Multi-disciplinary Patient Care
Complex patient care is a challenge with the potential for inter-agency friction, disagreement and associated excess legal spend if parties do not manage complex cases in an integrated way. We worked with various agencies and disciplines in order to put in place the community management of a challenging and high risk community patient.
Putting in place the community management of a challenging and high risk community patient who was challenging his care package. This involved:
- Working through relative roles and responsibilities in the context of capacity, consent, and deprivation of liberty;
- Supporting integrated working around mental and acute healthcare needs, accommodation and financial affairs; and
- Facilitating joint decision making around a Court of Protection application
There is the potential for inter-agency friction, disagreement and associated excess legal spend if parties do not manage complex cases in an integrated way.
Inter-agency and multi-disciplinary discussion and decision making took place around:
- Capacity assessment and the role of alcohol abuse in such an assessment;
- The role of the Mental Health Act ("MHA") and the Mental Capacity Act ("MCA"), and the inherent overlap in complex decisions around residence and treatment;
- Relative and shared responsibilities in terms of health and welfare decisions, financial decision making and the practical 'on the ground' implementation of decisions;
- Resourcing Court applications in financial and human terms for patients with multi agency input;
- Limiting financial cost and exposure to risk through shared working practice around MCA processes and court procedures.
Overcoming the challenges
Different agencies provide distinct parts of complex care packages which are funded separately. There is an inevitable tension around where margins are drawn.
Some roles are statutory (e.g. the Approved Mental Health Professional where the MHA is used), but the broader responsibilities around responsibility for different aspects of care, treatment, and the assumption of risk are more flexible.
In this case authorities and agencies worked together from the beginning, ensuring the patient care was:
- To the highest standard and devoid of any risk of serious incident;
- Without friction, disagreement or dispute between agencies which would increase risk and cost; and
- A streamlined and efficient Court of Protection process with shared resource and an avoidance of duplication.