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OK. Right. So what is it? And we probably talked a wee bit of what it is. It's a legal framework and it is there to um enable us to deprive a person of their liberty who lacks capacity. So uh it provides protection for the people that we're depriving of their liberty. So it looks very much at their human rights. And uh there's a number of checks and balances and safeguards that we have to ensure are in place to make sure that we're doing it lawfully and in their best interests. And I suppose as it is, it, that's, that's the human rights, but it uh and it also protects us as staff members from liability because until this came in to northern Ireland, we were working on legislation uh based in England who were working on the, on the guidance of that. Uh And so all though, we were doing all these things for the person's best interest to keep them safe, it was being done illegally. So this piece of legislation not only protects the person, it protects us as well. So when we know about it, we have to make sure that we're putting all the safeguards in place, uh, to make sure we're keeping both ourselves and our, uh, the people we work with safe. So, what is it not? It's not a power, it's just a series of safeguards as we go through this. You'll see, there's a number of safeguards that we need to ensure are all in place to make sure we're doing it lawfully. So, one is no more important than the other. It's not an imposition on staff. It is protection. And I suppose, I don't know whether some staff might not agree with that. Uh, but yes, it is a bit of additional, uh, work, but I suppose the fact is it's not going anywhere. It's here to stay. You know, we have, have a duty as a statutory requirement. Uh, and, you know, we, we have to do it and that, that's just at the end of it. So it, it's not a meaningless paperwork. It prevents harm to patients. So, it's about us making sure what, what we're doing is keeping the person safe. We're acting in the least restrictive way, uh, and in their best interests and as well as keeping us safe. So why do we need it? So, it's a legal precedent. It sets, it's set by a number of cases. Uh, there's a number of cases to talk about the Boer case and the Cheshire West case. When you come out to the training, you'll, you'll hear more about that and how they have helped to frame our legislation. The Boer case very briefly has brought in uh safeguards like um the person has the right to challenge the decision if we think they need to be deprived of delivery and they can do that through a review tribunal similar to the mental health order. But because they lack capacity, they don't always have the ability to do that for themselves. So what has also come from the bo case is that we identify what's known as a nominated person. And that would be somebody who's acting in a caring role, not a car, but it could be a family member, it could be a neighbor, it could be some relative if they, they're acting in a caring role for that person. And if the person can't do that for themselves, then the nominated person can uh can challenge the decision for them if they, if they want to do that along with other bits and pieces, they do so. And then we have a Cheshire West case and that looked about the Supreme Court's looked about where people are living and that we're not to make assumptions that just because somebody has a learning disability because they have a dementia that automatically living in a particular facility or environment is best for them. We have to make sure that they are, they get the same rights to um the Safeguards Capacity Act as, as you, right? So it's about that sort of thing. Yeah. So that came up with, like, the test about capacity. Yes. It's all like, just because they were disabled doesn't mean decision. We make the assumptions. Yeah. Yeah. So, as I did say, it protects us from, uh, criminal liability. So there's a number of professions and you'll be working with all of them on the wards as yourselves, as the nurses. There's ot s the speech and language, social work. all of these professions have a role in playing in, in the, the, the deprivation of liberty safeguards. So I think it's important that we all work together and support each other and, and share this and the, the staff will on the ground will be doing like the form ones and the twos and, and there's expectation that, you know, when you, you reach your suitably qualified status, but you will hopefully be taken on the form sixes, uh and then form elevens and things like that to admit people onto the wards. So, but it's a, a multidisciplinary decision and I suppose that's the key and keep it like that hospitals is like that anyway. So it's a finding your role within that, you know, and form is it that you need to be sort of looking at and, and I suppose it's like using your skills effectively. I mean, ii take it that, you know, some, uh somebody mentioned they've done a form one and that's fine. You can do the form one and the form six. But because you're maybe, um, short on the ground, it might be better to get either the social worker or the speech and language service or the ot to do the form ones and twos. And then that frees you up to do the form sixes. So you're not having to do all, all the form. So, it's about, it's about shared responsibility. Uh, yeah. So we've covered that. Mhm. So who does it apply to? It applies to anybody, any patient who likes capacity for any reason? And they're over the age of 16 and they live in Northern Ireland. But as Irene said, if the mental health order applies for now, we still apply it. It's our first go to but for all other cases, uh then we use the mental capacity. So as you'll see from, from this kind of it, so sample of of when people might lack capacity and when they can apply the mental capacity Act, it's broader than the mental health order allows. So there'll be things like dementia, stroke, brain injury, infection um and even alcohol and drugs. So while a person is under the influence of alcohol and drugs, when they're in the ward or coming in through the A&E department, you know, we we can deprive them of their liberty during those periods while they're still under the influence of alcohol, if we feel they lack capacity and it's in their best interests and preventing serious harm. So, whereas the um doesn't allow rest. Yes. Yes, those types of, of uh people that we're looking at. So it's broad ren these are just a few of the, of the, the reasons why we might want to deprive somebody of everybody. So in the hospital, uh there's, there's two formal authorizations that you can use. There's the short term detention and that is only happens in the hospital setting. So that would be relevant to the main. Yeah and stuff. Um So we kind of talk you through briefly, we probably covered some of this. So can the mental health order be used? And if it can't? Yes, that's the piece of legislation we go to. So is the situation an emergency. And when we say that if we, because there's a number of safeguards and processes and assessments we need to do to fulfill the short term detention criteria. Would it be, you have to ask yourself, would it be detrimental to that person or other people if we didn't deprive them of their liberty while we were doing all of this? So do we need to do it now? So is there an emergency here? We need to make a decision now and there's a process we can follow for that. So that's your second question, you have to ask yourself. So do they talk about pee as the person that we're deprived of liberty? So does pee lack capacity in relation to being having to remain in hospital where they're going to get care and treatment. Is it in their best interests? And they talk about the posh conditions? So as the prevention of serious harm? So, have we met those? And has there been a nominated person consulted with the nominated person? You will most likely be the person who um, he, he was there visiting, who's there, who's known as a carer, who's, he's making the phone calls. He would be the main person that the staff on the wards would be calling. So that is there, is there a nominated person? Because even though you're not doing the four months and twos as the medical practitioner, the nominated person, they wish to talk with you as well. So has a medical report been completed? That would be our form six, has a nominated person. Any objections to the deprivation of delivery? Generally speaking, I don't think that is very often, not very often. We've only had to do it once really in my time and that's four years. So nobody of the person could object to the deprivation of liberty. So we would then have to ask for a second opinion really? So when I'm the authorizer and he says off all that, when we go through the next few slides, we'll go through them probably. Um So it's a process, as I say, and once we go to authorize, if the nominated person doesn't agree, we have to get a second opinion from a, uh, an approved social worker. Yeah. Yeah. But it doesn't happen very often. Not very. So, uh, you can, if somebody's coming into hospital, I have never seen this done either. But maybe GP, with a copy of yours in it might be something that you'd be asked to maybe, uh, be involved in that somebody in their own home is very familiar with it and they don't meet the criteria for a deprivation delivery. But we would know in advance that if they're put into a different unfamiliar environment or situation that they may need to be deprived of because of maybe delirium or autism or something like that, that we know is going to be a trigger to them dementia or that it's a plan admission to hospital and, and we've not really been using it, but it can be the same process sort of applies. They can come in under emergency legislation or they come in, haven't done the assessment for short term. So it, it can be done in advance two days before the person comes into the hospital. But as I say, we don't know in, in the so has an admission report been completed. So it must be completed immediately on a mission. So that's when that happens. I'm imagining as we go through the form, I think we do in the next section don't. So that would be the admission form and then we have a further admission form that needs to be that the consultants would be accepting the person onto the ward and would explain that with the form which just there's two different. So when we have all of these uh ducks in a row, we have all the forms done. The, the short term detention can last for 14 days. And that gives us a legal right to detain that person or prevent them from leaving the hospital for a 14 day period. And then that can be reviewed and extended then for a further 14 days, if it's still needed, if they're still needing to be deprived of their liberty uh after the 214 day period. So at day 28 and they still need to deprive them of their liberty. We have to move to what's known as the trust panel authorization and that's a more long term authorization that just to say that the extension a after the 14 days is a purely medical one. So it's something you might come across consultant in particular. Um So it's a form 13 and that after the, you know, the first two weeks are done, the form 13, you're asked, then does this personal require another two weeks? That form 13 will give that person another two weeks on a short term detention? Just keep that in mind. So if the trust panel, would the doctors be very involved or they wouldn't be if someone was in hospital and then were planning their discharge. So it's the way I sort of explained it is if someone, perhaps even after the, the, the 28 days and they're in the hospital and they're not looking as if their delirium has settled and they're still lacking capacity. And you're thinking, well, we're going to have to look at placement for this person and that's a more complex decision and it may require another reassessment of their capacity and it might be looking at, are they safe to return home? Where do they, you know, where would they be placed in it? Do they understand the care arrangements that would be in a nursing home? And it's all that? So then that's a second process, but we can use the, if someone was under a short term, you can use the same medical form, but maybe update it. Um And if we haven't been in maybe prior to that and maybe they've just been become confused whilst they're in hospital, then we can go straight to try and plan on the trust panel. But and then the doctor will be asked for a medical form. So there's two different decisions, but the same process would apply. You would be reliant on the woman to, to inform your medical assessment, then one and two that would be done in relation to either of the, of the other. So again, just quickly, is it an emerging situation you're asking the same kind of questions do it at capacity. Uh Has the medical report been done? That's your form six. an application can be made to the trust panel then uh and once the trust panel get all of the forms together, they will have seven working days to make a decision of whether to uh run or authorize a uh a trust panel. So that's after the 28 days. So it, it, it would need to be in place whether they're part of the discharge plan apart from still remaining in the hospital, but they still lack capacity and need to be deprived. It can last for up to six months. Uh And then it's reviewed in six months if it's done. So it's quite hard for people to envisage that because you're looking from the hospital out if you know what I mean? So your forms will all go, someone will be making, putting all those forms in a pack taking that goes to a panel of people to authorize their detention in the nursing home or in their own home if necessary. So it's the same process as a short term detention, authorizer would do. Really? Yes, you're authorizing that detention and all those safeguards have been put in place to, to ensure that person. This is the least restrictive option available to this person. Um So that's just to give you that idea. So your forms are, are going somewhere eventually. Yeah. You know, so this is probably just reinforcing what we've talked about. So we talk about the acid test. So in the, um Lady Hale, who was the, um Supreme court judge who presided over the, uh one of the cases that we talked about. The, not the, the other one at the, um, Cheshire, Cheshire West, she had said that is the individual subject to continuous supervision and control. And are they free to leave? And that's the two questions that we ask ourselves if we're thinking, you know, do we need to have a deprivation of delivery? So if that person was saying they wanted to leave the ward, would they be free to go or would you be concerned that they don't have the capacity to understand the risks, they would be presenting themselves if they left? Uh, and is there a level of additional supervision and control that we're putting in place to make sure that person's safe? And that could be 1 to 1 where maybe the person's trying to get out of the bed and they had a number of falls or they're trying to, to walk independently, you know, that kind of stuff. And I think people who would have thought, um, or if they're trying to get out and they're breaking the door down to get out, those are the only ones we're looking at. It's not that really, it's, if they tried to leave, would you let them, you know, are they free to leave? So, under continuous supervision and control? Is not just a 1 to 1, you're under continuous super supervision control by giving that person their medicine, giving them personal care, giving them all that control. If they don't understand what it is you're doing, you know. So it's come back to the capacity. Do they understand all those care arrangements around them? Do they know that they're in hospital and they need to be here for care and treatment or do they not appreciate that? You know, so then you'd be looking at that, that person needs a doll as we call it and they need, they need a doll to be sort of put in place to protect them. Yeah, from home. Yeah. Make sure we know. Yeah. So as since it doesn't matter if the person can themselves as if they said they wanted to, would we let them, you know, if they were asking to people, why not? Yeah. And they do and whether the person is compliant or lacks an objection, uh We still have to consider it if we do. Do they meet the criteria? Is the place um relatively normal for that person? So, is it the least restrictive option? Is it the places and in the hospital setting, they need to be there to receive their treatment and uh what the reason or purpose of particular of the particular placement and then the hospital is to receive a medical care and care and treatment room, examination or whatever that might be so I'm just gonna stop here a minute, maybe, see, see how we confused you totally. Or uh, are you still all, are you with us? Are you with us? Are you still still awake? Even? We'll ask that question first. You're still awake. Yeah. All still awake. That's good. We've got one, we've got one still conscious. Is that clear enough for you to take you into that sort of understanding what the do when the doll is required, I suppose. Yeah. Yeah. Ok. Yeah, that's good. Keep going because the forms might be more informative for you. Yes. Yeah. And then I just wanna make sure that you're getting the, the, the message here. So we're the person. Uh So we've done all of that. So the safeguards we need to, to carry out. So we need to have a formal assessment of capacity. So who can complete that and that can be yourselves or anybody who has had training up to level four, you have to do your training up to level four, the department's training and two years post qualifying within the professional. So it would be F two and above for your Yeah, it's two years have work with somebody who lacks capacity and that's the only form that requires that. So the formal assessment of capacity has to be a person who is a two years and a professional capacity. Um So that's why some of the, the f ones can't really do it. So, but uh a doctor can do the form one, although they're doing a form six, which is a medical form as well. But we have had consultants in particular who like to do the one and the six because they may know the patient really well. Um And we have other doctors who have said no, I would prefer someone else does the one and I'll do the six, you know, my medical. But so, but one of the seven professionals, any of those people can do the formal. Really? Um So uh so you have to look about is it, is it in our best interest has a nominated person been consulted with? Uh and there's the prevention of serious harm condition and that's the sort of the draw criteria that we look to uh and the forms 126 and we will yes, ask these questions. So they'll be teased out. So you have to sort of try and remember them. They will direct you through, through that process. So your form form assessment capacity is your form one. If somebody comes and says, II need a form one done on that person, you know what that is for a short term or trust panel, that was something else that was. So that was just uh I thought there was another question that's fine. Uh OK, so that's the criteria we have. So this is really what we we've kind of covered, isn't it? Yeah. Yeah, kind of done about that. So, I mean, you, you can, you'll have this powerpoint anyway. Yeah, that's the illness. Now that for a short term retention in the hospital I, you need to have, it's one of the questions that number eight on your form. I know it that well. Um, the person has to have an illness or suspected illness and that illness doesn't have to be lifethreatening. It can be dementia, it can be delirium, but they have to have an illness to do a short term retention. Yeah, so that's why I suppose we need the medi the medical form is asked for. Yeah. Um and the prevention of serious harm is met and that the p like capacity in relation to that. So that, so you're doing that in their best interests and yeah, you know, but they have to have an illness. Mhm. I hear you. So what might you be required to do? As we said, you can do the form one? But I think because, you know, time pressure, you mean certainly there's no, there's no reason why you can't really like to. But what would be uh your particular as, as a medical person would be completing the form six, which is a medical report, you will be given a copy of the form one and the form two. So the form one is the form of a statement that the person lacks capacity and that will be done by one of the other professionals form two is looks at the person's been interest and that, that you know how the consultation with the nominated person and what would be best for that person uh considering, you know, their wishes and feelings and all of that. So you will have sight of those two forms uh to help you to to to do your medical report, the form six. But so you will be expected to see the person and uh you will then read the forms and then you will form your medical opinion on that. And I think when you see the forms, I don't, if you have done them already part why we're sort of as part of your form six, you are actually asked as a professional to do a capacity ases as well. So you're, you're really agreeing with form one and form two and within the form six, you'll see, have you had a conversation which you would have as a doctor, a conversation with your patients, but it's not just a conversation, it's have you assessed their capacity? And do you feel and are you in agreement with these forms that you know, have been completed that that person lacks capacity to understand that they're under continuous supervision and control and they're not free to leave and that they require the current treatment in the hospital and it's in their best interest to stay there until they get that current treatment. So that's really your a bit on the phone and that's, and each section of the form will sort of go through that with you and, yeah, tick boxes and that it takes you. Yeah. Yeah. So, I suppose that's, and that's why I think a lot of doctors don't like to maybe do the form one because they think they're already doing a wee bit of the capacity assessment in the form six. So I can't really agree with the themselves. So just agree with themselves. So it's good to have maybe a separate person doing the form one. And in the hospital at the moment, we, I have a pilot project and basically we're trying to run a process. We're trying to keep the form ones to be completed by ward staff like a nurse or a hospital, social worker, maybe if they've got to know them best and then that frees the doctor up to do their sort of more, you know, objective um assessment then and do their medical for six. and then to complicate things even further, we have, we have the form level. There's a nice form comes after that. So you've got your form on your form two and your form six. So all of those are are done and dusted. So then we have to admit the person onto the ward. So a form 11 and in fairness of form 11 is more just a there's no real. So I should have said after you do the 12 and the six, the doctor does, the six people think one should do a form and one that's it authorized. But that's the job of what we have as a short term detention. Authorizer and my team or the authorizer, terrible name. But anyway, the authorizer, we're an approved social worker similar to the mental health order. So we are simply saying that we agree and we are the safeguard to basically authorize that detention. So after we get the 12 and the six, we authorize that. And we also have another form to do for the review tribunal to say this person is capable of objecting to their job or not. But we then ask the consultant to do the form 11 and I would be sending my form eight which is the authorization of that detention and we send that to the consultant. So I'm sure maybe you've seen that coming out at times one of one or other of my team, send it out. Um So we would authorize and then we have to follow that with an admission form because even though we authorize, we have to have a doctor on that ward saying yes, I'm prepared to have this person on the ward and I, I'm treating them on the ward and they're being admitted for treatment. So that's really what the form 11 is, but it has to be a consultant level that does the form 11 and unfortunately, the Department of Health have brought in after CO when, during COVID, we were allowed to maybe use the two forms, uh, the same doctor for the two forms. But after COVID, we were informed quite clearly that they now have to be two different doctors. So that is why we're, you find we're asking, can you ask one of your junior doctors, maybe not an F one but, um, you know, someone who's at two years to do the form six and then a consultant confirms the admission on the form 11. Yeah, and that's a bit clear for you. Ok. So the form 11 and that's the admission onto the ward. They're obviously sitting on the ward at this time. But it's, it's a form form on the ward under a deprivation of delivery. And usually if we can, a consultant should be doing that. And as I said, a different person than who done the form. And these are all just the layers of safeguards that we have. And, and that's why I suppose it a safeguard because if I went authorizer and I, by the day sometimes it has happened, you know, we've got a 12 and a six in and the time by the time we get there, maybe that person's recovering from the delirium. And I say, well, actually, guys, I don't really feel I need to authorize this all because they've improved so much. And that's why the safeguards, that's why there's three different forms to fill in really? And it's a paper heavy process. It's a bit of a pain for everybody and it is, it's, it would be easier if there, it could be cut down a bit. But that is the reasoning behind it that there is always that safeguard, you know, because nobody needs to want to put somebody on a door under unless it's really necessary. You know, it's a big legal yeah, requirement for nothing, you know. Ok, so you can also do the form one, which is the formal assessment and you still need to have them that, that two years uh experience and, and completed the training, right? Uh This list may not be exhaustive at the minute. We won't, that's enough to tell you about what forms you might need to. So just to recap. So form six, which is uh the medical bit, then the form 11 which admits the person onto the board. And hopefully, usually that's by a consultant that has a different doctor that runs down the form six. If by any chance the form 11, we can't get a consultant on for whatever reason. Um to sign the form 11, then we will need to within 48 hours, which is, well, what happens is if I can't get a doctor or say the consultants on, on leave or something and I need to just sort of get them a have that admission, we can get another doctor to do the form 11. But within 48 hours, I have to get a consultant then to do the form the form 12. So that means the consultant would eventually do it within 48 hours. But at least we can keep them there for the recurring treatment for those 48 hours. And then I have to go and sort of try and get the consultant then to do the form 12. Um So it's just that sometimes it does happen but you have to do it, you know. Um So that's, that's the reason behind it. I suppose it would be easier if it, if the consultant was available to do the PM 11 and most of the time they are, yeah, it doesn't happen very often. Ok. So then as we said, if the person after the 1st 14 days is still feeling that we still need to deprive them of delivery, they still lacking capacity, then the uh consultant will then uh complete the form 13 to extend it for a further 13. And what happens is when we get the short term return in place, we will inform everyone and they're given that information. And then after the 14 days, we our admin team will actually email the consultant who's under their care or the patient under their care and ask them, do they want to extend that short term detention? And do they want to fill in the form of 13 So that's left with that decision is left with the consultant and the team then as to whether that's necessary. Yeah. So and, and we do that quite often as well. Mm So then when we're looking at somebody who's got the after the the 214 days, the 28 days, if they still need to be required to remain in hospital and they still need to be deprived of delivery, then a new form six will need to be done to form part of the trust panel process, which will be the longer term thing. And again, as we said, if somebody's being discharged into the community, uh the doctor on the ward may be asked to fill in a form six in relation to that discharge plan for the trust panel authorization when they've gone and they're moved out into the community set again. So there could be two routes. Yeah, without additional point. And I think it's just important to say we are not a capacity team and we're not running in and doing the capacity that a lot of people get mixed up. We have buddies in our team because my, our role really is the authorizing of that detention and I can't do a form one and do my form to authorize it. So it's really important that I get someone else to do the form one to make it objective. So part of our work now is trying to get buddies on the ward to give people a wee bit of help to do the form one because people were saying they, they did the training, but they might not have the confidence to actually put that training into practice. So we have buddies and we have guidance and we have an email and the people constantly email us and look for a bit of support. So we will send up our bodies to sort of sit with someone and help them do the capacity assessment or help them put it together or frame the words to do the form one. But we tend we're not sort of helicoptering in to do the capacity assessment as a team of experts because really, it's a reasonable belief. We're not talking about a diagnostic psychogeriatrician assessment. It's a reasonable belief that this person lacks capacity and it's for a very short period of time for the current treatment in the main, for the short term. And then we will get that bit about discharge planning and, and if someone needs to look at that and see, ok, you know, this person might still need a doll. Um and how are we going to pursue that? But we're, we sort of assist a lot of the time and go along with people and give them a hand. But in the short term detention process, it's because the authors authorizer can't actually authorize their own work. Yes. So that's really, it's just one of those things in the process. Yeah, it's very important. I'm just thinking, is there a BD for doctors? I just, I know that we have, uh, other professions and they will b along and body doctors, ot s whoever. But do we have, we don't have any specific doctors? No, but we have, I have b, doctors and doctors have come to me and said, I, I'm, you know, new to this, I've just been qualified and can you come up and we've sat with them so the buddies can do both, you know? But it would, it would be great if we had a doctor that was really good and maybe help your own profession. Do you know what I mean? And be helpful? That would be a great idea if we could get that. Um, we'll take names, somebody was interested, you know, just to buddy up with the doctors. But I know a lot of times we send out maybe exemplars, which we will today as well, um, of really sort of clear, sort of and it's not a war and peace. It does not have to be 1000 pages long. It has to be very succinct and to the point, you know, uncover those areas. Um, we've sort of a couple of exemplars for doctors who have been doing it a wee while and have gathered that sort of ability to write it in a very succinct way and they're really good, you know, for the short term and maybe that wee bit more complex bit about not appreciating, weighing up risks for going home and that sort of thing. So, um, but we use exemplars really and people have come along, but the bodies that I have certainly would go along with a doctor and we've actually had O TSB in us as well and, and speech and language therapists and stuff like that and we worked with speech and Irish therapists just to because of those communication difficulties sometimes as you know. Um So, so if that's something you think would be useful um in touch with Irene and she can help that. Absolutely. And, and talk to your colleagues if anybody's got a bit more experience, you know, just each other as you with any, I mean, there is loads of support out there. Um And I say we have an email that most people here, why people will find us the email, but it's an S TDA email, short term detention. And that is our focus usually, but we do and we have working with the hospital, social workers and, and the other distances in terms of trying to see, do the trust panel applications as well because we're very aware there's two different for, you know, it seems like a lot of forms for, you know, two different processes. So we're trying to streamline that at the moment. Um A wee bit and I suppose the reason the thinking behind that is short term is very short term. It's a short term decision to ask a person to, you know, to, to see if they've got the capacity to make that. Whereas the discharge, if you're, somebody's come in from their own home and we're feeling they need to go to a nursing home. They don't have the concerned about their capacity. That's a bigger, a lot bigger, more complex decision for the person to make. And that's why there's a different process and it's not like maybe you, you, you can't do it or they can't do it, but it might need a wee bit of maybe a multi working together to sort of help that person get to make that decision, you know, and the MDT, you are very much involved anyway. So it's still, we've kept it very much an MDT decision, you know. So hopefully that makes sense. So, uh what do you need to do for the form six? Just basically what we haven't covered. It's completed by the doctor who's seen the person uh within the last 48 hours. You have to have seen them in relation to the uh to the, to the, the illness, illness. And I've spoken to them about process and, you know, making your call, whether you agree with what's on the form one and two and, and you're happy that yes, they do that capacity in relation to this decision. You must be two years post qualified and have completed the MC training that was 23 and four. As I said, you can do them online. Uh and lots of people do that and they feel ok. Uh I would sort of always recommend that if you're not very familiar with it and you haven't done it before. Level two is only online, we don't have the capacity to do it. But if you can come out to the face to face sessions for the three and four cos it really does allow for that additional learning, the questions, you know, learning from other professions and stuff like that. So it's a lot, it's more richer experience for you as a, as a, as a practitioner. But again, I mean, there's no obligation for you to do that as long as you've done it and you do it with every, every 30. Exactly. Yeah. And that's part of why we brought in the body in really because people felt, you know, they wanted that experience and that those conversations is that, oh, what's this look like? Oh, I'm not sure about that, you know, so it would be good to do that. So as I said, you get the information that's on the form, on, on the form too. And you're saying whether your and your examination of the person, whether you think you, you agree with that or not is required for the short term detention. And also for the 16 is, is relevant to both as we said there, there are different decisions depending on what the what the, so the form 11 then that's to be completed by uh on the same day that the short term authorize the likes of Irene does her forming, she will review the form one, form two and the form six. And then I also go back up and do as, as well and do my assessment to make sure that they are, that I feel they lack capacity and, and that's a bit about, you know, and I will then send for the form 11 and because they have to be done on the same day, um There's a wee bit of leeway because I have 48 hours to write my report. So that gives us that time because initially, it was basically trying to, trying to get the two of us to do the same day was very difficult. So normally we send for the 11 and whatever date the level was back is the day we put all together, you know, so I've got 48 hours to play with so to speak, you know, so, and, and as we said, uh it covers it for the 1st 48 hours if it's not and dance with the formula, um They completed the consultant that they're covered for the 14 days and if it is the consultant that's done it, uh they must have seen them within the last 48 hours as well as well, you do that. Uh and you must have completed your levels 23 and four training. Uh So and again, as we said, if the form 11 isn't completed by the consultant, it's completed by another doctor, then the 13 or the 12 will be required. And as we said, you can't do the form six and form 11 because you can't mark your own homework. Basically, it's just another layer of, of protection for everybody. So and that's the 412 that and you still need to do the same uh the word for that. And 13, we've talked about that as well, so we can extend it then. So you must have seen them within 48 hours and also do your training and that can extend it the next then post that as we said, just refresh and it form six can be play again and it would be trust pan author and that could be either for the person to stay on the or be dis on the of into the community somewhere. Yeah. Um I mean, just to be mindful that there, it is a greater when you're, when somebody to make a decision about moving into somewhere that they're maybe not familiar with, they've never been before or whatever. So, you know, it, it, it is a bit more, a bit more detail is, is, is, is involved in that kind of bigger, bigger decision. I'm not sure what you need today. Uh Yeah, and we've covered that. Yeah. Uh does this cover any emergency decision, emergency process and I on my checklist? Ok. So you may have somebody coming in through a and a coming up onto the ward where you're thinking, you know, it's gonna take a couple of days maybe for me to have to get somebody to do a form one to do that capacity assessment, somebody to do a best interest form for me to get the form six. But this person is trying to get out of the bed. They're very confused. They've got an acute delirium. You know, we really need to deprive them of their liberty now. So how do we do that and keep ourselves protected within the law as well? So we can use what's known as the emergency provisions and I brought on the checklist. Now you can write them that person's notes. Um I place the name of them under emergency provisions and that was always the case and you can still do that even if you can't get sight of this form. But we brought on the form last December and it's a checklist basically to say we feel this person is under continuous supervision, make the as the test and there are a serious risk of harm if we were to let them leave the hospital and you tick all the boxes basically and we will start the forms one and two as soon as possible after we've done it. So that form is completed and put in persons five and then sent to us as well, just really to give us a bit of a heads up that that person's there and we can keep an eye on them and monitor how that's going to follow that up. Yeah. And that's purely that reason for that. Yeah. So as I said, it gives us the uh legal right to deprive the person of delivery before we have all the other safeguards in place. And as I said, you can either use the tick box checklist or you can write it in the person's notes. So uh yeah, that's really what, so you must have reasonable beliefs about capacity. You don't need to have done a formal assessment, but you just need to be, there's something there in their behavior the way they present what they're saying, that gives us a reasonable belief. They don't understand that they need to stay in hospital for their current treatment. Uh So, and for them to stay, there is gonna be in their best interest and if we didn't stop them from going now, then there would be a risk of serious harm. And I'll just give you an example. We really, I was talking to uh Ed yesterday in Craig, a who has had a serious car accident. She is there has been, she obviously has um very disturbed and very um confused and was looking to go home and wanted to go home, history of alcohol intake as well. But they, they felt that she needed further assessment for treatment and it wasn't safe for her to go home, but she was really making buttons to get out. So we put her under, she and we got the staff in the ward to complete the form, send it to us and that would then protect so they could deprive her, her liberty. Keep her in the hospital, keep her on the 1 to 1 sort of thing in her case because she was very, very disturbed and um and that meant that staff were safe, putting a hand on her to stop her leaving and that meant they were safe. So we've done that and then we follow that through to see, you know, doesn't need to go to a short term. Yeah. And uh we'll follow that through. Ok. Has anybody seen the emergency checklist that you know of our um would it be something that you, that you've been aware of? We, we'll send you a copy of that. Yes. Anyway, just in case um you and every ward has should have access to it. Yes. Uh um so and, and if you don't then just email us and we will have them. Yeah, we send them. Yeah. Um So I'm just thinking for the, the GP as well that this is, I know we, we don't have the conveyance and thing agreed yet and we are working hard to try and get some agreement there. But uh if you're thinking that somebody needs to go into hospital and the lack capacity, you can use the emergency checklist to, to get them there as well. Yeah. So um you know, you'll get a copy of that and we are doing some, some uh training with the out of hours GP services in the next couple of weeks. So I'm not sure if you want to share with your colleagues if that's something that, that they would like to. So because that's something you can use. Uh But if the person is really refusing, then we're kind of back to that sort of how you get them in, I suppose. And it's a bit like everything else long before MCA ever came about. It's about persuasion and using your skills and trying to that person. We've had this even discharging people who don't want to go wherever they're going or for that moment in time, they're very confused and we've had to get family to come up to the ward, go with them, coerce them, you know, in that way, persuade them to go. But that's a reasonable, that's a reasonable way of doing it because you feel that it's in their best interest to go and they don't, you're not driving, nobody wants to drive anybody kicking and squealing, especially, you know, an older person, you know, um, and vulnerable. So you try your best to use other ways but, and that's, I know there's no conven in place. We just try to try to work with it and in most cases, you know, we manage. Yeah. It's a very unusual cases that don't, maybe the person is just very disturbed or very traumatized and they just do not want to go. Um, but we have actually used emergency professionals previously. Someone has come to the hospital with that previously. Yeah. Um, so we pass that that can be applied at any time. Yeah. Uh if, if something, if the person starts to present uh the other thing that you can use just to, to uh get somebody to a place of safety is warrants that we can use. There's warrants that you can go to a magistrate and get a warrant to, to, to get some in and that's something that, that you can use. So as well just, and those who have just recently been enacted so that we haven't really used them as such. So maybe we haven. So that's another another way we can get the person 2 to 2 places. Um Yeah, but as I say, the protocols are being looked up, they just aren't a convention, protocols aren't in place. And sometimes the PS and I are just a wee bit afraid to deal with NC at the minute because they're not just clear about it, you know, and the difference between MH O and it, but um they are coming along they're coming along. Yeah, I'll see the emergency patient. So I just share the check list with you. You may already be familiar with it anyway. So just going over, that's just the flow chart about an emergency if you've had time to get all the safeguards in place and it hasn't been an emergency. Uh, I don't know of any cases that we would be considering that you wouldn't be starting off with the emergency provisions because you wouldn't be identifying somebody as needing a dog and then saying, well, you can go on home and I'll come back in three days and I've got all the forms done. Generally speaking, we are starting off at the emergency division place. So you just don't delay if, if delaying to get all the other safeguards is gonna put them up for the risk and then we just go with the emergency patients. I'm not sure what we spoke about. So just we enforcing that again or, ok, so further information. So we're sort of coming to the end of our talking. But now, and we're hoping that you have a few questions, maybe or a few uh queries, queries or, you know, I have a confusion entirely. So there are a number of uh guides and uh supports there. If you go into the MCA sharepoint tile on the Trust internet, we have a page tiger um resource that has all the latest up to date information in relation to training what forms you need uh where you can access support. Uh All of that is on the page Tiger. So it's a really good resource. So please um you know, do that. Um Irene's team will be here to support within the hospitals in the community. We have the MCA team as well uh and they run the duty system and, and we have recently new staff, all staff. So it should be a short term detention authorizer in Daisy Hill. And there's a short two, short term detention authorizer, 1.5, really one more part time in Craigavon and we cover Lurgan and South as well. So, you know, this is the thing. Um we're sort of stretched but that's why we're limited and we have three buddies who come in one twice a week and the other one day a week each to sort of buddy up the staff to go along with them and let them shadow them and help them with the forms. So that's the way we're running it at the moment. Um um And, and that's it. Any, any authorizations in Craig Mark mcnulty is the main there and Tiller is just new and son is here and I would have been here in prior to that. Um So, um and we're sort of around and we're accessible. Yeah, you know, even if you're not here, you email on a phone contact and we've got our email, our own CD. So Yeah, we easily got a hold of. So all of that information will be on the page Tiger if, if you want to access it. Um So um is there anything that we can help you with? Over and above having told you all of this information? Yes, thank you very much. That's very helpful. We we we enjoy the Mental Capacity Act and I know we might need to be have an assessment on our, but we do enjoy it. But we have the, I suppose the only thing is it's all we do. So we don't have everything that you have to do as well on top of that. And I find it's really a new piece of legislation. It's very um groundbreaking for, for northern Ireland or groundbreaking for, for a change for, for the right reasons because in England, Scotland Wales, they're still going to have the two pieces of legislation running alongside each other and the difference in England particularly. And if anybody's worked there, they have specific mental capacity teams who do all of this and a lot of staff here would think would not be brilliant happy days, but we're the per the people that know the person better. So this is deemed as a better service that, you know, the people who know the person who are seeing them on a day to day basis and are the ones making the decisions and not, not somebody that knew who and that it's in the ethics of the legislation really. But I think England is actually looking to move away from that. They've started off doing that. But we're saying maybe it's better the person that knows them best does it well, and somebody coming in from, you know, somewhere else today that doesn't mean to say you can't do it because any of the ones that I have done, I haven't known the person in advance, but I suppose, is that clear?