An issue with ReSPECT which I will be pointing out to the Public Guardian
NOTE: second attempt to post this - seemed to 'freeze up' when I just tried to post it.
I'll be sending the PDF to Alan Eccles, the Public Guardian for the Mental Capacity Act, later today: no need to go into details, you can read the PDF. But in brief - any recommendations on a ReSPECT form which are made on 'best-interests grounds' should not be 'signed off' by the senior clinician.
The form does that - only has clinical signatures on it - which seems to me to indicate that those learned clinicians who developed ReSPECT, do not accept that the MCA has moved 'decision-making' to patients, people chosen by patients, and other lay people involved in caring for mentally-incapable patients, and that 'clinical paternalism is supposed to be dead now'.
Associated files and links:
A concern about ReSPECT for the Public Guardian
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A very comprehensive analysis of the issues, thank you for continuing to take the time to address these issues. I too have some concerns about the potential power transfer in the ReSPECT process. It was difficult enough when we had hospitals putting DNARs in place without reference to anyone, but tis seems to move the whole thing to another level. Keep up the great work.
Hi Liz, I asked in my e-mail for confirmation of receipt from the OPG/Alan Eccles. So far, not even confirmation of receipt, let alone any comment on the issue I'm trying to raise.
You are right, I think, about 'It was difficult enough when we had hospitals putting DNARs in place without reference to anyone, but this seems to move the whole thing to another level'.
ReSPECT 'has an attitude' which seems to be 'in denial' about the transfer of decision-making away from clinicians, towards the patient and other involved lay persons.
The Office of the Public Guardian has now replied to an e-mail I sent yesterday, asking if I would get confirmation of my original e-mail. The OPG seems to think that clinicians writing guidance which is clearly 'in contradiction of' the Mental Capacity Act is not its concern - the OPG has pointed me at the Department of Health. This 'passing the buck' can go on forever, in my own experience.
The e-mail from the OPG:
Dear Mr Stone
Thank you for your email below.
I am sorry for the delay in response. We have referred your concern to our Policy team and they have advised that this is not a matter for the Public Guardian to deal with. It may be advisable to take the matter up with the Department of Health who are better placed to deal with issues concerning treatment decision at end of life.
I hope this information is helpful.
Further explanatory e-mail from the OPG (this didn't come as a surprise to me - it was a contact who suggested that I try the OPG re my issues with ReSPECT, and I never had any expectation of success anyway):
The Public Guardian does not have authority over how organisations carry out their duties and whether these are compliant with the Mental Capacity Act (MCA). The Public Guardian is not a 'custodian' of the MCA; he cannot become involved in how an organisation carries out its duties and whether these are in line with the MCA, or any other legislation.
The Public Guardian has jurisdiction over attorneys and deputies who act on behalf of people who lack mental capacity. If concerns are raised about an individual who is acting as an attorney or a deputy then the Public Guardian can investigate those concerns.
I hope this information clarifies the OPGs role.
I have sent my issue/concern/complaint re ReSPECT to the Department of Health, and an e-mail to me has confirmed receipt - if and when the DH gets back to me with a proper response, I will update here:
Thank you for contacting the Department of Health. Please note that queries are only monitored between 9am and 5pm Monday to Friday. This is an acknowledgement - please do not reply to this email.
If you require medical treatment please dial 111, visit NHS Choices, or contact your GP surgery. For emergencies please dial 999. The Department cannot provide clinical advice.
Where a reply is appropriate, we aim to respond within 18 working days, or 20 working days if your query is a Freedom of Information request or complaint.
If you have contacted the Department of Health about a current health or social care campaign, please visit the Gov.uk where a response may have been published. You may also find it helpful to refer to the Department of Health's what we do section.
Please note that the Department of Health does not handle complaints about the NHS or social services. If you wish to make a complaint about a healthcare professional, an NHS organisation or a social care provider, please visit the complaints procedure page on Gov.uk.
You can find out more about the Department’s commitments from our Personal Information Charter.
A copy of your query can be found below:
Dear Sir or Madam,
I raised an issue with the OPG/Alan Eccles, and I was pointed at the DH.
I attach the PDF which explains my issue, as sent to the OPG and Alan Eccles.
I also attach a PDF copy of an e-mail [which contains the e-mail from the OPG pointing me at the DH] which I sent to Jackie Doyle-Price on 26th September.
Will the appropriate person at the DH please read both of the PDFs, and then get back to me with a response about my concern(s), and please respond to me by e-mail and not by phone,
Regards, Mike Stone