should include a low secure service and should not
     run parallel to the consultation period
o    Sharing details of outcomes of CIRs is a very welcome development, members
     suggested that while sharing an annual report would be very useful it might
     be helpful to share findings of CIRs more swiftly as they become available in a
     bulleting fashion
o    There was debate about the need for a memorandum of understanding across
     agencies and it was agreed that this should be a specific question for the
     consultation process
o    Consideration should be given to how the Incident Reports would fit in with
     Fatal Accident Inquiries and past circumstances where Procurator Fiscals have
     specifically asked that there should not be an internal incident inquiry
o    Consideration should also be given to whether there is the need for some
     other form of alert across services that are “below the radar” of CIR
o    Is there a need for a more robust approach to CIR perhaps across all of
     mental health services and how does a Forensic Services CIR process differ
     from Generic CIRs in local areas
o    Further discussion is also required about interaction with Mental Welfare
     Commission and QIS, unsure that MWC will be happy to be within the
     process. Perhaps it would be better to remove the Special Incident Review
     from the process.
     John Crichton explained that there had been discussion with QIS about their
     Intention to develop something overarching but had given the impression that
     this would be some years away. He added that there is a greater need within
     Forensic Services for improving current practice

Members agreed that before the report goes out for wider consultation
amendments should be made to cover these points and the report should be sent
to Donnie Lyons at Mental Welfare Commission and David Steele at Quality
Improvement Scotland for comment before wider consultation.

The consultation should include the following pointed questions:

o    Is there a need/benefit       in   having   a   structured    Memorandum     of
     Understanding?




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o   Is it necessary to have a separate Incident Review Procedure for Forensic
    Mental Health Services and if so how would that fit with generic incident
    review arrangements within Boards?
o   Should the Special Incident Review level be included in the process or
    completely outwith the Health Service?

John McGinley asked if, from the audit carried out by the Scottish Executive
Health Department, there was any way of identifying predictor factors of
incidents. This particular audit did not capture that level of information, but it
was agreed that the results of the audit could be shared with him.
                                                              Action: Viv Gration

It was agreed that structuring the consultation questions and liaison with MWC
and QIS could be agreed between Andreana and Geoff and therefore the
consultation will not have to be delayed until after the next Board meeting.
                                    Action: Andreana Adamson/Geoff Huggins

9.     Forensic Learning Disabilities
Members welcomed the considerable work carried out to date and noted the
presentation by Dr Fergus Douds, a copy of the slides is attached. There is
ongoing discussion with Greater Glasgow and Clyde Health Board about the
provision of 4 LD beds within Rowanbank.

An event for care providers and social work and health commissioners is planned
for 2 March with a view to then extending an event for care workers. Fergus plans
to establish better relations with ADSW colleagues and hopes to establish forensic
LD multi-agency groups suggesting that working with young people might be a
good place to start.

10.   Any Other Business
The Board considered the need to establish additional short life working groups

Victims – The Executive are still awaiting feedback from OSSE on this matter and
the network will await the outcome before considering this piece of work any
further. However, it was pointed out that The Orchard Clinic currently has seven
out of area patients due to victim issues and consideration will have to be given
to how to ensure that Lothian Health Board do not have to bear the expense of
these patients indefinitely.

Long Term Care/Community Accommodation – The Board agreed that this would
be a useful piece of work and that a small group should be established to consider
this issue, scope the requirements and offer proposals for a suitable way forward
given that it is so different from community services.


11.    Date Of Next Meetings
The meetings for 2007 will be held in Stirling Management Centre, Stirling
University on the following dates (all from 10am – 12noon and followed by
lunch):

        Friday   2   March
        Friday   8   June
        Friday   7   September
        Friday   7   December




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