Standards for Medium Secure Units

1 Charity registration no. 228636 Standards for Medium Secure Units Quality Network for Medium Secure Units Edited by Sarah Tucker and Tessa Hughes 1st Edition CRTU 044 1: Relational Security 1 2: Procedural Security 5 3: Physical Security 7 4: Personal Dignity 10 5: Core Interventions 12 6: Workforce Development and Training 14 7: Equality and Diversity 15 8: Workforce, Recruitment, Retention 15 9: Supervision and Support 16 10: Patient Involvement 17 11: Advocacy 17 12: Carer Involvement 17 13:Interagency Working 18 14: Management 18 Appendix 1: References 19 Appendix 2: Advisory Group 22 Appendix 3: Project Team 23 Appendix 4: Acknowledgements 24 Appendix 5: Standards Order Form 30 Appendix 6: Standards Feedback Form 31 Contents Foreword It is a great pleasure to introduce these Standards for Medium Secure Units and to welcome their implementation by the new Quality Network for Medium Secure Units .

2 These Standards specifically for Medium Secure Units are very long-needed. Moreover, their implementation promises to play a key role in assisting pioneer members of the quality network to develop and respond to the objectives identified by the Department of health s Standards for Better health . The Department of health with specialist commissioners will continue work on refining Standards for Medium security. This work will be incorporated into the implementation of the Standards by the Quality Network for Medium Secure Units in an on-going way. In turn the work of the Quality Network will inform the development of the Department of health Standards . New policy will not lead to improvement unless front-line staff are fully involved in the process of change.

3 This exciting new quality network aims to engage and support front-line staff of all professions. The well-tested quality network model offers frontline staff invaluable opportunities to explore common difficulties and learn from each other, during Standards -based peer-review visits. These service Standards for Medium Secure Units provide often-isolated individual Units the opportunity to speak to commissioners with a united voice about common problems. The changes occurring to commissioning in England and Wales make it timely to engage and involve commissioners with this initiative as the pressing next stage. It seems inevitable that the future will bring about the need for accreditation, and the implementation of these Standards promises to prime Units to move in this direction.

4 Dr John O Grady Chair of the Forensic Faculty, Royal College of Psychiatrists Introduction The Standards for Medium Secure Units (MSUs) include all the Department of health Standards ( health offender Partnerships, 2004) and extra Standards identified by members of the Quality Network for MSUs from a supplementary set. The development of this supplementary set and the editing of the final document is summarised below. Department of health Standards are marked (DH) and supplementary Standards are marked (S). 1) The Development of the Supplementary Standards for MSUs ) Literature Review and Development of Draft Standards A bibliography of key documents was compiled from professional bodies, regulators, policy, other quality networks, and experts (see Appendix 1).

5 These were reviewed and Standards were identified or derived from guidance and recommendations. A pre-consultation draft of supplementary Standards was developed, informed by, and referenced to, the literature. ) Consultation A consultation took place at a stakeholder workshop on 23 January 2006 as part of the Third National Conference on Research and Development in Medium Secure Psychiatric Units at the Institute of Psychiatry (see Appendix 4). The Standards consisted of ten sections. Stakeholders worked in five small groups and were asked to comment on two sections each. ) Editing The process of consultation and incorporation of expert comments, staff member and ex-client member comments ensured that the draft Standards reflect contemporary Medium Secure unit practice.

6 2) Augmentation of the Department of health Standards for MSUs ) Consultation and Editing The Department of health Standards for MSUs were numbered and sent out for consultation to members of the Quality Network for MSUs. Members were asked to read through the Department of health Standards and then identify Supplementary Standards which would usefully augment the Department of health set. The Department of health Standards for MSUs were therefore augmented, but not changed. ) Standards for Better health The resulting Standards were mapped on to the Department of health Standards for Better health (2004) and an identifying code was added in the far right column. This enables members of the Quality Network for MSUs to use local review reports as evidence of compliance with Standards for Better health .

7 This is required in the Healthcare Commission s Annual health Check. Where the column is left blank there is no obvious corresponding standard. 1 1. Relational Security Relational Security Admission and Assessment Source Standards for Better health Units have systems and processes in place that ensure good quality multi-disciplinary assessment prior to admission (DH) The assessment takes into account relevant history, problems, issues, legal status and risks (S) There is a clearly defined process for the admission of people to the unit (S) There are written referral criteria (S) Staff and patients provide written information about the unit that addresses the needs of prospective patients, referrers and other relevant professionals (S) C16 The information provided contains a clear description of the aims of admission, the current programme and modes of treatment (S)

8 C16 Measures are in place to record and audit refusals, terminated referrals and waiting lists (S) Where patients are refused admission to the service, the reasons for refusal are explained to the person and referrer, and they are informed about alternative options (S) Those presenting as high risk or with more severe conditions are given priority with assessment (S) C19 All patients have an initial treatment plan in place within 24 hours following admission (DH) C19 All patients on admission have an initial risk assessment (DH) C7c; C1b 2 Relational Security - Care and Treatment Source Standards for Better health All patients are managed within the framework of the CPA process (DH) C5a The staff team develop a written care pathway in consultation with each patient, within the limits of safety and risk assessment (S) C17 Patients are given a copy of the management or care plan or have ready access to it (S) C16 There is a core day described in each patient's individualised care plan (A description of the core day may also be found elsewhere in ward programme or individual timetable) (DH) C16 There are regular case reviews in line with good practice ECC/CPA guidelines (DH)

9 C5a Relational Security - Team Composition and Skills There are processes in place which demonstrate an evaluated staffing profile to meet the needs of the patients ( skills assessment and needs assessment) (DH) C5b; C5c; C11a There are clear and effective systems for communication and handover within staff teams (DH) C1b There are regular multi-disciplinary team meetings for clinical matters and administration, and the team is consulted on relevant management decisions such as developing and reviewing operational policy (S) C5b The ratio of Consultant Psychiatrists to Medium Secure beds is 1: 14 (DH) There are multi-disciplinary teams identified as part of the staffing establishment, with each team including psychiatrists, nurses, psychologists, occupational therapists, and social workers (DH) There is at least one nurse holding the RMN qualification on duty at all times (S) At least four staff hold an appropriate qualification on duty per shift and two at night-time (Grade E-H) (S) 3 Relational Security - Team Composition and Skills cont d Source Standards for Better health A typical unit with 10-12 places includes at least one WTE SpR or equivalent (S) A typical unit with 10-12 places includes at least one level two SHO (S) In a typical unit about one WTE clinical psychologist is provided (S)

10 In a typical unit about one WTE Occupational Therapist is provided (S) WTE social work input is provided in a typical 10-12 bed unit (S) The unit has access to a substance misuse specialist or dual diagnosis specialist either working as part of an integrated or parallel model (S) The unit has access to a range of practitioners offering psychotherapeutic sessions (S) 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 (S) All staff can demonstrate an understanding of their role in relation to meeting the complex needs of patients (DH) The variance between staff in post and establishment is minimised (DH) C11a The number of nursing staff on the unit is sufficient to safely meet the needs of the patients at all times (S) Extra nursing cover is available when needed, there is access to additional on-call staff in emergency (S) The unit is staffed by permanent staff and agency staff are used only in exceptional circumstances (S) C11a There are published and monitored plans to deliver therapy and treatments in line with planned programmes (DH) C5a.