Elsie Tindle
8 Mar 2016 · Coroner Derek Winter · Sunderland
The coroner's concerns
1. inadequate SOAD provision
“I heard evidence that the present compliment of SOADs is approximately 105 and that in 2014/15 they carried out 14,373 visits. 25% of cases with a SOAD led to changes in a treatment plan and in 3% of cases the SOAD did not approve the plan. The SOAD safeguard in theory can prevent the inappropriate use of ECT.”
2. delayed SOAD attendance
“For ECT, SOADs attend within 5 days in 82% of cases but I am concerned that in 1:5 cases this does not happen.”
3. default use of s62 MHA
“Lam concerned that there is a danger of the use of s62 MHA becoming a default position and that the numbers of SOADs may be insufficient to deal with matters in a more timely way.”
4. lack of proactive follow-up
“each of the agencies had reviewed practices and procedures, particularly Northumberland Tyne and Wear NHS Foundation Trust, who were to set up a system for the treating Psychiatrist to chase the CQC in the absence of a timely appointment of a SOAD.”