The national policy of ‘Least restrictive practice’ puts everyone but the most dangerous patients at greater risk. Fact.
You were doing well, Neil until the last paragraph. I’ll explain where you went wrong.
The ground floor professionals, who’ll have been community nurses, RMNs, do not have the power to insist on forcing a depot. I know, I’ve tried jumping through those hoops many times, sometimes with success. (And just a sidenote, once the patient is on a CTO and legally can be forced to accept a jab, you (*) usually need, in this order, a bed, a warrant for a CTO, for which you have to chase the overworked consultant, take the warrant to court (remotely, not in person, thank heavens) and often it will be batted back to you when the judge wants more information or justification for sectioning the patient. Once you get that, if it’s after say 2 p.m. you can forget it until tomorrow because you (see *) work 9-5, you can’t pass the job off to the 24 hour team (Crisis Resolution) so you have to pick it up again the following day.
Then, with the warrant in your sticky hand, you need the police to be available at the same time that you are.
You may also need a lot of large hairy- arsed male nurses present if the patient is violent or a runner. Really tricky to arrange nowadays, it can eat up your whole shift. Once upon a time we were better staffed.
Who do you think wrote all this nonsense? And how did that coatrack of managers (that no ground floor staff actually needs) manage to dodge having to do any of the work?
*) you = the ground floor community nurse, yes just you, no manager, team leader, clinical director or any of the other scores of bullshit job titles above you cop for any of this. They have managed to cascade the entire lot downhill onto the over-worked foot-soldier – in addition to all the rest of their unwanted work that they previously cascaded onto him/her. And that’s another blog post or ten.)
The Inquiry did not investigate how far up the ladder that critical decision failed to be made, but they could and should have. It’s the managers who write and enforce the least restrictive practice policy.
I bet HH Deborah Taylor, chair of the full public enquiry, has already been given instructions to stay well away from this topic. Get the little people instead Your Honour.
Let’s look at some selected quotes from the Theemis report.
In today’s post I’ll focus on just three things.
1. Least restrictive practice. Here, the report writers make the lightest reference possible to the true villain of the piece, the national ‘least restrictive’ policy which has career ending consequences if you disobey it.
‘The inpatient teams involved in VC’s care were trying to treat VC in the least restrictive way and took on board VC’s reasons for not wanting to take depot medication which included him not liking needles.’
If this report had been written with an overriding obligation to truth rather than avoiding hurt feelings and protecting policy-makers from blame it might instead read –
‘We were tied up in knots trying to reconcile two irreconcilable objectives (and avoid disciplinaries and stealth punishment from management). The objectives were to a) safely manage a provenly dangerous, treatment refusing pt in the community and b) at the same time, obeying the inoperable and impossible demands of least restrictive practice.’
But it wasn’t, so I’ve done it for you. Read on in part 3.
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