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CHAPTER SIX - NOTIFICATION OF INCIDENTS

Notification of incidents

6.1 While the RMO has primary responsibility for the patient's care and treatment, Scottish Ministers have specific responsibilities in relation to restricted patients and officials must, therefore, be advised of all serious incidents involving restricted patients. Scottish Executive Health Department ( SEHD) officials are responsible for responding to any media interest in incidents relating to restricted patients and must be able to brief Ministers, if necessary. It is also essential that officials are informed about any serious incident involving a restricted patient to ensure that Scottish Ministers have a full and up to date record of each restricted patient. It is the RMO's responsibility to report all such incidents to the Scottish Executive and the Mental Welfare Commission. A checklist of information required when reporting an incident is attached at Annex A2.

Definition of serious incident

6.2 A serious incident involving a patient can be defined as one which:

• results in serious injury or death to the patient or to another person involved in the incident;
• requires a formal critical incident review by the hospital management (whether internal or external) as result of a disturbance or other event occurring;
• results in serious damage to the unit;

or involves:

• concerted indiscipline by a number of patients involving violence;
• the use of seclusion;
• the taking of a person hostage;
• making a protest in a public place, for example, following unauthorised access to a rooftop;
• escapes from the hospital building;
• absconds while on suspension of detention (escorted or unescorted) out with the hospital building.

6.3 A serious injury can be defined as any which results in:

• injury to the patient or another person requiring treatment in hospital; or
• any of the following injuries whether or not hospitalisation is required:

The aim where any restricted patient absconds or escapes is to ensure that the patient is found and returned to the hospital as soon as possible with no violence being perpetrated. Where an incident occurs within the hospital, it should be resolved with minimum force necessary, to prevent injury to the patient and others wherever possible.

6.4 It must be recognised that there will be occasions when an incident has the potential to result in media interest. In the event of a serious incident involving a restricted patient, arrangements for providing the media (including the radio and television companies) with information about the incident must be handled sensitively.

6.5 The Scottish Executive Press Office will co-ordinate all media liaison about incidents involving restricted patients. However, arrangements can be made for a Trust's Public Relations staff to be authorised to carry out this function in liaison with the Scottish Executive (see paragraph 6.17).

Who to notify in event of an incident

6.6 The hospital authorities must advise the police immediately of an escape, serious assault, abscond or other significant incident involving a restricted patient. Immediately thereafter, the hospital should make a telephone report to the SEHD as set out in the Notification of Incidents Circular issued by The Scottish Executive Health Department ( see Annex A1). The circular provides out of hours' telephone and pager numbers for SEHD officials which should be used to contact officials between the hours of 5pm and 8.30am and on weekends and on public holidays. Where, exceptionally, no contact can be made with an official, a message may be left with the Security Guards at the Scottish Executive, Victoria Quay (by dialling the main Scottish Executive phone number - 0131 556 8400). Security will relay the message to an official as soon as possible. should patient details be left as part of such a messageon no accountPlease note that .

6.7 The SEHD official will contact the Press Office (Health Desk during office hours, Duty Press Officer out of hours) who will, where appropriate, contact the Crown Office and a decision will then be made on what information, if any, should be given to the media. Where permission is required for the release of a photograph of the patient, SEHD officials will liaise with the Crown Office.

Escape

6.8 An escape will have taken place when a restricted patient breaches a physical barrier, for example, breaks out of a locked ward. In such cases, the police and the SEHD should be notified immediately.

6.9 When advised of an escape, the SEHD official will require the information set out in the checklist at Annex A2. If any of the following apply:

• the assessment is that the patient is "high risk"; or
• that the patient's recent conduct indicates that there may be some risk to the public,

the Press Office (as referred to in paragraph 6.7) will be contacted to arrange the issue of a short statement to the media. Unless the restricted patient is considered as "high risk", the statement will give the patient's name and age, the hospital concerned and a brief physical description. Other information may be included as appropriate. The media will not automatically be notified of the crime for which the restricted patient has been sentenced. Scottish Criminal Records Office are the holders of this information and it is a breach of the Data Protection Act to disclose this information. Crown Office will be consulted on any occasion when a photograph is to be used.

6.10 In the case of an untried prisoner on transfer to hospital who escapes, no details will be volunteered. However, if media enquiries are made, no details of any previous convictions will be given and particular care must be taken to ensure that no information is given out which might be argued to be prejudicial to any future proceedings. It is also unlikely that the escapee would be described as dangerous. This would only be done on the basis of advice from the Crown Office.

Abscond

6.11 An abscond will have taken place when a restricted patient is absent without authority from a ward, work placement, open supervision ( i.e. supervision which does not require the use of physical restraints nor continued oversight), or exceeds his or her authorised suspension of detention, or makes away from an escort. The police and the SEHD should be notified immediately.

6.12 When advised of an abscond, the SEHD official will establish the answers to the questions at paragraph 6.9 above. If they are all negative, no immediate press statement is necessary. Once 24 hours have elapsed and the patient has not returned, a short Press Release may be issued. The Press Office will be informed of the absconding to hold against any enquiries but will not volunteer information to the media in these cases. Where their recent conduct indicates that they may present some danger to the public, the procedure for an escape (at paragraphs 6.8 to 6.10) will be followed.

Transferred Prisoners

6.13 Prisoners do not become the responsibility of the Health Service until they are received into hospital, and a warrant/receipt handed over to those transferring the patient by the hospital managers after reception. Similarly they cease to be the lead responsibility of the Health Service while under escort from hospital to court or prison. Such escort will normally be provided by Reliance Prisoner Custody Officers, as part of Reliance Custody Services, who have responsibility for the prisoner while attending court. Good practice suggests that hospital staff should accompany the patient. Enquiries concerning any prisoner who absconds from escort going to or from hospital before or after trial, or from police custody or a police cell, should be referred to the police force in the area in which the incident has taken place.

The Police Role

6.14 Hospital authorities should note that, in addition to the statement put out by the Scottish Executive Press Office, it is always open to the police to issue to the media any supplementary material which may assist in the recapture of a patient who has absconded or escaped. Each case is considered on its own merits. The hospital authorities should co-operate in the supply of any material requested by police and advise the SEHD of the information provided: they in turn will advise the Press Office.

6.15 In cases where a press release has been issued by the police, it will be the responsibility of the police to inform the media in all instances where an escapee or absconder is recaptured. Press Office will be responsible for issuing a short statement in those cases when a press release has been issued on behalf of Scottish Ministers and the patient has been returned to hospital.

The Press Office Role

6.16 The Press Office will inform the SEHD, the local hospital authorities, the Crown Office and the appropriate police headquarters of the issue of the statement. At this point, the matter becomes the responsibility of the investigating police force to whom the Press Office will refer all enquiries relating to the abscond or escape.

The Role of Hospital Information Officers

6.17 NHS Board PR Officers, or private companies handling media enquiries for hospital authorities, should not deal directly with the media in any incident involving a restricted patient: all enquiries should be referred to the SEHD. The SEHD can, however, authorise arrangements for hospital staff to fulfil the media liaison role assigned to the Press Office in this guidance. The SEHD will provide written approval and guidance for such an arrangement, where necessary.

Reports to the Scottish Executive Health Department

6.18 Once the incident has been resolved, the RMO should make a formal report to the SEHD. Where the incident involved the patient being absent without permission, full details of what occurred while the patient was absent should be provided, including any misdemeanours or suspected misdemeanours.

Critical Incident Review

6.19 Following an incident involving a restricted patient, Scottish Ministers may seek a Critical Incident Review ( CIR). Alternatively, the NHS Board, hospital managers or lead clinician involved in the case, may consider it appropriate to initiate a CIR. In such circumstances, the RMO should advise SEHD officials of the likelihood of a CIR when submitting their report on the incident (see paragraph 6.18 above).

6.20 Critical incidents are defined in the Mental Health & Well Being Support Group - Risk Management Report [ NHSHDL (2000) 16], as follows:

(a) Death of a resident, in-patient or out-patient which is sudden or unexpected or where suicide is the most likely cause.

(b) Homicide allegedly committed by the in-patient or out-patient.

(c) "Incidents" including those which might have resulted in suicide or homicide, episodes where there is evidence of serious intent of self-harm, violence to others or which led to injury or disability.

(d) An event where an important policy, procedure, or practice was not followed by staff leading to a detriment or potential detriment of care - so called "near misses".

6.21 A CIR, as described in the Risk Management Report, is intended to be seen as part of the NHS Board's wider risk management processes to link all levels of the organisation - ward, clinical managers and Board managers - into a system which takes the opportunity to learn from incidents and enact any changes in practice necessary to forestall a similar incident in future. It should not be seen as a disciplinary process. Further guidance on procedures for CIRs can be found in Annex D of the Risk Management Report, circulated under cover of NHSHDL (2000) 16.

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