APPENDIX 2 REPORT OF MENTAL HEALTH ACT COMMISSION VISIT TO GLOUCESTERSHIRE PARTNERSHIP NHS TRUST ON 7 JANUARY 2004 1. OBJECTIVES OF THE VISIT • • • • 2. 2.1 To visit all the units in this part of the Trust where there are detained patients. To make contact with or interview in private as many detained patients as possible. To check the statutory documentation. To meet with members of staff.
METHODOLOGY Commissioners met with staff and senior management at the beginning and end of the day. The following wards were visited. Montpelier, Greyfriars, Dean, Abbey, Priory and Kingsholm at Wotton Lawn Hospital. Holly House, Colliers Court, Fieldview and Laurel House. On the day of the visit there were 47 detained patients 30 men and 17 women. 13 were on leave. Commissioners interviewed 12 patients in private and a further 5 were contacted. They were generally happy with their care and most issues were settled at ward level. One patient on Priory Ward complained about an incident. Further information is provided in the confidential annex. Recommendation 1 An investigation into this matter should be conducted.
2.2
2.3 2.4
2.5
2.6
3.
CONCLUDING COMMENTS Commissioners were of the opinion that this is a well run service with excellent staff and good facilities, some environmental improvements are needed.
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4. 4.1
ISSUES ARISING MENTAL HEALTH ACT DOCUMENTATION The documentation was generally in good order. The date for the application for admission was one month before the patient was detained. This renders the detention illegal. Staff spoke to the patient and the statutory forms were re-done. Recommendation 2 The scrutiny process should ensure that mistakes of this nature do not occur.
4.2
MENTAL HEALTH ACT TRAINING Training is not mandatory, the managers stated that it is always available and staff can seek advice when needed. It is important to ensure that all staff, particularly in outlying units are given regular updates in the provisions of the Act.
4.3
CONSENT TO TREATMENT (SECTION 58) Montpelier Ward/Kingsholme A patient was being given medication which was not included on the Form 39. In the case of 3 patients it was not possible to find evidence that that the RMO had recorded the patient’s capacity and consent. There was no record at Laurel House that the RMO had informed 2 patients of the SOADs decision about medication. Recommendation 3 The provisions of the Code of Practice chap 15 and 16 must be followed.
4.4
STAFFING Patients on the wards spoke well of the staff . Staffing levels are down, problems have been experienced with retention, qualified members of staff apply for jobs in the community. This is a problem experienced by many Trusts. Recommendation 4 If the Trust can set up a career pathway for qualified staff in the Acute Units this may assist the difficulties with retention.
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4.5
ENVIRONMENT PRIORY WARD The bathroom needs redecorating, and the carpet needs replacing in one double bedroom. ABBEY WARD Work is being done to upgrade the smoking room and the shower . COLLIERS COURT There are four bedded dormitories at this unit. They do not even have washbasins and the patients have to use bowls. This is not acceptable. Recommendation 5 The environmental issues listed need to be resolved.
4.6
PSYCHOLOGY There is no inpatient psychology, although patients are able to access psychological treatments in the community. Staff on Priory Ward are of the opinion that psychology would be particularly helpful in the care and treatment of two patients on the ward at this time. Recommendation 6 The Trust should investigate providing access to psychology while patients are on the wards.
4.7
ACTIVITIES The provision of a gym and a sports therapist is much appreciated by patients. Weekend activities are limited but staff informed commissioners that efforts are being made to increase activities, where this is possible.
4.8
SPECIFIC ISSUES FIELD VIEW The Commissioner who visited expressed the view that the staff are very dedicated and skilled. The patients are to be moved to a new unit in Stroud (the new Hollybrook).
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Recommendation 7 The Trust policy should be very clearly set out stating. 1 The reasons for the use of seclusion. 2 The reasons why the RMO is not able to check patients during seclusion. HOLLY HOUSE The Commissioner who visited this unit felt that the care given to the patients by a good loyal staff team is exemplary.
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ISSUE IDENTIFIED
ACTION REQUIRED
RESPONSE
LEAD OFFICER
TARGET DATE FOR COMPLETION
1. Administration of Nursing staff must unauthorised drugs on ensure all drugs are Form 39. properly authorised. It is illegal to administer unauthorised medication. (Code of Practice Chapter 16) 2. No discussion about The RMO must record capacity or consent a discussion with the recorded by the RMO patient about capacity at Montpellier and and consent at the Kingsholm Wards. time a Form 38 is completed. (Code of Practice paragraphs 16.9 and 16.13.) 3. There was no record The RMO must inform that two patients at the patient about the Laurel House had SOADs decision at the been informed of the time a Form 39 is SOADs decision about completed and make medication sure a note to say this has been done. (Code of Practice paragraph 16.27)
A check list from Care Group Manager – May 2004 another Trust has Working Age Adults been recommended. This will be discussed with Senior Nurses and implemented. Write to all consultants identifying good practice and requesting a response Medical Director 31 May 2004
Write to all consultants identifying good practice and requesting a response. Develop a checklist to support good practice.
Medical Director
31 May 2004
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ISSUE IDENTIFIED 4. There are difficulties with retention of qualified staff. Experienced staff apply for jobs in the community.
ACTION REQUIRED A career pathway for qualified staff working on the acute units may be a way forward.
RESPONSE
LEAD OFFICER
TARGET DATE FOR COMPLETION Review in September
5. On Priory Ward a bathroom needs redecorating, the carpet in one double bedroom is in bad condition. At Colliers Court the four bedded dormitories with no wash basins are out dated.
Work to develop Acute Care Group Manager – Inpatient Nursing as a Working Age Adults specialty is underway. A new course has been developed and started this year. There is also a group looking at the changing roles of unqualified staff. This work links in with the work of the Acute Care Forum as mentioned at Point 6. These environmental Refurbishment issues need to be completed. resolved. The issue of future in- Care Group Manager – patient provision is Older People Services under review with our Commissioners. Until then highly physically dependant patients will be nursed in rooms that have washbasins en suite.
March 2004
Review of services – May 2004 Practice – immediate
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ISSUE IDENTIFIED
ACTION REQUIRED
RESPONSE
LEAD OFFICER
TARGET DATE FOR COMPLETION September
6. There is no inpatient Staff are of the opinion psychology at Wotton that patients could Lawn. benefit from psychological input while on the acute wards. It would be beneficial if this could be arranged. 7. Seclusion is used The Trust policy frequently for short should state the need periods at Fieldview. to: a) set out the reasons for the use of seclusion b) the reasons why the RMO is not able to check patients during seclusion as required by the Code of Practice paragraphs 19.16 to 19.22.
AHP Skill Mix Review Care Group Manager – Review completed as part of Working Age Adults 2004 the Acute Care Forum work. Psychology identified as a priority. Work continues through this Forum. The Operational Policy Medical Director of the new Hollybrook is presently under review and this will be constructed so as to prevent the use of seclusion that is not consistent with Best Practice (the Code of Practice). The use of the extra care area for care planned treatment in a low intensity environment will continue. April 2004
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