Quality Network for Forensic Mental Health Services

Transcription

1 Quality Network for Forensic Mental Health Services Annual Report Cycle 6 Annual Report Quality Network for Forensic Mental Health Services Editors: Sarah Tucker, Maddy Iqbal, Ilham Sebah and Sarah Stubbs Publication Number: CCQI124 Date: May

2 The Quality Network ran a competition to find a piece of service-user artwork to use on the front cover of the Cycle 6 Annual Report. The winning design was painted by a service user from The Kenneth Day Unit. The team would like to thank all of the service-users who submitted entries. 2

3 Contents Preface 5 Introduction 7 Overview 13 Key Themes 17 Recommendations 19 Key Findings 21 A. Safety and Security Physical Security Procedural Security Relational Security Serious and Untoward Incidents Safeguarding Children and Child Visiting Policies 30 B. Clinical and Cost Effectiveness 32 C. Governance 34 D. Patient Focus 36 E. Accessible and Responsive Care 38 F. Environment and Amenities 40 G. Public Health 42 APPENDICES A. Aggregated Data 44 B. Member Units C. Examples of Good Practice 60 D. The Review Process 89 E. Project Team 91 F. Advisory Group 93 3

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5 Preface I am very pleased to introduce this report from the Quality Network for Forensic Mental Health Services summarising the key findings of the 6th annual peerreview cycle of 69 medium secure units across England, Wales and Ireland. Once again it is rewarding to see that in line with a central aim of the Quality Network, namely to provide a national driver for improving the quality of medium secure services, over the last three years services across the network have improved across all but one of the standard domains. I am particularly proud of the service user and carer involvement in the process of running the network and of the reviews themselves. The input from our service users and carers is noted in the introduction to this report. It is an area of growth and development for the Quality Network and we are extremely grateful to the committed group of service users and carers who work with us to this end. It is also well worth drawing attention to Appendix C of this report (Examples of Good Practice). This provides a great resource for services to contact each other to find out more about what they do well. This year the project team have again worked closely with staff and service users from member services to organise troubleshooting workshops in response to key findings and recommendations from Cycle 5. These workshops are extremely popular and described in more detail in the introduction. Looking to the future, the Quality Network has recently launched a comparable network for low secure services. We look forward to reporting back on the first cycle of this new venture next year. Dr Paul Gilluley, Chair Advisory Group 5

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7 Introduction The Quality Network for Forensic Mental Health Services was set up in 2006 at the College Centre for Quality Improvement. The sixth annual cycle of the Quality Network is now complete ( ) and this report summarises the aggregated results of the reviews undertaken across 69 medium secure units (295 wards) in England, Wales and Ireland during this period. Using a multi-disciplinary approach, the Quality Network facilitates quality improvement and change through a supportive peer-review process. The Quality Network serves to identify areas of good practice and achievement as well as areas for improvement by promoting a culture of openness and enquiry between peers. A fundamental principle of the Quality Network is that service users and front line staff are central to integral and sustainable quality improvement; this is reflected in the structures and processes used by the project. Member units can use the results of reviews to develop action plans in order to achieve year on year improvement. They can also share their results with key groups locally, including commissioners, health and local authorities, those making referrals to their services and local user and carer groups. What does the Quality Network for Forensic Mental Health Services do? The Quality Network s activities include: Developing and applying criteria for forensic mental health services through a system of self and external peer-review; Supporting local implementation of the Best Practice Guidance: Specification for adult medium-secure services, Department of Health 2007; Producing reports for participating services that highlight areas of achievement and areas for improvement; Providing a national benchmarking service to allow services to compare their activity with other services; Facilitating information-sharing about best practice between members of the network; Organising workshops to support services to share information and troubleshoot on shared problem areas; Supporting routine data collection, e.g. regarding clinical and cost outcomes; and Promoting service user and carer involvement at all stages of the review process. A full description of the Quality Network s review process and activities can be found in Appendix D. Responding to Cycle 5 Recommendations The Quality Network made four recommendations in response to the key areas for improvement during peer-reviews in Cycle 5 ( ). For each recommendation, the project team at the Quality Network undertook tasks aimed at supporting member services to share and implement good practice. In this way the Quality Network has offered opportunities for services to learn from each other over and above the core peer-review visit process. This work has been disseminated across the network and posted on the website

8 Recommendation 1: Opportunities to Work The Quality Network recommended focussing on ways of providing opportunities for work within the secure perimeter (e.g. horticultural projects, librarian posts, working in a patient shop or café, painting and decorating), investigating local volunteering and establishing links with external agencies to support service users in accessing work projects, both within the medium secure perimeter and in the community. In response to this recommendation the Quality Network held a workshop on 25 January The workshop aimed to be an interactive event for professionals and service users in medium secure services and to provide a forum for troubleshooting on the provision of work opportunities, to explore what hinders the provision of such opportunities and to provide a context in which to share good practice in the provision of work opportunities. The workshop was attended by over 50 staff and service users. Following the workshop the Quality Network presented key themes arising at the Annual Forum on 1 May 2012 and published a summary leaflet of the problems and solutions discussed 2. In addition the Quality Network published a themed newsletter in December 2011 containing articles from across the network staff and service users on the topic of creating opportunities for work. Recommendation 2: Recovery Plans The Quality Network recommended improving service user input and access to recovery plans by for example identifying staff and patient recovery leads, and developing workshops to share learning from the use of the recovery tools. In response to this recommendation the Quality Network held a workshop on 10 January The workshop aimed again to be an interactive event for professionals and service users in medium secure services and to provide a forum for sharing good practice and troubleshooting service user involvement in recovery and recovery plans. The workshop was attended by over 100 staff and service users. Following the workshop the Quality Network presented key themes arising at the Annual Forum on 1 May 2012 and published a summary leaflet of the problems and solutions discussed 3. In addition the Quality Network published a themed newsletter in April 2012 containing articles from across the network staff and service users on the topic of recovery 4. Recommendation 3: Induction for Staff who work with Women in MSUs The Quality Network recommended focussing on the provision a specific and formal induction programme addressing the needs of women in medium secure care to be delivered to all new members of staff, and not just those working on the female wards. In response to this the Quality Network consulted with member services via to gather examples of staff inductions for working with women in medium secure care. The information gathered was posted on the discussion group as a way of sharing good practice. Recommendation 4: Access to Education The Quality Network recommended units focus on providing access to education. For example ensuring that patients have risk assessed access to the internet to allow them to access distance learning courses, establishing links with local colleges, and using clinical governance structures to create financial support for education

9 In response to this recommendation the Quality Network held a workshop on 24 January The workshop aimed again to be an interactive event for professionals and service users in medium secure services and to provide a forum for sharing good practice and troubleshooting access to education. The workshop was attended by over 50 staff and service users. Following the workshop the Quality Network presented key themes arising at the Annual Forum on 1 May 2012 and published a summary leaflet of the problems and solutions discussed 5. In addition the Quality Network published a themed newsletter in December 2011 containing articles from across the network staff and service users on the topic of education 6 Standards Development This year the Quality Network published supplementary standards for deaf people in medium secure care 7 publishing an accompanying DVD in sign language which will be available on the website. In addition the network developed supplementary standards for psychotherapy in medium secure units to be published later in Both sets of supplementary standards were developed using the following process: 1) A literature review of key documents 2) On the basis of the literature review a first draft of standards was developed 3) Stakeholders and experts were consulted at meetings and workshops on the first draft of standards 4) On the basis of comments made a second draft of the standards was developed 5) Consultation across the quality network consulted electronically on the second draft 6) A final draft of the standards edited on the basis of consultation was presented at the Annual Forum. The Quality Network has also initiated work on the development of standards for low secure services and community forensic services using the same method. Annual Physical Security Workshop In response to findings two years ago in Cycle 4 concerning perimeter security the Quality Network facilitated a Physical Security Workshop in 2011 aimed at facilitating information sharing and troubleshooting problems concerning physical security. Following the success of this workshop it was agreed that the Quality Network would facilitate a similar workshop on an annual basis. This year security Leads and staff with an interest in security issues were invited to an event at Cheswold Park Hospital on the 9 th March 2012, the event was attended by staff from 40 services. Following the workshop the Quality Network presented key themes arising at the Annual Forum on 1 May 2012 and published an illustrated summary booklet of the problems and solutions discussed 8. Service User Involvement The Quality Network has continued to increase service user involvement during The service user expert team increased from 6 to 9. This team is involved in a number of key aspects of the project s work in an integral way. Service users conduct telephone conferences with local service user representatives at the host unit at the self-review stage and attend the peerreview visits as full members of the peer-review team. They make regular

10 contributions to the Quality Network s newsletter, present their work at the Annual Forum conference and are represented on the Advisory Group. The service user experts are supported in their work by an expert clinical advisor and the project team. This support includes preparatory meetings before Advisory Group meetings, regular interim support meetings (either in a group or individually), support during telephone conferences, day-to-day telephone support on arrangements prior to peer-review visits, meetings with staff from units where service user experts are in-patients to clarify roles risk and pre-empt any problems. Carer Representation During the Quality Networks two carer representatives, who are members of the Advisory Group, have worked with the project team to pilot telephone carer telephone conferences across 16 units. This has involved identifying carers willing to take part from member services, developing additional standards regarding carers to add to the self-and peer-review questionnaire, and conducting telephone interviews with the carers as part of the self-review for participating units. The carer representatives intend to roll these telephone conferences out across more member services during Cycle wards across 69 medium secure units participated in the sixth annual cycle. The self-reviews were completed by member units between July 2011 and February 2012, and the external peer-reviews were undertaken between September 2011 and March Out of the 69 member services, 38 cater for women in medium secure care. These services were also reviewed against the Standards and Criteria for Women in Medium Secure Care as well as the Implementation Criteria 9. Further to this, 22 of the services reviewed provide services for patients with Learning Disabilities and were reviewed against the newly implemented learning disability standards, as well as the implementation criteria 10. Figure 1 shows the distribution of participating units across England, Wales and Ireland. Figure 2 shows the proportion of NHS and Independent sector units Figure 1: Distribution of units 3% 4% 93% England Ireland Wales 9 In the appendix all criteria marked with a w denote the standards for women. 10 In the appendix all criteria marked LD denote the standards people with learning disabilities. 10

11 Figure 2: Proportion of NHS and Independent Sector Units 42% 58% Independant Sector NHS As part of the self-review services are asked to provide a range of information, such as their average occupancy and the average age of their patients. The average occupancy of units taking part was 87% 11, while the average length of stay was approximately one year and nine months 12. Approximately 290 staff participated as peer-reviewers, interviewing over 2000 staff and 320 service users in medium secure units. Service user telephone conferences were undertaken as part of the self-review at 99% of the member units, in preparation for the peer-review. On average Medium Secure Units received 78 referrals 13 during the period June 2010 June 2011, with of these being admitted to services on average. The typical wait for admission to Medium Secure Units is 58 days 15. This report This annual report summarises the aggregated results of the reviews undertaken by the 69 medium secure units who participated in Cycle 6 of the Quality Network ( ). It is structured around the seven sections of the Best Practice Guidance: Specification for adult medium-secure services, Department of Health The criteria forming the basis of the review process have also been mapped on to the Care Quality Commissions Essential Standards of Quality and Safety (March 2010) and the Department of Health Standards for Better Health (see Implementation Criteria for Recommended Specification: Adult Medium Secure Units 2 nd edition, The body of the report highlights achievements, areas for improvement, and gives examples of solutions to common problems. For anonymity purposes each unit has been assigned a number; the graphs on the following pages have been ordered on the horizontal axis by score so it is possible to see where each unit lies in comparison with the lowest, the highest and the average. The average score for each section has also been highlighted on the graphs. Appendix A is a full summary of the extent to which the 69 services met the criteria. 11 This figure is based on data returned from 91% of participating units. 12 This figure is based on data returned from 84% of participating units. 13 This figure is based on data returned from 77% of participating units 14 This figure is based on date returned from 83% of participating units 15 This figure is based on data returned from 59% of participating units 11

12 How members of the Quality Network for Forensic Mental Health Services can use this report: How well are we doing overall in comparison with the Quality Network? Your unit s local report provides you with a summary of the number of criteria which are rated as met, partly met and unmet, which then gives an average score for each area. These averages enabled us to obtain a measure of your unit s overall performance for each section of the criteria. Average scores for Cycle 6 are detailed in the key findings and in Appendix A so you can immediately see how well you are doing compared with the other units in the Quality Network. Each member has also been assigned a unique team number so that you can use the graphs in this report to compare yourselves with the rest of the Quality Network. What are the key areas of variance within the Quality Network? The key findings highlight areas identified within each section that best discriminate services from one another, and also those criteria considered to be critical to the quality of care provided. How can we identify other services that could provide advice or support on specific areas of service development? A summary of good practice that peer-review teams have identified during reviews is presented in Appendix C to aid information sharing amongst the Quality Network s members. ACKNOWLEDGMENTS: The project team gratefully acknowledges: The staff in member units who organised, attended and received peerreviews. Service users in member units who took part in the peer-review of their unit. The Advisory Group (see Appendix F) for their continuing support and advice. Our Advisory Group Service User Experts and Carers (see Appendix F) for their work promoting service users involvement within the Quality Network. 12

13 Overview This section provides an overview of the findings from the Cycle 6 review period. Figure 3 gives the average percentage of met criteria in each standard area; Figure 4 details the total percentage of met criteria across all the units and Figure 5 shows the improvements that units have made from Cycle 4, 5 and Cycle 6. Figure 3: Average Percentage of Met Criteria per Section On average, services were found to be compliant with 89% of the implementation criteria across all the standard areas. As the graph above highlights Procedural Security was the area in which units scored most highly, on average services met 97% of the criteria in this area, followed by Public Health and Serious and Untoward Incidents, where 95% and 94%, respectively, of the criteria were fully met. It is particularly commendable that services achieve so highly in relation to Public Health, given the close relationship the criteria in this standard area have with patient care. Further to this, it is praiseworthy that services were found to be compliant with 89% of the criteria in both Relational Security and Clinical and Cost Effectiveness and 88% of the criteria within Patient Focus. Safeguarding Children and Child Visiting was the area in which most challenges were identified by peer-review teams, on average services were found to fully meet 81% of the criteria in this area. The visiting facilities provided were noted to be a particular challenge, due to the location of the child visiting room or the lack of appropriate decoration and facilities. Accessible and Responsive Care and Environment and Amenities were also areas in which services achieved less well, partly or not meeting 18% and 17% of the criteria in these areas respectively. The number of beds on the wards was identified as a challenge within Accessible and Responsive Care for a number of services and ligature points, patient access to hot and cold drinks and snacks and the quality of the food provided were consistently identified as a challenge, within Environment and Amenities, for many member services. 13

14 Figure 4: Total Percentage of Met Criteria Across All Units Average: 89%

15 Figure 4 outlines the overall score each unit achieved during their peer-review. On average, services were found to fully meet 89% of the implementation criteria across the 11 standard areas. It is praiseworthy that over half of the units reviewed (38 out of 69) were found to be compliant with 90% or above of the implementation criteria. Further to this, no service was found to fully meet less than 69% of the criteria included in the Cycle 6 workbooks. Figure 5. Comparison between Cycles 4, 5 and Cycle 4 Cycle 5 Cycle 6 It is encouraging to see that improvements have been made, in the core criteria, within all but one of the standard areas from the last three cycles. Particular improvements have been identified in Clinical and Cost Effectiveness. In Cycle 5 the average percentage of fully met criteria was 72%; this has increased to 84% in Cycle 6. Particular improvements within this area relate to the implementation of the use of recovery plans for services users. During Cycle 5 only 53% of services were found to be compliant with this criterion, however during the Cycle 6 review 78% were rated as fully met for this particular criterion. In addition, whilst still an ongoing challenge for units, staff access to clinical supervision was found to be improved during the Cycle 6 reviews. Increasing on an annual basis from 28% in Cycle 4, to 43% in Cycle 5, to 60% compliance during Cycle 6. This is still an area in which significant improvement work is required in many services. Serious and Untoward Incidents and Environment and Amenities are other areas in which noteworthy improvements have been made. For example, improvements have been made in relation to the number of services fully meeting the criterion requiring there to be a Serious and Untoward Incident policy in place, which is reviewed on an annual basis. Previously this was fully met by 78% of services reviewed as is now fully met by 85%. In relation to Environment and Amenities the accessibility of a dietician for service users has increased from 76% in Cycle 5 to 91% in Cycle 6 and there has been a small improvement relating to service user satisfaction and the food provided (6%). 15

16 As the graph above depicts Safeguarding Children and Child Visiting was the only area in which improvements were not made from Cycle 5 to Cycle 6. It was found that 9% fewer services meet the criterion requiring there to be a policy in place addressing child visiting which is reviewed on an annual basis. During many of the reviews it was noted that many services have this policy in place however it is not reviewed on an annual basis, thus meaning that a number of services did not fully meet this criterion. In addition, within this standard area, challenges were identified in relation to the child visiting facilities provided at a number of units. As discussed above the appropriateness of the decor, the location of these rooms and the availability of certain facilities were identified as recurring themes across a number of member services. 16

17 Key Themes This section outlines the key issues that emerged from the reviews. It recommends action that units can take in response to the problems raised and action that the Quality Network for Forensic Mental Health Services will take to support services. Physical Security Aspects of Physical Security continue to pose a challenge to a number of the Network s member services. For example, only 54 of the 69 units reviewed (78%) were found to fully meet the criterion requiring there to be a secure perimeter in place. Indeed, five units were found to not meet this criterion at all and 10 were rated as partly met. Whilst the majority of units do have a secure perimeter in place, comprising of fencing and buildings peer-review teams on a number of review visits identified climb points which undermine the security of this area and provide an opportunity for egress from within the medium secure perimeter. Inappropriately located lights, cameras, air conditioning units and smoking shelters are some examples of climb points identified by peer-review teams which potentially weaken the Physical Security of a service. This is further evidenced by the fact that 25% of units reviewed either partly or did not meet the criterion requiring building roofs to be protected against climbing and climbing points were identified on roofs in courtyard areas in 18 of the units reviewed. Further to this, a number of peer-review teams identified issues with areas where the fence abuts a building, to form the perimeter, as sometimes gaps in this area can provide handholds for climbing. Facilities A number of issues were highlighted during the Cycle 6 reviews relating to the facilities provided to service users. Ligature points in bathroom areas Of the 69 units reviewed only 29 fully met the criterion requiring bathroom and shower areas to be free of ligature points. Thirty four services were rated as partly met and six as unmet. A range of ligature points were identified within these areas, for example towel rails, shower heads, taps, toilet seats, clothes hooks, light fittings, ceiling tiles and shower curtain rails. Patient access to a private telephone Service users in 38% of the services reviewed reported to be dissatisfied with the privacy of the phones provided on the wards. A number of service users reported the phones to be located in day areas, enabling other service users to overhear their conversations. In addition to the privacy issue it was also regularly reported that noise levels in these areas also impact upon the quality of the calls service users have with their family and friends. Many units have arrangements in place whereby service users are able to use a portable telephone for calls to solicitors however the same privacy is not extended to calls to friends and relatives. Further to this, in some units which do not utilise portable telephones for calls to solicitors, these calls are often facilitated in the nursing office which raises issues of confidentiality both for the service user making the call and other service users whose information may be available in this area. Child Visiting and Multi-Faith rooms The provision of dedicated spaces for both child visiting and practising faith was identified as a challenge at 70% and 68% of the services reviewed respectively. 17

18 Whilst many units had a space identified to fulfil these requirements the decor in these rooms was often noted to be inappropriate and the location was often highlighted as an issue. In a number of units the peer-review teams noted that these facilities were often outside of the secure perimeter, consequently requiring service users to need leave to access these spaces and impacting upon the unit s ability to fully meet these criteria. Lastly, the provision of toys in child visiting rooms often undermined units ability to meet the criterion and similarly the provision of articles required to practice faith was also highlighted as a challenge in a number of the multi-faith rooms reviewed. Patient access to alarms Providing a way for service users to raise an alarm in an emergency was noted to be a challenge in 57% of the units reviewed, indeed this was found to be unmet in eight services and partly met in a further 22 services. Staff and service users at many of these services reported that they would have to shout in order to obtain attention in an emergency. Peer-review teams raised concerns when such systems were cited due to the unreliable nature of obtaining attention in this way in an emergency situation. Relational Security Whilst Relational Security was one of the highest scoring standard areas in Cycle 6 particular challenges were identified within this area. The reviews found that only 70% of services provide regular meetings for staff to discuss and reflect on Relational Security issues. It was often reported that this is not explicitly addressed in staff meetings, handover sessions or reflective practice groups and that the management of the patient group is often not addressed in terms of Relational Security. Another area within Relational Security that was identified as a challenge for services was having mechanisms in place for measuring and monitoring Relational Security against established outcomes, such as those outlined in the See Think Act document. Indeed, only 59% of the services reviewed were found to fully meet this. During the reviews a number of host teams reported that they were unaware of how to go about implementing systems for measuring this and noted that they do not use the See Think Act documentation to support this work. Clinical Supervision Staff access to clinical supervision continues to be a challenge for services. Whilst this has greatly improved over each of the Cycles, only 58% of services reviewed fully meet the criterion requiring staff to receive an hour of clinical supervision on a monthly basis. During the reviews it was found that it is mostly nursing staff who face challenges in accessing clinical supervision, due to their commitments to the wards and the less structured schedules for nursing staff. Further to this, it was often noted that identified supervisors are often not available on the same shift as their supervisee or indeed that staff have limited or no choice as to who supervises them. Moreover, a number of frontline staff at units raised an issue with the quality of the supervision provided and senior managers reported a misconception amongst frontline staff as to the purpose of clinical supervision sessions. In addition to this, peer-review teams noted that the distinction between clinical and managerial supervision is not clearly delineated within a number of units, and often hour long sessions are used to cover both. 18

19 Recommendations The following recommendations address the issues identified from the key themes previously discussed. For each recommendation the Quality Network has outlined how it plans to support services in addressing these issues over the coming cycle. Recommendation 1: Physical Security To carry out a thorough review of all perimeters to ensure that all climb points are identified. To consider ways in which service users can be involved in testing and reviewing the security of the perimeter. For example, consulting ex-service users. What will the Quality Network for Forensic Mental Health Services do? The Quality Network will hold the annual Physical Security workshop to facilitate the sharing of information and good practice regarding the issues raised during the Cycle 6 reviews. Recommendation 2: Facilities To review, in consultation with service users, the appropriateness of all facilities within the service, to ensure that the needs of the patient group are met. For example, to consider conducting a facilities survey specifically addressing provision of the following items: A multi-faith room A child visiting room A private telephone Ligature free bathroom and shower areas To identify a lead individual to review ways in which the current environment can be adapted to ensure that the above facilities are available and to implement action plans. What will the Quality Network for Forensic Mental Health Services do? The Quality Network will hold a workshop addressing the challenges and solutions regarding the provision of certain facilities within medium secure units. 19

20 Recommendation 3: Relational Security To ensure that an individual within the service is identified to implement the criteria and to consolidate the work outlined in the See Think Act document. To ensure that Relational Security is a standing agenda item in staff meetings and in discussions regarding patients. What will the Quality Network for Forensic Mental Health Services do? The Quality Network will hold a workshop to address the challenges and solutions regarding the implementation of the Relational Security criteria within services. A themed edition of the newsletter will be published addressing Relational Security to facilitate the sharing of good practice and information across the network. Recommendation 4: Clinical Supervision To review ways in which the provision and uptake of supervision for frontline staff can be improved. For example: provide written information outlining the programme of supervision and expectations for supervision provide training for supervisors and supervisees implement protected time on the wards, for nursing staff, which is supported by the MDT What will the Quality Network for Forensic Mental Health Services do? The Quality Network will hold a workshop addressing the challenges and solutions in relation to staff up take of clinical supervision, building on the previous work that has been done in this area. To join the MSU discussion group please Join to MSU@cru.rcpsych.ac.uk To view policies shared by member units please go to And click on the Policy Library link The library is password protected Please MSU@cru.rcpsych.ac.uk for details 20

21 Key Findings In the following pages the key findings from each section have been briefly highlighted. This includes areas of achievement and areas for improvement, as well as solutions and examples of good practice in each section from some of our member units. A graph showing the percentage of met criteria across all units is also provided for each section; this shows the units in order of achievement and provides the average score, allowing units to benchmark themselves against each other. 21

22 A: Safety and Security 1. Physical Security Key Findings Number of criteria in Physical Security: 23 Average percentage of criteria fully met: 86% Range: 43% 100% Achievements It is praiseworthy that 99% of services were found to fully meet the criterion requiring staff to complete the security induction prior to being issued with keys. All services reviewed were found to have hardwired and personal issue alarm systems in place. Out of the 69 services reviewed 65 reported that action plans are implemented to remedy weaknesses or compromises identified in the maintenance of the perimeter. All but five of the services reviewed have a Physical Security Document in place, which is reviewed on an annual basis. Areas for Improvement Access to alarms for service users was found to be a challenge in 44% of the services reviewed. Only 64% of services were found to fully meet the criterion regarding the unit having clear lines of sight for observation. As in previous Cycles the provision of a secure perimeter continues to pose a challenge for a number of services. Indeed, this criterion was only fully met by 78% of the services reviewed. 17% of services were found not to be compliant with the use of sealed key rings. Solutions - For those services who do not have accessible hardwired alarm systems for patients, to review the need to install one. - To carry out a thorough review of all patient areas to identify areas with limited lines of sight and to consider installing parabolic mirrors in these areas and/or review the systems in place for observation. - To review the need to purchase sealed keys rings to be used for all secure pass keys within the unit. Examples of Good Practice Alpha Hospital: - There are hardwired alarms accessible for staff and patients in the outdoor courtyards, as well as indoor spaces. St. Andrew s Healthcare -Malcolm Arnold House: - All the activity rooms in the therapy corridor have windows which allow a line of sight through the rooms, from one end of the corridor to another. This was noted to be particularly useful in relation to lone working. St. Andrew s Healthcare - William Wake House: - All staff undertake a Belts and Braces course upon induction, prior to being issued with keys. 22

23 Figure 6: Percentage of met criteria for Physical Security Average: 86%

24 A: Safety and Security 2. Procedural Security Key Findings Number of criteria in Procedural Security: 23 (inclusive of one female specific criterion) Average percentage of criteria fully met: 97% Range: 82%-100% Achievements It is praiseworthy that of the 23 criteria in this area 12 were found to be fully met by 100% of services reviewed. All services reviewed were found to have policies in place addressing: searching; the management of violence and aggression; the use of seclusion; the use of forced medication and rapid tranquilisation; observation; control of illegal substances; substance misuse; the control of prescribed medication; visiting procedures; confidentiality; the CPA approach and the management of critical incident reviews. Of those services with female patients 95% of the policies in place regarding restraint and seclusion address the potential requirement for individualised care needs. Areas for Improvement Of the 69 services reviewed 20 were found to either partly or not meet the criterion requiring there to be a policy in place on the prosecution of offences within the unit, which is agreed with the police and CPS. Further to this, having written contingency plans in place, which have been agreed with the police was found to be a challenge in 13% of services reviewed. Solutions - To work towards identifying a link individual within the local Police department to ensure that an established way of working can be developed and maintained. - To involve Trust managers in the establishment of this relationship with the Police, to support the unit in this work. Examples of Good Practice Central Mental Hospital: - The unit has developed a liaison relationship with the local Police Inspector to ensure that the implementation of certain policies is agreed with the Police. Hellingly Centre: - The unit has carried out a joint exercise with the police, fire services and ambulance to ensure that staff fully learnt and were aware of the contingency systems in place and to ensure that these systems had been thoroughly tested. 24

25 Figure 7: Percentage of met criteria in Procedural Security Average: 97% 25

26 A: Safety and Security 3. Relational Security Key Findings Number of criteria in Relational Security: 34 (inclusive of three female specific criteria and four criteria for services with patients with learning disabilities) Average percentage of criteria fully met: 89% Range: 63%-100% Achievements Service users at all services have an initial plan in place within 24 hours of admission, as well as an initial risk assessment. 100% of services were found to fully meet the criterion requiring that all contact with visitors and other external communication is regularly risk assessed. Having clear and effective systems for handovers within staff teams was found to be fully met at all but two of the services reviewed. Only four services did not fully meet the criterion regarding the provision of 25 hours of activity per patient per week. Areas for Improvement Of the 69 services reviewed 21 were rated as either unmet or partly met in relation to providing staff with regular meetings to discuss and reflect upon Relational Security issues. 41% of services either partly or did not meet the criterion which requires the service to have a mechanism for measuring and monitoring Relational Security against established outcomes. Access to a range of educational professionals was identified as a challenge in 16, out of the 69 services reviewed. 19% of services reported that the number of nursing staff on the wards is not always sufficient to safely meet the needs of the patients at all times. Solutions - To ensure that Relational Security is a standing agenda item for staff meetings, handovers and reflective practice sessions. - To develop tools (for example staff surveys) to ensure that staff understanding of Relational Security is regularly monitored. To consider incorporating this into the appraisal and supervision structures in place. - To continually review the staffing levels, in consultation with staff and patients, to ensure that these are appropriate. Examples of Good Practice The Bracton Centre: - The unit has developed an in-house tool for measuring and monitoring outcomes and staff understanding in relation to Relational Security. Eric Shepherd Unit: - The unit has an Adult Education department run by the local further education college. This is based within the secure perimeter to enable the maximum number of patients to receive education and careers guidance. WLMHT- Tony Hillis Wing: - There are staff meetings once a week whereby staff members score themselves against the See, Think, Act guidelines. 26

27 Figure 8: Percentage of met criteria in Relational Security Average: 89%

28 A: Safety and Security 4. Serious and Untoward Incidents Key Findings Number of criteria in Serious and Untoward Incidents: 3 Average percentage of criteria fully met: 94% Range: 67%-100% Achievements It is praiseworthy that 100% of services reviewed were found to have systems in place to continually monitor Serious and Untoward Incidents (SUIs) to identify trends and learning points. The majority of services, 97%, have systems in place to share learning beyond the immediate service/provider concerning incidents. Areas for Improvement Of the 69 services reviewed 11 were found to partly meet the criterion requiring there to be a Serious and Untoward Incident policy in place, which is reviewed on an annual basis. Generally, this was found to be partly met as services do not review this policy annually. Solutions - To ensure that the Serious and Untoward Incident policy is reviewed on an annual basis. If this is a Trust policy units could review the policy internally and make recommendations to the Trust for changes that ought to be made, in order to maintain its continued appropriateness for Forensic services. Examples of Good Practice Bamburgh Clinic and Kenneth Day Unit: - Staff at the unit can seek support from Care First, following a serious or untoward incident. Chadwick Lodge: - Service users are asked for their feedback regarding their impression of any incident that has taken place; there is a standardised form which they complete. The Bracton Centre - The Unit carries out trend analysis to map staff sickness, ward atmosphere, patient mix etc onto SUI data to further analyse the incidents and their potential causes. 28

29 Figure 9: Percentage of met criteria for Serious and Untoward Incidents Average: 86%

30 A: Safety and Security 5. Safeguarding Children and Child Visiting Policies Key Findings Number of criteria in Safeguarding Children and Child Visiting 5 Policies (inclusive of two female specific criteria): Average percentage of criteria fully met: 81% Range: 0-100% Achievements Service users at 92% of the services, with female patients, reviewed reported that there are sufficient staff available to enable children to visit during evenings and weekends. Staff are provided with awareness training on safeguarding children and child visiting at all but seven of the services reviewed. Areas for Improvement Of the 69 services reviewed 12 were found to partly meet the criterion requiring there to be a policy in place addressing child visiting/child contact, which is reviewed on an annual basis. Generally, this was found to be partly met as services do not review this policy annually. Child visiting facilities were identified as a challenge in 31% of the services reviewed. Solutions - To ensure that the Child Visiting policy is reviewed on an annual basis. If this is a Trust policy units could review the policy internally and make recommendations to the Trust for changes that ought to be made, in order to maintain its continued appropriateness for Forensic services. - To ensure that all child visiting rooms are appropriate for hosting a child visit, for example with suitable decoration and facilities available. - To ensure that the location of the child visiting room is appropriate and accessible to all patients. Examples of Good Practice Caswell Clinic: - The child visiting room at the Caswell Clinic was noted to be excellent; it was observed to have the necessary facilities such a kitchen and toilets as well as toys. Newton Lodge: - Written feedback is provided to the MDT after each child visit has taken place. Tŷ Llywelyn: - Service users reported that staff are flexible and will facilitate child visits in the sports hall so patients are able to play sports with their children. 30

31 Figure 10: Percentage of met criteria in Safeguarding Children and Child Visiting Policies 68 Average: 67 81%

32 B: Clinical and Cost Effectiveness Key Findings Number of criteria in Clinical and Cost Effectiveness: 12 (inclusive of three specific criteria for services with patients with learning disabilities) Average percentage of criteria fully met: 89% Range: 56%-100% Achievements 94% of service s staff training needs are informed through the skills needed within the unit, staff development plans and supervision systems. 100% of services with patients with learning disabilities have a local protocol in place to ensure there is access to an epilepsy specialist (who may be the Responsible Clinician). All services have now fully implemented the use of the HoNOS Secure and the HCR-20, which is an improvement from last year. Areas for Improvement 42% of units do not fully meet the criterion requiring one hour of supervision to be provided per month for all members of staff. This is noted to be an ongoing challenge particularly for nursing staff and healthcare assistants. 14% of units are yet to identify service user and staff recovery leads and organise workshops/groups within the unit to share and explore learning from the use of recovery tools. In addition, not all services have fully imbedded the use of recovery tools such as WRAP and Recovery Star. Solutions - To consider training additional supervisors to enable more staff to access clinical supervision. - To record and audit supervision attendance to identify obstacles to accessing supervision and to identify those staff that do not/are not able to regularly attend supervision. - To ensure that the identification of recovery leads is a standing agenda item in meetings and to consider providing Recovery training for staff as well as creating a Recovery forum for patients, to help increase awareness of the benefits of the models and to provide support. Examples of Good Practice Farmfield Hospital: - The unit ensures supervisors are available during night shifts so this quieter time can be used for supervision. Fromeside: - The unit provides training on both delivering and receiving supervision. Charles House: - There is a service user recovery lead who provides recovery training and a buddy system for new staff and service users. In addition service users and their named nurse complete the Recovery Star scoring separately then come back together to work through any discrepancies. 32

33 Figure 11: Percentage of met criteria for Clinical and Cost Effectiveness Average: 89%

34 C: Governance Key Findings Number of criteria in Governance: 19 (inclusive of three female specific criteria and four criteria for services with patients with learning disabilities) Average percentage of criteria fully met: 85% Range: 56%-100% Achievements All 69 units ensure that all mandatory training is undertaken and regularly updated and all staff receive basic security procedure induction training on their first day. At 99% of services complaints are continually monitored to identify trends and learning points which are then reviewed quarterly and patients at 96% of services reported that there is a clear complaints procedure. Areas for Improvement 41% of units with patients with learning disabilities have found it a challenge to deliver training to staff in working with people with learning disabilities, autism spectrum conditions and epilepsy or induction training on communicating with people who have learning disabilities. 35% of services are unable to ensure adequate time is made available for supervision to be delivered. Solutions - To ensure training is delivered to all staff in services, with patients with learning disabilities, in working with and communicating with people with learning disabilities, autism spectrum conditions and epilepsy. - To consider the involvement of patients in delivering this training and to liaise with external agencies or specialists such as a Speech and Language Therapist to help deliver the relevant training. - Through the revision of the ward timetables review ways in which nursing staff can be provided with formally protected time for regular supervision sessions to take place. Examples of Good Practice Calderstones- Woodview: - All staff receive a mandatory three week induction programme which is centred on working with individuals who have a learning disability. Alpha Hospital- Bury: - The service delivers training on working with women in medium secure services which covers trauma, domestic violence and abuse. There is also patient led training on self harm including a self harm booklet written by patients. The Janet Shaw Clinic: - All clinical supervision takes place on one day and this is known well in advance so staff are able to organise their time so they are able to attend. 34

35 Figure 12: Percentage of met criteria for Governance 40 Average: %

36 D: Patient Focus Key Findings Number of criteria in Patient Focus Security: 24 (inclusive of five specific criteria for services with patients with learning disabilities) Average percentage of criteria fully met: 88% Range: 63%-100% Achievements 67 out of the 69 services provided evidence of patient involvement in all aspects of the service including their own care plan, quality monitoring and service improvement programmes and patients at 91% of services reported that feedback from patients and carers is used to improve the quality of the unit. 84% of units provide links to local Carer Advocacy services and 81% offer counselling/support sessions to the families of service users. Service users at 96% of services reported that staff treat them with respect Areas for Improvement 22 out of the 69 units reviewed have found the provision of a multi-faith room for use by all patients a challenge. 38% of services have been unable to provide patient access to a telephone in a private area. Solutions - To review the room allocation policy to ensure the multi-faith room is located within the secure perimeter and if it is a multipurpose room to ensure there is appropriate and accessible decoration and resources for patients to practice their faith. - To review ways in which the privacy of calls made on the patient payphones could be increased i.e. possible relocation of phone, use of a telephone trolley, the use of a hood or a cordless phone. Examples of Good Practice Cheswold Park Hospital: - The unit provides mobile phones to patients as well as Skype to facilitate communication with family and carers. St Andrew s healthcare Birmingham: - The spiritual needs of patients are reflected in care plans and an assessment tool is being developed for this. The Imam and Chaplain work as part of the MDT and the chaplain meets every new admission. St Andrew s healthcare Nottingham: - The multi-faith room has a place for foot washing, clerical robes, prayer mats, relevant religious text, the direction of Mecca is identified and there is a Chaplain available three days a week. 36

37 Figure 13: Percentage of met criteria for Patient Focus 47 Average: 57 88%

38 E: Accessible and Responsive Care Key Findings Number of criteria in Accessible and Responsive Care: (inclusive of four female specific criteria) 9 Average percentage of criteria fully met: 82% Range: 40%-100% Achievements 93% of services ensure that all staff receive regular update training on basic first aid skills and CPR. It was reported that 95% of services with female patients include a female member of staff in the pre-admission assessment. Areas for Improvement 16% of services find it a challenge to ensure that a decision is made within two weeks and that a bed is offered within a further six weeks for routine referrals. Meeting the criterion requiring services to adhere to the Safety, Dignity and Privacy Policy was found to be a challenge for 13% of units reviewed. It was observed that 45% of services contained wards which exceeded the specification of no more than 15 beds. Similarly, for services with female patients, 15 out of 38 units did not fully meet the criterion of requiring there to be no more than 12 beds on each female ward. Solutions - To review the need to have regular bed management meetings to ensure that all referrals are dealt with within the time frames specified. - To continually review the appropriateness of having a mixed sex ward environment in order to adhere to the Safety, Dignity and Privacy policy. - To review the current bed numbers on the wards, where these have been identified as above the maximum level, and to continue to monitor the appropriateness of this in consultation with service users in order to ensure they feel safe. Examples of Good Practice Ridgeway: - The unit holds Rapid Process Improvement Workshops, which aim to get members of staff from a range of disciplines together, and service users where appropriate, to discuss an issue and possible solutions. The Butler Clinic: - Service user groups at the service are led by an ex-service user, to ensure that these meetings are run in an appropriate way for service users. 38

39 Figure 14: Percentage of met criteria for Accessible and Responsive Care 39 7 Average: 82%

40 F: Environment and Amenities Key Findings Number of criteria in Environment and Amenities: (inclusive of two female specific criteria) 11 Average percentage of criteria fully met: 83% Range: 44%-100% Achievements The majority of services (97%) were found to provide facilities that are appropriate to the patient group. 67 out of the 69 services reviewed ensure that books and magazines are provided in recreation areas for patients. Service users in 88% of services are provided with dietary advice and support from a qualified dietician. It is praiseworthy that all but two units provide rooms that are large enough for patients and staff to meet where everyone can see and hear each other. Areas for Improvement Providing ligature-free bathroom and shower areas were found to be a challenge for 58% of services. It was reported by service users in 31% of units reviewed that they are not provided with meals that are of high quality, offer choice, address nutritional/balanced diet and specific dietary, cultural and religious requirements as well being sufficient in quantity. 21% of services with female patients do not provide access to outdoor space for women only that is private and secure. Solutions - To ensure that regular environmental checks are carried out and any identified ligature points are included on a risk register. To also implement plans to reduce the ligature risks in bathroom and shower areas, as a matter of priority. - To ensure that any access to areas with identified ligature risks is appropriately risk assessed. - To review ways in which the provision of food could be improved, in consultation with service users, in relation to the range of meals available, including the range of vegetarian and cultural options. - To review the need to have a designated garden area for women only. Examples of Good Practice SLAM Bridge House: - The unit has Health and Safety champions on each of the wards, part of whose role is to carry out regular environmental checks. The Scott Clinic: - There are food tasting sessions as part of the food focus groups where service users are able to taste and the vote for certain foods to be included in the menus. The Humber Centre: - Patients are able to choose their food on the same day and do not have to plan their meals in advance. 40

41 Figure 15: Percentage of met criteria in Environment and Amenities 67 Average: 47 83%

42 G: Public Health Key Findings Number of criteria in Public Health: (inclusive of two female specific criteria) 8 Average percentage of criteria fully met: 95% Range: 50%-100% Achievements 99% of services identify physical healthcare needs as part of the patient s treatment plan, and this includes any treatment regime as prescribed. 67 out of 69 units provide access to health promotion support which is in line with expectations in the community. Service users in the majority of units (96%) have access to a primary health care service. Service users have supervised free access to fresh air outside of the building, at least daily, in 97% of units. Areas for Improvement Female service users in 18% of units were unable to access a female General Practitioner and practice nurse. 8% of services with female patients did not fully meet the criterion requiring all female patients to have access to primary and secondary screening programmes, such as cervical screening and mammography. Solutions - To consider negotiating an arrangement where the visiting male GP is replaced by a female colleague once a month. - To ensure that the in-house primary healthcare service provides patients with access to screening programmes that are available to the general population, and to ensure that service users are provided with information regarding what is available and what they are entitled to. Examples of Good Practice WLMHT- Three Bridges: - The new Physical Health Care Suite was highly praised and the unit was commended for the normalisation this area provides as well as the wide range of health care services provided. North London Forensic Service: - The unit have a rewards card whereby service users can earn points by engaging in healthy behaviours. Ardenleigh: - The unit use The Five Point Living Plan, a traffic light system that promotes healthy living. Shaftesbury Clinic: - Service users are able to access accredited programmes in exercise and nutrition. 42

43 Figure 16: Percentage of met criteria in Public Health Average: 95% 43

44 APPENDIX A: AGGREGATED DATA A1: Physical Security A1* A2* Standard Met Partly Met Unmet There is a physical security document (PSD) that defines the physical security including the 64 perimeter creating the secure area which is annually reviewed There is a secure perimeter of EITHER: A 5.2 metre fence of weld mesh surrounding the whole unit OR: A 5.2 metre fence of weld mesh joining reception and surrounding the remainder of the unit OR Of integral design formed by the building creating the enclosed secure area. Building design and specification must be as detailed in this specification, particularly windows and climb points OR Integral buildings forming the perimeter with a 5.2 metre fence around the sports area/field. A4* There is a daily recorded inspection of the perimeter which is reviewed quarterly A5 A7.1* A9* There is no shrubbery close to or on the perimeter fence or buildings that form the perimeter. Action plans are implemented to remedy weakness or compromises identified in the maintenance of the perimeter. Reception is EITHER: Within the secure area OR: Forms part of the perimeter. And Where reception is part of the perimeter the rear of the building within the secure area must be protected against climbing. N/A Don t Know 44

45 Standard Met Partly Met Unmet N/A Don t Know A17* A18* A21* A28* Where building roofs form part of the perimeter they are protected against climbing (in ways which are not intended to cause injury e.g. revolving spikes, razor wire/barbed wire) in one or more of the following ways: Gooseneck capping Flexible secure topping (FST) Weld mesh fence with or without FST fixed from below the eaves to a height of 5.2 meters. Infrared alarm on the roof (in combination with one of the above) Hanging eaves with projection a minimum of 1200mm from the face of the building Where the building roofs surround courtyards or patient access areas there are no climbing points (e.g. poor sighting of light fittings, trees, unprotected window sills, water drain pipes, the placing of air conditioning units. Windows forming part of the perimeter in patient areas (e.g. bedrooms, communal areas) are designed to prevent the passage of contraband. There is a key management system in place which accounts for all secure pass keys including those in store, those issued, those held in reception A28.4* Secure keys are on a sealed ring and only secure pass keys are on this ring A28.5* Secure pass keys are not taken out of the secure perimeter A29* Staff entering the secure area can obtain keys only upon production of a valid identity card/tally A29.1* Staff are not to be issued with keys until they have undertaken security induction A31* Reception has an electronically controlled air lock operated by reception, there is no entry to the reception office/control room from within the air lock and entry to that office is be controlled by reception A36* Alarms are hardwired alarms or personal issue alarms A36.2* Alarm systems and personal alarms are tested daily A36.4* Personal alarms are controlled, issued, returned and accounted for by reception A40* There is a security committee chaired by the forensic services director or equivalent

46 Standard Met Partly Met Unmet N/A Don t Know A42 There is a way for patients to raise an alarm in an emergency A45 A46 The unit is well designed and has the necessary facilities and resources for people requiring 51 medium secure care There are areas with clear lines of sight to enable staff to monitor patients who need closer 44 observation A49 All confidential case materials, e.g. notes, are kept in locked cabinets or locked offices A2: Procedural Security A50* A51* There is a procedural security index document (PSID), which lists the procedural policies which is annually reviewed. There is a searching policy which includes patient searching, bedroom searching, and ward and off ward areas, and the searching of visitors A52* There is a policy on management of violence and aggression (NICE guideline 25) A53* There is a policy on use of seclusion A54* There is a policy on use of forced medication including rapid tranquilisation A55* There is a policy on observation A56* There is an anti bullying policy (for those who are bullying and those who are bullied) A59* There is a policy on the use of handcuffs A60* There is a policy on escort procedures A62* There is a policy on the control of illegal substances A63* There is a policy on substance misuse A64* There is a policy on the control of prescribed medication and drugs A65* There is a policy on the prosecution of offences within the unit which is agreed with the police and CPS

47 Standard Met Partly Met Unmet N/A Don t Know A69* There is a policy on the censorship of material including pornography A72* There is a policy on prohibited items and a clear statement of these in reception and provided to all visitors, patients and staff and as a minimum this will include mobile phones, cameras, firearms, weapons, chewing gum, bluetac A73* There is a policy on the use of computers and access to the internet A74* There is a policy on visiting procedures including child protection issues A75* There is a policy on patient confidentiality A76* There is a policy for managing critical incident reviews A78* There are contingency plans in place agreed with the police as a minimum A80 There are written policies and procedures that implement the requirements of the Care Programme Approach (CPA) A81 There is a procedure regarding obtaining consent from patients A2w Policies regarding restraint and seclusion address the potential requirement for individualised care needs e.g. Previous trauma or abuse, physical health issues, advanced directives A3: Relational Security A88* All staff have had enhanced CRB checks A89* There are regular multi-disciplinary individual patient care reviews and assessments A90* There is a programme of clinical supervision for all staff A90.1* A91* There is a programme of continued professional development (CPD) and personal development plans (PDPs) for all staff which are annually reviewed There is an annually reviewed training and development strategy which includes the provision of security training

48 Standard Met Partly Met Unmet N/A Don t Know A94* (also There is a planned programme of treatment with a minimum of 25 hours per week per CQUIN_C patient of structured activity which is reviewed quarterly 5 Goal No. 3) A94.1* The programme of treatment includes occupational therapy A94.2* The programme of treatment includes psychological sessions A94.3* The programme of treatment includes substance misuse therapy A94.4* The programme of treatment includes offence related therapy A94.5* The programme of treatment includes access to real opportunities to work A95* All patients will have an initial plan in place within 24 hours of admission A99 All patients on admission have an initial risk assessment A100 Patients are given a copy of the management or care plan or have ready access to it A102 There are clear and effective systems for communication and handover within staff teams A104 There are multi-disciplinary teams identified as part of the staffing establishment, with each team including psychiatrists, nurses, psychologists, occupational therapists, and social workers A106 The unit has access to a range of practitioners offering psychotherapeutic sessions A107 A110 A111 The unit has access to a range of education professionals which include teachers, a special educational needs co-ordinator, an educational psychologist, and career guidance The number of nursing staff on the unit is sufficient to safely meet the needs of the patients at all times Extra nursing cover is available when needed, e.g. there is access to additional on-call staff 67 in emergency

49 Standard Met Partly Met Unmet N/A Don t Know A114 The unit promotes an open, blame-free culture for reporting incidents A1w A4w Initial assessments and individual care plans include key components which are particularly pertinent to women: self-harm gender specific formulation of risk cultural needs physical health issues effects of medication eating disorders trauma (including domestic and sexual violence) alcohol and substance misuse family and primary carer roles There are clear and consistent policies for the individualised management of women who self harm A9w All overnight observations in bedroom areas are undertaken by female staff RS. 1 RS. 2 RS. 3 The induction training programme covers relational security. This includes as a minimum material on: boundaries, therapy, patient mix, patient dynamic, patient s personal world, physical environment, visitors and other external communication. This may be facilitated by the See, Think, Act training slides There is annually updated staff training on relational security. This includes as a minimum material on: boundaries, therapy, patient mix, patient dynamic, patient s personal world, physical environment, visitors and other external communication. This may be facilitated by the See, Think, Act training slides There are regular meetings where staff discuss and reflect on relational security issues. This includes as a minimum discussion of boundaries, therapy, patient mix, patient dynamic, patient s personal world, physical environment, visitors and other external communication and may be facilitated by the See, Think, Act Relational Security Explorer RS. 4 Contact with visitors and other external communication is regularly risk assessed RS. 5 There is a mechanism for measuring and monitoring relational security against established outcomes such as those in See Think Act: Your guide to Relational Security (DH 2010) Please refer to We know we are getting it right when: sections in See, Think Act

50 Standard Met Partly Met Unmet N/A Don t Know LD. 2 There is a suitable skill mix of staff LD. 2.1 Senior Clinicians are trained in Learning Disability and Forensic Psychiatry LD. 2.2 There is a combination of nurses trained in mental health/learning disability LD. 2.3 Goal No. 4 (CQUIN) There is access to a Speech and Language Therapist with experience in learning disabilities and mental health. The unit has systems in place to continually assess the 25hr a week activity plans and recording systems. A4: Serious and Untoward Incidents A124* There is a serious and untoward incident policy which is annually reviewed A127* Untoward incidents are continually monitored to identify trends and learning points A127.1* There are mechanisms in place to share learning beyond the immediate service/provider concerning incidents A5: Safeguarding Children and Child Visiting Policy A128* There is a policy on child visiting/child contact which is annually reviewed A128.1* There are visiting facilities in place for children (people 18 years of age and under) to visit patients which are external to the ward area but within the secure area appropriately supervised by staff with suitable play areas and facilities (HSC/1999/222: LAC (99)32) A130* There is staff awareness training on safeguarding children and child visiting A15w Staff that facilitate child visiting have undergone appropriate training in child protection A16w There are sufficient staff available to enable children to visit during evenings and weekends

51 Standard Met Partly Met Unmet N/A Don t Know B: Clinical and Cost Effectiveness B12* B13* Where patients from the MSU catchment area are in high security, the MSU develops and maintain links with the high secure team and participates in all CPA meetings to ensure timely transfer of the patient when ready to leave high security. All patients have an individual care plan, drawn up in collaboration with the patient on admission and a first CPA review held within 3 months of admission B15* There is a multi-disciplinary assessment to determine readiness for discharge/transfer There are adequate numbers of appropriately trained staffed at all times ensuring that a B18* full multi-disciplinary service is delivered meeting the needs of the current patient population. Training needs are informed through the skills needed within the unit, staff development B24 plans and supervision systems which have assessed in the last year All staff receive regular supervision totalling at least one hour per month from a person B28 with appropriate experience Staff demonstrate awareness, understanding and are able to apply established LD. 1.3 psychological approaches used in working with people with learning disabilities commensurate to their role. There is a local protocol in place so there is access to an epilepsy specialist (who may be LD. 2.5 the Responsible Clinician). The service incorporates the aims of Valuing People and Valuing People Now and person LD. 3 centred planning e.g. with Health Action Plans Goal No. 4 All patients are offered the opportunity to complete a recovery plan. E.g. Recovery Star, (C5_CQU WRAP and DREAM. IN) Goal No. 2 (CQUIN) Goal No. 6 (CQUIN) The unit utilises HoNOS Secure (including PBR elements) and the HCR-20 (CAMHS services should use CGAS). The unit has identified service user and staff recovery leads and has organised workshops/groups within the unit to share and explore learning from the use of recovery tools

52 Standard Met Partly Met Unmet N/A Don t Know C: Governance C1* There is a clear complaints procedure C1.1* Complaints are continually monitored to identify trends and learning points which are reviewed quarterly C5* All staff receive basic security procedure induction training on their first day at the service C7* All mandatory training is undertaken and regularly updated (E.g. First Aid, Fire, COSHH) C8* All staff are trained in the Management of Aggression and Violence (NICE 25) C11.1* Training is provided on disciplinary and grievance procedure; whistle blowing policy, discrimination, harassment, bullying and violence policies C20* There are records of a robust clinical supervision C20.2* There is adequate time made available for supervision to be delivered C28* Lead clinicians are involved in the commissioning process C41 C2w C4w Telephone numbers for external agencies are available (e.g. Citizens Advice Bureau, statutory regulatory bodies, Commission for Racial Equality) All new staff undergo a basic induction that includes information regarding the specific needs of women in medium secure care The service-specific programme of training will include: Gender Responsive practice Inclusive practice and issues of discrimination culturally responsive practice Victim issues (including domestic and sexual violence, other trauma and supporting disclosure) Gender Influenced presentation of mental Illness personality disorder eating disorders deliberate self-harm child protection and liaison with Children s Services

53 Standard Met Partly Met Unmet N/A Don t Know C5w LD. 1 LD. 1.1 LD. 1.2 LD. 1.4 Goal No. 3 (CQUIN) Goal No. 5 (CQUIN) D: Patient Focus Service users are involved in the ongoing development of gender specific policies and procedures Staff working with people with learning disabilities are trained to work with people with learning disabilities Managers ensure that all staff receive training in how mental illness presents in people with learning disabilities. Managers ensure that all staff receive training in working with people with learning disabilities, autism spectrum conditions and epilepsy. Staff receive training at induction that is regularly updated on communicating with people who have learning disabilities. There are systems in place for recording and reporting the length of stay of all service users within the hospital. The unit has identified service user and staff involvement leads whose roles are to involve service users and staff to work jointly and introduce, discuss, and understand the underpinning objectives of the Shared Pathway QIPP work stream D1* Patients are supported in their personal care including dental hygiene D4 There is access to services which support patient s improved well being e.g. aromatherapy D7* There is a multi-faith room is available for use by all patients D8* D9* There is an implemented policy setting out the consultation and involvement of carers in the care provided. There is evidence of patient involvement in all aspects of the service including their own care plan and quality monitoring and service improvement programmes at the service D10* All patients have access to independent civil advocacy D12* The unit works with visitors and families on their health and well being, for example, coping with stress, conflict resolution and sustainable transport plans for visiting D13 Staff demonstrate respect for patients

54 Standard Met Partly Met Unmet N/A Don t Know D14 D15 Staff are made aware of complaints that are relevant to their work and the outcome of the complaints process Patients have access to a telephone in a private area, within the limits of safety and risk assessment D16 There is indoor and outdoor space for recreation within a medium secure perimeter D17 Patient's rights and what they can expect are explained, for example, they are given a copy of the Patient s Charter or similar document D19 The programme of activities offered is planned in consultation with patients D20 Patients are consulted about the unit environment and have choice when this is appropriate D21 Patients are encouraged to personalise their bedroom spaces appropriately. (Pictures of nude bodies or pictures of children may be inappropriate) D22 Feedback from patients and carers is used to improve the quality of the unit Carer. 1 The unit provides links to local Carer Advocacy services Carer. 2 The unit offers counselling/support sessions to the families of service users LD. 2.4 LD. 4 There is access to an advocacy service which is competent at working with people with learning disabilities in a forensic setting. There is access to clear and easy to understand information in accessible formats (e.g. leaflets and other media) LD. 4.1 Patient forms are clear and in easy to read format LD. 4.2 There is information about learning disabilities, autism spectrum conditions, epilepsy and how mental illness presents in people with learning disabilities LD. 4.3 Patients are given assistance by staff to help them to understand the information Goal No. 1 (CQUIN) The unit has developed improvement plans from the outcomes of the Essen Climate Evaluation Scale

55 Standard Met Partly Met Unmet N/A Don t Know E: Accessible and Responsive Care E1* E4.1* The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving health care services. For routine referrals a decision is made within 2 weeks and a bed offered within a further 6 weeks E5* Wards normally have no more than 15 beds E6* Patient facilities are single sex and adhere to the Safety, Dignity and Privacy policy E12.1* All staff receive regular update training on basic first aid skills and CPR E1w Medium-secure inpatient wards for women have no more than 12 beds E2w The pre-admission assessment team ideally includes at least one female member of staff E9w The service offers gender specific access to all therapeutic and recreational activities E10w The service offers mixed-gender access to appropriate therapeutic and recreational activities F: Environment and Amenities F8* Bathroom and shower areas free of ligature points F9.1* F10* F10.1* F12 There is a system in place for staff to report any ligature points identified with prompt follow up action Dietary advice and support is available from qualified dieticians reflecting the value of good 61 quality food on a person s wellbeing Patients are provided with meals which are of a high quality, offer choice, address nutritional/balanced diet and specific dietary requirements and which are also sufficient in quantity, are varied and appealing and reflect individual s cultural and religious needs (Better Hospital Food Department of Health 2004). There are facilities appropriate to the patient group, e.g. a pool table and board/console games are provided

56 Standard Met Partly Met Unmet N/A Don t Know F13 There are facilities for patients to make their own hot and cold drinks and snacks F14 Books and magazines are provided in recreation areas for patients F16 F17 The unit contains an adequate number of large and small rooms designed for individual and group work There is a room large enough for staff and patients to meet, where everyone can see and hear each other F1w At ward level, medium secure inpatient services are single sex F9w There is access to outdoor space for women only that is private and secure G: Public Health G1* All patients have access to a primary healthcare service G2* G3* G3.1* G13* G15* All patients have at least daily supervised free access to fresh air outside the building as a minimum. All patients have their primary healthcare needs assessed on admission and reviewed at least annually or more frequently if required. Physical healthcare needs are identified in the patient s treatment plan. The plan includes any treatment regimes as prescribed. There is a policy and/or working group which addresses Healthy Settings approaches to promoting well being and physical good health in patients and staff. There is access to Health Promotion support in line with expectations in the community, including alcohol and addictions, physical activity; diet and nutrition G1w All women have access to a female General Practitioner and practice nurse G4w All women have access to primary and secondary screening programmes, e.g. cervical screening, mammography

57 APPENDIX B: MEMBER UNITS Unit Name Trust/Organisation No. of Completed Cycles Alpha Hospital Bury Alpha Hospitals 3 7 Arbury Court Psychiatric Services Partnerships in Care 3 3 Ardenleigh Birmingham and Solihull Mental Health Foundation Trust 3 2 Arnold Lodge Nottinghamshire Healthcare NHS Trust 4 7 Bracton Centre Oxleas NHS Foundation Trust 5 5 Broadland Clinic Hertfordshire Partnership NHS Foundation Trust 3 4 Brockfield House South Essex Partnership NHS Foundation Trust 4 5 Butler Clinic Devon Partnership NHS Trust 5 2 Calderstones - Gisburn Lodge Calderstones Partnership NHS Foundation Trust 2 1 Calderstones - Woodview Calderstones Partnership NHS Foundation Trust 2 4 Calverton Hill Partnerships in Care 3 4 Caswell Clinic Abertawe Bro Morgannwg, NHS Wales 3 5 Central Mental Hospital Health Service Executive 6 6 Chadwick Lodge Priory Group 3 5 Cheswold Park Hospital Cheswold Park 3 5 Charles House Hospital Forensic Services Craegmoor Healthcare 3 2 Cygnet Hospital Stevenage Cygnet Healthcare 5 3 Edenfield Centre Greater Manchester West NHS Foundation Trust 3 14 Eric Shepherd Unit Hertfordshire Partnership Foundation NHS Trust 2 5 Farmfield Hospital Priory Group 3 3 Fromeside Avon and Wiltshire Mental Health Partnership NHS Trust 6 8 FSD (Northumberland Tyne and Wear) - Bamburgh Clinic FSD (Northumberland Tyne and Wear) - Kenneth Day Unit Northumberland Tyne & Wear NHS Foundation Trust 5 3 Northumberland Tyne & Wear NHS Foundation Trust 5 4 No. of wards reviewed in Cycle 6 57

58 Guild Lodge Lancashire Care NHS Foundation Trust 3 8 The Hatherton Centre South Staffordshire & Shropshire Healthcare NHS Foundation Trust 3 4 Hellingly Centre for Forensic Mental Health Sussex Partnership NHS Trust 5 2 The Humber Centre Humber NHS Foundation Trust 4 6 Janet Shaw Clinic Coventry and Warwickshire Partnership Trust 3 1 Jasmine Unit Priory Group 1 1 The John Howard Centre East London Mental Health Foundation Trust 3 11 Kneesworth House Hospital Partnerships in Care 3 5 Linden House Care Principles 3 3 Llanarth Court Hospital Partnerships in Care 3 4 Marlborough House Oxford and Buckinghamshire Mental Health NHS Foundation Trust 2 2 Newton Lodge South West Yorkshire Mental Health NHS Trust 6 7 North London Clinic Partnerships in Care 3 3 North London Forensic Service Barnet, Enfield & Haringey Mental Health NHS Trust 5 9 Norvic Clinic Norfolk and Waveney Mental Health NHS Foundation Trust 3 5 Oxford Clinic Oxford and Buckinghamshire Mental Health NHS Foundation Trust 2 2 Priory Hospital Widnes Priory Group 1 2 Ravenswood House Hampshire Partnership NHS Foundation Trust 6 5 Reaside Clinic Birmingham and Solihull Mental Health Foundation Trust 4 7 Ridgeway Tees, Esk & Wear Valleys NHS Foundation Trust 5 6 Rowan House Care Principles 3 4 Scott Clinic Mersey Care NHS Trust 3 5 Shaftesbury Clinic South West London and St Georges NHS Trust 3 3 Shannon Clinic South and East Belfast Trust 6 3 South London and Maudsley - Bridge House South London and Maudsley NHS Foundation Trust 3 2 South London and Maudsley - River House South London and Maudsley NHS Foundation Trust

59 St Andrew's Healthcare Birmingham St Andrew s Healthcare 3 2 St Andrew's Healthcare Nottinghamshire St Andrew s Healthcare 2 2 St Andrew's Healthcare Northampton - Lowther St Andrews Healthcare 3 5 St Andrew's Healthcare Northampton - Malcolm Arnold House St Andrews Healthcare 3 4 St Andrew's Healthcare Northampton - Smyth House St Andrews Healthcare 5 4 St Andrew's Healthcare Northampton - William Wake House St Andrews Healthcare 2 8 St. John s House LDS Partnerships in Care 3 2 St. Magnus Hospital St Magnus 2 3 St Mary's Hospital St George Healthcare Group 3 2 Stockton Hall Hospital Partnerships in Care 3 6 Suttons Manor Hospital Partnerships in Care 3 1 The Dene Partnerships in Care 3 3 The Spinney Partnerships in Care 3 5 Thornford Park Hospital Priory Group 3 2 Trevor Gibbens Unit Kent and Medway NHS and Social Care Partnership Trust 5 4 Tŷ Llywelyn Betsi Cadwaladr University Health Board 1 3 Wathwood Hospital Nottinghamshire Healthcare NHS Trust 4 3 West London Mental Health Trust - The Orchard West London Mental Health Trust 4 3 West London Mental Health Trust - Three Bridges West London Mental Health Trust 5 4 West London Mental Health Trust - Tony Hillis Wing West London Mental Health Trust

60 APPENDIX C: EXAMPLES OF GOOD PRACTICE A: Safety and Security 1. Physical Security Team Name Achievement Contact Name Contact Number Contact Alpha Hospital Arnold Lodge Bracton Centre Bracton Centre There are hardwired alarms accessible for staff and patients in the outdoor courtyards as well as flashing light alarm systems for deaf staff. The decorated acoustic sound boards which reduce echo in the wards and also act as art work were praised by the peer-review team. The peer-review team were impressed with the systems in place to ensure that alarms cannot be taken out of the secure perimeter. The peer-review team were impressed with the systems of annual expiry dates on the identity badges, which will stop the badge from enabling access to the service if they have not completed the security refresher training. Joanne Ward Amanda Santaney Lisa Dakin Lisa Dakin

61 St. Andrew s Healthcare - Malcolm Arnold House North London Forensic Service SLaM - River House SLAM - Bridge House Stockton Hall Hospital The peer-review team particularly commended the therapy corridor and the windows on each side of the room which enables a line of sight through all of the rooms in this area; from one end of the corridor to another. This was noted to be particularly useful in relation to lone working. The unit have a Productive Teams board on each ward which includes photos of each staff member, information on sickness, behaviour on the ward and leave status. The new x-ray chairs in use at SLaM were noted to be an excellent way to search patients for contraband. The security initiatives that the unit have implemented, such as the Buddi system and the full body scanner, were noted to be good and a clear example of the unit s willingness to explore its options in terms of development and working to meet the patients therapeutic needs within the confines of medium security. The unit review their Physical Security Document every 6 months. Ginny Smith gsmith@standrew.co.uk Melanie Evans melanie.evans@beh-mht.nhs.uk Sam Antwi-Marful Sam.Antwi-Marful@slam.nhs.uk Sam Antwi-Marful Sam.Antwi-Marful@slam.nhs.uk Mandy Lang amanda.lang@partnershipsincare.co.uk 61

62 Trevor Gibbens Unit St. Andrew s Healthcare - William Wake House The subtlety of the security measures in place throughout the service was noted to be praiseworthy by the peerreview team. For example, the fob system for accessing certain areas within the secure area and the fact that service users are able to have access to this system, with levels of access being controlled electronically. All staff undertake a Belts and Braces course upon induction prior to the issuing of keys. Dr Jonathon Pyott Jonathan.Pyott@kmpt.nhs.uk Lynn Baxter lbaxter@standrew.co.uk 2. Procedural Security Team Name Achievement Contact Name Contact Number Contact Central Mental Hospital Hellingly Centre Marlborough House The unit has developed a liaison relationship with the local Police Inspector to ensure that the implementation of certain policies is agreed with the Police. The unit carried out a joint exercise with the police, fire services and ambulance to ensure that staff fully learnt and were aware of the contingency systems in place and to ensure that these systems had been thoroughly tested. The peer-review team were particularly impressed with the policy that has been developed giving staff advice regarding their personal use of Facebook. Prof. Harry Kennedy harry.kennedy@hse.ie Lystra Madho Lystra.madho@sussexpartnership.mhs.uk Vanessa Odlin vanessa.odlin@oxfordhealth.nhs.uk 62

63 Newton lodge St. Andrew s Healthcare - CAMHS The Dene The Scott Clinic The peer-review team were impressed with the unit's policy addressing the use of computers and access to the internet. The design of this policy was particularly commended. The peer-review team praised the feedback form for carers, which is included in the CPA policy. The peer-review team were most impressed with the unit s contraband list which was displayed in the reception area. It was reported that the information is well displayed as that this is clear and concise for visitors. The use of flow charts within the managing critical incident reviews policy, which aids the implementation of the policy, was praised by the peerreview team. Catherine Eaves catherine.eaves@swyt.nhs.uk Ginny Smith gsmith@standrew.co.uk Kim Hill kim.hill@partnershipsincare.co.uk Hilary Lomas Hilary.Lomas@merseycare.nhs.uk 3. Relational Security Team Name Achievement Contact Name Contact Number Contact Alpha Hospital The unit has put in-house training in place for Health Support Workers to help them deliver psychotherapeutic groups. Joanne Ward joanne.ward@alphahospitals.co.uk 63

64 Alpha Hospital Arbury Court Bracton Centre The extensive self harm policy which includes recovery aspects was noted to be excellent. As was the suicide and self injury committee which meets every month to ensure policies are up to date and effective. The patient led self harm training and the self harm booklets for patients and staff which have been created with service user involvement were also highly praised by the peer-review team. The peer-review team praised the use of an electronic and hard copy list of patients names, pictures, likes and dislikes which is available on the wards for bank and agency staff so they are able to engage with patients more easily. The peer-review team commended the OT facilities in place and noted the therapeutic programme to be an area of good practice at the service. In particular, the Greenwich market stall was noted to be an area of good practice at the service. In addition, it was noted that the occupational therapy team facilitate access to sessional input from a range of providers, such as: urban art therapists, film projects; music teachers; drama therapists; street dance teachers and service users can make requests for additional activities to be facilitated. Joanne Ward joanne.ward@alphahospitals.co.uk Nick Shaughnessy nshaughnessy@partnershipsincare.co.uk Lisa Dakin lisa.dakin@oxleas.nhs.uk 64

65 Bracton Centre SLaM - Bridge House Broadland Clinic Chadwick Lodge Chadwick Lodge The unit has developed a tool for measuring and monitoring staff understanding and outcomes in relation to Relational Security. The unit has developed an HCR-20 group which has a clear recovery focus, to ensure that patients have an awareness and understanding of their own risk. This group provides service users with an opportunity to discuss and reflect on their own risks. The unit have recently introduced a Shared Risk Assessment whereby patients get involved in their initial risk assessment. The efforts to incorporate simple language for their LD population in such tools were commended. The unit has established links with the volunteer centre in the local area (Milton Keynes) and the peer-review team were impressed that service users have organised an event to say thank you to all the external organisations who have provided work and volunteering opportunities for them in the community. The peer-review team were impressed that the wards are all reviewing themselves against the relational security explorer, as part of the ward clinical Governance systems. Lisa Dakin lisa.dakin@oxleas.nhs.uk Sam Antwi-Marful Sam.Antwi-Marful@slam.nhs.uk Owen Fry owen.fry@norfolk-pct.nhs.uk Malcolm Campbell malcolmcampbell@priorygroup.com Malcolm Campbell malcolmcampbell@priorygroup.com 65

66 Charles House Central Mental Hospital Eric Shepherd Unit Guild Lodge Guild Lodge The unit has installed white boards in patient bedrooms and patients and their named nurse use this to plan and display the patient s individual activity plan for the week. The peer-review team were impressed with the Pillars of Care model that has been developed within the service, to ensure that recovery based and therapeutic needs are met. The unit has an Adult Education department run by the local further education college. This is based within the secure perimeter to enable the maximum number of patients to receive education and careers guidance. The unit has income generating metal and wood workshops and a horticultural garden. The products generated from these projects are available for sale to the general public. The training department at the unit was noted to be excellent. The peer-review team praised the swift response to training needs identified in PDPs, which is facilitated by links to local colleges and easy access to internal training. There is a service and education development group, who reflect on current agendas, handle the training budget, create training strategies and monitor the uptake of training. Pheneas Ishemunyoro Prof. Harry Kennedy pheneasishemunyoro@priorygroup.com harry.kennedy@hse.ie Ian Tearle ian.tearle@hertspartsft.nhs.uk Roy Butterworth Roy.Butterworth@lancashirecare.nhs.uk Roy Butterworth Roy.Butterworth@lancashirecare.nhs.uk 66

67 Hellingly Jasmine Unit Kneesworth House Llanarth Court Hospital Linden House Linden House St. Andrew s Healthcare - Lowther There are ward job roles available within the service, such as cleaning and maintenance, resident consultant. In addition, there are work opportunities within the cafe and service users are paid to be involved in recruitment interviews. The service user involvement in designing their personal activity planners was praised by the peerreview team. The unit s skills centre provides a range of opportunities to service users, including a charity shop which provides patients with opportunities to work, as well as a place to buy clothes on site. The unit has a well organised 25 hour programme of activities which incorporates classroom activities and social clubs that occur in the evenings. Communication at the unit was noted to be enhanced by the distribution of information flyers and minutes to staff after all meetings. Service users at the unit help deliver staff induction training. The unit has developed systems to identify and tap into particular interests of service users to encourage their engagement in occupational therapy Lystra Madho Lystra.madho@sussexpartnership.mhs.uk David Williams DavidWilliams@priorygroup.com Linda Ram lram@partnershipsincare.co.uk Dr Phil Huckle phil.huckle@partnershipsincare.co.uk Alison Tait Alison.Tait@huntercombe.com Alison Tait Alison.Tait@huntercombe.com Ginny Smith gsmith@standrew.co.uk 67

68 North London Forensic Service North London Forensic Service Norvic Clinic Oxford Clinic Oxford Clinic The unit has instigated maths and oral comprehension tests as part of the interview process for band 3 posts. The unit is trying a new training approach towards staff development which involves using a drama group to explore every day ward situations and encourage reflective practice. The unit actively works to identify the specific needs of service users to provide sessions relating to their particular interests where possible, such as guitar lessons and ICT. The peer-review team praised the system of categorising activities into optional (blue activities) and those which are an essential part of the treatment programme (black activities) to ensure service users are clear about the activities they are required to engage in. The unit obtains feedback from new employees who have recently undertaken the induction programme, to ascertain their thoughts and understanding in relation to the Relational Security training component of the induction to ensure that this is robust. Melanie Evans melanie.evans@beh-mht.nhs.uk Melanie Evans melanie.evans@beh-mht.nhs.uk Marcus Hayward Marcus.hayward@nwmhp.nhs.uk Vanessa Odlin vanessa.odlin@oxfordhealth.nhs.uk Vanessa Odlin vanessa.odlin@oxfordhealth.nhs.uk 68

69 Ravenswood House Rowan House Smyth House St Andrew s Healthcare - Birmingham St. Andrew s Healthcare - CAMHS The Butler Clinic The peer-review team praised the practice of employing service users on Trust contracts and providing management supervision for all service users in employment. The board in place for advertising new job vacancies within the unit was also noted to be praiseworthy. Patients who work at in-house and external job roles are not paid but all voluntary hours are recorded and certificates are given at a formal awards ceremony which it is reported patients find incredibly rewarding. The peer-review team noted the risk system in place to be good and well articulated, service users were very aware of the system and the impact their behaviour has on their own risk status. The range of psychotherapeutic sessions was praised by the peerreview team, including family therapy, CBT, compassionate mind, mindfulness and drama psychotherapy. The peer-review team were impressed with the sensory work that the unit does in relation to self-harm, for example the massage chair, the weighted blanket and the use of Swiss balls. The motorcycle restoration project was praised by the peer-review team. Dr. Jim Ormsby Jim.Ormsby@southernhealth.nhs.uk Alan Sockalingum alain.sockalingum@huntercombe.com Dr. Katina Anagnostakis Elizabeth McKeever kanagnostakis@standrew.co.uk emckeever@standrew.co.uk Ginny Smith gsmith@standrew.co.uk Jim Masters jim.masters@nhs.net 69

70 The Janet Shaw Clinic The Spinney The Spinney Thornford Park Hospital Trevor Gibbens Unit All nursing staff are able to access a weekly clinical supervision drop in group. The creativity and originality of the security training at the unit was praised. There are security road shows, 'who wants to be a security millionaire?' security quiz, powerful video clips of the consequences and importance of security are used and a security newsletter is attached to every payslip. Relational Security is a standard agenda item in PDT meetings and the See, Think, Act booklet is used to help teams score themselves in relational security and help identify strengths and weaknesses which lead to action plans. The unit has a system in place to denote the ward atmosphere for people coming onto the ward, to ensure that they are aware of how settled the ward is prior to entering. The unit has links with mental health support workers at the local colleges, to support service users in accessing education. Elaine Aston Elaine.Aston@covwarkpt.nhs.uk Aillie Wallace awallace@partnershipsincare.co.uk Aillie Wallace awallace@partnershipsincare.co.uk Paul Cowans paulcowans@priorygroup.com Dr Jonathon Pyott Jonathan.Pyott@kmpt.nhs.uk 70

71 Wathwood Hospital Wathwood Hospital WLMHT- Tony Hillis Wing The unit was noted to have an excellent staff library, access to journal subscriptions, e-learning and face to face training. The peer-review team were also impressed with the joint learning that occurs with both staff and service users. Woody s, the patient shop was praised as it is well stocked with a range of items, and patients are able to gain valuable work experience as it is open to the general public. Staff have regular meetings to discuss and reflect on Relational Security issues. For example, reflective practice sessions that take place on a weekly basis, which are compulsory for staff to attend. In addition, there are staff meetings once a week whereby staff members score themselves against the See, Think, Act guidelines. Steve Ball steve.ball@nottshc.nhs.uk Steve Ball steve.ball@nottshc.nhs.uk Dawn Harwood dawn.harwood@wlmht.nhs.uk 4. Serious and Untoward Incidents Team Name Achievement Contact Name Contact Number Contact Bracton Centre Good Practice meetings are held where presentations are given to share lessons learnt in relation to serious and untoward incidents. The peer-review team were impressed with the trend analysis that is carried out to map staff sickness etc to further analyse the incidents and their potential causes. Lisa Dakin lisa.dakin@oxleas.nhs.uk 71

72 Bamburgh Clinic and Kenneth Day Unit Chadwick Lodge Chadwick Lodge SLAM- Bridge House It was commended by the peer-review team that staff at the unit can seek support from Care First, following a serious or untoward incident. The peer-review team were impressed with the systems in place for circulating pertinent information from the Clinical Governance forums, in the form of a brief bulletin that is easily accessible to all staff. Service users are asked for their feedback regarding their impression of any incident that has taken place; there is a standardised form which they complete. The unit has systems in place for new staff to shadow other staff members at the unit in order to learn how to report incidents. Paul Thornton paul.thornton@ntw.nhs.uk Malcolm Campbell malcolmcampbell@priorygroup.com Malcolm Campbell malcolmcampbell@priorygroup.com Sam Antwi-Marful Sam.Antwi-Marful@slam.nhs.uk 5. Safeguarding Children and Visiting Policies Team Name Achievement Contact Name Contact Number Contact Caswell Clinic Newton Lodge The child visiting room at the Caswell Clinic was noted to be excellent; it was observed to have the necessary facilities such a kitchen and toilets as well as toys. Written feedback is provided to the MDT after each child visit has taken place. Andrew Simmonds andrew.simmonds@wales.nhs.uk Catherine Eaves catherine.eaves@swyt.nhs.uk 72

73 Guild Lodge The Scott Clinic Tŷ Llywelyn There is an appropriately decorated child visiting room and they praised the size of the outdoor garden attached. The child visiting room at the unit was noted to be excellent with excellent facilities such as a toilet, baby changing facilities, microwave and a good range of refreshments and toys are available. Service users reported that staff are flexible and will facilitate child visits in the sports hall so patients are able to play sports with their children. Roy Butterworth Roy.Butterworth@lancashirecare.nhs.uk Hilary Lomas Hilary.Lomas@merseycare.nhs.uk Simon Allen Simon.allen@wales.nhs.uk B: Clinical and Cost Effectiveness Team Name Achievement Contact Name Contact Number Contact Alpha Hospital Arnold Lodge Bracton Centre The unit provides debriefing session at the end of every day on the Personality Disorder ward. The passport supervision logs and the consultant buddying supervision system were praised. Service users are encouraged to visit other services they may be transferred to and home visits are also facilitated to help determine readiness for discharge/transfer. Training is offered to patients to support them in their involvement in the CPA processes at the unit. Including training in writing their CPA report and how to be involved in the meeting. Joanne Ward joanne.ward@alphahospitals.co.uk Amanda Santaney amanda.santaney@nottshc.nhs.uk Lisa Dakin lisa.dakin@oxleas.nhs.uk 73

74 Brockfield House Brockfield House Calderstones - Woodview Charles House Farmfield Hospital Farmfield Hospital Bank staff at the unit must receive supervision or they are unable to work at the service. It was praised that staff training needs is a standard agenda item in ward meetings. The unit have piloted a full-mdt HCR- 20 post-admission assessment. The unit has a service user lead for recovery who provides training and a 'buddy' system for new staff and also new service users. It was reported that the information from the recovery star is included in the computer based clinical notes. It was reported that all goals regarding the recovery star are decided jointly between the service user and member of staff. In addition, staff and service users complete the scoring separately and then use this as a point of discussion, especially if there are discrepancies. There is a Recovery Project Audit Group in place to ensure the effective implementation of recovery within the service There are always supervisors on the night shifts to ensure that this, quieter, time can be used for staff to access clinical supervision. Neil West neil.west@sept.nhs.uk Neil West neil.west@sept.nhs.uk Karen Birchall karen.birchall@calderstones.nhs.uk Pheneas Ishemunyoro pheneasishemunyoro@priorygroup.com Paul O Connor PaulOConnor@priorygroup.com Paul O Connor PaulOConnor@priorygroup.com 74

75 Fromeside Kneesworth House Kneesworth House Linden House North London Forensic Service Ravenswood House Ridgeway The peer-review praised the practice of including training on delivering and receiving supervision as part of the induction programme. A focus group was held with frontline staff to identify what they feel they need from clinical supervision, which consequently informed the training that was delivered to supervisors. The work the unit has done around My Shared Pathway was noted to be excellent. In particular, the literature that has been produced in this area was praised by the peer-review team. It was praised that a number of staff recently carried out investigating and complaints training to help ward staff investigate complaints. The unit conduct internal quality assurance peer-reviews to help assure the service meets CQC standards The unit s structured development plans in place for nurses and HCAs, which provides a clear pathway, were noted to be excellent in providing career progression for nursing staff. The peer-review team praised the system of displaying staff uptake of clinical supervision in the ward offices. This was noted to support a culture of accessing clinical supervision amongst ward teams. Steve Batson steve.batson@awp.nhs.uk Linda Ram lram@partnershipsincare.co.uk Linda Ram lram@partnershipsincare.co.uk Alison Tait Alison.Tait@huntercombe.com Melanie Evans melanie.evans@beh-mht.nhs.uk Dr. Jim Ormsby Jim.Ormsby@southernhealth.nhs.uk Susan Sirrell susan.sirrell@tewv.nhs.uk 75

76 The Spinney St. Andrew s Healthcare - William Wake House C: Governance Patients at the unit write articles on what recovery means to them and there are recovery newsletters and information sheets available for patients. Im:Roc Recovery champions, which involve both staff and service users, have been appointed across the service. Aillie Wallace awallace@partnershipsincare.co.uk Lynn Baxter lbaxter@standrew.co.uk Team Name Achievement Contact Name Contact Number Contact Alpha Hospital Calderstones Gisburn Lodge Calderstones - Woodview Personality Disorder training including working with women has recently been carried out by frontline staff. There is also working with women in medium secure services training which covers trauma, domestic violence, abuse. The patient led training on self harm was especially praised. Managers are responsive to training needs in relation to how mental illness presents in people with learning disabilities and staff have the opportunity to gain Diplomas in this area. All staff receive a mandatory 3 week induction programme which is centred upon working with individuals who have a learning disability. Joanne Ward joanne.ward@alphahospitals.co.uk Karen Birchall karen.birchall@calderstones.nhs.uk Karen Birchall karen.birchall@calderstones.nhs.uk 76

77 Cheswold Park Hospital Marlborough House Newton lodge Reaside Clinic Ridgeway St. Mary s The Janet Shaw Clinic The unit has a simulated search room that is used to train staff on how to conduct thorough room searches. This was noted to be highly beneficial since it provided a real-life experience to trainees. The peer-review team commended the exchange programme that is run between the unit s wards to enable staff to gain experience of the acute service as well as the rehabilitation and recovery area, to support them in their continued professional development. The unit has developed an awareness group which addresses and discusses the needs of the LD patients, which is accessed by both patients and staff. In relation to complaints, the unit were commended for their initiative to introduce a drop-in session once a month during the evenings in order to resolve matters on a local level. There are e-learning discs available on the wards to ensure that all staff can undertake the necessary training conveniently. The annual refresher training includes a test component to ensure that the training has been fully understood. All clinical supervision takes place on one day so this is known well in advance and staff are able to organise their time so they are able to attend. Vanessa Blanshard vblanshard@cheswoldparkhospital.co.uk Vanessa Odlin vanessa.odlin@oxfordhealth.nhs.uk Catherine Eaves catherine.eaves@swyt.nhs.uk Dr Alison Reed alison.reed@bsmhft.nhs.uk Susan Sirrell susan.sirrell@tewv.nhs.uk Adrian Needham Adrian.needham@stgeorgehealthcaregroup.co.uk Elaine Aston Elaine.Aston@covwarkpt.nhs.uk 77

78 WLMHT - Orchard Unit The Spinney Ty Llywelyn The unit has made changes to the recruitment process; to specifically state that the unit is recruiting for staff to work on a female ward to ensure they have applicants who actively want to work with women and are therefore more likely to be prepared for the challenges of this client group and will be less likely to leave. The peer-review team were impressed that patients present their views on security to staff during the security training and they also praised the scenario based exercises. It was praised that all staff have are trained in the, which is a 5 day course. There is a 2 day refresher in Management of Aggression and Violence training every year and if this is not attended the full 5 days must be completed again. There are 2 trainers on the team. Karen Jones karen.jones@wlmht.nhs.uk Aillie Wallace awallace@partnershipsincare.co.uk Simon Allen Simon.allen@wales.nhs.uk 78

79 D: Patient Focus Team Name Achievement Contact Name Contact Number Contact Arnold Lodge Patients reported that there are yoga sessions and a sensory room where relaxation sessions are held. They also reported that the structured day nurse frequently brings in massage chairs. There is also a well equipped Amanda Santaney amanda.santaney@nottshc.nhs.uk 'First Impressions' salon which provides a variety of beauty and hairdressing treatments. This was noted to be excellent in helping to promote patient s well being. Arnold Lodge Patients reported that there is an information box which contains the minutes from the various patient meetings, to help include those who did not attend. Amanda Santaney amanda.santaney@nottshc.nhs.uk It was reported that one service user Bamburgh Clinic from one ward will attend the and Kenneth Day community meetings at another ward Paul Thornton paul.thornton@ntw.nhs.uk Unit to ensure that ideas are shared between wards. Calverton Hill The peer-review team were impressed that there are patient run reflection groups on the wards, a patient organised and run open day as well as patient led activity groups on the ward. Wendy Khan wkhan@partnershipsincare.co.uk 79

80 Central Mental Hospital Cheswold Park Hospital Cygnet Hospital Stevenage Edenfield Jasmine Unit The unit s management team visit the wards on a monthly basis to ensure that service users have direct input into the running of the hospital. The unit s efforts to facilitate communication between service users and carers was noted as an area of good practice; the unit provides mobile phones to patients and Skype as a means of keeping in touch with family members. The patient s café was commended for the way in which it operates in such a professional manner. It is very clear that the café is at the heart of the hospital's vocational rehabilitation programme and evident that the service users take ownership. Comprehensive information is provided to carers in a pack, which includes links to carer advocacy services. Furthermore, carers are involved in CPA meetings and tribunals. It was praised that there are pamper sessions for the patients once a week, which include face and hand massages, foot spa and hair dressing. Prof. Harry Kennedy Vanessa Blanshard harry.kennedy@hse.ie vblanshard@cheswoldparkhospital.co.uk Jenny Sayer jennysayer@cygnethealth.co.uk John Walker john.walker@gmw.nhs.uk David Williams DavidWilliams@priorygroup.com 80

81 Marlborough House Newton lodge North London Clinic Norvic Clinic Oxford Clinic Service users at the unit are central to the planning of action plans and implementing the action points following the completion of the Essen Climate Evaluation Scale. This is rolled out via the Service User Forum. The use of the dialogue group format used within the service was noted to be an excellent way of facilitating carer involvement. There is strong evidence of patient involvement throughout the entire service. For example, patients are involved in their own care plan, recovery star plan, recovery focus groups, patient service user involvement clinical governance meetings, ward representative meetings as well as physical health meetings. The Norvic Challenge, a charity set up by the service for post-tsunami victims, was noted to be a great example of staff and service users working collaboratively for a worthy cause. The unit has a carer s induction in place. Vanessa Odlin vanessa.odlin@oxfordhealth.nhs.uk Catherine Eaves catherine.eaves@swyt.nhs.uk Pippa Philipson Pippa.Philipson@partnershipsincare.co.uk Marcus Hayward Marcus.hayward@nwmhp.nhs.uk Vanessa Odlin vanessa.odlin@oxfordhealth.nhs.uk 81

82 Reaside Clinic Rowan House Shaftesbury Clinic Shaftesbury Clinic Shannon Clinic St. Andrew s Healthcare - Smyth House The unit have a Family and Friends group whereby regular meetings take place to discuss relevant issues as well as open day events to support positive relationships and information sharing. The unit ensures staff receive feedback from incident investigation formally with a written letter as well as informally, there is also a dedicated person who is responsible for dealing with all incidents where staff have been injured by patients. Farewell parties that are held for each patient upon discharge. Courses are provided to carers via the Trust, for example in Improving Communications Between Carers and Patients. Video links have been established to further support carer involvement in the unit and the care of their relative and there is a carer advocate within the service. Service users have been involved in delivering training regarding the use of seclusion. Dr Alison Reed alison.reed@bsmhft.nhs.uk Alan Sockalingum alain.sockalingum@huntercombe.com Jonathan Hepworth Jonathan Hepworth Jonathan.hepworth@swlstg-tr.nhs.uk Jonathan.hepworth@swlstg-tr.nhs.uk Jackie Elliot jackie.elliott@belfasttrust.hscni.net Dr. Katina Anagnostakis kanagnostakis@standrew.co.uk 82

83 St Andrew s Healthcare Birmingham St Andrew s Healthcare - Nottingham St. John s House St. Magnus Sutton s Manor It was noted that there is an excellent multi faith room and strong spiritual culture at the service. Spiritual needs are reflected in care plans and an assessment tool is being developed for this. It was reported that there is a lot of input from the Imam and chaplain, who work as part of the MDT and the chaplain meets every new admission. The peer-review team were impressed to note a place for foot washing, clerical robes, prayer mats, relevant religious text, and the direction of Mecca was identified in the multi-faith room. It was also praised that there is a chaplain available 3 days a week. It was also noted that the patient representatives can attend involvement meetings at sister hospitals to have input in these services and share good practice and take lessons learnt back to their own service. One to one nursing time is provided to each patient on a daily basis. Evening meetings which take place on the wards on a daily basis to provide a space for reflection for staff and service users together and an opportunity to review the day's events, to ensure that the views of patients are heard. Elizabeth McKeever emckeever@standrew.co.uk Simon Lloyd SiLloyd@standrew.co.uk Fungai Nhiwatiwa fnhiwatiwa@partnershipsincare.co.uk David Munns dmunns@stmagnus.co.uk Brian Mandisodza brian.mandisodza@partnershipsincare.co.uk 83

84 The Butler Clinic The Humber Centre The John Howard Centre The Spinney There is a carer newsletter and carer events where carers are able to express their view. One result of this was the implementation of the supervised use of Skype on the unit. It is praiseworthy that the ward courtyards are treated as an extension of the ward and are easily accessible to service users. This areas were redeveloped with input from service users, working with an external team. Service users have designed the service user led audit and carry out the audits themselves which monitors the quality of service Social workers visit carers in their homes to help strengthen relations Jim Masters jim.masters@nhs.net Dave King dave.king@humber.nhs.uk Deborah Bull debbie.bull@eastlondon.nhs.uk Aillie Wallace awallace@partnershipsincare.co.uk E: Accessible and Responsive Care Team Name Achievement Contact Name Contact Number Contact Calverton Hill Priory Widnes The peer-review team were impressed that the unit holds random updates for CPR training and also unexpected resuscitation simulations for staff. The seclusion suite has an automatic door which was praised by the visiting peer-review team. Wendy Khan wkhan@partnershipsincare.co.uk Donna Dale DonnaDale@priorygroup.com 84

85 Ridgeway WLMHT - Orchard Unit The Butler Clinic The unit holds Rapid Process Improvement Workshops, which aim to get members of staff from a range of disciplines together, and service users where appropriate, to discuss an issue and possible solutions. It was noted that these are effective in making rapid and positive changes within the service to ensure that best practice is striven for at all times. The unit has arranged for underwear fittings from an external supplier to be facilitated for service users. It was praised that service user groups are led by an ex-service user, for example to consult on the new build. Susan Sirrell susan.sirrell@tewv.nhs.uk Karen Jones karen.jones@wlmht.nhs.uk Jim Masters jim.masters@nhs.net F: Environment and Amenities Team Name Achievement Contact Name Contact Number Contact Arbury Court The peer-review team were impressed with the level of choice and detail in the patient s food menu and that they could pick the individual ingredients for a salad option. Nick Shaughnessy nshaughnessy@partnershipsincare.co.uk 85

86 Bracton Centre SLaM - Bridge House SLaM - River House The Hatherton Centre The Humber Centre The Scott clinic The Spinney The peer-review team were impressed with the management of access to hot drinks at the service, noting that free access is available on all wards, as well as the smoothie makers that are available in the kitchens. The unit has Health and Safety champions on each of the wards, part of whose role is to carry out regular environmental checks. The healing garden containing herbs and plants was praised by the peerreview team. The unit has an excellent horticulture area including a poly-tunnel which patients use to grow produce which the catering department then use to make patient meals. Patients are able to choose their food on the same day and do not have to plan in advance. It was also praised that some patients are trained to make their own food and have food hygiene certificates and can then supervise other service users. There are food tasting sessions as part of the food focus groups where service users are able to taste and the vote for certain foods. It was praised that there are drinks machines for patients providing high quality drinks with a number of drinks options. Lisa Dakin lisa.dakin@oxleas.nhs.uk Sam Antwi-Marful Sam.Antwi-Marful@slam.nhs.uk Sam Antwi-Marful Sam.Antwi-Marful@slam.nhs.uk Dave Mason ext 5346 david.mason@sssft.nhs.uk Dave King dave.king@humber.nhs.uk Hilary Lomas Hilary.Lomas@merseycare.nhs.uk Aillie Wallace awallace@partnershipsincare.co.uk 86

87 Wathwood Hospital The patient library and e-learning facilities were noted to be excellent and would rival a community library. Steve Ball steve.ball@nottshc.nhs.uk G: Public Health Team Name Achievement Contact Name Contact Number Contact Ardenleigh The unit use The Five Point Living Plan, a traffic light system that Sarah Beasley sarah.beasley@bsmhft.nhs.uk promotes healthy living. Arnold Lodge The outdoor exercise /gym equipment in the patient courtyard was noted to Amanda Santaney amanda.santaney@nottshc.nhs.uk be excellent. Brockfield House The unit has a dedicated Health and Lifestyle staff member, who acts as a health idol. The unit also has a director of physical health in post who focuses on nutrition, metabolic health issues and weight management. Neil West neil.west@sept.nhs.uk The unit have a rewards card North London whereby service users can earn points Forensic Service by engaging in healthy behaviours. Melanie Evans melanie.evans@beh-mht.nhs.uk Unit has the MEWS (modifying early warning signs) system in place SLaM whereby the nurses monitor changes, such as an increase in body temperature, in all patients once a week. Sam Antwi-Marful Sam.Antwi-Marful@slam.nhs.uk Shaftesbury Clinic Service users are able to access accredited programmes in exercise and nutrition. Jonathan Hepworth Jonathan.hepworth@swlstg-tr.nhs.uk 87

88 WLMHT - Three Bridges The Spinney Wathwood Hospital The new Physical Health Care Suite was highly praised and the unit were commended for the normalisation of this suite. In addition, the wide range of health care services provided was noted to be excellent. The themed health promotion months at the unit such as smoking cessation, obesity and run a marathon, have been successful in engaging patients. It was also noted that the unit are skilling up nursing staff on health promotion issues. The peer-review team were impressed with all the physical healthcare facilities available including the twice weekly GP visits podiatry, physiotherapy on demand, Chiropody, epilepsy and diabetic checkups, in house phlebotomy service as well as dental facilities. Dawn Harwood dawn.harwood@wlmht.nhs.uk Aillie Wallace awallace@partnershipsincare.co.uk Steve Ball steve.ball@nottshc.nhs.uk 88

89 APPENDIX D: THE REVIEW PROCESS The real benefit of being a member of the Quality Network is in taking part in the self and peer-reviews. The reviews aim to improve services incrementally by applying standards, using the principles of the annual review cycle, outlined in Figure 17 below. Figure 17: The annual review cycle: Self-review Each year the Quality Network organises a self-review for each unit. This involves completing a workbook developed from the implementation criteria. The Quality Network s service user experts facilitate telephone conferences supported by a member of the Quality Network s central team, to enable service user input at this stage of the review process. Peer-review visit The Quality Network organises a peer-review team to visit each medium secure unit who aim to validate the self-review scores and comments. The peer-review teams usually consist of four members of staff from two different services. Membership comprises a variety of staff from the multi-disciplinary team (MDT) including a consultant psychiatrist At present a proportion of the peer-review teams include one of the Quality Network s service user experts. This is an area of new development and it is planned for all peerreview teams to include service users in the future. 89

90 Visits to other services Throughout the cycle staff from each medium secure unit participate in a peerreview visit to two other services, as members of peer-review teams. Staff feedback that they find these visits useful as they provide the opportunity for teams to learn from observed good practice and to engage in frank discussion about shared problems and possible solutions. Detailed local report Following the peer-review visit the Quality Network team writes a detailed local report for each member unit. This report summarises the findings of the self-and peer-review, providing suggested action points made by the peer-review team for partly met and unmet criteria. Annual members forum Members are invited to an annual conference which includes a presentation of the key findings from the previous year s cycle of reviews, an annual general meeting of the Quality Network for Forensic Mental Health Services and member-led workshops/presentations that explore their experience of the review process, share achievements, exchange good ideas between peers and discuss solutions for the challenges identified. Quality Network newsletter and discussion group The members newsletter provides policy news, project updates, articles written by members describing good practice initiatives and research taking place, as well as a regular column from the Quality Network s service user experts. The discussion group provides a speedy way to access the experience and knowledge of other members. Policies shared on the discussion group are made available in an electronic library on the Quality Network s website 17. Lead reviewer training The Quality Network organises lead reviewer training days which aim to train staff in the required skills for leading peer-review visits

91 APPENDIX E: PROJECT TEAM Name Job Title Contact Details Sarah Tucker Programme Manager Maddy Iqbal Deputy Programme Manager Ilham Sebah Project Worker (Improving Mental Health Services) Sarah Stubbs Project Worker (Improving Mental Health Services) Dr. Paul Gilluley Chair, Advisory Group 91

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93 APPENDIX F: ADVISORY GROUP First Name Surname Role Organisation Status Joined Alain Aldridge Service User Expert Quality Network for Forensic Mental Health Services Service User Expert Nov-07 3 year service N/A Phil Brian Head of Secure Services Commissioning West Midlands Commissioning Team Co-opted Sep-10 N/A Rosie Ayub Secure Services Commissioning/ National QIPP Programme Ian Carmichael Service User Expert Sheryle Cleave Clinical Nurse Manager Dr. Paul Stephen Gilluley Godwin Consultant Forensic Psychiatrist Deputy General Manager Yorkshire and Humber Secure and Specialist Mental Health Commissioning Team Quality Network for Forensic Mental Health Services Northumberland Tyne and Wear NHS Foundation Trust West London Forensic Service Co-opted Oct-11 N/A Service User Expert Sep-11 N/A Selected Feb-12 Feb-15 Chair Apr-09 Apr-15 Ridgeway Selected Feb- 11 Feb-14 Julian Haines Social Work Manager North London Forensic Service/ National Group for Social Work Managers in Co-opted Dec-10 N/A Secure Services Dr. Quazi Haque Group Medical Director Partnerships in care Co-opted Sep-11 N/A Dr. Mary Prof. Harry Dr. Jeremy Mat Dr. Clive Doreen Kath Dr. Janet Harty Kennedy Kenney- Herbert Kinton Long McCollin Murphy Parrot Consultant Forensic Psychiatrist & Associate Medical Director Executive Clinical Director & Consultant Forensic Psychiatrist Clinical Director/Consultant Forensic Psychiatrist Mental Health Act Policy Advisor Associate Director of Psychology and Psychological Therapies Corporate Director of Nursing Head of Secure Services Policy Consultant Forensic Psychiatrist/Chair Forensic Faculty Susan Riding Carer Representative South West London & St Georges Mental Health NHS Trust National Forensic Mental Health Service, Central Mental Hospital Selected Feb-12 Feb-15 Selected Feb-12 Feb-15 Reaside Clinic Selected Dec-09 Dec-12 Care Quality Commission Co-opted Sept- 11 N/A St. Andrew s Healthcare Selected Feb- 11 Feb-14 Partnerships in Care/Royal College of Nurses Co-opted Feb 09 N/A Department of Health Co-opted Dec- 11 N/A Royal College of Psychiatrists Quality Network for Forensic Mental Health Services Co-opted Dec-08 N/A Carer Expert Dr. Pete Snowden Medical Director Partnerships in Care Selected Dec-09 Dec-12 Anita Trenfield Carer Representative Quality Network for Forensic Mental Health Services Carer Expert Sep- 10 Sep- 10 N/A N/A 93

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