C. THE HOSPITAL MANAGEMENT TEAM
1. Composition
6.68 We suggest that the Team should be composed of:
The Chairman of the Medical Executive Committee
The Divisional Nursing Officer
The Sector Administrator
The Principal Psychologist
The Principal Social Worker
The Head of Occupational Therapy
6.69 We suggest that the Sector Administrator should be the co-ordinator, but he will probably delegate much of the work to the Unit Administrator who, in any event, will service the Team and should attend all its meetings. Any member of the District Management Team will be able to attend meetings.
6.70 The Divisional Nursing Officer may on occasions like to ask one of the Senior Nursing Officers to attend on his behalf.
6.71 Where appropriate to the matter under discussion, for example a problem peculiar to one Clinical Area or Ward, there should probably be additional attendance at the meeting from that Clinical Area or Ward.
2. Responsibility and Task
6.72 (i) The Team will have a corporate responsibility to the District Management Team for the efficient running and functioning of the hospital under delegated authority from the District Management Team. We envisage that the delegated authority will include the following matters:
(a) Acting in an advisory capacity to the Health Care Planning Team and Support Services Manager.
(b) The preparation of policies and plans for the development of the psychiatric services, and, subject to approval of the District Management Team, ensuring their implementation.
(c) The provision of guidelines within which the Clinical Area Multidisciplinary Teams would be required to prepare operational policies.
(d) The receipt and approval of policies and plans for improvement from ward and clinical area teams and ensuring that they are reviewed and updated at regular intervals.
(e) The co-ordination of the activities of the Clinical Area Teams and of the changes in institutional care and in the level of community care.
(f) The approval of the allocation of resources between the Clinical Area Teams and the correction of any imbalance between them, particularly in relation to bed allocation.
(g) Ensuring that plans and policies are prepared for the development of professions allied to medicine e.g. psychology and occupational therapy.
(h) Ensuring that clinical area teams maintain liaison With appropriate local authorities.
(i) Carrying out fact finding visits to clinical areas and other departments of the hospital.
(j) Ensuring that training programmes are provided to meet the needs of all disciplines within St. Augustines.
(k) Reviewing the District plans for the psychiatric services and ensuring that they take account of any proposals put forward by the Hospital Management Team.
(l) The receipt of the minutes of clinical area and other formal meetings and the taking of such action as may be necessary.
(m) The initiation of changes and ensuring that the hospital is keeping abreast of national trends.
(n) The authorisation of expenditure within the limits imposed by the District Management Team.
6.73 (ii) The authority delegated should be clearly set out in writing. Where there is doubt about the extent of the delegated authority reference should be made to the District Administrator before action is taken. It is possible that the Team will be granted delegated authority (a managerial role) in some matters and a co-ordinating role in others but in our view such a division should if possible be avoided.
6.74 (iii) The Hospital Management Team should meet the District Management Team at regular intervals. After a 'running-in period' we do not suggest that such meetings should occur more than once every six months.
6.75 (iv) If the instructions of the Hospital Management Team are not complied with the matter should be referred at once to the District Management Team.
3. The Team Co-ordinator
6.76 We have already suggested that this should be the Sector Administrator who will, in effect, be the Team’s Executive Officer. As already indicated in the Ward context, although all minutes will be sent to the District Management Team for information, matters referred to it for a decision or advice should be sent out on a separate piece of paper.
4. The Team Chairman
6.77 We consider that there should be a regular Chairman for the conducting of the meetings.
D. A NURSING COMMITTEE
6.78 In the same way as the Teams referred to above will be helped by the Medical Executive Committee and the Medical Staff Committee, we consider that it could be helped by a Nursing Committee to advise on nursing matters. We recommend that such a Committee should be set up under the Divisional Nursing Officer and that it should be drawn from all levels of nursing staff. We believe that such a Committee will help to fulfil the need of all levels of nursing staff to participate in improving nursing standards and shaping policies in St. Augustines.
11. An Outside Inspectorate
6.79 Dr. Ankers submitted that there is a need for an outside inspectorate and national standards for mental hospitals. We regard both these proposals as outside our terms of reference.
6.80 There is at present a clear duty on the Regional and Area Health Authorities and on the district Management Teams to see that hospitals for which they are responsible are run properly and that the patients are well cared for. This duty will be more effectively discharged if monitoring is carried out in the manner set out in paragraphs 6.8- 10.
6.81 An additional check on performance within the present system is provided by the Community Health Council members. In their role as representatives of the public they are expected to direct their attention to the standards of care of long stay patients and they are in a unique position quite independent of management to visit the hospitals and observe the facilities and care provided. We recommend that they should regard it as part of their duty to assess the extent to which action has been taken on these recommendations and the validity of any explanation given for failure to follow any of them.
6.82 In addition we hope that it will be possible for the Hospital Advisory Service to be developed so that it can visit St. Augustine's every three years or so.
12. Matters that we suggest that the Regional Health Authority should consider drawing to the attention of the Secretary of State
6.83 We respectfully suggest that the Regional Health Authority could usefully refer the following specific matters to the attention of the Secretary of State:
6.84 (i) The need to develop and extend the work of the Hospital Advisory Service, both by ensuring that there are regular visits to psychiatric hospitals, we suggest once every three years, and also by ensuring that it has sufficient back-up facilities to make repeat visits, when necessary, to deal with problem situations.
(ii) The unsatisfactory practice illustrated in Appendix 5 whereby a mental hospital may be compelled against its better judgment to take a patient from a special hospital in order to get a patient admitted to that special hospital.
(iii) The question of how far our advice on the resolution of the management problems in St. Augustine’s should be Applied in other psychiatric hospitals.
09 February 2025
