W.r.t.
@Nightsong the question about why the treating consultant didn't get her on to his ward.
I worked in the NHS in the 90's as a locum SHO in medicine and surgery. It was considerably busier than NZ. Likely to be even more busier now.
But much the same, I think, is the Bed Management Team, then and now. These are usually made up of senior nurses who have to decide placement. All patients needing a bed goes via them. They are in touch with the charge nurses of each ward who can supply (after ward rounds) the planned discharges for the day, freeing up beds for admission from A&E and other sources eg planned admissions for procedures etc. As well as transfer's of the consultant's patients back to his/her ward after they have become "medical outliers" (i.e. admitted to other medical wards).
The admitting consultant has virtually no power where his/her patient is going to be admitted to if his/her ward is full. However, I find it very strange they admitted a medical patient to a ward which I would consider a psychiatric ward delivering medical care. Eating Disorders is a subspecialty of Psychiatry. But who knows? might be different in the UK. Our Eating Disorder beds are often not in a busy district hospital, like this hospital, and are overseen by a psychiatrist with advanced, specialised training in Eating Disorders.
My only thought of why they admitted Maeve there was the nursing staff would have a lot of experience in placing NG tubes (which they do in NZ) and with weighing patients and varying dietary needs. (though clearly, they failed in their care of her on many occassions and no clear explanation given...). Why wasn't her consultant/registrar insisting on proper weighing and recording caloric and fluid intake, which was the reason for her admission! So I consider that another omission. Or maybe they tried and the nurses just decided not to, perhaps too hard?...Even with access problems, all things can be negotiated. Seems she was left with her mother in her room and neglected.
I know councils deliver care in the community in the UK. It is my understanding (and please correct me if I am wrong) that when discharge from the ward is being considered a referral has to be made by the hospital. (Discharge Planning and Referral). This is usually not done by doctors but other team members involved in her care - eg. the ward social worker (?a psychiatric social worker in this case) and the primary nurse or someone from the nursing team. I do wonder if that is why the content of this referral information to the DCC is full of reference to FII, Munchausens by Proxy, coercive behaviour etc. It seems one hell of a lot of speculative material and highly inflammatory. Perhaps the referrer was writing down what they think was happening from scraps of reported "behaviour" observed,
OR peppered through the nursing and medical notes and they have summarised this material.
I have read here, of the evidence given in the hearing, that senior nursing staff thought M had a psychiatric disorder or suspected one. I have seen nurses start to try and put together diagnoses like this when I did CL psychiatry. M and her mother were in a quiet dark private room, they probably couldn't speak to M because of her ME and her mother was the main source of information. It probably is not something they experience often on a busy eating disorder ward, full mostly of young people, who are often quite social and it can be quite a lively environment sometimes. Nurses start talking with each other to try to gain an understanding of interactions with the mother and M. At handover time, the charge/senior nurse will enter into discussions and see if he/she can answer questions about any of the nursing staff's concerns. It is then up to the charge nurse to discuss any concerns with the registrar/consultant they are under. Sometimes this leads to a referral to CL or to a medical social worker if there are major concerns.
It is unclear what was really going on in the MDT's, they are not sharing the workings of them. I would presume that would only come out in an internal hospital enquiry. It does appear the treating physician did test M's capacity on several occasions as this was mentioned in the testimony and may have been at odds with the nursing team and their "FII opinions". There is certainly no record of CL psychiatry being called in to make an assessment.
