Mental Health Act Annual Statement November 2009

Transcription

1 Mental Health Act Annual Statement November 2009 South West Yorkshire Partnership NHS Foundation Trust Introduction The Care Quality Commission (CQC) visits all places where patients are detained under the Mental Health Act Mental Health Act Commissioners meet and talk with detained patients in private and also talk with staff and managers about how services are provided. As part of the routine visit programme information is recorded relating to: Basic Factual details for each ward visited, including function, bed occupancy, staffing, and the age range, ethnicity and gender of detained patients. Ward Environment and Culture, including physical environment, patient privacy and dignity, safety, choice/access to services/therapies, physical health checks, food, and staff/patient interaction. Issues raised by patients and patient views of the service provided, from both private conversations with detained patients and any other patient contacts made during the course of the visit. Legal and other statutory matters, including the scrutiny of Mental Health Act documentation, adherence to the Code of Practice, systems that support the operation of the Act and records relating to the care and treatment of detained patients. At the end of each visit a feedback summary is issued to the Trust identifying any areas requiring attention. The summary may also include observations about service developments and / or good practice. Areas requiring attention are listed and the Trust is asked to respond stating what action has been taken. The response is assessed and followed up if further information is required. The information is used by the CQC when verifying the NHS Health Check and making decisions about the inspection programme in both the NHS and Independent Sector. In future years it will be used to inform the registration decisions. A list of the wards visited within this Trust is provided at Appendix A. Background This year the former South West Yorkshire Mental Health NHS Trust achieved authorisation as a Foundation Trust and from 1 May 2009 became South West Yorkshire Partnership NHS Foundation Trust. The Trust continues to provide services across the four care groups of: Adults of working age with a mental health problem.

2 Older people with a mental health problem. People with a learning disability whose behaviour challenges services, with intensive support needs and/or a mental health problem. Mediums secure forensic services for people with a mental health problem and/or learning disability. In the 2009 Care Quality Commission Annual Health Check the Trust scored good for quality of services and good for financial management which compared with the 2008 scores represents an improvement from fair for financial management but a deterioration from excellent for quality of services. This statement draws on findings from visits by Mental Health Act Commissioners both under the auspices of the Mental Health Act Commission and those which took place after April when the functions of the Mental Health Act Commission were taken over by the Care Quality Commission. The Annual Statement provides an overview of the main findings from visiting, highlighting any matters for further attention and / or areas of best practice. It is published on the CQC website, together with other publications relating to individual mental health providers. Main Findings Overview The Trust s administration of the Mental Health Act remains fundamentally sound and administrative preparation for the changes brought about by the Mental Health Act 2007 has been thorough and effective. The Trust has continued to provide timely and robust responses in respect of issues identified on individual visits and in most cases have taken appropriate remedial action without delay. This willingness to acknowledge problem areas and to act quickly to bring about improvements is to be commended. As noted in previous years there is still considerable variability in the standard of service provision across the wide range of in-patient facilities. Patients remain generally positive about the caring and professional approach of staff, but this year there has been some deterioration in aspects of ward environments in respect of cleanliness and smoking areas. Patients Rights The 2008 report recommended that the Trust should audit provision of rights information and other information to detained patients to ensure that its practice is consistent with the requirements of the Code of Practice, Chapter 2: Information for patients, nearest relatives and others. Commissioners found that most detained patients were aware of having been informed of their rights. Recording of informing patients of their rights is of a consistently high standard and the recording format has been appropriately updated to include informing patients of their right to an Independent Mental Health Advocate and how to access one.

3 Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) The 2008 report recommended that the Trust should ensure that clinical staff are competent in the application of the Mental Capacity Act in readiness for implementation of the Deprivation of Liberty Safeguards. Commissioners found that knowledge and application of DOLS assessment and more broader best interests decision-making under the Mental Capacity Act remain variable across the Trust. For example staff at Dewsbury Hospital were conversant with the Mental Capacity Act and were familiar with the DOLS assessment process. However, staff at the Dales Unit were largely unaware of the Deprivation of Liberty Safeguards and could not identify which, if any, patient had been considered for a DOLS assessment. The Trust has responded by issuing DOLS guidance, policy and record sheet to all staff to read and sign, but it will be important to ensure that staffs knowledge of the arrangements is, where appropriate, translated into practice. Section 17 Leave of Absence The 2008 report recommended that the Trust should introduce a single system for recording Section 17 leave of absence authorisations that is compatible with the requirements of the Code of Practice, Chapter 21: Leave of Absence. Commissioners found a satisfactory standard of recording of leave of absence authorisations in accordance with the Code of Practice. Some concern was expressed by patients about the frequency of cancellation of planned leaves due to staff shortages. Commissioners understand that a further audit of this issue is to be undertaken. Seclusion and Extra-care Arrangements Commissioners were concerned that the use of the former extra-care area on Elmdale Ward at the Dales as the 136 suite left the ward without a suitable deescalation area as an alternative to seclusion. This was a temporary arrangement but Commissioners understand that it is not intended to restore the area to it former use. The rationale for this is that Psychiatric Intensive Care Unit (PICU) beds are now available within the Trust and that bedrooms can be used if patients need to be supported in a quiet area. However, the PICU facility is some distance from the Dales and use of bedrooms for de-escalation raises the question as to when patients are deemed to have been in seclusion. Similar issues were identified at other facilities where the care of a patient away from other patients was not deemed to be seclusion and therefore the safeguards for patients in seclusion were not enacted. The seclusion policy has been under review and it will be necessary to ensure that any patients confined in a room are afforded the safeguards set out in the Code of Practice. Advocacy There are clear arrangements in place for accessing Independent Mental Capacity Advocates (IMCAs) and Independent Mental Health Advocates (IMHAs). The Trust has done well to incorporate informing detained patients of their right to an IMHA from the point of implementation in April Awareness amongst patients of the availability of general advocacy is more variable, and more could be done to publicise the role of Cloverleaf on the wards Catering Patients complained about the quality and quantity of food at several facilities. For example on the Priestly Unit patients commented on the small portions served and

4 the lack of food available between meals and at The Bretton Centre patients spoke negatively about the poor quality of food in general particularly the Halal meals; the lack of healthy options and the lack of choice. Ward Environments and Smoking Areas The standards of cleanliness and maintenance of some wards had deteriorated since previous visits. For example on Beechdale at the Dales there were strong toilet smells and corridors were cluttered and untidy. Managers have responded quickly to requests for action in respects of ward cleaning etc but it is a cause of concern that acceptable standards are not always being achieved through routine maintenance. The roll-out on a number of wards of new smoking arrangements has impacted negatively both on the patients who smoke and on patients who don t smoke in respect of its impact on the ward environment. For example on Elmdale at the Dales the fencing off of the smoking area has created what looks like a cage which is unsatisfactory for patients who smoke and for others using the garden. Recommendations for Action 1. The Trust should examine, either through audit or clinical review, the application in practice of Mental Capacity Act best interests decision-making in respect of patients who lack capacity in relation to aspects of their care and treatment. 2. The Trust should, as planned, undertake an audit of the occasions when planned Section 17 leave is cancelled or postponed due to shortages of staff. 3. The Trust should ensure that any patients subject to supervised confinement in a room are afforded the safeguards set out in the Code of Practice, Chapter 15: Safe and therapeutic responses to disturbed behaviour. 4. The Trust should publicise the details of Advocacy services so that detained patients are aware of all the advocacy service provision that is available to them. 5. The Trust should review its catering provision to ensure that all detained patients are given choices of a variety of healthy and culturally appropriate food, and that portions are adequate to meet patients nutritional needs. 6. The Trust should ensure that cleanliness and tidiness of all wards are maintained at an acceptable standard. 7. The Trust should re-examine its smoking arrangements for detained patients, with a view to enhancing the quality of life of smoking and non-smoking patients. Forward Plan Commissioners will continue to visit the Trust s in-patient facilities in 2010 to meet with detained patients and to review progress against the recommendations of this Annual Statement.

5 Appendix A: List of wards visited at South West Yorkshire Partnership NHS Foundation Trust: Detained Records Date Ward patients seen checked Dewsbury Hospitals 29 Sep 2009 Ward 18, Priestly Unit 5 4 Ward 19, Priestly Unit 1 1 Total for Dewsbury Hospitals 6 5 Newton Lodge Regional Secure Unit 19 Aug 2009 Waterton 5 6 Total for Newton Lodge Regional Secure Unit 5 6 Dales Mental Health Unit 9 Jan 2009 Beechdale 0 1 Elmdale Ward Jun 2009 Beechdale 0 4 Elmdale Ward 2 3 Total for Dales Mental Health Unit 2 10 Enfield Down 25 Jan 2009 Enfield Down Mar 2009 Enfield Down 1 3 Total for Enfield Down 3 6 The Bretton Centre 26 Jan 2009 Almond Bury Unit 4 3 Ryburn Unit Jan 2009 Sandal Unit 2 4 Thornhill Unit 4 4 Total for The Bretton Centre Total Number of Visits: 8 Total Number of Wards visited: 10 Total number of Patients seen: 26 Total Number of documents checked: 39