Download dorset healthcare nhs foundation trust

FOR INFORMATION ONLY
REPORT TO HEALTH SCRUTINY COMMITTEE ON THE HEALTHCARE COMMISSION’S
REVIEW OF ACUTE MENTAL HEALTH INPATIENT SERVICES
1.
The Healthcare Commission awarded the Trust the highest overall rating of Excellent.
The review relates to St Ann’s Hospital which treats people with serious mental illness requiring
inpatient care from Purbeck, Wimborne, Christchurch, Poole and Bournemouth. It also
provides specialist services for the whole of the County (e.g. low secure unit, mother and baby
unit, eating disorders, etc)
2.
The Trust is the highest rated in the South West Health Authority area.
3.
We are the third highest in England out of the 69 Trusts which provide mental health services.
4.
The Trust is particularly proud that we are only one of two Trusts in the country to have scored
Excellent for both the Community Mental Health Services and Acute Inpatient Reviews by the
Healthcare Commission.
5.
Trusts were scored on four criteria which are set out below with our Trust’s individual scores:



6.
7.
8.
Effective Care Pathway
Individualised Whole person Care
Involvement with service user and carers
Safety
4
4
4
3
(Excellent)
(Excellent)
(Excellent)
(Good)
The Trust is particularly pleased at the recognition of:
An effective integrated care pathway with involvement from the Crisis Resolution Home
Treatment Team to ensure that admissions are appropriate.

Service users offered sufficient access to staff and a range of appropriate interventions
(including the pioneering Tidal model) to meet their needs.

Service users and carers are given information and involved in decisions about their care
and treatment, how the ward is run and helping to improve the service.

Staff training in prevention or handling of violence and aggression.

The range of activities provided for service users including evenings and weekends.
We were disappointed that we did not reach an Excellent score on the fourth criteria of safety.
The reasons we did not are primarily:a)
the condition of the building. This will be rectified by the Trust’s £35 million investment
over the next few years to refurbish the wards so that everyone has their own individual
room preferably with ensuite facilities as well as new modern low secure units and
psychiatric intensive care units being built.
b)
staff training in dealing with service users who use alcohol or drugs - All of the Trusts
scored the same on this. We were surprised at our score as we have always given a
high priority to staff training. However, we will ensure that all staff are fully trained on this
subject over the remainder of this year.
The Trust realises that there are still things to improve and we want to do this to make sure we
provide the very best assessment and treatment for local people. As soon as we got the
provisional scores we started working on a detailed action plan and this is currently being
finalised via the hospital’s Acute Care Forum of service users, clinicians and managers. We
want to reach the highest standards on those aspects which did not reach the excellent level
and we want to try and do even better where we were rated highly. Particular areas that we are
focussing on in addition to those stated in para 7 are:-
9.

Many improvements only require simple changes to our data collection as we do not think
the data supported the true position in all cases.

For example, the standard of the proportion of care records where a range of care
planning tasks were completed to cover the first 72 hours of admission was based on 50
care records audited by the Healthcare Commission. Since the time of that audit last
year, changes to the admission arrangements have been introduced and all new service
user admissions are now via the Acute Admission Unit which sees all people when first
admitted and draws up care plans. A further detailed audit undertaken by our Consultant
Nurse in January this year showed 100% compliance with this standard.

The proportion of discharges that occurred early with support from the Crisis Resolution
Home Treatment Team during October 2006 to March 2007 - the Trust Crisis Resolution
Home Treatment Team has developed significantly since the time of the Healthcare
Commission review following the St Ann’s public consultation during the latter part of last
year and we believe that discharges which should happen early are now done with
support where appropriate from the Crisis Resolution Home Treatment Team. We are
currently analysing data for the first quarter of this year and expect to reach level 4.

The proportion of care records on which service users consent to treatment was recorded
– our records showed 80% against the required excellent standard of 95%. This is based
on 46 notes audited of which there was appropriate recording in 38 notes. Nursing staff
have been reminded that it is important that service users consent is recorded in the
notes and this is also now highlighted in the staff shift handover sheets.

Staff reporting having experienced physical violence, bullying, harassment or abuse – the
Trust Board and Management Team have been giving extra closer attention to this and
brought in a number of measures to avoid or minimise this happening. We recognise that
the clients with whom we are dealing, particularly in low secure units, may have more
challenging and in some cases violent behaviour but we wish to safeguard staff and are
working hard to improve matters. We are working jointly with the Staff Unions on this.
We are also working jointly with the Staff Ethnic Minority Group in respect of those cases
where staff may have experienced racial abuse.
I hope that this report is helpful to the Health Scrutiny Committee. We are happy to provide any
further information or progress reports for the Committee as it wishes. The Trust is committed
to continuing to develop more treatments and support to people in their own homes or near to
home and to avoid hospital admission but also to ensure that there are the highest standards of
care and environment for those people who do have to be admitted to acute inpatient care.
Roger Browning
Chief Executive
21 August 2008
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21 August 2008
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