Frequently Asked Questions

Urgent help in a crisis: If you need help during a mental health crisis or emergency, the C.A.L.L Mental Health Helpline for Wales can help, call free: 0800 132737 or text 'help' to 81066

Below are a list of frequent asked question with appropriate responses

MHLDCC FAQ
FAQ	Question	Response
1	How is personal protective equipment (PPE) being issued to private providers? What is the process and latest guidance?	WHO guidance has been published and there are a range of PPE information links on the MHCC website or from the UK Government website
2	When will the changes to the Mental Health Act (1983) under Covid-19 legislation come into force in Wales?	The Coronavirus Act 2019 received Royal Assent on the 26 March 2020. For clarity, a large part of the Act has come into force, today, the 1st April 2020, including provisions to modify arrangements for how the Mental Health Review Tribunal for Wales (MHRTW) review individual cases. However, other than for the MHRTW, the emergency provisions that relate to the Mental Health Act 1983 (under Schedule 8 of the Coronavirus Act 2019) have not yet come into force. The Welsh Government is working with the UK government and key stakeholders in Wales to consider when these emergency powers may come into force, alongside the necessary guidance and modifications to statutory forms. We shall keep you updated of developments as they occur
3	How will the bed management and placement process work for independent providers?	A standard operating procedure has been drafted and is attached Supporting Document Available
4	What is the protocol around visits and patient leave – will there be guidance on this for Wales?	The letter issued by the Chief Nursing Officer gives additional information
5	What guidance / legal powers are available in cases where patients (including inpatients) are unable or unwilling to comply with social distancing or social isolation measures?	The Coronavirus Act 2019 received Royal Assent on the 26 March 2020. For clarity, a large part of the Act has come into force, today, the 1st April 2020, including provisions to modify arrangements for how the Mental Health Review Tribunal for Wales (MHRTW) review individual cases. However, other than for the MHRTW, the emergency provisions that relate to the Mental Health Act 1983 (under Schedule 8 of the Coronavirus Act 2019) have not yet come into force. The Welsh Government is working with the UK government and key stakeholders in Wales to consider when these emergency powers may come into force, alongside the necessary guidance and modifications to statutory forms. The Health Protection (Coronavirus) (Wales) Regulations 2020 provides powers for a person to be detained at the following: A facility designated, by notice published on Welsh Government website, for the purposes of these Regulations by the Welsh Ministers; in that person’s home; in a hospital; at another suitable place; The supporting documents provide additional information covering specific parts of the The Health Protection (Coronavirus) (Wales) Regulations 2020. Supporting Document Available
6	Suggestion that admission / discharge model be adapted for mental health	The supporting documents provides resources produced by Local Health Boards which might be helpful to those considering local arrangements. Supporting Documents Available
7	All Wales Ceiling of care - framework of anticipatory care planning. When should transfer to district general hospitals occur. Concerns about thresholds for accepting those in high risk groups and capacity at DGH. What is the DGH triage process?	We are sharing some information produced that is emerging practice. The COVID19 Clinical Pathway is written by Betsi Cadwaladr University Health Board Care which may be helpful to other areas.
8	How will mental health staff not trained in critical / end of life care receive training to upskill?	A number of courses that address this need have been circulated to Directors of Nursing, Medical Directors, Directors of Therapies & HC Science, Directors of Workforce & OD Health Education and Improvement Wales (HEIW) has been working closely with the Digital Learning Team within NHS Wales Shared Services Partnership (NWSSP) and have grouped a range of online packages together under the title “COVID19 additional training”. This multi-disciplinary training package has been developed to enable staff attending the ‘Non-Critical Care Staff working in Critical Care’ programme that we’ve recently developed in partnership with our HEIW colleagues with a useful baseline prior to commencing the 3-day courses. However, this online learning will benefit a wider range of staff and I would be obliged if you could disseminate through your organisations. ESR Training Packages Fluid Record Chart 000 NHS Wales Aseptic Non Touch Technique (ANTT) - Certification 000 NHS Wales - Medicines Administration, Recording, Review, Storage & Disposal 000 NHS Wales - Nasogastric Tube eLearning Package (Doctors and Nurses) 000 NHS Wales - Measuring Basic Patient Observations (RRAILS) 000 NHS Wales - National Early Warning Score (NEWS) (RRAILS) 000 Introduction to Anaesthetics 04 - Airway Care 000 Introduction to Anaesthetics 07 - Critical Incidents and Resuscitation 000 National Tracheostomy Safety Project 000 Med Eqpt 3:Suction Units: Introduction, 000 Med Eqpt 3:Suction Unit: Vacsax S-SCORT new Duet, 000 Med Eqpt 3:Suction Unit:Oxylitre PSP Portable
9	Temperature checks for mental health staff - should these be undertaken as they are for some visitors?	Public Health Wales advises that there is no guidance suggesting staff should be temperature checked. Individual teams / units should make decisions about what is practical for their setting and should take precautions to ensure staff are aware of the symptoms and alerting management if they feel unwell.
10	Minimum staffing levels - Is there a position on minimum staffing levels for wards?	As general guidance from Jean White CNO in recent letter to Nurse Directors; Your duty under section 25A of the Act will remain an important factor in how you are deploying your nursing staff across the entirety of your health boards wherever nursing care is provided or commissioned. Even during a period where “providing sufficient nurses” will seem like a foreign concept, your responsibility of minimising risk to patient safety through applying your professional judgement will remain.
11	What is the guidance for pharmacies and supervised consumption requirements during COVID-19?	A number of related concerns are covered in the substance misuse and homeless services guidance. The latest update was issued on March 27, 2020. Specific extracts in relation to pharmacies and supervised consumption requirements can be found in the supporting document. Supporting Document Available
12	Can clients with eating disorders have access to priority supermarket slots or to secure foods in line with dietary requirements?	We support the principle of clinicians issuing letters to clients to take with them to local supermarkets to facilitate these discussions based on individual needs. If this is a frequent issue perhaps a member of the eating disorders subgroup could produce a template for use by staff.
13	Electronic prescribing - who has access, and how is remote prescribing being managed?	We do not have any information on guidance related to electronic prescribing. Welsh Government advise that the system is in its early stages of discussion and will not be widely available for some time. We welcome any feedback from health boards regarding this.
14	How will mental health staff know who is in the shielded group?	Letters were issued by GP surgeries. Health boards should be able to access lists through their GP contacts and may wish to consider ways of flagging this status via IT systems where possible
15	How should we make patients aware of the higher risks of acquiring COVID-19 if they are admitted to hospital? Should we send a letter to all making them aware?	Patients should be made aware of the risks of admission and decisions to admit should be limited only to those absolutely necessary. We would not wish to discourage people from seeking emergency or urgent treatment by sending them letters. Betsi Cadwaladr University Health Board are also producing some information that will be shared once available.
16	What is happening with staff wellbeing resources?	Staff can now access the NHS Wales Staff and Wellbeing COVID19 Portal Portal. The portal provides a range of health and wellbeing resources to support at this time. In addition, self-help resources are being collated for publication on the Community Advice and Listening Line (CALL) website, due to go live shortly. Welsh Government has extended the Health for Health Professionals programme to offer support to all NHS staff. Details can be found in the practical information section.
17	How can staff be assured that they understand the appropriate use of PPE?	Revised PPE guidance has been issued from Welsh Government. Public Health Wales Information for Health and Social Care Professionals UK Government - COVID-19: infection prevention and control (IPC) Guidance Video training for the use of PPE in aerosol generating situations is available through the PHE e-learning site and should be viewed in the context of the guidance being updated frequently. Access to the e-learning site is open. e-Learning for Healthcare - Coronavirus Programme NHS England - PPE Guidance for Hospital Staff NHS England - Removal of PPE Guidance
18	Police issue - stopping vulnerable people who are needing time out of own home?	Response from Welsh Government: Discussions are ongoing with the police liaison team, and communication channels have been established to ensure police have access to any information they require with respect to vulnerable groups. Police have issued guidance to officers to support the new regulations, and have provided assurance that police with engage with members of the public to fully explain why restrictions are in place and the risks of not complying with restrictions. Police are also increasing visibility to provide reassurance. We welcome any feedback or queries with respect to this issue.
19	What is happening with regards to the release of female prisoners in private provider beds purchased for MH / release of female prisoners that are pregnant or have children?	Welsh Government has been working with Her Majesty's Prison and Probation Service (HMPSS) and the relevant Local Health Boards to ensure that the appropriate links and safe transition arrangements have been made for the very small number of cases where women have been released.
20	Can people self-refer to LPMHSS during the COVID19 period? Fewer referrals are coming from GPs due to pressures?	Various options for service continuity have been discussed through the PMHSS Community of Practice and with COVID19 leads and any decision to proceed will be considered in more detail. At present there is not an intention to proceed with this approach.
21	Can we ensure that the CALL resource is readily available via the MHCC website?	You can visit the CALL website for more information and details can be found under Practical Information.
22	What is the mental health activity at this time for CMHT, Crisis and Inpatient care?	Dr. Andrew Goodall (Chief Executive of NHS Wales) has issued a letter to Chief Executives and WAST detailing mental health service expectations. A minimum dataset has been established and is attached below for information. Health Boards will collate information for discussion in COVID lead meetings. Supporting Documents Available
23	Can an admissions pathway for sCAMHS be created?	A pathways has been developed and is available. Supporting Document Available
24	What duties do services have to parents in CAMHS when they are asking about COVID19 on wards?	There should be transparency and candour if there is known COVID exposure on the wards, without identifying individuals affected. The two national inpatient units run by CAMHS have taken steps to protect the staff and children and we are currently unaware of COVID on either unit as of 14/04/20.
25	Can a standardised response to managing confirmation of C19 positive people on MHLD wards be developed?	Attached is some guidance from NHS England about establishing an isolation unit / section, including standard operating procedures and flow charts. The BCU guidance for adults also highlights points of escalation and process (CAMHS pathway in development). Welsh Government will be releasing guidance around use of legislation for deprivation of liberty safeguards, which will be linked in FAQs. Supporting Document Available
26	How do mental health hospitals order more oxygen supplies, what is the process?	BOC are not providing additional oxygen cylinders to the NHS or any other providers and will continue to refill what sites already have. There has been an issue in that BOC had been told to only deal with the Department of Health (DoH) – they mistakenly thought that the DoH covered the whole of the UK. They now understand the devolved nature of the UK in terms of governmental responsibilities. There is absolutely no concern over BOCs supply – they have initiated their emergency plans and can provide the service they normally do, or can do better so there is no need to have additional oxygen storage and are fully able to continue as normal.
27	Are there now reasons to introduce incentivising staff - overtime etc before going to bank / agency?	Whilst it is up to individual health boards to make decisions about the NHS Dress Code for Mental Health usage and bank staff, this has also been put forward to the Welsh Government workforce team for consideration.
28	Do all staff need uniforms in MH? Other providers / social care staff wanting to use health uniforms when working as they don’t have own supply?	As above (any further updates will be posted online once available)
29	Need to reinforce the no uniform policy as staff should not be wearing uniform outside of work?	As above (any further updates will be posted online once available)
30	Can a similar letter to the one circulated in England be issued for Wales relating to Learning Disabilities, CPR and DNA orders?	A letter has now been published and is attached in English, Welsh and Easy Read below. The letter provides assurance that all decisions to enact CPR and DNA orders for individuals who are older or have Learning Disabilities are considered on a case by case basis. Supporting Documents Available
31	Are health boards working with local authorities around COVID planning? How can we ensure this is happening?	Health Boards and local authorities should work in partnership to address the needs of their population during the COVID crisis. Feedback from health board leads is that regular dialogue is taking place, and that while challenging, overall this is an improving picture, with some examples of good practice emerging.
32	Will there be additional support for bereavement service providers due to higher numbers of bereaved families due to COVID?	On 26 April 2020, the Welsh Government has announced an additional £72,000 to support bereavement services in Wales. The press release is attached for more information. Supporting Document Available

Frequently Asked Questions

FAQ

Question

Response

How is personal protective equipment (PPE) being issued to private providers? What is the process and latest guidance?

When will the changes to the Mental Health Act (1983) under Covid-19 legislation come into force in Wales?

How will the bed management and placement process work for independent providers?

What is the protocol around visits and patient leave – will there be guidance on this for Wales?

What guidance / legal powers are available in cases where patients (including inpatients) are unable or unwilling to comply with social distancing or social isolation measures?

6

Suggestion that admission / discharge model be adapted for mental health

The supporting documents provides resources produced by Local Health Boards which might be helpful to those considering local arrangements.

7

All Wales Ceiling of care - framework of anticipatory care planning. When should transfer to district general hospitals occur. Concerns about thresholds for accepting those in high risk groups and capacity at DGH. What is the DGH triage process?

We are sharing some information produced that is emerging practice. The COVID19 Clinical Pathway is written by Betsi Cadwaladr University Health Board Care which may be helpful to other areas.

8

How will mental health staff not trained in critical / end of life care receive training to upskill?

A number of courses that address this need have been circulated to Directors of Nursing, Medical Directors, Directors of Therapies & HC Science, Directors of Workforce & OD

Health Education and Improvement Wales (HEIW) has been working closely with the Digital Learning Team within NHS Wales Shared Services Partnership (NWSSP) and have grouped a range of online packages together under the title “COVID19 additional training”.

ESR Training Packages

000 Med Eqpt 3:Suction Units: Introduction,

000 Med Eqpt 3:Suction Unit: Vacsax S-SCORT new Duet,

9

Temperature checks for mental health staff - should these be undertaken as they are for some visitors?

10

Minimum staffing levels - Is there a position on minimum staffing levels for wards?

11

What is the guidance for pharmacies and supervised consumption requirements during COVID-19?

A number of related concerns are covered in the substance misuse and homeless services guidance. The latest update was issued on March 27, 2020.

Specific extracts in relation to pharmacies and supervised consumption requirements can be found in the supporting document.

12

Can clients with eating disorders have access to priority supermarket slots or to secure foods in line with dietary requirements?

We support the principle of clinicians issuing letters to clients to take with them to local supermarkets to facilitate these discussions based on individual needs. If this is a frequent issue perhaps a member of the eating disorders subgroup could produce a template for use by staff.

13

Electronic prescribing - who has access, and how is remote prescribing being managed?

We do not have any information on guidance related to electronic prescribing. Welsh Government advise that the system is in its early stages of discussion and will not be widely available for some time. We welcome any feedback from health boards regarding this.

14

How will mental health staff know who is in the shielded group?

Letters were issued by GP surgeries. Health boards should be able to access lists through their GP contacts and may wish to consider ways of flagging this status via IT systems where possible

15

How should we make patients aware of the higher risks of acquiring COVID-19 if they are admitted to hospital? Should we send a letter to all making them aware?

Patients should be made aware of the risks of admission and decisions to admit should be limited only to those absolutely necessary. We would not wish to discourage people from seeking emergency or urgent treatment by sending them letters.

Betsi Cadwaladr University Health Board are also producing some information that will be shared once available.

16

What is happening with staff wellbeing resources?

Staff can now access the NHS Wales Staff and Wellbeing COVID19 Portal Portal.

The portal provides a range of health and wellbeing resources to support at this time. In addition, self-help resources are being collated for publication on the Community Advice and Listening Line (CALL) website, due to go live shortly.

Welsh Government has extended the Health for Health Professionals programme to offer support to all NHS staff. Details can be found in the practical information section.

17

How can staff be assured that they understand the appropriate use of PPE?

Revised PPE guidance has been issued from Welsh Government.

Video training for the use of PPE in aerosol generating situations is available through the PHE e-learning site and should be viewed in the context of the guidance being updated frequently. Access to the e-learning site is open.

18

Police issue - stopping vulnerable people who are needing time out of own home?

19

What is happening with regards to the release of female prisoners in private provider beds purchased for MH / release of female prisoners that are pregnant or have children?

Welsh Government has been working with Her Majesty's Prison and Probation Service (HMPSS) and the relevant Local Health Boards to ensure that the appropriate links and safe transition arrangements have been made for the very small number of cases where women have been released.

20

Can people self-refer to LPMHSS during the COVID19 period? Fewer referrals are coming from GPs due to pressures?

Various options for service continuity have been discussed through the PMHSS Community of Practice and with COVID19 leads and any decision to proceed will be considered in more detail. At present there is not an intention to proceed with this approach.

21

Can we ensure that the CALL resource is readily available via the MHCC website?

You can visit the CALL website for more information and details can be found under Practical Information.

22

What is the mental health activity at this time for CMHT, Crisis and Inpatient care?

23

Can an admissions pathway for sCAMHS be created?

A pathways has been developed and is available.

24

What duties do services have to parents in CAMHS when they are asking about COVID19 on wards?

There should be transparency and candour if there is known COVID exposure on the wards, without identifying individuals affected. The two national inpatient units run by CAMHS have taken steps to protect the staff and children and we are currently unaware of COVID on either unit as of 14/04/20.

25

Can a standardised response to managing confirmation of C19 positive people on MHLD wards be developed?

26

How do mental health hospitals order more oxygen supplies, what is the process?

BOC are not providing additional oxygen cylinders to the NHS or any other providers and will continue to refill what sites already have.

There has been an issue in that BOC had been told to only deal with the Department of Health (DoH) – they mistakenly thought that the DoH covered the whole of the UK. They now understand the devolved nature of the UK in terms of governmental responsibilities.

There is absolutely no concern over BOCs supply – they have initiated their emergency plans and can provide the service they normally do, or can do better so there is no need to have additional oxygen storage and are fully able to continue as normal.

27

Are there now reasons to introduce incentivising staff - overtime etc before going to bank / agency?

Do all staff need uniforms in MH?

Other providers / social care staff wanting to use health uniforms when working as they don’t have own supply?