Hospital managers are very similar to Tribunals, with some differences:

• There are almost invariably three people on the panel.
• Decisions must be taken by a majority comprising at least three people. In practice, panels almost invariably consist of three members so they must be unanimous. By contrast, Tribunals can make majority decisions to discharge.
• There is no legal or medical member on the panel, and they are generally less willing to discharge patients.
• As there is no medical member, there is no medical examination before the hearing.
• In practice they have the power to discharge unrestricted patients only (because the MoJ must consent to their discharge of restricted patients).
• They are organised by the hospital MHA Administrator, whereas Tribunals are organised by the Tribunal secretariat in Leicester.
• Rather than granting deferred discharged they tend to adjourn for a further hearing.
• There are no eligibility periods: an application can be made at any time.

According to the Code of Practice 2008:

31.11 Hospital managers:

• may undertake a review of whether or not a patient should be discharged at any time at their discretion;
• must undertake a review if the patient’s responsible clinician submits to them a report under section 20 of the Act renewing detention or under section 20A extending SCT;
• should consider holding a review when they receive a request from (or on behalf of) a patient; and
• should consider holding a review when the responsible clinician makes a report to them under section 25 barring an order by the nearest relative to discharge a patient.

31.12 In the last two cases, when deciding whether to consider the case, managers’ panels are entitled to take into account whether the Tribunal has recently considered the patient’s case or is due to do so in the near future.

The managers' unfettered power to discharge is contained in s23; guidance on procedure and discharge criteria can be found in Code of Practice chapter 31.