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Difficult to engage patient panel Referral

Please note: Any NEWS2 deterioration/safeguarding should be escalated through the usual process e.g. 999

This form is to be completed by CHN who face challenges to provide care. Your form will be emailed to: elft.chn.complex@nhs.net. (a receipt will be sent to the email provided).

The panel will be convened within 48 hours but no longer than 1 week for cases requiring urgent oversight. Important patient information.

Title
Briefly summarise the background to the case and an overview of the decision that you need Panel support with.
Outline the risks involved and potential mitigations.
Has a formal capacity assessment taken place. Does the patient have capacity to consent to care?
Does the patient have any mental health issues or a learning disability / autism which require specialist advice? (If Yes please include information on the referral and outcome below)
Have any safeguarding concerns been raised, and a referral made? (If Yes please include information on the referral and outcome below)