Quality Network for Forensic Mental Health Services

1
Quality Network for Forensic Mental Health
Services

• Preliminary Findings Third Annual Cycle
• Sarah Tucker, Programme Manager
• Kerry Painter, Deputy Programme Manager

2
Overview

• Peer-reviews Cycle 3
• Expansion of the quality network Cycle 4
• Future developments and events
• Preliminary findings Cycle 3

3
Peer-reviews Cycle 3

• 68 wards across 22 units
• 98 MSU staff participated as peer-reviewers
• Over 340 MSU staff were interviewed as part of
  the review visits
• Over 140 service users were interviewed

4
Member Units - Cycle 3

• Arnold Lodge Nottinghamshire Healthcare NHS
  Trust
• Central Mental Hospital Health Service
  Executive
• Edenfield Centre Greater Manchester West Mental
  Health NHS Foundation Trust
• Fromeside Avon and Wiltshire Mental Health
  Partnership NHS Trust
• Humber Centre Humber Mental Health Teaching NHS
  Trust
• Newton Lodge South West Yorkshire Mental Health
  NHS Trust
• Ravenswood House - Hampshire Partnership NHS
  Trust
• Shannon Clinic South and East Belfast Trust
• Seacole Unit and Geoffrey Hawkins Unit
• St Andrews Health Care
• The Orchard West London Mental Health NHS Trust

5
Member Units - Cycle 3 (cont)

• Cygnet Hospital Stevenage Cygnet Healthcare
• North London Forensic Service - Barnet, Enfield
  Haringey Mental Health NHS Trust
• Forensic Services Directorate - Northumberland
  Tyne Wear NHS Trust
• Butler Clinic - Devon Partnership NHS Trust
• Bracton Centre Oxleas NHS Foundation Trust
• Ashen Hill Sussex Partnership NHS Trust
• Hutton Centre Tees Esk and Wear Valleys NHS
  Trust
• Reaside Clinic - Birmingham and Solihull Mental
  Health Foundation Trust
• Runwell Hospital - South Essex Partnership NHS
  Trust
• Trevor Gibbens Unit - Kent and Medway NHS and
  Social Care Partnership Trust
• Wathwood Hospital Nottinghamshire Healthcare
  NHS Trust
• Linden Unit Affinity Healthcare

6
Responding to Review Findings Supervision

• Aggregated finds from cycles 1 and 2 showed staff
  supervision was not taking place across most
  units
• Advisory Group Organised a Workshop in Response
• Addressing the Challenges of Supervision in
  MSUs - February 2009
• Aims
• troubleshooting on supervision for nursing and
  other frontline staff
• interactive event for MSU nurses, supervisors and
  managers
• exploration of what hinders the provision and
  uptake of supervision
• A context in which to share and develop
  supervision and training policies
• Attended by representative cross section of staff
• Key themes to be disseminated across Quality
  Network Members

7
The Expansion of the Quality Network

• Cycle 4 expect approx 300 wards across 71
  medium secure services
• Increased project team capacity
• Training of reviewers
• 100 already trained
• 3 more reviewer training days planned 2009
• Length of peer-reviews
• 1-4 wards 1 day, 5-7 wards 1.5 days, 8-12 wards
  2 days

8
Future Developments Events

• Proposal for developmental reviews
• National Report end April 2009
• Lead Reviewer Trainings
• 19 May, 2 June, 15 September 2009
• Outcome and Activity Measures Workshop Tuesday 5
  May 2009
• New members What to expect in Cycle 4

9
Cycle 3 Preliminary Findings
10
The Total Percentage of Met Criteria Across Units
11
Average Percentage of Met Criteria
12
AchievementsStaffing and Therapy

• Approx 4/5 of units have an appropriate ratio of
  consultants to patients
• The majority of units have sufficient nursing
  staff to safely meet the needs of the patient
  group
• For the majority of units the programme of
  therapy includes
• Psychological sessions
• Occupational Therapy
• Substance misuse therapy

13
AchievementsTraining and Patient Focus

• 95 of units provide staff with a basic security
  induction on 1st day at service
• 86 units have implemented policy to meet the
  cultural needs of patients
• The majority of units provide patients with
  access to an independent civil advocacy service
• 95 units use feedback from patients and carers
  to improve the quality of the service

14
ChallengesPhysical and Procedural Security

• 1/3 of units do not fully meet the criterion
  regarding the secure perimeter
• Just over 1/2 of units were observed to be well
  designed
• Only 1/4 of units have CCTV coverage in child
  visiting areas
• Only 1 unit was found to meet all the criterion
  regarding the child visiting area
• Less than half of units review their policies
  annually

15
ChallengesStaff and Training

• 1/3 of units reported using bank or agency staff
  to cover staff shortages on the wards
• 1/4 of units do not meet the requirement that
  mandatory training is undertaken and regularly
  updated
• Almost 1/2 of units offer training in the
  management of relationships between patients and
  between staff and patients
• Only 1/4 of units met all of the criteria
  relating to gender-specific training

16
ChallengesPatient Focus

• 1/3 of units do not have an implemented policy
  for the consultant and involvement of carers
• 1/3 units do not show evidence of patient
  involvement in a range of aspects of the service
• Almost 1/2 of units do not explain patients
  rights and what they can expect

17
ChallengesEnvironment and Amenities

• Only 1/2 of units have access to dietary advice
  and support form a qualified dietician
• Service users were not satisfied with the meals
  provided at 1/2 of the units
• 1/3 units did not have an adequate number of
  small and large rooms

18
ChallengesPublic Health

• Almost 1/2 of units do not provide patients with
  access to a primary healthcare service
• Only 1/3 of units provide women with access to a
  female GP and Practice Nurse
• 1/3 of units do not provide access to screening
  programmes that are available to the general
  public

19
ChallengesClinical Supervision

• 2/3 of units have a programme of clinical
  supervision
• Only 1/4 of units provide all staff with one hour
  of supervision per month
• 1/3 of units do not facilitate a reflective
  practice group
• 1/4 of units do not monitor and audit staff
  take-up of supervision

20
Comparison Data from Cycles 1, 2 and 3
21
In Summary

• The key challenges for Cycle 3 members were
• Primary Healthcare
• Supervision
• Environment and Design
• Staffing

22
Contact Details

• Sarah Tucker
• Programme Manager
• 0207 977 6661
• stucker_at_cru.rcpsych.ac.uk
• Kerry Painter
• Deputy Programme Manager
• 0207 977 6665
• kpainter_at_cru.rcpsych.ac.uk
• Maddy Reeve-Hoyland
• Quality Improvement Worker
• 0207 977 6662
• mrhoyland_at_cru.rcpsych.ac.uk