Lousia Ovington independent investigation report ... - NHS North East

CHAPTER 9 – CONCLUSIONS AND RECOMMENDATIONS
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1, during a period when serious concerns were being expressed about her. In
June 2000 she had been similarly discharged by Consultant 12 after three non
attendances at outpatients. The letter she was sent remarked, “When people
do not attend and do not let us know that they are not attending, then we can
assume that things are going well for them at present and that they no longer
need our services”. At other times she was discharged because she was felt
not to fit the profile of the service. The drug and alcohol services discharged
her twice, accepting her statements that she no longer needed their help. The
CRT saw no role for themselves in May 2004, since the primary diagnosis was
‘alcohol dependence and anger management’ issues. Social Worker 5, in early
2004, discharged her, noting that she had ‘agreed’ with Louisa Ovington that
she did not need input further, leaving her without an active care coordinator
and with her file closed to social services.
It is easy to sympathise with front line staff in overstretched services dealing
with difficult clients who only ‘engage’ when they feel like it. The panel’s
view however is that the services were sometimes too ready to believe that
because Louisa Ovington was not attending she must therefore be in less need
of services; or that the responsibility should lie on her to arrange and attend
appointments; or that they should ‘empower’ Louisa Ovington by accepting her
own evaluation of her needs. The panel is also concerned that in some instances
services may have elevated their discharge practice to the status of policies,
which may then have been too rigidly enforced.
Additionally, patients with personality disorder will, by the nature of the disorder,
present additional problems in terms of engagement.
• Recommendation 24. That the trusts reviews all policies, formal or
informal, that prescribe general rules for discharge from services and
ensure that they are not applied in a formulaic way. Discharge should
be dictated not by non attendance per se, or by self evaluation, or
by rigidly applying service criteria, but by clinical need and an up to
date assessment of risk. If a patient has repeatedly failed to attend
appointments, careful consideration should be given to whether
more active steps should be taken to ensure engagement. The care
coordinator’s opinion should be sought, as he or she is likely to have a
broader knowledge of the patient.
• Recommendation 25. There should be programmes in place to ensure
those working with patients with personality problems are appropriately
trained in motivational interviewing and engagement techniques.