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DoH sign outside department buildings in Stormont grounds.
THE Northern Trust has failed to confirm that its community mental health team possesses the full and complete medical file of one of its patients, The Detail can reveal.
This patient, who we will call Charlie, is a vulnerable man in his thirties who suffered an acquired brain injury and has underlying mental health issues.
Concerns about the whereabouts of his medical records, along with other issues, have led Charlie's family to support a judicial review into the levels of scrutiny provided over mental health services in Northern Ireland (NI).
Regulation and inspection of NI’s mental health services is weaker than in England, Scotland or Wales.
On this basis, Charlie’s family is preparing to provide a sworn affidavit for the judicial review, which is being led by a survivor of child sex abuse who wishes to remain anonymous.
Róise Fitzpatrick, a lawyer acting for both Charlie’s family and the child sex abuse survivor, told The Detail she’s concerned that mental health services in NI face inadequate oversight, and that her team has issued a pre-action letter of claim to the Department of Health (DoH) threatening judicial review proceedings. Ms Fitzpatrick called for this “serious deficit to be addressed”.
She added that her clients have “suffered for years” and have found themselves facing “lonely battles when raising concerns about both the level and quality of mental healthcare they were experiencing”.
Ms Fitzpatrick, from KRW Law, also said that concerns over the Regulation and Quality Improvement Authority (RQIA) – NI’s health watchdog – and its lesser powers to scrutinise mental health services than its equivalents elsewhere in the UK, were “magnified to us when we recently saw the mass resignation of the RQIA board members” over decisions the DoH made in relation to Covid-19.
Weaknesses in NI’s system of regulation and inspection were revealed in an article published by The Detail in November 2019.
At that time, the SDLP's Mark H Durkan, the chair of Stormont’s all-party mental health group, said the level of mental health oversight in NI risks “a dereliction of duty”.
Following this, representatives from the DUP, Sinn Féin, Alliance and the UUP all called for changes to the system, in an article published by The Detail in April 2020.
NI’s newly appointed mental health champion, academic Siobhán O’Neill, also told The Detail that greater scrutiny of mental health provision would “improve the public’s confidence in the quality of the services provided”.
Charlie's mother, a former nurse of over 30 years, said: "We just wonder if everything we’ve experienced would have transpired if our country’s mental health services faced proper scrutiny.”
His uncle said: “It makes us question if mental health services are sufficiently safe in NI. If I buy a mobile phone, the service providers are even regulated. Is mental health not as important?
“Change surely must now prevail, language such as 'lessons to be learned' and 'missed opportunities' must be sufficiently challenged.”
Transfer
Charlie has been in the care of the Northern Trust (NHSCT) community mental health team for five years, following his transfer from the Belfast Trust (BHSCT) in the summer of 2015.
Documentation provided to The Detail shows the NHSCT had been treating and assessing Charlie for over two years without being in possession of some of his medical records.
The Health and Social Care Board (HSCB) protocol on the transfer of adult mental health patients, between trusts in NI, states that a full copy of the patient’s medical file should be handed over to the receiving trust within six weeks of their formal request to transfer, unless there are ‘sound clinical reasons for a longer period’.
This didn't happen in Charlie's case when he moved to the NHSCT from the BHSCT.
In January 2016, Charlie’s uncle raised concerns about his nephew’s medical file with the office of Dr Tony Stevens, the now retired Chief Executive of the NHSCT.
Later, in a December 2017 meeting between the family and representatives from the NHSCT, Charlie’s mother and uncle again raised concerns about their loved one’s file.
The following month, Oscar Donnelly, the director of mental health and learning disability in the trust, sent correspondence to the family which proves that Charlie had been treated by his trust’s community mental health team from August 2015 until December 2017, without his full and complete medical history being at their disposal.
Charlie’s uncle said: “From when I first raised this, directly with Dr Stevens’ office, it took almost two years to discover that they didn’t have the full and complete medical file.”
Mr Donnelly’s January 2018 correspondence to the family shows that the trust didn't receive Charlie's Knockbracken Hospital records, from the BHSCT, and his Ards Hospital records, from the South Eastern Trust (SEHSCT), until December 2017.
Charlie's mother questioned: “How many people have seen and treated my son without having his full and complete medical file at their disposal?”
Records “not immediately transferred”
Dr Tony Stevens later wrote to Charlie’s mother in April 2019.
His correspondence acknowledged that all of Charlie’s medical files “were not immediately transferred” from the BHSCT to the NHSCT, when he moved to the NHSCT's care in 2015.
The Health Permanent Secretary Richard Pengelly was cc’d into this correspondence. Mr Pengelly had previously been directly contacted by the family about their concerns.
The DoH declined to provide a comment on Charlie’s specific case. However, a department spokesperson informed The Detail that it's "key that the available psychiatric notes are transferred to the receiving trust" when a mental health patient moves from one trust to another and that such information "should be sought as soon as practical".
Nyall Brown was a 19-year old man, from Cromer in England, who took his own life in May 2018.
The BBC reported that Norfolk coroner, Jacqueline Lake, criticised the mental health trust which was treating him for not accessing his full medical history.
Charlie’s mother said: “Reading about what happened in that case frightens the life out of us. It just highlights the importance of medical files to mental health patients and why we are so concerned about all of this.”
In March 2020, a spokesperson for the NHSCT told The Detail the trust received Charlie’s “2011-2015 notes”, just after he came under its care, and that a trust consultant “made contact by telephone with a consultant who had been involved in previous care”.
The spokesperson admitted that other notes of Charlie’s weren’t received until December 2017, but despite being asked to do so, they declined to provide categoric confirmation that the trust is now in possession of his full and complete medical file.
The spokesperson added: “It was, and remains, the consultant’s professional opinion that he had the most relevant and recent documentation to allow him to treat Charlie."
Charlie’s mother said: "All we've ever wanted is for Charlie to receive safe and proper care, and treatment – as is his entitlement.
"It all just makes us think back to that terrible incident at Knockbracken."
Knockbracken
In December 2007, Charlie informed his community psychiatric nurse in the BHSCT that he was suicidal. The nurse said this behaviour was “uncharacteristic”, adding that something was “really amiss”.
Charlie told her “things can’t go on this way” before being admitted into Knockbracken Hospital which looks after psychiatric patients.
One week later, Charlie was discharged from Knockbracken on his own volition with no doctor present at the hospital. The family also wasn't informed of Charlie's discharge until after he had already left the hospital.
Half an hour after his discharge, Castlereagh PSNI informed the hospital that Charlie had been hit by a school bus outside its entrance. Charlie ran in front of the vehicle.
“Thank God it was empty,” his mother said.
Charlie was taken into the ICU of the Royal Victoria Hospital in Belfast following his collision with the bus. He went into a coma and also suffered an acquired brain injury.
Charlie’s mother told us: “He had a bandage on his head which said ‘do not touch’ where part of his skull was temporarily removed from. I wouldn’t wish it upon anyone to see their child like that.”
He was then taken into Musgrave Hospital’s brain injury unit where he had to learn to walk and talk again. His mother was "so grateful" to the staff in the Royal and Musgrave.
Charlie’s shoulder was badly damaged from the incident too and he lost sensory feeling in his hand which continues to give him trouble with his balance.
He was 20-years-old when he was struck by the bus.
We questioned the trust if it was ok for Charlie to discharge himself without a doctor present and without his family being informed, and we also asked about the nature of his transfer to the NHSCT in 2015 when his Knockbracken records weren't initially sent.
However, the BHSCT declined to comment on the issues raised in this article.