The Coronavirus Act 2020 introduces temporary modifications to the 1986 Order in the event of an emergency. The purpose of the Coronavirus Act is to enable Government to respond to an emergency situation and manage the effects of a COVID-19 pandemic.
The main sections of interest for GPs in relation to the MHO are highlighted below
The amendments should only be used in emergency and the process still needs to be followed when detaining a patient.
Patients should still be seen face to face if possible. Depending on assessment of risk a GP may decide to assess a patient for detention through a closed door/a window or using videolink technology. However they must be satisfied that the method of assessment has allowed them to use sufficient professional judgement
A relevant social worker can make applications is an approved social worker is not available.
The GP must have seen the patient in the 5 days before making the report (previously 2 days)
The hospital doctors holding powers have been extended from 48 hours to 120 hours while waiting for a medical assessment for detention.
Key sections from new code of practice
Interpretation of ‘personally seen’ and ‘personally examined’
- On a number of occasions, the 1986 Order requires a person to have ‘personally seen’ or ‘personally examined’ a patient before making an application or report . The expectation is that this means the person making the application or report will have visited the patient and have had a face to face interview with them.
- During the COVID-19 period, it is expected that, in most cases, it will be necessary to continue to personally see or examine someone in order to make a sound professional assessment and judgement on the right course of action.
- However, the 1986 Order Code of Practice notes in paragraph 2.6 that good communication with the patient is essential, but that the patient may be interviewed through a closed door or window ‘where it is necessary to avoid serious risk to other people’.
- Therefore, while the emergency Coronavirus Act provisions are in place, alternative methods of communication such as Facetime or Skype may be considered in exceptional circumstances where an assessment of the risk involved indicates it. The use of barriers or screens, perhaps in a ward environment, may also potentially be justified, again in these exceptional circumstances.
- At all times the professional making the application or report must be satisfied that any alternative methods used allow them to exercise sufficient professional judgement.
Requirement for applications for assessment to be made by an Approved Social Worker
- The 1986 Order requires an application for compulsory admission to hospital for assessment to be made by an approved social worker. In an emergency applications can, in addition to approved social workers, be made by a relevant social worker, if an approved social worker is not available.
- A relevant social worker is a person who is registered as a social worker in the principal part of the register maintained by the Northern Ireland Social Care Council under section 3 of the Health and Personal Social Services Act (Northern Ireland) 2001 and has at least 5 years’ experience in the last 10 years working as a social worker. For this purpose, the 5 years need not be a single period, or continuous periods, of such experience. That social worker must also be of the opinion that it would be impractical or would involve undesirable delay to wait for an approved social worker to make the application.
Requirement to personally see the patient before reports
27. The 1986 Order requires a person to personally have seen a patient within two days before making an application or completion of a medical report. During an emergency this is modified to five days for both the person making an application for assessment (either the approved social worker or the relevant social worker) and the medical practitioner completing the medical report
28. The 1986 Order provides holding powers for medical practitioners and nurses which allow a patient who is already in hospital to be detained while an application for assessment is made. These provisions are modified to allow the doctor’s holding powers to be extended from 48 to 120 hours and nurse’s holding powers to be extended from 6 to 12 hours. There are no modifications to the respective Forms (5 and 6) and no other modifications are made in respect of the holding powers.