Yvonne Barnes and Cora Evans v Mid-Staffordshire Health Authority

MRS YVONNE BARNES AND MRS CORA EVANS – APPELLANTS AND MID-STAFFORDSHIRE HEALTH AUTHORITY – RESPONDENT Decision of Registered Homes Tribunal held at the Court House Eccleshall in the County of Stafford on Wednesday 22 July 1987. Before Mr William Morris Jones (Chairman).Miss Dorothy Jean Harris BA RGN SCM HV Cert.Dr Stephen W Brown MA MA MB B Chir MRC Psych. Appeal by Mrs Yvonne Barnes and Mrs Cora Evans against the conditions imposed upon the proposed amended Registration of Hilcote Hall Nursing Home, Eccleshall aforesaid by the Mid Staffordshire Health Authority. Representation Mr R Brown of Counsel instructed by Messrs Dean Flowers & co Solicitors of Macclesfield for the Appellants. Mr A Hotham of Counsel instructed by the Solicitor to the West Midlands Regional Health Authority on behalf of the Mid Staffordshire Health Authority. Grounds of Appeal The 5 paragraphs set out in the Appellants' Statement of Grounds of Appeal dated the 29 June 1987. Issues As the result of consultation between the parties before the hearing, it was agreed that the issues between the parties which had not been resolved were:

1. The staircase leading from the 1st floor of the building to the 2nd floor should be provided with handrails on each side.

2. The door to the sluice room on the 2nd floor, and the steps from the landing into the said room, both need to be modified to make them safe for the staff using this room.

3. The ceiling in room No 14 on the 2nd floor being only 7'2" in height should be raised.

4. The arrangements for access from the 1st floor to the 2nd floor are such that there should be a restriction upon the dependency of patients being accommodated on the 2nd floor. Decision The Tribunal are unanimous in their decision which is as follows:

1. The staircase leading from the 1st floor to the 2nd floor must be provided with a handrail upon each side. The one on the right hand side (going up) to be recessed into the wall. The one on the left hand side may be a cord or rope.

2. The door leading from the landing to the sluice room on the 2nd floor must be heightened and the steps leading into that room must be modified to provide that the risers are no more than 170mm in height.

3. That the Respondent be at liberty to withhold the amended Registration Certificate until such time as they are satisfied with the modifications to the building out-lined in paragraphs 1 and 2 of this decision.

4. That room No 14 on the 2nd floor may be used in its present state and condition for 3 patients.

5. That the only patients who may be accommodated on the 2nd floor should be those who:- a. are ambulant and b. not dependent upon wheelchairs nor upon aids to walk and c. are not mentally confused. The patients intended to occupy rooms on this floor shall be assessed by the Matron upon admission and thereafter by her from month to month and a record kept. These assessments shall be confirmed by the Respondent's visiting officers from time to time. Interpretation The Tribunal adopt Regulation 2(1) of The Nursing Homes and Mental Nursing Homes Regulations 1984 SI No 1578 of 1984. "The Appellants" means Mrs Yvonne Barnes and Mrs Cora Evans. "The Respondent" means the Mid Staffordshire Health Authority. "Hilcote Hall" means Hilcote Hall Nursing Home Eccleshall aforesaid. Witness a. for the Appellants:- Mr Alan Frederick Barnes ("Mr Barnes") the husband of Mrs Yvonne Barnes.Mr David McAsey (Mr McAsey) Dr Patrick John Carr ("Dr Carr") BA PhD RMN SRN RNT.In addition there were signed statements served upon the Respondents and handed to the Tribunal before the hearing from: The Appellants andMr Trevor John Reeves none of whom was called to give oral evidence. b. for the Respondents:- Miss Sheena Newbury SRNMiss Jillian Mary MacGuire BA SRNMr Kenneth John Rider SRN RMN RNT and Mr Ian Ralph William Cox ARIBA, all of whom signed statements served upon the Appellants and handed to the Tribunal before the hearing. (There were no affidavits). History The Appellants purchased the property Hilcote Hall before it became a Nursing Home in July 1986. After carrying out necessary work to the said property and obtaining the necessary consent from all bodies concerned, the Appellants were jointly registered by the Respondents for the purpose of carrying on a nursing home in the said property for a total of 25 patients. The Registration Certificate bears the date the 16 December 1986. Visit The Tribunal visited Hilcote Hall which they found to be a pleasant Grade II Listed Country House in 5 acres of ground. The surrounding gardens were well maintained and there was a pleasant atmosphere in the home. The Tribunal went to the 1st and 2nd Floors to inspect that area of the house in which the problems appeared to have arisen leading to the issues now between the parties. The Reasons

1. The staircase from the 1st floor to 2nd floor is 27½" inches in width and has a door leading from the 1st floor landing. There is then an abrupt 180° turn to the stairs themselves. The evidence of Mr Barnes shows that he was experienced in undertaking simple building work and he undertakes maintenance work at Hilcote Hall. He would be able to undertake the provision of such handrails upon the staircase as might be necessary. The witnesses for both parties agree that the narrow stairs were difficult for patients. That patients who relied upon wheelchairs and aids to walking, as well as those who were mentally confused could not use these stairs. For those who could manage the stairs, rails should be provided on both sides. There was no conflict of the evidence. There is a modern electric lift from the ground floor and serving all floors. However in the event of a failure the stairs would have to be used and would be the only way to reach other floors of the building. Evidence was given that some patients would not use the lift in any event. Both as the result of the evidence and of the inspection of the staircase in question the Tribunal consider that there should be a handrail provided upon each side of this staircase.

2. The door from the landing to the sluice room on the 2nd floor and the steps going up into that room. On the inside of the door lintel in the sluice room a notice of a prominent nature reading "Duck or Grouse" had been affixed. It is necessary for anybody entering or leaving that room to bend in order to get through the doorway. The evidence supported the view of the Tribunal that the door frame was too low and the 3 steps were not satisfactory because of the height of the treads. In his evidence Mr Cox said that he had measured the steps and the treads were 240mm in depth and the risers were 225mm in height. These measurements did not accord with the Buildings Regulations 1985 (although it was claimed in submissions made on behalf of the Appellants that these Regulations were for the construction of new hospitals for the Department of Health) which appeared to be a guide. Mr Cox suggested modifications which included provision for 4 steps instead of

3. This would reduce the risers to about 168 mm. Although there were alternative suggestions made, the witness indicated that the necessary work would not be difficult or expensive, although no figures or plans were produced. In his evidence Mr Barnes believed that he could undertake the work of modification. The area below the sluice on the first floor is a passage. There were doors in this passage, but witnesses indicated that the appropriate remedial work could be carried out. The Tribunal considered that both the doorway entrance and the steps on the 2nd floor should be modified.

3. Room No 14 on the 2nd floor. The ceiling in this room is 7'2" from the floor. The floor area of the room is agreed to be 24.6 square metres. The Tribunal inspected this room, which seemed to each one of them light and airy, with two adequate windows reaching almost to the floor. On the day of the inspection the weather was dull and the sky clouded. Provision was made for 3 patients. The evidence of the Respondent's nursing witnesses was that the height of this ceiling gave a claustrophobic feeling to anybody entering the room, and that over a long period of time in the room, the occupants would become breathless because the air would be used up. The evidence of Mr Barnes and of Mr Cox showed that no surveys had been carried out of this room nor of the ceiling and the area above. Joists were set upon the top of the walls, but the witnesses could not be certain that they did not rest upon the one wall surrounding the lift shaft and adjacent to the room. No calculations or plans detailing the construction of the ceiling were produced in support of the evidence, which was not satisfactory. Mr Barnes said that if the ceiling were to be stripped to the joists, then, because of the construction, an increase in height of ½" only would result. As the building is a Grade II listed building, there could be difficulties with the Planning Department. No calculations of the volume of air were available. Dr Carr in his evidence considered the room adequate and was supported by Mr McAsey. Clearly there is a conflict of evidence on this point. The Tribunal inspected this room and after hearing the evidence and the submissions' of the Learned Counsel, prefer the evidence on behalf of the Appellants and consider this room adequate for 3 patients, without altering the height of the ceiling.

4. The degree of dependence of the patients to be accommodated upon the 2nd floor. Much of the evidence concerning the 1st issue – being that of the staircase from the 1st floor to the 2nd floor was relevant to this point as well. The medical evidence including that of Mr McAsey on behalf of the Appellants considered that no patient who was wheelchair bound or who needed aids to walk should be accommodated upon the 2nd floor. He went further and included those patients who had become mentally confused. It is repeating the point made earlier that some patients will not use a lift. So this, too, strengthens the case for considering the dependency of the patients. As was submitted on behalf of the Respondents the consideration of the welfare of the patients is paramount. The nursing evidence was overwhelming. The Tribunal consider that the limits imposed upon patients who are accommodated upon the 2nd floor at Hilcote Hall should conform to the paragraph 5 of the Decision herein. W M JONESD J HARRISS W BROWN