Sarah Tucker

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Quality Network for Forensic Mental Health
Services Key Findings Cycle 2

• Sarah Tucker
• Programme Manager
• Kerry Painter
• Quality Improvement Worker

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Overview

• Background
• Key findings
• Feedback from members
• Next steps

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Background, Aims and Principles Quality Network
for Forensic Mental Health Services

• Background
• Established 2006 as the Quality Network for MSUs
• Aims and Principles
• Facilitate quality improvement in forensic mental
  health settings through a supportive peer-review
  network
• Adopt a multi-disciplinary approach to quality
  improvement
• Listen to and be led by frontline staff and
  service users
• Identify areas for improvement through a culture
  of openness enquiry rather than inspection or
  blame

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Progress

• Successfully completed 2nd cycle of reviews for
  54 wards across 16 units
• Consultation event with DH November 2007
• Published implementation criteria for recommended
  specifications for adult medium secure services
• Published standards and criteria for women in
  medium secure care
• Recruited Service User Experts to Advisory Group
• Active email discussion group

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Member Units Cycle 2

• Central Mental Hospital Health Service
  Executive
• Fromeside Clinic 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
• Sitwell Unit and Geoffrey Hawkins Unit
• St Andrews Health Care
• Three Bridges West London Mental Health NHS
  Trust

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Member Units Cycle 2 (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
• Trevor Gibbens Unit - Kent and Medway NHS and
  Social Care Partnership Trust

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Clinical Audit Cycle

Revise Criteria
Self-review
Annual conference and presentation of aggregated
data
Peer-review
Action planning
Local Report
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Peer reviews Cycle 2

• 79 MSU staff participated as peer reviewers
• 240 MSU staff were interviewed as part of the
  review visits
• Over 100 service users were interviewed

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Key Findings Cycle 2

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Relational Procedural Security

• Less than half of the units provide adequate
  educational services
• ¾ of units do not have formally agreed
  contingency plans with the emergency services
• Over ¼ of units do not have a procedure regarding
  the control of illicit substances
• ¼ of units do not have a policy for prescribing
  drugs above BNF recommended dosages

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Physical Security

• 15/16 units carried out planned and recorded
  daily inspections of the perimeter to detect
  damage and/or contraband.
• Only 6 units had security that prevented the
  passing in of contraband items
• Only ½ the units were well designed
• ¼ units do not provide all staff with personal
  alarms
• 1/3 of units do not have a way for patients to
  raise an alarm

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Personal Dignity

• Most patients spoke positively about staff
• The primary healthcare needs of patients in ½ of
  the units are not being met
• Only ¼ of units provide patients with good
  quality food
• ½ of the units provide a good quality environment
  that is well maintained.

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Core Interventions

• ¼ units have short staffed psychology departments
• Limited access to creative therapies and family
  therapy and offender related treatments e.g. SOTP

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Staff

• Only 1/2 of the units staff have individual PDPs
  that are annually updated
• About a quarter of the units provide staff with
  annual security awareness training.
• 0/16 units provide one hour of supervision a
  months for all staff.

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Patient Carer Involvement

• Only ½ of units consult patients about policies
  and procedures
• Carer Involvement policies are in place but
  reviewers reported little evidence of routine
  involvement
• Carer involvement is variable

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Feedback from members

• The self-review provided a useful focus.
• The quality network in my opinion helps to
  ensure that best practice is shared and that
  services learn from similar organisations across
  the country.
• There are benefits both to the service being
  reviewed, but also from being involved in the
  review team.

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What next?

• Cycle 3 commences May 2008
• Lead reviewer training 13 May 16 September
  2008
• Prison In-reach
• Low secure and high secure services
• National Service Mapping and Cost Study
• Consolidate close working relationship with DH
  and regional commissioners

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Contact Details

• Sarah Tucker
• Programme Manager
• 020 7977 6661
• stucker_at_cru.rcpsych.ac.uk
• Kerry Painter
• Quality Improvement Worker
• 020 7977 6665
• kpainter_at_cru.rcpsych.ac.uk