The issue raised by the Deputy potentially spans a wide range of care facilities, care recipients, and individual case circumstances. Patients, family caregivers and health care providers all play vital roles in maintaining a patient's health after discharge, from whatever type of care facility. Effective discharge planning is designed to help recovery, ensure that medications are properly prescribed and correctly given, assist in responsibility for caring, and reduce the chances that a relative is re-admitted to care. Every effort is made by the Department and the HSE to ensure that these principles are reflected in relevant health legislation, policies and operational guidance documents, and carried through in the type of care provided by individual facilities to each patient. Regulated health professionals adhere to codes of conduct which set out frameworks and guidelines of professional and ethical standards across a range of practices, including communicating with patients and their families on all aspects of treatment. These codes are revised at regular intervals.
In relation to acute care, the HSE National Integrated Care Guidance (2014) has been developed by the National Integrated Care Advisory Group under the auspices of the Quality and Patient Safety Division. The guidance is based on feedback received following extensive national and targeted consultation with service providers in both the acute and community healthcare settings, and on review of the HSE Integrated Discharge Planning Code of Practice (2008). This practical guide to integrated care is designed to support healthcare providers to improve their discharge and transfer processes from the acute hospital setting back into the community. This guide will support service providers in demonstrating how they are meeting the National Standards for Safer Better Healthcare, and outlines nine key steps in effective discharge and transfer of care which will facilitate faster, safer discharges for patients.
In relation to psychiatric services, in 2009 the Mental Health Commission published a Code of Practice on Admission, Transfer and Discharge to and from an Approved Centre, pursuant to Section 33(3) (e) of the Mental Health Act 2001. The code of practice is relevant to all partners involved in the delivery of mental health care and treatment. The Commission has also developed a similar guide for service users, carers and advocates. A primary aim of Mental Health Commission publications is to create a more positive approach to recovery for service users through in-patient mental health services, by improving the continuity and co-ordination of care and treatment provided.
The national policy document, 'A Vision for Change ', recognises the vital role played by family members in the recovery process, which is accepted and supported by mental health professionals. It is acknowledged that patient outcomes are better where families and/or carers are involved, and healthcare professionals should actively encourage patients at all stages to involve their family and/or carer in the development of the patients care and treatment plan. However, it is also acknowledged that patient confidentiality should not be compromised and, in some cases, patients specifically request that contact is not made with families. If this confidence was breached, it could damage the health professional/patient relationship. The Medical Council's Ethical Guide does, however, allow a doctor to ethically breach confidentiality if, for example, he/she believes that the patient is at-risk of harming himself/herself or others.
I have asked the Expert Group, which is currently reviewing the Mental Health Act 2001, to specifically consider the broader issue of whether mental health legislation should be amended to require health professionals to consult with the family of persons with mental health problems. The Expert Group is also expected to report on a range of other issues, including discharge planning from approved centres. The Group are coming towards the end of their deliberations, and I expect to receive its Report in the coming months.