Transition Plans in the Court of Protection

1. Transition Plansin theCourt of Protection By District Judge Peter Avis

2. Thanks toVictoria Butler-Coleand…………..

3. Transition Plan orTransfer of Care Plan?

4. The Law

5. Article 8 – Right to respect for private and family life • 1. Everyone has the right to respect for his private and family life, his home and his correspondence. • 2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others. ECHR Art 8- Right to private and family life

6. “A care plan is more than a statement of strategic objectives- though all too often even these are expressed in the most vacuous terms. A care plan is – or ought to be – a detailed operational plan…... whatever the level of detail which an individual case may call for, any care plan worth its’ name ought to set out the operational objectives with sufficient detail – including detail of the “how, who, what and when” - to enable the care plan itself to be used as a means of checking whether or not those objectives are being met” Munby J (as he then was): R(J) v Caerphilly County Borough Council [2005] 2 FLR 860:

7. “In the event that it is expected that the assistance of the Police may be required…the following steps should be taken: • The LA/NHS body/other organisation applying to remove P….should discuss and, where possible agree with the Police the way in which removal shall be effected • The Applicant should ensure that information about the way removal is to be effected is provided to the court and to the litigation friend • Where the Applicant and the Police do not agree about how removal should be effected, the court should give the hearing consideration to inviting/directing the Police to attend Coleridge J in:Re MP; LBH v GP [2009] FD08P01058

9. The Bury-Rossendale Inquiry, 1975 • 15 elderly women moved • Only 4 survived 12 months, nine died within 3 months

10. David Jolley et al: “Enforced relocation of older people when Care Homes close: a question of life and death?” (Published in Age and Ageing 2011)

11. The study identified those at highest: • Gender: Males do less well • Age • Dementia • Depression • Anxiety • Regression or withdrawal in the face of relocation • Impaired eyesight and/or hearing • Reduced mobility • Incontinence • Multiple problems together

12. Identified those elements of relocation that are most stressful: • Sudden or unplanned moves • Failure to assess and meet medical and psycho-social needs • Multiple moves, including temporary interim placements • Discontinuity of care • Lack of consultation with residents and families • Lack of information and explanation of rights • Highest risk in the first three months after relocation

13. Good practice pre-relocation: • Informing P and family early • Careful planning • Comprehensive needs assessments and adjust Care Plans accordingly • Identify a number of alternative placements, if possible • Prepare handover notes and share these with receiver home in advance • Arrange familiarisation visits for P and family, if feasible • Arrange for staff from the “donor” home or hospital to be available to the “receiver” home during the first couple of weeks after transfer

14. Good Practice during Relocation: • Ensure all parties are aware of date, time and details • Ensure that adequate physical and staffing arrangements are in place • Ensure suitable transport is provided • Ensure appropriate health check at both departure and arrival • Ensure that a familiar and responsible person travels with P and that they have everything necessary for continuing care, medication, equipment etc. • Ensure P is welcomed and made safe and comfortable • Advise family and “donor” home/hospital of safe arrival

15. Good practice Post-relocation: • Review progress and Care Plan after 1 week, 4 weeks and 3 months and take appropriate action • Provide orientation in the new environment • Maximise stability and continuity • Provide opportunity to discuss and come to terms with the move • Facilitate and environment where P and their family know they are being heard • Keep good records

17. Lack of Planning

18. • Lack of Planning • Lack of a Co-ordinator

19. Lack of Planning • Lack of a Co-ordinator • Lack of all participants "signing off” on the Plan

20. Lack of Planning • Lack of a Co-ordinator • Lack of all participants “signing off” on the Plan • Lack of Care Plan on arrival

22. • The Checklist is incremental. • Consider whether you need to order sedation at the outset. • Most unlikely to be ordering restraint at outset, more likely to order an urgent application in event that physical restraint is required. Transition Plans in the Court of Protection

23. The Golden Rules: • “How, Who, What and When” • Make sure that a named person is responsible for the entire Transition. • Ensure all parties, Hospitals, Care Homes, Local Authorities, the family where appropriate, Ambulance transport etc. all “sign off” and specifically confirm their agreement to the plan Transition Plans in the Court of Protection

24. District Judge Avis dj.peter.avis@ejudiciary.net Transition Plans in the Court of Protection