Contents
1 Introduction
There may be circumstances during a patient’s period of detention whereby they need transferring to another hospital and section 19 of the Mental Health Act 1983 (MHA 1983) gives authority to the hospital managers (for example, the foundation trust) to do this. It is a duty which the hospital managers may delegate and, if this is the case, it is the responsibility of the officer to whom the Managers delegate this duty to ensure that the transfer is being made for valid reasons and that the needs and interests of the patient have been fully considered. (Code of Practice 2015, 37.16 to 37.27).
2 Purpose
The purpose of this procedure is to:
- provide clinical staff with a clear framework in which to operate the legal requirements of section 19
- provide a consistent approach across the care groups in the application of section 19 transfers
- detail the responsibilities and duties of staff in relation to section 19
- state what training is available to staff in relation to the MHA 1983 and, in particular, section 19
- detail what arrangements the trust has in place to monitor compliance with the legal requirements of section 19 transfers
3 Scope
The contents of this procedure apply to all clinical staff working within the trust across all care groups who, in the course of their work, may be involved in the transfer arrangements for a detained patient under section 19.
4 Responsibilities, accountabilities and duties
4.1 Mental health legislation operational group
The trust’s mental health legislation operational group is responsible for:
- overseeing the implementation of the MHA 1983 within the organisation
- the review and issuing of all policies and procedures which relate to the MHA 1983
- monitoring the Trust’s compliance with the legal requirements of the MHA 1983
- undertaking audits and agreeing action plans in relation to the MHA 1983
- providing an annual report on Mental Health Act activity within the trust to the board of directors
4.2 Hospital managers
Whilst the MHA 1983 uses the term “hospital managers”, in NHS Foundation trusts, the trust themselves are defined as the “hospital managers”. They have certain statutory duties they must fulfil under the act and some of these duties, including the transfer of patients detained under section 19 of the act, can be delegated by the hospital managers but in delegating this responsibility they must be satisfied that:
- the clinical staff, to whom the responsibility to transfer a patient under section 19 has been delegated, are aware of the legal requirements and adhere to this procedure
- the transfer is taking place for good reason, and the needs and interests of the patient have been considered
- the patient has been given information about the transfer and the reasons for it
- the patient’s nearest relative and carers have, where appropriate, been involved in the decision to transfer the patient (with the patient’s consent)
- any information given is done so in a suitable manner, at a suitable time, and in accordance with the law, as detailed in the trust’s section 132 policy
4.3 Independent mental health advocates (IMHA)
The role of the IMHA is to help qualifying patients (those detained under the MHA, conditionally discharged, subject to guardianship or a community treatment order but not those detained under section 4, section 5, section 135 or 136) understand the legal provision to which they are subject under the MHA 1983 and the rights and safeguards to which they are entitled. This could include assistance in obtaining information about any of the following:
- the provisions of the legislation under which she or he qualifies for an IMHA
- any conditions or restrictions she or he is subject to, for example, any arrangements made for section 17 leave or transfer under section 19
- the medical treatment being given, proposed or being discussed and the legal authority under which this would be given
- the requirements that would apply in connection with the giving of the treatment
- their rights under the Act and how those rights can be exercised. (MHA1983, 130B (1))
4.4 Responsible clinician
The responsible clinician will:
- authorise the transfer of detained patients to other hospitals or units as necessary
- liaise with the responsible clinician at the receiving hospital or unit about the transfer and the current or proposed treatment plan for the patient
4.5 Registered clinical staff
In relation to this procedure all registered clinical staff must be aware of and comply with the contents of this procedure when making arrangements for the transfer of a patient under section 19 as, at any time when they are in charge of the ward, they will be responsible for:
- signing the statutory form (H4)
- liaising with the receiving hospital or unit about the transfer arrangements
- making arrangements for all the necessary statutory and additional paperwork to be transferred with the patient
- making arrangements as necessary for the safe transport of the patient
- arranging adequate staffing levels to provide a staff escort to accompany the patient during the transfer
Registered clinical staff should also:
- attend any training which is provided in relation to this procedure
- bring to the attention of senior managers any concerns they may have about the transfer arrangements of patients under section 19
4.6 Non-registered clinical staff
Any non-registered staff working within clinical services must:
- be aware of this procedure and its contents
- direct any patient who has a query about a planned transfer to a member of registered staff
- report any breaches they become aware of in relation to this procedure
4.7 Mental Health Act office
Within each of the trust localities where there are inpatient services, there is a Mental Health Act office and in relation to this procedure the staff working in these offices are responsible for:
- providing clinical staff with copies of the H4 transfer form
- copying the patient’s original detention papers so that these can be kept on file and the originals transferred with the patient
- notifying the relevant personnel of the transfer in the event of the patient having a mental health tribunal or hospital managers hearing scheduled to take place after the transfer
- to liaise with the Mental Health Act offices in the other trust localities about any planned internal trust transfers of detained patients and arrange for the transfer of the relevant documentation
5 Procedure and implementation
5.1 Under which detaining sections can a section 19 be used to transfer a patient?
Section 19 can only be used to transfer patients who are subject to detention under a section 2, 3, 37, 47 of the MHA 1983, or are on a community treatment order and subject to recall or, are subject to guardianship. For any other section there is no power of transfer under section 19.
It must also be noted that for patients detained under a 37 to 41 or 47 to 49, a transfer under section 19 can only take place with prior approval from the home secretary and with a transfer direction issued by the Ministry of Justice. In these circumstances staff should refer to the Ministry of Justice guidance for transfers between hospitals in England and Wales attached at appendix A.
5.2 When should section 19 be used?
Any detained patient who is transferred to a hospital or unit in another trust (for example, one which comes under the authority of different hospital managers) must do so under the provisions of section 19. Section 19 can also be used to transfer a patient to a nursing home which is registered to accept patients who are detained under the MHA 1983.
5.3 Action to take when transferring under section 19
- The patient and their nearest relative, carer or friend (subject to the patient’s consent) are to be involved in any discussions about the proposed transfer.
- Patients are to be reminded that they can have support from the independent mental health advocacy services.
- The patient’s responsible clinician must refer them to a responsible clinician at the receiving hospital or unit.
- The receiving hospital or unit must agree to the acceptance and subsequent transfer of the patient.
- In the event of a patient requiring transfer to Scotland, Northern Ireland or the Channel Isles, staff should seek advice from the Mental Health Act office.
- In the case of patients who are subject to a restriction order for example, section 37 to 41 or 47 to 49, the responsible clinician must obtain authority to transfer from the secretary of state. This authority is requested via the Ministry of Justice. Without this authority no transfer can take place. Refer to the Ministry of Justice guidance on transfers between hospitals in England and Wales attached at appendix A.
Note, this can also be the case when transferring these patients between wards of the same NHS Hospital Trust, seek advice from the MHA office.
5.4 Action once the patient has been accepted for transfer
- Wherever possible, any such transfer should be planned well in advance.
- The following people must be notified and given details of why, to where and when the patient is to be transferred (if not already aware):
- the patient
- the patient’s nearest relative, carer or friend (if the patient consents)
- the patient’s care coordinator
- the Mental Health Act office
- A risk assessment must be undertaken in relation to the transfer and a care plan completed. These should detail:
- what transport is to be used for the transfer
- how many staff will be needed to undertake the safe transfer of the patient
- what training the staff have had in the control of violence and aggression
- he need for at least one staff member to be of the same sex as the patient
- that one of the staff must be a qualified nurse as they will be responsible for handing over the patient at the receiving hospital
- the estimated length of the journey and the need for comfort breaks
- any specific risk issues relating to the patient
- administration of any medication due whilst travelling
5.5 Information for the receiving hospital
- As much information about the patient as possible should be provided beforehand and this can either be done by letter or secure fax (dependent on time constraints).
- They must also be notified of the expected time of arrival for the patient.
5.6 On the day of transfer
- The patient’s belongings must be packed in a suitable manner and an inventory made.
- The original detention papers must be obtained from the Mental Health Act office and these must accompany the patient (copies must be retained for our records).
- A form H4 (section 19) (Form H4 Regulation 7(2)(a) and 7(3) MHA 1983) will be provided by the Mental Health Act office and part one of the form must be completed prior to leaving. The receiving hospital will complete the second part of the form to accept the patient into their authority. The original form H4 will be kept by the receiving hospital but the escorting nurse must bring back a photocopy for the Mental Health Act office for our trust’s records. For those patients on a restriction order (S37 to 41 or S47 to 49) a copy of the Ministry of Justice transfer direction must also accompany the papers.
- Photocopies of the patient’s medical notes, nursing notes and drug card are to be taken on the day of transfer to the receiving hospital.
- A transfer letter from the patient’s responsible clinician should also be taken (if not already sent).
- Any medication the patient is receiving should be obtained as TTOs for an appropriate period and taken with the patient.
Staff should refer to the trust policy for the discharge and transfer of patients for full guidance on the safe transfer of patients.
5.7 Action by staff on return to their unit following transfer
- The photocopy of the completed form H4 is to be forwarded to the Mental Health Act office
- Any problems encountered during the transfer should be reported to the service manager, modern matron or senior nurse
- If the patient has been transferred to a non-NHS psychiatric hospital or private psychiatric hospital, then staff must follow the CPA 72 hour follow up guidance (opens in new window).
5.8 Section 19 transfers from outside hospitals or units into the trust
Any detained patients who are to be transferred into any of the trust services will do so under section 19 and:
- the transfer is to be planned
- there is to be agreement as to who their responsible clinician will be within the trust. For those patients who transfer in on a restriction order the decision to accept the transfer should be have been agreed in advance via the responsible clinician
- the patient must have a form H4, part one of which will already have been completed by the previous hospital and will be received by the nurse in charge of the ward who will complete the second part of the form. For patients on restriction orders there should be a copy of the Ministry of Justice transfer direction
- the patient will only be accepted with the original relevant detention papers
- the form H4 is to be completed, photocopied and a copy given to the escorting staff
- the nurse in charge of the ward will at the earliest opportunity make
arrangements for the patient to:- have their legal rights under section 132 explained to them
- have their consent to treatment provisions reviewed by the responsible clinician
5.9 Transfers to another hospital or unit within the trust
- Detained patients who are to be transferred to another hospital or unit within the trust remain under the same hospital managers and so do not need an authority under section 19 to be transferred. However, staff are still to follow the guidance provided in this procedure.
- In these circumstances, if the detention papers state a specific unit or ward within the trust, the transfer is allowed as if he had been admitted to the original hospital based on the original application. However, in order that the patient can be transferred to the new unit or ward a section 17 form will be required to authorise the leave of absence to provide authority for the journey between sites.
- In these circumstances for those patients on a restriction order (section 41 or section 49) the permission to transfer the patient will need to be sought via the Ministry of Justice in advance as the order usually prescribes the specific ward or unit where the patient is to be detained.
- The Mental Health Act offices will liaise between localities about any planned internal trust transfers of detained patients and arrange for the transfer of the relevant documentation between offices.
- The Mental Health Act offices will notify each other of the dates for any mental health tribunal or hospital managers Hearing which may be planned.
- Whenever a detained patient is transferred to another locality within the trust, their legal rights under section 132 should be re-read by the receiving ward or unit.
- Any patients, who are subject to consent to treatment provisions under a form T2, are to be seen by their new responsible clinician and a new T2 completed upon arrival at the new ward or unit.
5.10 Transfers under section 136
There are provisions within the Mental Health Act to allow for the transfer of people subject to assessment under section 136. This means that during the 72 hour period of assessment a transfer can be made to another place of safety. Staff should refer to the trust section 136 policy for full details.
5.11 Additional requirements for the transfer of patients subject to community treatment orders who are recalled
- For any patients who are recalled from their community treatment order, the hospital managers can authorise their transfer to another hospital or unit.
- The maximum 72 hour period of detention in hospital on recall will continue to run from the original time that the patient was detained.
- Either prior to, or at the time of the transfer taking place, the receiving hospital or unit is to be provided with a copy of the form CT04 which records the time of the patient’s detention following recall.
- Ward staff will complete a form CT06 which is to accompany the patient to the receiving hospital or unit.
6 Training implications
There are no specific training needs in relation to this policy as the legal requirements under section 19 are included in the trust Mental Health Act training. However, the following staff will need to be familiar with the policy contents:
- inpatient consultant psychiatrists
- qualified inpatient nursing staff
- non-qualified inpatient staff
- junior doctors
- Mental Health Act office staff
Awareness will be achieved through a presentation of the updated policy at the consultants meeting, ward meetings, and via the MHA manager to the MHA office staff.
7 Monitoring arrangements
7.1 All detained patients subject to transfer under section 19 have the appropriate documentation completed
- How: Audit of the forms H4, CT04, CT06.
- Who by: MHA office.
- Reported to: The relevant local MH legislation monitoring group. Data will be reported, by exception, to the trust mental health legislation operational group.
- Frequency: Audit is ongoing but the results and any action plans will be reported quarterly.
7.2 All patients who are transferred into the Trust under section 19 will be given an explanation of their legal rights under section 132 at the earliest opportunity following their transfer
- How: Audit of the forms 14a.
- Who by: MHA office.
- Reported to: The relevant local MH legislation monitoring group. Data will be reported, by exception, to the trust mental health legislation operational group.
- Frequency: Audit is ongoing but the results and any action plans will be reported quarterly.
7.3 Patients and carers satisfaction with the transfer process
- How: Audit of the forms 14a.
- Who by: MHA office.
- Reported to: The relevant local MH legislation monitoring group. Data will be reported, by exception, to the trust mental health legislation operational group.
- Frequency: Audit is ongoing but the results and any action plans will be reported quarterly.
8 Equality impact assessment screening
To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.
8.1 Privacy, dignity and respect
The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.
Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).
8.1.1 Indicate how this will be met
No issues have been identified in relation to privacy, dignity, and respect.
8.2 Mental capacity act
Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individual’s capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.
Therefore, the trust is required to make sure that all colleagues working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.
8.2.1 Indicate how this will be achieved
This policy will be implemented in accordance with the guiding principles of the Mental Capacity Act 2005. (Section 1).
9 Associated documents
- Policy and procedure relating to the handling of formal complaints, general policies.
- Policy for the development of information for service users, general policies.
- Policy for clinical record keeping standards and clinical record management, clinical policies.
- Police liaison policy, clinical policies.
- Clinical risk assessment and management policy, clinical policies.
- Policy for the discharge and transfer of service users from inpatient services, clinical policies.
- Section 136 policy, clinical policies, mental health legislation.
- Procedure for informing detained patients of their legal rights under section 132 of the Mental Health Act 1983, clinical policies, mental health legislation.
10 References
- Department of Health (2015): Code of Practice, Mental Health Act 1983
- Jones R (2018): Mental Health Act Manual, twenty first edition, Sweet and Maxwell.
- National Institute for Mental Health in England (2008): Independent mental health advocacy, guidance for commissioners.
- Care Quality Commission: Leave of absence and transfer under the Mental Health Act 1983 (Guidance Note-March 2010).
11 Appendices
11.1 Appendix A NOMS Transfers between hospitals in England and Wales
11.2 Appendix B CPA 7 day follow up guidance#
11.2.1 Appendix B1 Application for trial leave or full transfer to another hospital
11.2.2 Appendix B2 Assessment of patient by proposed RC at accepting hospital
Document control
- Version: 12.
- Unique reference number: 96.
- Ratified by: Mental health legislation operational group.
- Date ratified: 15 April 2021.
- Name of originator or author: MHA manager.
- Name of responsible individual: Executive medical director.
- Date issued: 25 May 2021.
- Review date: April 2024.
- Target audience: Clinical and MHA office staff.
Page last reviewed: April 30, 2024
Next review due: April 30, 2025