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Comment : The Mental Health Review Tribunal – a Time for Change

(January 2007)

On 3 April 2006 the Mental Health Review Tribunals for England moved from the Department of Health (DH) to the Department for Constitutional Affairs (DCA) to become part of the newly formed Tribunals Service. This was a significant milestone that marked the end of a year in which the Secretariat had also undergone a substantial physical move to consolidate its offices into one site in central London. It also heralded the beginning of a period of change for the Tribunal as part of its new parent department.

In this profile of the MHRT, Jack Fargher, Head of the MHRT Secretariat, talks about the changes taking place within the MHRT and the challenges it faces.

The MHRT for England brought with it a number of existing plans for change. This included a pilot of Judicial Case Management and a commitment to replace the current IT database. The move to DCA also offered opportunities to re-examine the MHRT's administration and systems to identify further areas for improvement and to draw on DCA resources and experience in providing administrative support in other tribunal jurisdictions. These initiatives and projects have been drawn together to form the MHRT Modernisation Programme.

The MHRT Modernisation Programme includes three formal projects and a number of other change initiatives:

  1. The Judicial Case Management Pilot in the South London and Maudsley Mental Health Trust
    • This pilot finished on 29 September 2006. The full evaluation report, commissioned by the Department of Health, is due to be released by the King's Fund and Sainsbury Centre for Mental Health by the end of January 2007. The MHRT are hopeful that it will provide evidence to support a business case to extend judicial case management across the jurisdiction. During the pilot period the tribunal presidents also worked with the MHRT and the Trust to develop initial draft accommodation guidelines for tribunal venues.
  2. The IT database replacement project
    • This project is still in its early stages. It will be formally project managed by an experienced manager from the DCA eDelivery Group, which is currently seeking to procure a new system, which will both reduce development time and associated costs.
  3. The MHRT Business Improvements Project
    • This project includes three initiatives: the electronic movement of documents; prospective booking of panel members; and a review of the current arrangements for providing Tribunal Assistants.

There has been significant progress in the first of these initiatives. We have agreed to put in place two connected, secure email systems, to which the professional parties to MHRT proceedings will be able to subscribe. We expect to publish full details of when this will be implemented on the MHRT website very soon, along with a rollout schedule and implementation plan. This will also include an initial draft of a protocol for exchanging patient information with the MHRT Secretariat via secure email, which is being developed in partnership with the Department of Health, NHS and the Home Office Mental Health Unit.

Administrative Case Management

Administrative case management will provide a single point of contact and accountability for a case throughout its lifespan. Caseworkers will also be able to build more consistent customer relationships with regular users and gain better local knowledge of their own customer base.

In addition to responding to requests from our stakeholders to introduce administrative case management, this also provides the clearer responsibility and accountability, the need for which was highlighted in the 2005 Stakeholder Survey results. Administrative case management will enable our staff to engage with Mental Health Act Administrators (MHAAs) on a one-to-one basis. Establishing these strong working relationships is fundamental to ongoing improvement and streamlining of the end-to-end administrative process.

During the reviews of the administrative case management implementation stakeholders made it clear that, although the move to case management was very much welcomed, they would prefer caseworkers to be organised on a geographical basis. This will also allow the MHRT Secretariat to work more effectively with its key customers and increase opportunities to strengthen relationships with MHAAs at Trust level.

Improving the Secretariat's telephone call-handling

We have taken the first steps towards improving our telephone call handling by investing in a new telephone system that will also enable us to gather management information, and through which we can analyse call patterns and volumes with a view to designing improvements for the future.

Implementing the MHRT Modernisation Programme is not the only challenge for the MHRT England. The DCA and MHRT are working closely with the Department of Health to understand the implications for the tribunal of the government's proposed legislation and to prepare for its implementation in April 2008. Integration into the Tribunals Service was not an instantaneous process and a proportion of the work could not commence until after the transfer had taken place. Although significant progress has already been made, further work will continue over the next year.

Within this business year, as part of our ongoing commitment to improving our stakeholder engagement and customer service, we are also:

  • Undertaking a follow up stakeholder survey
  • Holding workshops for the Secretariat with Mental Health Act Administrators
  • Holding an open day at the Secretariat Office

The decision making body for the MHRT Modernisation Programme is the MHRT Steering Group. The Group is chaired by Guy Tompkins (Director of DCA's Tribunals Development Group) and includes Jack Fargher (Head of the MHRT Secretariat) along with representatives from the Department of Health and observers from the Council on Tribunals. Judicial interests are represented on the Group by His Honour Judge Phillip Sycamore.

Questions & Answers with Jack Fargher

1. What are the key aims of the MHRT Modernisation Programme?

  • To improve the level of service the MHRT England offers its customers and the way it interacts with other organisations
  • To streamline our processes and improve the quality of our work and management information
  • To source and implement IT solutions that properly support the efficient administration of the tribunal
  • To reduce the number of hearings adjourned or cancelled at short notice, particularly as a result of administrative failings
  • To help prepare the tribunal for changes that will result from the government's proposed legislation to amend the 1983 Mental Health Act

2. How will the investment in the MHRT Modernisation Programme result in an improved service for users of the MHRT?

  • Administrative case management will provide a single point of contact and accountability for our service users for a case throughout its lifespan. Our caseworkers will also be able to build consistent customer relationships with regular users and gain local knowledge of their own customer base.
  • Providing our staff with a quality IT database will enable them to give fast, accurate responses to customer queries without the need to check back to the hardcopy files
  • The new IT database will also provide improved management information that will enable the Secretariat to manage its resources more accurately and with greater flexibility. We will be able to identify and focus on areas for improvement more quickly.
  • Implementing a secure email solution for the MHRT and its professional parties will allow instantaneous exchange of case papers, reducing the number of hearings where reports have not been provided to the panel members and the parties in good time.
  • What makes the MHRT one of the most challenging tribunal jurisdictions? The MHRT is the only tribunal that deals with issues of the liberty of an individual and a requirement under Human Rights legislation to do so "speedily". Because of this it is subject to very tight listing targets but also requires the submission of in-depth, and so lengthy, reports, assessments and statements within those short timescales. It is also the only jurisdiction where the three-person panel exclusively travels to the individual in accommodation outside the control of the tribunal. To achieve the desired result, of a quality and speedy MHRT hearing, requires the co-ordination and resolution of multiple logistic issues in every instance.

4. How will the MHRT remain 'patient-focused'?

  • It is set in Human Rights legislation that patients are entitled to a speedy hearing and this has been, and will continue to be, the main business driver of the MHRT Secretariat. The MHRT also recognises that the provision of a speedy hearing should be paired with high quality administration to ensure the tribunal process is both as quick and as smooth as possible. The focus of the MHRT Modernisation Programme is on improving the quality of our administration and our service to tribunal users, always with an aim to providing hearings as soon as possible.

5. How important is administrative case management?

  • In addition to responding to the direct requests from our stakeholders to introduce administrative case management, it also provides the clear responsibility and accountability that they requested in responses to the 2005 Stakeholder Survey. Administrative case management will enable our staff to engage with MHAAs on a one-to-one basis. Establishing these strong working relationships is fundamental to ongoing improvement and streamlining of the end to end administrative process.

6. How important is giving caseworkers geographical responsibility?

  • During the scheduled reviews of the administrative case management implementation our stakeholders made it clear that, although the move to case management was very much welcomed, they would prefer for case-workers to be organised with geographical responsibilities. It also allows the MHRT Secretariat to parallel its main customer and increases the opportunities to strengthen relationships with Mental Health Act Administrators at a Trust level.

7. One of the initial aims of the Modernisation Programme was to work towards 'improving information flows' and this included 'investigating the possibility of alternative methods of submission of decisions by Presidents to the Secretariat'. What are some of these proposed methods and are they based on anything that works well in other systems?

  • The Tribunals Service has successfully negotiated a solution for exchanging information electronically, based on extending and co-ordinating two connected secure email systems, namely NHSmail and CJSM. NHSmail is currently used for this purpose within the NHS by over 100,000 active users and there is an ongoing body of work to migrate the remaining NHS users over the next few years. CJSM has been working successfully in the Criminal Justice System for over 3 years. Both have secure, accredited connections to each other and to the Government Secure Intranet (GSI). We hope to be able to include the transfer of decisions in this solution; however, we are still in the process of examining and drafting a full protocol detailing exactly which documents and information can be exchanged this way, including looking at requirements for original signatures. In any event the Tribunals Service will continue to look for ways to make the submission of decisions an easier process.

8. What was the outcome of the pilot of judicial case management?

  • Although the pilot finished on 29 September 2006, there were naturally a proportion of cases involved in the pilot that did not conclude until some time later. The full evaluation needs to include the impact on these cases. It is currently scheduled for publication at the end of January 2007.

9. What has prompted you to undertake a review of your tribunal assistant/clerking arrangements?

  • The results of the 2005 stakeholder survey stated that only 17% of tribunal panel members were satisfied with tribunal administrative support in regard to tribunal hearings. This demonstrates an unacceptable shortfall in service. However, the formal review of the current model is only one of the ways we are tackling this issue. We have already taken steps to improve the way we manage the current contract and will continue to do so pending the recommendations of the review. We are also including a discussion and feedback session on TA "role and responsibilities" in each of our workshops with MHAA's to help identify improvements we can make within the current arrangements.

10. What are the main ways the MHRT can improve its administrative relationship with hospitals?

  • Administrative case management will allow our staff to build one-to-one customer relationships with MHAA's.
  • Secure email will provide instantaneous exchange of documents and information with a clear audit trail, relieving significant pressure on the administrative process for our staff and MHAA's
  • The workshops between secretariat staff and MHAA's will provide invaluable opportunities to communicate openly and honestly with each other and develop joint approaches to solving administrative issues and improving processes.

11. What are the key challenges for integrating the MHRT within the Tribunals Service?

  • The transition of the MHRT from the Department of Health to the Tribunals Service took a great deal of planning and effort but a lot has been achieved in the integration process. The outstanding tasks are largely centred on implementing some of the internal DCA human resources procedures, so should not directly impact our stakeholders. However, we hope that they will help to improve staff morale and so assist in reducing our staff turnover rates.

12. In 2005 you undertook a stakeholder survey and now plan to complete a second survey by the end of 2006. How will these findings help the Modernisation programme?

  • The 2005 survey identified the three main areas of weaknesses as:
    • Timeliness of receiving reports
    • Design and running of the MHRT secretariat processes
    • Willingness of MHRT staff to take responsibility
  • In addition, one of the most overwhelming comments from general stakeholders on key areas for improvement concerned future communications, with 80% of stakeholders stating that they would welcome secure email. These results were the direct impetus for the main elements of the MHRT Modernisation Programme. We hope that the 2006 survey will confirm that we are focusing on the correct areas and will help us to identify further areas for improvement for the future.

Contacting the MHRT:

Queries on MHRT Operations or the Modernisation Programme can be referred through Paul Smith or Penny Letts, who both sit as Council on Tribunals observers on the MHRT Steering Group – enquiries@cot.gsi.gov.uk

Alternatively you can email Jack Fargher, the Head of MHRT England Secretariat, at jack.fargher@tribunals.gsi.gov.uk.

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