| JURISDICTION : STATE ADMINISTRATIVE TRIBUNAL STREAM : HUMAN RIGHTS ACT : GUARDIANSHIP AND ADMINISTRATION ACT 1990 (WA) CITATION : TR and CJ [2013] WASAT 119 MEMBER : MR M ALLEN (SENIOR MEMBER) HEARD : 24 APRIL 2013 DELIVERED : 2 JULY 2013 PUBLISHED : 30 JULY 2013 FILE NO/S : GAA 1040 of 2013 BETWEEN : TR Applicant
AND
CJ
Represented Person
Catchwords: Guardianship and administration - Review of guardianship and administration orders at request of hospital treating team - Parents of represented person joint guardians and administrators - Consideration of whether guardians have acted in best interests of represented person by not being contactable by hospital treating team and not accepting treatment recommendations - Conclusions that guardians and administrators may not have always acted in represented person's best interests but that they should continue in these roles - Imposition of conditions on appointment of joint guardians requiring them to make themselves
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reasonably available, to consider treatment recommendations objectively, and to provide written reasons for any recommendation not accepted - Orders to be reviewed after one year Legislation: Guardianship and Administration Act 1990 (WA), s 4, s 43, s 44(5), s 51, s 64
Mental Health Act 1996 (WA) Result: Administration order confirmed
Guardianship order varied by imposing conditions on the appointment of the joint guardians
Summary of Tribunal's decision: The Tribunal reviewed guardianship and administration orders concerning a 25yearold woman who suffers from autism, intellectual disability and associated anxiety resulting in aggressive and selfharming behaviour. The woman's parents jointly were the appointed guardians and administrators, and the reviews were conducted on the application of the treating team at the hospital responsible for treating the woman and where she had made many presentations to the emergency department and been admitted on numerous occasions. Some admissions had been under the Mental Health Act 1996 (WA) because the guardians refused to consent to recommended treatment. The treating team was concerned that the current orders may not be operating in the woman's best interests, as the guardians sometimes could not be contacted, sometimes refused to consent to treatment, had refused to allow the woman to have contact with an organisation that provided social services to her, and would not agree to the woman's participation in recommended psychological treatment that might assist the woman's ability to cope with stress and anxiety that caused her behavioural problems in particular, self-harming behaviour. The parents' reasons for refusing to permit the woman to participate in such psychological programs were said to be based on their religious beliefs.
The Tribunal concluded that the parents may not have always made decisions in the woman's best interests by not giving objective consideration to various treatment options. However, the Tribunal decided that the parents should continue to be the woman's joint guardians and administrators because it was in accordance with the woman's wishes, the parents were sincere in their wishes and intentions to act in the woman's best interests, and the treating team's
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concerns could be addressed by imposing conditions on the guardians' appointment requiring them to make themselves available to the treating team at all reasonable times, to consider all treatment proposals in a bona fide and objective way, and to provide written reasons for any treatment proposal they do not accept. The orders are to be reviewed again in one year.
Category: B
Representation: Counsel:
Applicant : N/A
Represented Person : N/A
Solicitors:
Applicant : N/A
Represented Person : N/A
Case(s) referred to in decision(s):
Nil
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REASONS FOR DECISION OF THE TRIBUNAL:
Background 1 These proceedings concern CJ, a 25-year-old young woman, and involve, on applications made by Ms R on behalf of the treating team at the hospital treating CJ, the review of a guardianship order and an administration order concerning CJ under the Guardianship and Administration Act 1990 (WA) (GA Act). 2 There have been a number of previous proceedings concerning CJ under the GA Act in the Tribunal. The first was an application made in February 2010 for a guardianship order by the local area coordinator of the Disability Services Commission in the town where CJ and her family lived at the time. The application was made, it was said, because CJ was not able to live with her family as they were unable to manage her behaviour, and her increasingly frequent attempts to harm herself. 3 At the time of the hearing of that application in May 2010, CJ had been admitted to Graylands Hospital. A guardianship order was made appointing the Public Advocate as CJ's limited guardian, with powers to make decisions in relation to accommodation, employment, treatment and services, education and legal advice. At the same time an administration order was made on the application of a social worker from Graylands Hospital, and the Public Trustee was appointed as CJ's plenary administrator. 4 Both of those orders were made reviewable after one year because the evidence before the Tribunal at the time, in particular from a psychologist who had been involved, was that CJ's problems appeared to be temporary, and there was some reason to think that her previous ability to live more or less independently would return. 5 The orders were reviewed in the middle of 2011. By that time CJ was living in a group home, although I note that she had also spent a period of time in prison as a result of a charge against her. On 28 September 2011, orders were made appointing CJ's parents (Mr J and Mrs J) as joint administrators with plenary powers and as joint guardians with limited powers, being the same powers as had previously been given to the Public Advocate. 6 As noted, CJ was not living at home and her parents at that time felt better able to take on the roles of guardian and administrator, and CJ herself supported the appointment of her parents at that time. A report (Page 5)
was provided to the Tribunal at that time from Dr M, a forensic psychiatrist, who noted diagnoses of autism, mild mental retardation and a depressive disorder. 7 The next thing that occurred in the Tribunal was that in February 2013 CJ herself applied for a review of both those orders, seeking the appointment of the Public Advocate and the Public Trustee as guardian and administrator, citing in the application as her reasons for making that application that her parents would not let her live in a group home, she did not want to live at home, and her father controlled her by taking her telephone and her money. 8 That application was supported by a report from Ms R on behalf of the treating team who noted CJ's frequent distress and frequent attendances at emergency departments, with threats to harm herself, and acting in what were thought to be very risky ways – for example, jumping onto train tracks. The report noted that there had been 88 attendances at the hospital alone in the period from 2010 to 2012. That application never went to a hearing because in March 2013 CJ applied for and was granted leave to withdraw her application, saying that she was no longer angry with her parents. Leave to withdraw was granted on 12 March 2013. 9 Approximately one week later the present application was made by Ms R, citing concerns that the current orders may not be providing optimum benefit for CJ, noting that CJ often gave as reasons for her distress and risky behaviour that there had been arguments with her parents over guardianship and administration matters, and that CJ had apparently said that she did not want her parents involved. 10 Ms R, in her report, noted that CJ was often distressed when her parents visited her at the hospital or after telephone conversations with her father, and it was thought that a change of guardian or administrator may relieve some of that distress. Ms R also noted that there was a need for a decision to be made regarding a possible move to a group home for CJ, which CJ was quoted as saying she wanted to do. If that were to occur, then there might be a need for someone to manage her financial affairs. 11 That application came on for hearing on 24 April 2013, and I heard evidence at that time from all concerned. As a result of the evidence I made orders that the parties could lodge written submissions, if they wished, and, in the event, written submissions were lodged by the treating team, by CJ's parents and by the Public Advocate. (Page 6)
Issues to determine 12 The issue that I have to determine in this proceeding is whether or not the guardianship and administration orders are needed and are still justified and, if so, who, and with what powers, should be appointed as guardian or administrator. In order for a guardianship order to be maintained, I have to be satisfied that the requirements of s 43 of the GA Act are met; namely, that I must be satisfied that CJ is: a) over the age of 18 years (which is not in dispute); b) incapable of looking after her own health and safety; c) unable to make reasonable judgments in respect of matters relating to her person; d) in need of oversight, care or control in the interests of her own health or safety, or for the protection of others; and e) in need of a guardian. 13 In the case of the administration order, I need to be satisfied (as required by s 64 of the GA Act) that CJ is, by reason of a mental disability, unable to make reasonable judgments in respect of matters relating to all or part of her estate, and is in need of an administrator. 14 In determining matters such as this, I must observe the principles that are set out in s 4 of the GA Act, which I will summarise in this way: • that the primary concern of the Tribunal is to be CJ's best interests; • that CJ is to be presumed, until the contrary is proven to my satisfaction, to be capable of looking after her own health and safety, of making reasonable judgments about matters relating to her person, and of managing her own financial affairs and her personal affairs; • that any order made should be the least restrictive of CJ's freedom of decision and action; • that limited orders should be made wherever possible so as to impose the least restrictions on CJ; and • the Tribunal should, as far as possible, seek to ascertain the views and wishes of CJ, as expressed in whatever (Page 7)
manner at the time or as was gathered from her previous actions. 15 At this point, I note CJ's views, as explained at the first hearing, that she wanted to be responsible for her own decision-making now that she is 25 years of age, but she realised that she needed some help in making decisions. If there must be orders, then she wanted her parents to carry on with their current roles, as she thought they were doing a good job and, so far as money is concerned, she said she could manage her allowance of $100 per week.
CJ's capacity to make decisions for herself 16 I turn then to the question of CJ's capacity to make decisions for herself. I start by noting the report from Dr V, a consultant psychiatrist, who expressed the view that, in his opinion, CJ is not capable of making reasonable decisions regarding her personal healthcare, her living situation, her financial affairs, or making documents such as an enduring power of attorney or an enduring power of guardianship. 17 Dr V noted the diagnoses that had been made in respect of CJ in the past, and confirmed that they represented his view. He noted that autism is a pervasive developmental condition, with associated difficulties that are likely to continue in a fluctuating course. He thought CJ had no clear mental illness, but that she had periodic bouts of distress, due to conflict with carers. He noted numerous emergency department presentations by CJ, often involving serious self-harm attempts when her needs were not met. There were significant behavioural problems when she was aroused. Dr V noted that CJ changes her mind about the role of her parents and whether to live with them, and that this resulted in difficulties in planning treatment, and it resulted in conflict with the parents regarding limit setting. He noted that CJ at times said that her parents contributed to her self-harming behaviour, but she would later deny that. 18 Dr V also gave oral evidence at the hearing, noting over 90 presentations to the emergency department in 18 months, and numerous admissions to hospital. He said that in the last year there had been an admission about every two weeks on average. The admissions were due to distress, not to a mental illness. He was in no doubt that CJ lacks capacity to make decisions by reason of her low IQ, that there was no consistency in her decision-making, and that she could not retain information and act on it – for example, in relation to ways to reduce her anxiety - and the result was repeat presentations that almost always involved the Police. (Page 8)
19 Dr V noted a current management plan that involved briefly admitting CJ to hospital, but then she would not be able to go home for two weeks. This was to be a deterrent, but he was not sure that it would work. 20 Dr V also noted that about 50% of the time CJ was treated involuntarily under the Mental Health Act 1996 (WA) (MH Act). Dr V said that it was apparent on the ward that CJ cannot think through issues or consequences of her behaviour. He thought that her behaviour is not to get attention, but is driven by distress and an inability to deal with problems. 21 In a subsequent written submission by the treating team, the Tribunal was given information that, between 2010 and April 2013, CJ had presented to emergency departments on 97 occasions, more than half of them outside business hours, and that in 2013, up until April, there had been a total of 73 inpatient days. 22 Mr J told me at the hearing that he thought CJ can think for herself and can resolve challenges, and that she seems now to understand the consequences of her actions. Mrs J said that in recent times, for about the last three weeks before that hearing, she and Mr J had tried to let CJ make more of her own decisions regarding things, such as where she was to live, and she thought that there had been a subtle change in CJ in that time. She still threatened self-harm, but had not made any actual attempts, except one incident involving the taking of excess medication. 23 Mrs J thought that CJ wanted more control over decision-making, and the lack of that caused her frustration, and that her parents were now more accepting of her choices, even if they thought CJ's choices were not necessarily the right ones, and she thought that CJ could make decisions other than in relation to medication. 24 Ms E, who is the coordinator of Life Without Barriers (LWB), which is an organisation that operates the group home in which CJ lived, and which has subsequently provided social support as needed, attended the hearing and also gave evidence. She thought CJ needed a guiding hand and needed help to weigh the pros and cons of situations. CJ certainly found it difficult to make quick decisions. 25 My conclusions regarding CJ's capacity can be summarised in this way: (Page 9)
a) I find that CJ has a mental disability as defined in the GA Act, in particular, autism and an intellectual disability, and that, as a consequence, she suffers from distress and an inability to deal with problems, particularly in relation to understanding and weighing up the consequences of her actions. I note that CJ said herself at the hearing that it often did not occur to her to try to weigh up the consequences of anything that she did. b) It is abundantly clear to me that CJ has a profound and ongoing inability to cope with even small amounts of distress or stress, as evidenced by her behaviour when distressed, leading to risky, even extremely dangerous, behaviour, and it leads to numerous hospital presentations and admissions. I accept that there may be some times when CJ can make or contribute to decisions regarding her personal and financial affairs but, overall, I am satisfied that the presumption of capacity to manage and make decisions about personal and financial affairs is rebutted. c) I am satisfied that all of the aspects of s 43 and s 64 of the GA Act that I referred to are satisfied, and that all of the criteria are satisfied that make CJ a person for whom both a guardianship order and an administration order can be made.
Need for guardianship or administration orders 26 The question then is whether there is a need for a guardian and an administrator. The concept of need in this context involves identifying decisions that need to be made, but which CJ herself cannot make. 27 In the guardianship personal decision-making area, it seems to me that there are decisions that will need to be made on an ongoing basis concerning where CJ is to live, her medical treatment and the services that she may require. They are the most likely matters that will need to be made. Other functions that are in the current guardianship order seem less relevant at the moment, and I will return to those below. 28 So far as her financial affairs are concerned, these are quite straightforward, in the sense that her only income is a disability support pension, and most of that goes to her parents to manage. CJ manages a relatively small allowance that is given to her. There may be a greater (Page 10)
need in the future for her financial affairs to be managed, depending upon where she lives. If she is not at home, then her affairs will be more complicated. 29 I conclude that CJ needs both a plenary administrator and a limited guardian.
Who should be appointed guardians or administrators? 30 That brings me to the question that was the most contentious in these proceedings; namely, who should be appointed as administrator and guardian. CJ's parents seek reappointment in both roles, and CJ supports that if orders are to be needed, as I have concluded that they are. The only other possible contenders are the Public Advocate in relation to the guardianship order and the Public Trustee in relation to the administration order. 31 A guardian and an administrator must act in a person's best interests, be capable of performing the functions given to them, and they must be otherwise suitable to be appointed. In the case of a guardian, they must also not have any interests that would conflict with CJ's interests. 32 It is important to note at this point, in relation to the guardianship order, that s 44(5) of the GA Act provides that the Public Advocate shall not be appointed as a guardian (except as a joint guardian with someone else) unless there is no other person who is suitable and willing to act. There is no comparable provision in the case of administration orders. 33 I have said that a guardian and an administrator must be otherwise suitable to act, and the GA Act sets out some factors that relate to this question of suitability. In the case of a guardianship order, in determining suitability, the Tribunal must take into account the desirability of preserving existing relationships within the family, the compatibility of the proposed guardian with the represented person and with any administrator that there is, the wishes of the person, and whether the proposed guardian will be able to perform the functions. Similar factors apply in the case of an administrator, but not relating to the preservation of relationships within the family. 34 Against that statutory framework, I note the following relevant points: a) CJ's wishes are that her parents be appointed if orders are needed. (Page 11)
b) I consider her parents are compatible with CJ, even though there is some history of her expressing views in the past about not wanting to live with them, or for them to be administrators or guardians. In large part, I consider this inconsistency is a product of the anxiety that CJ suffers from, and her inability to cope with that. c) I am satisfied that CJ's parents obviously care for her greatly, and want whatever is best for her. The most recent submissions from the parents are to the effect that CJ is much more settled at home, now that some alternative respite accommodation is available as an alternative to hospital, and there have been no presentations to hospital over some weeks. d) With the best will in the world, the Public Advocate could never devote the time or effort to CJ's interests that her parents could. e) The treating team emphasised that they wanted to acknowledge the parents' contribution, and to acknowledge their attendance at and contribution to many family meetings, often at short notice, to talk about CJ's welfare. 35 However, it became apparent late in the hearing in April 2013 that there were some significant issues regarding the parents' involvement with CJ that caused the treating team some concern, and led to the team raising questions of whether the Public Advocate's appointment as guardian at least should be considered. I heard some evidence about that in April 2013, and I invited the parties to make further submissions. 36 The concerns fell into two broad categories. The first concern was about the availability of the guardians. The point was made that Mr J was not always available by telephone after hours, after about 9 pm. Instances were cited where emergency department staff had tried to contact the guardians to arrange for CJ to go home (when she was happy to do so), but being unable to make contact with the guardians because the telephone was not answered or was off the hook. The result sometimes, indeed fairly often, was an admission to a mental health ward, sometimes under the MH Act. 37 Mr J's response to this concern was along the lines that, as he refuses medication that over-sedates CJ, he was often asked to take her home (Page 12)
when she was extremely agitated and aggressive. On occasions when he had taken her home she often ran off immediately and went to a different hospital. Sometimes he had made himself unavailable late at night to prevent CJ being discharged and thereby putting herself at risk again. 38 The second aspect of the treating team's concerns related to what they perceived to be the guardians' attitude towards treatment, and again there were two aspects to this. 39 The first aspect related to the treating team being concerned that not all treatment options are being used for CJ, as the guardians would not consent to certain forms of psychological treatment that would involve CJ's participation in group therapies - one that was referred to as Mindfulness and another that involved anxiety management. 40 The treating team said that these forms of treatment are evidence-based options that can be effective in stress reduction and mood regulation. They note that Mindfulness is a prerequisite for accessing further long-term psychological treatment, such as participation in a program called Dialectical Behaviour. The treating team was concerned that the guardians are denying CJ access to learning basic emotional regulatory skills and distress tolerance skills. It is not guaranteed that these things will work for CJ, but the treating team thought they should be explored. 41 The treating team also had concern that CJ was not getting full access to the psychosocial rehabilitation options that are available to her through LWB, as the guardians have cancelled some activities – for example, visits to the hospital by the LWB worker, and social outings with LWB people - because the guardians thought that CJ's behaviours precluded her from activities she enjoyed. Overall, the treating team was concerned that they could not get CJ's parents to even consider these options. They could not get them even to look at the possibility of these options. 42 The second aspect of the treating team's concern regarding treatment was that, on occasions, the guardians could not or would not make treatment decisions. An example was cited from notes from a January 2013 presentation at the hospital, when a staff member at the hospital had contacted Mr J, and the note that was recorded was, 'Father is unwilling to have CJ home. He doesn't want her medicated. He doesn't want her placed back in a group home. He does not want a mental health admission'. The result is that this, according to the treating team, places (Page 13)
emergency department staff in a very difficult position. CJ is extremely aggressive and agitated when unwell, placing herself and others at risk. 43 Mr J's response at the hearing to concerns such as these was quite emphatic. He said that the family's religious beliefs meant that they are opposed to certain things, in particular anything 'Eastern' – for example, meditation. He said that from his research the whole concept of 'self-esteem' was not a Christian concept, and was to be opposed. He made a statement that I consider worth repeating, namely, that 'criminals have self-esteem', as justifying why such a concept could have no part to play in CJ's treatment. 44 In a subsequent written response, the parents made somewhat less emphatic points about these issues. They said they had considered various treatment options in the past, and could do so again if the treating team provided data and details of the proposals. They disputed some of the treating team's statements regarding preventing social activities, although they did not dispute that at least once they had not agreed to a LWB worker visiting CJ in hospital because, they said, it was an unnecessary expense as the hospital already had staff who could care for CJ. Overall, the parents thought that social outings should be with family members. 45 CJ said at the hearing that she would try these various forms of therapy if her parents agreed, but not otherwise, and that the things recommended were not consistent with the family's religious views, which she shared. Against that statement is a suggestion from the treating team that CJ has said at times that she is quite willing to try these treatment options. 46 I summarise my assessment of these issues as follows: a) I must say that what I heard and what I have read concerns me greatly. CJ's disabilities affect her day-to-day behaviour and her wellbeing greatly. Her quality of life has been and may well continue to be greatly diminished. On the issue of the availability of the guardians, I agree with the observations made by the Public Advocate's representative that it is most unfortunate if CJ is admitted to a hospital ward if that is not really necessary, and that will be particularly so if it is under the MH Act. (Page 14)
b) A guardian who deliberately makes him or herself not available will be failing to act in accordance with the guardian's obligations to act in the person's best interests if no alternative appropriate arrangements are in place. Anything that restricts or prevents effective treatment, including any psychosocial interventions that may help CJ better cope with her difficulties or give her skills that will help in future, could hardly be seen at first glance as being in her best interests. I am in no doubt that the treating team has tried to explain the nature of the interventions they would like to try, and the possible benefits that may accrue from them, so I do not accept the parents' contentions that they have never had a formal or properly detailed proposal to consider. c) Equally, I am in no doubt that the parents have not given those possible interventions the objective assessment that they deserve. Bearing in mind what Mr J said at the hearing, it seems to me that the parents may have allowed their religious views to cloud and colour their assessment. In one sense there is nothing wrong with that. Treatment and other lifestyle decisions will often reflect values that the decision-maker holds dear, whether they come from religious points of view or other perspectives, but the obligation on a guardian is to make decisions in the best interests of the person concerned. d) Section 51 of the GA Act provides guidance as to how that can be assessed. That section expressly refers to consulting the represented person, maintaining supportive relationships that the person has, and maintaining the person's familiar cultural, linguistic and religious environment. e) However, in my view, none of that can justify a guardian rejecting treatment options or declining to make a treatment decision for a represented person for reasons that depend too heavily on religious views that exclude appropriate and modern modes of treatment - without giving those treatment options an objective and considered assessment, to see if they may, notwithstanding religious beliefs to the contrary, bring some benefit to the represented person. (Page 15)
f) In CJ's case, I have no clear statement regarding how these possible treatment options conflict with the principles of the parents' religious faith. I only have assertions that things associated with anything 'Eastern' are unacceptable, and that self-esteem is not a Christian concept. It is by no means clear to me that CJ's parents have brought an open mind to the options presented. I would be the first to accept that, in many ways and over considerable time, her parents have tried many ways of dealing with CJ's problems, but it seems to me that they have approached the problem from a too-narrow perspective and they have, by their own statements, tried to be over-protective and over-prescriptive. g) To complicate the picture, because of the intractability of CJ's condition and her extraordinary number of presentations to hospital, it is not surprising to me that any treating team would be, to some extent, frustrated by an approach of a guardian that ruled out treatment options without proper consideration. It is no surprise to me that communication difficulties have arisen, as the treating team tries to present options and the parents respond negatively, in a way the treating team believes to be ill-considered. 47 The result of all this is that I do not believe that CJ's bestinterests have always been served, despite my belief that her parents have always wanted to do the best thing and they think they are doing just that. As a consequence, I have had to consider carefully whether to change either the guardianship or the administration order by removing the parents from those roles, or by making some other order that may limit or direct what the guardian or administrator may do. 48 I have concluded on balance that I will leave CJ's parents as her guardian and administrator, but that I will impose certain conditions on how they are to do those jobs. My reasons for this are as follows: (Page 16)
positively to some new respite arrangements, plus the fact that CJ is said to have re-engaged with LWB, and the position overall is said to be improving. c) The treating team does not rule out the parents continuing as guardian and administrator, provided their concerns can be addressed and they can seek further review if necessary. d) I hope that the current review process will have caused the parents to reflect on how their approach to their roles as guardian has made the task of the treating team more difficult, and caused the treating team to hold real fears for the welfare not only of CJ, but also others who may be affected by her behaviour, and also to reflect on whether their approach, however well intentioned, may not have always operated in CJ's best interests. 49 For the time being, I consider it appropriate to leave CJ's parents as administrators. No criticism has been made of how they are doing that job, and I accept their evidence that they are attempting to give CJ greater involvement in decision-making, as well as managing her allowance day-to-day. As I noted previously, that position may change if CJ began living somewhere else on a full-time basis, or if some other person were to be appointed as CJ's guardian. 50 My conclusions are, therefore, that the administration order made in September 2011 should be confirmed, with the parents as plenary administrators. The guardianship order made in September 2011 should also be confirmed, with the parents as limited joint guardians. The functions regarding education and employment can be deleted, as they do not appear to be still required, but all other functions should continue. 51 However, I will add to the guardianship order a condition that the appointment of the guardians is subject to the condition that, in the performance of the functions and powers vested in them as guardians, they are to do the following: a) make themselves available at all reasonable times to respond to any contact from any health practitioner involved in the care of the represented person; (Page 17)
52 The purpose of these conditions should be clearly understood by the guardians. Firstly, they emphasise the fine balance between retaining them as guardians, and replacing them. They emphasise the extreme seriousness of the need for them to consider carefully each and every proposal from the treating team regarding CJ's possible treatment and other factors, and it requires them to justify their decisions to not accept recommendations of the treating team in a way that will inform any future review of this guardianship order, so that there can be no doubt what was proposed and what was agreed to or refused by the guardians, and why. 53 It is regrettable that this degree of formality is required, but it does reflect my considerable concerns that CJ's parents, despite their best intentions for their daughter, may not in fact always be serving her best interests. In the end, I am willing to allow the parents to carry on as guardians and administrators, but under orders that will, I hope, permit a better level of communication with CJ's treating team, and also permit a better scrutiny and assessment of the position in future. 54 These orders will need to be reviewed, and I order that they are to be reviewed in one year's time. That will allow enough time to see if things are working. I note that any party can apply to the Tribunal at any time for a review of these orders should there be a change of circumstances or should there be any other sufficient reason to justify a review. |