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High quality care for all, now and for future generations

Dear Dr Pal,

Re: Ms Maureen Fernandes, Learning Disability Patient on Ward 18
Leicester Royal Infirmary

Thank you for copying me in to your email correspondence to the Care Minister,
Norman Lamb, dated 3 May 2014. From the information you have provided there
appears to be a number of factors which are influencing this case and that are
worthy of more detailed scrutiny.

I am sorry that it has taken me some time to get back to you, but I wanted to
seek further expert input before responding.

We have reviewed the issues you raised and examined the online content that
you have drawn our attention to discussing this case. I have included some
information below that I hope will provide you with further clarity along with some
practical next steps.

Based on your report there are many challenges surrounding the care and
assessment for Ms Fernandes, not least:
her recent family bereavement
ongoing issues concerning her usual place of residence
complications arising from Ms Fernandes learning disability

Running throughout these challenges is the central question about whether and
to what extent Ms Fernades has the capacity to make decisions about her own

On this point it is important to note that Ms Fernandes is entitled to due process
under the Mental Capacity Act (2005). This assessment should consider and
reflect Ms Fernandes understanding of where she wishes to reside and
her understanding of leaving home to live in a care home.

From the information contained within the links concerning Ms Fernandes case, I
note some content alludes to her having capacity and other parts suggests that
she does not. Clearly it would be advisable for those lead agencies involved in
her care and welfare to determine the current position in this regard as a first

Dr Rita Pal
Independent Medical Journalist

(via e-mail)
Patient Safety Domain
NHS England
Skipton House
80 London Road

13 June 2014
High quality care for all, now and for future generations

In the event that Ms Fernandes is deemed not to have capacity then I would
advise a multi-stakeholder best interest forum is convened as soon as
possible. By holding such a forum this would be in line with current best practice
and should enable a definitive position to agree in relations this lady's best

Given what is presented regarding the recent death of Ms Fernandes mother, in
addition to this ladys recent trauma concerning where she should reside and her
ongoing physical health issues, it would be strongly advisable to initiate some
specialist bereavement support for her to run concurrent to any considerations
being made about her future home, as all too often people with learning
disabilities are excluded from support for grieving.

Whilst national policy should be reflected, we would always discourage making
changes to peoples care without including them and their families in the planning
process unless this were shown to be absolutely necessary for the safety of the

In this event, if Ms Fernandes has capacity and wishes to stay at home and her
family are keen to see remains at home then some form of person centred
planning should be carried out. It may be beneficial for Ms Fernandes to be
supported via an independent advocate which would afford Ms Fernandes a
voice and help all parties concerned think about and plan for both the short term
and longer term issues.

Whilst it is reported in some of the web commentary that it is 'more expensive' to
keep people at home, this is not always the case. The person centred planning
process can serve as a useful platform to think about and plan both the design
and costings for a person package of care.

In relation to both the hospital issue and those issues being raised concerning
her future home, this may be better managed as two separate entities with
distinct considerations being made in relation to each of these.

For all of the above, both local and national policy/protocol should be used
to facilitate a suitable resolve. I trust this addresses some of the concerns you
have raised and serves a signposting function for local services to work in
partnership with Ms Fernandes and her family.

Please accept my best wishes

Dr Mike Durkin
National Director of Patient Safety

Norman Lamb MP
Minister of State for Care Services