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The National Hospital for Neurology and Neurosurgery Good

All reports

Inspection report

Date of Inspection: 12 November 2012
Date of Publication: 20 December 2012
Inspection Report published 20 December 2012 PDF

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Meeting this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We reviewed all the information we have gathered about The National Hospital for Neurology and Neurosurgery, looked at the personal care or treatment records of people who use the service, carried out a visit on 12 November 2012 and observed how people were being cared for. We checked how people were cared for at each stage of their treatment and care, talked with people who use the service, talked with carers and / or family members and talked with staff.

Our judgement

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Reasons for our judgement

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. When we visited the hospital we saw consent forms that were being used if required. For example, we saw an example of a specific form for patients to sign if they were going to have a Botulinum Toxin injection. When we spoke to patients they told us they had been asked for their consent by medical staff.

Where staff identified that people might not have the capacity to consent, the provider acted in accordance with the Mental Capacity Act 2005 (MCA) and a capacity assessment was completed for them. Where major decisions affecting patients without capacity needed to be made, best interest meetings were taking place. The hospital was involving relatives, advocates and care professionals from within and external to the trust at these meetings as appropriate.

When we visited David Farrier Ward we met a patient who had an appropriately authorised Deprivation of Liberty Safeguard in place. This was where the staff working in the hospital had recognised that it was in his best interest for a restriction to be in place. This demonstrated that the hospital understood when these steps were needed and how to get this agreed to safeguard the patient.

We asked staff about what their responsibilities were in assessing the capacity of a patient to make a decision (in accordance with the MCA). Whilst some staff were able to describe their individual responsibilities, many were not. For example, some staff were not able to describe the process they would use to assess someone’s capacity. The provider might wish to note that some nursing staff may benefit from more training so they feel confident in using the MCA in their work.

When we were on the Intensive Care Unit we asked to see the trust policy for supporting patients with more complex and challenging behaviours, but it was unavailable at the time. When we asked, staff were not able to explain what the process was for managing a patient who wished to leave their unit against medical advice or who may lack capacity to make that decision. The provider might like to note that not all staff had easy access to information, or demonstrated knowledge, on how to manage patients with complex challenging behaviours who might present a risk to themselves, other patients or staff.