04 Patient Voice - Forensic Services - Rampton Hospital.pdf

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BOARD OF DIRECTORS 28th JULY 2016 INVOLVEMENT, EXPERIENCE AND VOLUNTEERING PATIENT VOICES REPORT FORENSIC SERVICES: RAMPTON HOSPITAL

1. PURPOSE This is the monthly Patient Voice report produced for the Board of Directors. The main purposes of this report are to: Inform the Board of Directors of our headline patient experience indicators for the Trust as a whole, for each division and for a specific service. •

To summarise the full breadth of feedback received from service users, carers and staff over the previous six months about the specific service featured and any plans to address the main issues raised.



To update the Board of Directors on the action taken to address the main issues raised about the service featured in the Patient Voice report three months previously.

The report is part of our approach to Service User and Carer Experience which is a key part of the Involvement, Experience and Volunteering strategy (2015 – 2018). One of our three involvement aims is to change services by listening and responding to service user and carer views and aspirations. Our approach is also based on the Trust’s values and aligned to Department of Health priorities. As an NHS funded service we are required to carry out the Friends and Family Test. We must also meet the CQC Standard that requires us to seek and act on feedback so we can continually evaluate services and drive improvement. As part of the Trust’s development of its approach and the Francis Report we are continually looking at how we can improve both how we listen and respond to the patient voice. Our feedback website enables the public to leave and view feedback and also able see the changes we have made in response to feedback. The website also enables staff to view feedback about their team. As part of our approach the Board of Directors receives a quarterly Involvement, Experience and Volunteering Report which looks at key achievements in the Involvement, Experience and Volunteering strategy and outlines our strategic direction and next steps.

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This Patient Voice Report is a monthly report and focuses on key patient stories and comments raised by service users, patients and carers. 2. EXECUTIVE SUMMARY The Trust’s Service Quality Rating for April – June 2016 is 94%. Our Friends and Family Test Score is 97% (this is the percentage of people who would be extremely likely or likely to recommend our services if their friends or family needed similar care or treatment). This month’s Patient Voice Report focuses on Forensic Services with an in-depth look at Rampton Hospital and an update on Arnold Lodge (featured in April’s report). The report highlights all prominent and/or recurring feedback in the last six months from the full range of feedback mechanisms used by Rampton Hospital, including those targeted at carers and families. The report then summarises the main issues identified and action taken or proposed to address these issues. The main issues identified are: • Lack of access to off ward activities on the Peaks unit and frequent cancellation of planned sessions. • Low staffing levels affecting patients care and treatment. • Staff attitude and restrictive practices. It also updates on the issues presented in the previous paper focussing on Forensic Services in April 2016, which related to Arnold Lodge. These were: • • • • • •

Patient shopping Information on admission Information on the assessment process Communication with friends and family, particularly via Skype Seclusion facilities Staffing level, particularly how this impacts on leave

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3. TRUSTWIDE HEADLINES 3.1 TRUSTWIDE HEADLINES Data collected from the Service User Feedback survey: April to June 2016 94% 97% 6683 225

Service Quality Score Friends and Family Test (FFT) SUCE survey returns Patient Opinion stories

January to March 2016 95% 97% 7088 200

3.2 PATIENT OPINION HEADLINES Data collected from Patient Opinion website (patientopinion.org.uk): April to June 2016

TRUSTWIDE

LOCAL SERVICES

FORENSIC SERVICES

HEALTH PARTNERSHIPS

225

47

16

162

0

0

0

0

4

4

0

0

Number of postings Number of postings without a response

• Number of postings rated as moderately critical or above

• • •

Number of postings with change planned/completed

One posting relates to the gender clinic in Specialist Services (see section 4.4) One posting relates to St. Francis mental health unit, within Mental Health Services for Older People One posting relates to a lack of psychiatric beds for adults in Nottingham One posting relates to adult crisis services

5

1

3

1

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3.3 TRUSTWIDE MAIN ISSUES AND ‘BEST THING’ Data collected from the Service User Feedback survey: Current rolling year (July 2015 – June 2016)

Emerging issues (April to June 2016)

ISSUES (based on 9068 responses to the ‘What could we do better’ question) Availability of services (Category: Access to Services)

10%

General communication (Category: Communication)

8%

Appointments (Category: Care/Treatment)

6%

No emerging issues

COMPLIMENTS (based on 15404 responses to ‘What did we do well’ question) Helpful/Caring/Friendly (Category: Staff/staff attitude)

20%

General (Category: Service Quality/Outcomes)

13%

General (Category: Care/treatment)

9%

No emerging compliments

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3.4 TRUSTWIDE TREND IN SERVICE QUALITY, FRIENDS AND FAMILY TEST AND KEY QUESTION SCORES

4. LOCAL SERVICES HEADLINES

4.1 DIVISIONAL HEADLINES Data collected from the Service User Feedback survey:

Service Quality Score Friends and Family Test (FFT) SUCE survey returns Patient Opinion stories

April to June 2016 93% 94% 1575 47

January to March 2016 94% 94% 2096 33

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4.2 DIVISIONAL MAIN ISSUES AND ‘BEST THING’ Data collected from the Service User Feedback survey:

Current rolling year (July 2015 – June 2016) ISSUES (based on 1671 responses to the ‘What could we do better’ question) Availability of services (Category: Access to services)

10%

Waiting time (Category: Access to services)

8%

Staff/Service User communication (Category: Communication)

7%

Emerging issues (April to June 2016)

No emerging issues

COMPLIMENTS (based on 3043 responses to ‘What did we do well’ question) Quality of Care/Service (Category: Service Quality/Outcomes)

16%

Helpful/Caring/Friendly (Category: Staff/staff attitude)

15%

Improvements in Mental Health (Category: Service Quality/Outcomes)

7%

No emerging compliments

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4.3 DIVISIONAL TREND IN SERVICE QUALITY, FRIENDS AND FAMILY TEST AND KEY QUESTION SCORES

4.4 PATIENT OPINION Patient Opinion postings published in the last month deemed moderately critical or above: •

A patient posted about delays in accessing the gender clinic, part of Specialist Services, for gender dysphoria. “I have now been on a waiting list for almost a year and have ended up self-medicating which I am aware is at risk to my health.” They explained that they felt that had been treated ‘appallingly’ and that they felt it was having an impact on their health. Angie Jackson, Service Manager for prescribed services, responded to say that “The demand for The Nottingham Gender Clinic has increased significantly but the service does not currently have the resources to be able to see patients more quickly. We are talking to our commissioners, NHS England, about this issue.” She suggested that the person should speak to their GP if they were feeling distressed. www.patientopinion.org.uk/opinions/296253

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5. HEALTH PARTNERSHIPS HEADLINES 5.1 DIVISIONAL HEADLINES Data collected from the Service User Feedback survey:

Service Quality Score Friends and Family Test (FFT) SUCE survey returns Patient Opinion stories

April to June 2016 96% 98% 4823 162

January to March 2016 96% 98% 4826 146

5.2 DIVISIONAL MAIN ISSUES AND ‘BEST THING’ Data collected from the Service User Feedback survey: Current rolling year (July 2015 – June 2016) ISSUES (based on 6763 responses to the ‘What could we do better’ question) General communication (Category: Communication)

13%

Availability of services (Category: Access to Services)

11%

Appointments (Category: Care/Treatment)

8%

COMPLIMENTS (based on 11688 responses to ‘What did we do well’ question) Helpful/caring/Friendly staff (Category: Staff/Staff Attitude) General (Category: Service Quality/Outcomes) General (Category: Care and Treatment)

23% 18% 12%

Emerging issues (April to June 2016)

No emerging issues

General communication (Category: Communication) 14%

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5.3 DIVISIONAL TREND IN SERVICE QUALITY, FRIENDS AND FAMILY TEST AND KEY QUESTION SCORES

5.4 PATIENT OPINION Patient Opinion postings published in the last month deemed moderately critical or above: •

No postings deemed moderately critical or above published in the last month

6. DIVISION IN FOCUS: FORENSIC SERVICES This month the focus is on the Forensic Services. We are taking an in-depth look at the views and experiences of patients at Rampton Hospital, and the views and experiences of their carers’ and families. We also include an update on the issues presented at the March Board of Director’s regarding Arnold Lodge. 6.1 DIVISIONAL HEADLINES Data collected from the Service User Feedback survey:

Service Quality Score Friends and Family Test (FFT) SUCE survey returns Patient Opinion stories

April to June 2016 78% 71% 285 16

January to March 2016 78% 68% 164 12

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6.2 DIVISIONAL MAIN ISSUES AND ‘BEST THING’ Data collected from the Service User Feedback survey: Current rolling year (July 2015 – June 2016)

Emerging issues (April to June 2016)

ISSUES (based on 634 responses to the ‘What could we do better’ question) Staffing levels (Category: Staff/Staff Attitude) Comments relate to patients requesting more listening from staff, and more staff to facilitate activities.

10%

Activities (Category: Care/Treatment) Comments are not limited to any particular services, and relate to a mix of therapeutic and leisure activities, particularly fitness.

7%

Approach to care (Category: Care/Treatment) Comments, though difficult to summarise, relate to aspects of choice and restriction – “Involve patients in their care rather than imposing care” (Tamar Ward)

6%

Quality of care (Category: Service Quality/Outcomes) 6%

COMPLIMENTS (based on 673 responses to ‘What did we do well’ question) Quality of Care/Service (Category: Service Quality/Outcomes)

16%

Being listened to (Category: Communication)

12%

Helpful/Caring/Friendly (Category: Staff/staff attitude)

10%

No emerging compliments

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6.3 DIVISIONAL TREND IN SERVICE QUALITY, FRIENDS AND FAMILY TEST AND KEY QUESTION SCORES

6.4 PATIENT OPINION Patient Opinion postings published in the last month deemed moderately critical or above: •

No postings deemed moderately critical or above published in the last month

6.5 UPDATE ON PREVIOUS BOARD PAPER WITH FORENSIC SERVICES FOCUS ARNOLD LODGE MEDIUM SECURE UNIT (featured in Board of Directors paper, April 2016) Below we update on any developments in relation to the main issues presented in the March report:

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ISSUE

Patient shopping

Information on admission

DETAIL

Patients have raised this issue regularly within the Patients’ Forum, commenting on the difficulty ordering, payment methods, catalogues, in-house patient shop opening times etc.

Mixed responses to the question in the Quality Network Peer Review “Were you provided with information about the service before you were admitted? For example a welcome pack or leaflet?” Sample quote from the Feedback survey: “More support when we first get here” (Cannock Ward)

ACTION TAKEN/PROPOSED

An internet shopping pilot was initiated in February as a response to many stores stopping the publication of paper catalogues and ordering being available via the internet only. Initial results have been promising and patients from across the service have been involved in a working group to look at how this system will be operationalised on each ward as it is a significant change to current practice. One of the wards will be undertaking a pilot during April and May with nursing staff facilitating internet shopping for patients during evenings and weekends with a view to rolling the system out across the whole unit after that.

Information has been collated from across the service in order to provide a comprehensive information pack to be given to patients prior to, or immediately after, their admission to the service. This replaces the information that is currently given to patients by individual wards and which varies in quality and content. The information pack will be professionally printed and is currently being designed by the Trust Communications Team.

UPDATE – July 2016 There have been pilot internetbased shopping sessions on three wards, and a full scale trial implementation of the new shopping procedures will be run on one of the Personality Disorder wards in August 2016. There have been challenges in reconciling hospital procedures and practice with the security systems of some on-line retailers. A working system has been agreed within the hospital which will be incorporated into the trial implementation in August.

Work in progress and planning for final document to be ready for circulation by end of September 2016 allowing time for final approval by staff, patients, visitors and the Readers’ Panel.

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Mixed responses to the question: “Were you told what to expect from the service as part of your introduction?” Information on the assessment process

Communication with friends and family, particularly via Skype

Mixed responses to the question to friends and family: “Did the service involve you as part of the admission process to the service?” – More people answered negatively.

Patients have raised this regularly within the Patients’ Forum, and with the advocacy service. Requests have been made to open channels for Skype and for email, alongside phone and letter.

A short, explanatory leaflet has been designed in response to the need for more information about the assessment process. This has been formatted by the Trust Communications Team and has just been returned by the Readers’ Panel for some minor tweaks before ratifying and circulating.

Access to Skype facilities has recently been offered as an additional service to patients and has been successfully introduced, with four patients having now called relatives using Skype. The service is offered principally to patients whose relatives live some distance from Arnold Lodge, or who have difficulty visiting very regularly. Training will be offered to a variety of staff in April and May 2016 to help broaden the access to Skype for patients. Once this has been successfully implemented across the service, staff will be exploring the means for patients to access email, although this will be for receiving email only for security reasons.

The leaflet has been designed and amendments made further to comments from the Readers’ Panel. Staff assessing patients for admission advised to give this leaflet to patients on assessment and also on admission. Longer term plan to incorporate this information into an Admission & Assessment Pack. Skype is offered regularly to patients at Arnold Lodge: patients have used Skype to contact friends and family around the country and also overseas. A cohort of staff from each of the wards will undergo training in the use of Skype during July 2016 and will be cascading this learning to the rest of the staff group. The system for patients receiving emails from friends and family has been set up and advertised at the Arnold Lodge Summer Open Day for friends, family and carers: several patients have subscribed to this service.

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The Directorate Management Team are aware of the issues relating to the build of the Women’s Seclusion area and nursing staff manage these as safely and effectively as possible.

Seclusion facilities

Staffing level, particularly how this impacts on leave

Patients have raised concerns that seclusion facilities in the Women’s Service are not fit for purpose as there is no natural light in the seclusion rooms, it is difficult to communicate effectively with observing staff using the intercom system and there is no en-suite shower facility, meaning that patients have to leave the seclusion room to take a shower.

More staff (Thornton Ward) Improve Staff (Rutland Ward) Staffing levels to improve individualised care (Tamar Ward) Improve staffing levels, more OTs (Tamar Ward)

Capital bids have been submitted in order to improve the seclusion area, i.e. installation of CCTV and an improved intercom system, but changes to include natural light and an en-suite shower would involve major building work and is unlikely to be funded in the short-term. Prior to building the new Women’s Service, extensive consultation took place with other Women’s Services around the country. This was factored into the design of the facility. There is CCTV in both seclusion rooms to assist staff with patient observations - this CCTV does not record. CCTV that does record will soon be added outside the seclusion rooms, for safety reasons. Works to the intercom will take place when we can safely move both patients currently in seclusion to alternative rooms. Works will take 5 days and should be completed by midMay 2016. There is a national shortage of qualified nurses. In response to this, Arnold Lodge have over-recruited to unqualified posts in order to have more staff available on wards to facilitate leave where possible, which staff make every effort to reschedule if cancellations are necessary. In addition to this, there is a rolling recruitment programme on NHS Jobs, and the unit have been proactive in using other media to attract staff to the service, i.e. radio advertising and attendance at job fairs. ‘Group leaves’ have been used effectively so that more than one patient can go out at a time with a reduced number of staff required.

Work to install CCTV to seclusion lobbies is to commence 25.07.16. The Engineer attended mid-June but the recommendation was to replace the existing intercom system. Funding was provided and installation of a new system that is consistent with other seclusion facilities in the Unit will be undertaken in August 2016. The service has started a review on the use of seclusion for women to address numbers of patients who have advance statements re use of seclusion as a coping mechanism.

Following a robust recruitment campaign, all vacant qualified Nursing posts have been recruited to with candidates anticipated to commence in post September 2016. In addition to this the DMT (Directorate Management Team) has supported a project to look at alternative ward based roles to complement Nursing roles by expanding the role of Occupational Therapists to work in traditional Nursing roles on wards. This project is ongoing.

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7. SERVICE IN FOCUS: RAMPTON HOSPITAL HEADLINES Rampton Hospital provides high secure inpatient services for male and female adults with mental illness, personality disorder, learning disability. Services are currently arranged over three Clinical Directorates which provide admission and assessment, treatment and pre- discharge support. These are: • • •

Male Mental Health Service (including the National Deaf Service) and the National Learning Disability Service. Male Personality Disorder Services and National Women's Services. Male Enhanced Personality Disorder Services.

Patients within all Clinical Directorates have multi-disciplinary teams working with them to deliver their care and treatment. These include medical staff, Psychology and Social Work, as well as Allied Health Professionals in Therapies and Education and the nursing staff. Staff at the Hospital employ a range of mechanisms to capture feedback from and involve patients, and their carers and families – including a monthly Patients’ Council, and Open Forum, an inpatient survey every 18 months in addition to bi-annual Trust Feedback Survey, Patient Opinion, quarterly Carer Events which are planned jointly with Carers, visitor feedback survey in reception to capture real time feedback and a bi-annual Family, Friends and Carers’ newsletter – In Touch. 7.1 DIRECTORATE HEADLINES Data collected from the Service User Feedback survey:

At directorate level, we compare the current rolling six month period with the previous rolling six month period, due to the six monthly surveying cycle in Forensic Services Service Quality Score Friends and Family Test SUCE returns Patient Opinion stories

January to June 2016

July to December 2015

72% 54% 132 11

73% 31% 135 20

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7.2 DIRECTORATE MAIN ISSUES AND ‘BEST THING’ Data collected from the Service User Feedback survey: Current rolling year (July 2015 – June 2016) ISSUES (based on 193 responses to the ‘What could we do better’ question) Staffing levels (Category: Staff/Staff attitude) 18% Activities (Category: Care/Treatment) 10% Approach to care (Category: Care/Treatment) 9% Being listened to (Category: Communication) 7% General (Category: Staff/Staff Attitude) 3% COMPLIMENTS (based on 200 responses to ‘What did we do well’ question) 16% Quality of Care/Service (Category: Service Quality/Outcomes) Activities (Category: Care/Treatment) 8% Helpful/Caring/Friendly (Category: Staff/Staff attitude) 8%

Emerging issues (January - June 2016)

No emerging issues

No emerging compliments

7.3 COMMENTS AND STORIES WHICH ILLUSTRATE THE MAIN ISSUES RAISED In the following section we present a summary of the feedback received through the major channels used across Rampton Hospital over the last 12 months. This feedback serves to illustrate the main issues that have been raised by patients, their carers’ and families, and staff. 7.3.1 COMMENTS FROM THE SERVICE USER FEEDBACK SURVEY WHICH RELATE TO THE MAIN ISSUES RAISED: Comments that illustrate what has been said about the main issues raised: Staffing levels • • • • •

I feel that more staff are needed and that staff are not taken off us to cover other wards or seclusions, leaving our ward short and the patients unable to achieve the goals set out for them (Cheltenham Ward) Get more staff and stop taking staff off one ward making my ward short of staff. (Kempton Ward) Provide more staff to avoid things (activities) being cancelled due to staff shortages (Firs Ward) The low staffing numbers also stress staff out making them bad tempered and demoralised. (Jade Ward) I feel more staff would be good at times so sessions are not cancelled and more activities are in place (Quantock Ward)

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Activities • More off ward sessions but more staff needed for this. They don't follow care plan. I feel the staff let me down when it's to do with physical things. (Ruby Ward) • At times there could be more staff to do more activities. (Quantock Ward) Approach to care • After reporting verbal abuse by a nurse in charge, I have been treated disrespectfully ever since. When staff are playing mind games with me how is that making a positive difference. (Grampian) • Retrain most staff to do the job of nursing/caring. Instead of punitive/prison guards. Detain, supress, control, medicate. (Eden ward) Being listened to • Change of mentality. Give patient some credit when complain. Some staff speak in code which makes me uneasy/paranoid. Staff listen but don't believe when you put your point across. I have been treated poorly by some staff and they get away with it. I don't have enough trust with staff, they sometimes put their own interests instead of patient interest. (Juniper Ward) • Listen more to what would make patients feel better in the environment (Firs ward) • There is a difference in being "listened" to and feeling like you are being "heard". This is an area that needs improvement and hopefully one day patients can feel more human. This is an area that has been vastly improved over the last 12-24 months and seems to still be improving. (Eden Ward) Quality of Care/Service • They don't really care, it’s whatever is easier for them and you may think I have something against Rampton but I don't. I came here hoping to get better and open mind but you have bad apples. (Cheviot ward)

7.3.2 PATIENT OPINION In the last year, 19 stories have been published on Patient Opinion commenting on Rampton Hospital. • 17 postings were rated as entirely complimentary • 1 postings were rated minimally critical • 1 postings were rated as moderately critical All stories have been responded to; the vast majority of stories received a response on the same day they were published. Two of the stories state that a change in services is planned: • The first posting (www.patientopinion.org.uk/opinions/244982) relates to the lack of a communal lavatory on The Peaks unit (which caused inconvenience when staff were not available to escort people back to their rooms), a lack of fresh air, receiving other patient’s notes, and medicine errors. Page 17 of 28

The Modern Matron on The Peaks Unit responded to say “I will ensure that your comments and feedback is shared amongst our senior management team and we will then notify you of the changes we are planning in response to your concerns.” A Service Review was commissioned by the General Manager in response to complaints from patients residing on Eden Ward. The complaints ranged from the physical environment to nursing practices and clinical leadership. The outcome of the review was that patients were happy with the care that they received and with the compassionate leadership provided by both the ward manager and senior management. An action plan was co-produced by the patients and staff to enhance improvement of patient experience in a few areas including communal toilets. Ensuite toilets had been installed in all patients’ individual wards to promote privacy and dignity and infection prevention and control. A patient can have access to his toilet at any time. Communal toilets were rejected on the grounds of potential for bullying and sexual activities. The patient who posted these issues was part of the working group on completing the action plan and shaping the future of the ward. As a result of his positive experience he has moved on to a lesser secure environment to continue his treatment. The ward has continued to have community meetings whereby together patients and staff formulate action plans when required and working collaboratively to resolve issues. •

The second (www.patientopinion.org.uk/opinions/299841) was posted in the last 3 weeks and refers to a 15 Step Challenge which was conducted within Rampton’s new health centre with the support of patients from the mental health and learning disability wards. “The challenge was taken seriously by the patients, and they came up with many constructive suggestions, and a few criticisms. This in turn was fed back to the area Manager, and the Quality Improvement Lead for the hospital. Patients are looking forward to seeing if any of their suggestions are implemented.”

Two of the stories have resulted in a change: • Both stories relate to the newly launched Patient Involvement group within The Peaks unit, which is giving new opportunities for patients to raise issues: www.patientopinion.org.uk/opinions/295965 www.patientopinion.org.uk/opinions/296752

Sample of quotes from the stories received in the last year: •

“I would like to take time to thank Martina, Peaks Modern matron for her proactive and positive approach in launching the Peaks meaningful activity plan. I think this is an exciting initiative that will help us in our recovery.Thank you!” (The Peaks) (https://www.patientopinion.org.uk/opinions/296752)



“Dear Kath, Jay, Sarah, Karen, Mike, Alan, Steve (Therapeutic Involvement Workers - TIWS) and all others who helped us to celebrate St George’s Day and also the Queen’s birthday on this wonderful summer’s day. Thank you and also cheers for the pancakes and all the

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other wonderful things you do for us all on the Rampton wards. ps. all the walks mean everything to me, having the gym up and available every day at the DRC (Diamond Resource Centre) is ace!” (https://www.patientopinion.org.uk/opinions/290556) •

“I am writing to express my thanks to you, Kath Alder, Jacqui Vincent, Mark Johnson, the band "Blue's Experience and the Rosewood Involvement Centre Team… Personally and environmentally times are difficult, difficult because of the hard work in therapy, coping with new thoughts, feelings, emotions and adapting my behaviours too. The Band, music, people and food have really helped! It’s been a delight to hear, see, feel and "to be" all the music! it feels like a piece of normal has come back.” (https://www.patientopinion.org.uk/opinions/245276)

7.3.2 COMPLAINTS In past 12 months, Rampton Hospital received 350 complaints. The below table shows the number of complaints received in the last 12 months from each speciality at Rampton Hospital:

Speciality Forensic Mental Health Forensic Peaks Forensic Women’s' Services Forensic Personality Disorder Forensic Learning Disabilities Forensic Security Forensic Physical Healthcare Forensic Therapies & Education Forensic Services Facilities High Secure Total

Total 80 79 53 52 40 22 8 8 5 3 350

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The below table shows the top five most frequently selected categories for these complaints, along with the percentage that were upheld or partially upheld.

Category

Total number of complaints in 2015/16 raising this issue

% of those which have been investigated and closed which were upheld or partially upheld

107 65 42

31% 19% 12%

30 27

9% 8%

Nursing care Staff attitude Assault/physical aggression/threat incident Patient property/expenses MDT care

Nursing care A snapshot of complaints from October and November last year show that many nursing care complaints arise from patients’ differences with ward restrictions: • • • • • • •

Excessive confinement in side room Exclusion from side room Lack of basic amenities and privacy while secluded Restrictions due to required escort levels Restricted access to/use of telephone Meal arrangements Restrictions on personal property

Management of such issues, as well as related concerns about some staff and fellow patients displaying an unsympathetic attitude, continues to feature prominently in complaints. Eleven of the 26 Rampton complaints closed in May 2016 concerned patients’ dissatisfaction with their relations with staff or other patients, or with the sort of restrictions described above. Staffing levels ‘Staffing levels’ is not currently a Ulysses category; however, a qualitative review of the details of complaints received in the year from July 2015 indicates that patients felt strongly, especially in the third quarter of last year, that staffing levels were inadequate on a number of wards. Patients complained that this resulted in reduced access to fresh air, to activities and therapy sessions and to a less safe environment. Page 20 of 28

These concerns appear to have diminished with the recruitment of additional nursing staff at the hospital.

7.3.4 VISITOR/CARER POSTCARDS/SURVEY A total of 184 visitors left feedback using the iPads situated in the Reception (170 of the total number) and the Visitors Centre at Rampton (14 of the total number). Eight of those were visitors attending CPA (Care Programme Approach) meetings, and 16 of the surveys were undertaken by children. Visitors Reception Feedback Feedback suggested the overall experience of visiting the hospital was positive. Information taken from the free text comment sections indicates that there have been some issues surrounding visitor waiting times (20 comments from 15 separate surveys). Most of these comments were made relating to weekend visits. Once these issues were identified, we looked at the cause and put measures in place to deal with the delays. Since then the number of delay related complaints has reduced. Forty-seven visitors took the time to leave additional comments which contained positive feedback relating to level of service both on the ward and also in reception. All but one visitor said that the reception team made them feel welcome when attending the hospital and again, all but one said that they felt they were treated with courtesy and respect. Out of 57 people asked if they felt safe when visiting the hospital, 49 said they felt completely safe, seven said most of the time, one said rarely.

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Visitors Centre Feedback The feedback around carer experience and the quality of service was positive overall, with only one small issue raised surrounding an issue with the TV not functioning correctly at the time of the visit. Three of the visitors leaving feedback on the visitors centre iPads were children attending the hospital on child visits.

Child Visits Out of the 16 child visits, 14 said they felt happy after their visit, one said they felt worried and anxious and another said they felt angry and cross. The names of the children visiting who gave negative responses were passed onto social work & visitors centre staff so the matter could be looked into further. Despite this, all 16 children taking the survey said they would like to visit again. Whenever visitors request to be contacted regarding the matters that are raised the process is followed up and they are written to explaining the steps taken to resolve any of the issues raised. We constantly review the feedback received and look at how we can improve the visiting experience and share this information with visitors on the feedback wall, forwarding comments on to staff where appropriate. 7.3.5 FEEDBACK FROM ADVOCACY ABOUT ISSUES RAISED/RESOLVED:Together (for Mental Wellbeing) Together (for Mental Wellbeing) provides the Independent Mental Health Advocate (IMHA) service and Generic Advocacy Service to patients detained at Rampton Hospital and across the wider Forensic Division. Meetings with the patient are held in private; patients are supported to discuss issues or concerns relating to care and treatment or their detention/rights, and enabling them to make an informed choice regarding their preferred course of action. The advocate helps the patient to explore options and consider potential consequences of each course of action, but ultimately the patient decides on the avenue they wish to pursue. The advocate then acts on instruction from the patient, ensuring they are fully informed and involved throughout the advocacy process. Solutions could include: relaying concerns to a Named Nurse; facilitating a meeting between the patient and Ward Manager; contacting a member of the Clinical Team; identifying and approaching a specific Department Manager within the Trust who may be able to help; helping the patient access local complaints procedures. In addition to 1:1 appointments, advocates ensure the service is accessible to all patients by conducting regular advocacy drop-in sessions on wards allowing patients to meet the advocate without requesting a formal appointment. Advocates attend Community Meetings on a regular basis and the service facilitates Rampton Hospital Patients Council. Page 22 of 28

Issues and themes raised by patients both individually and at group meetings over the last year have included: • Staffing levels across the hospital • DTV (Distributed TV) and access to technology • Patient activities in the hospital • Treatment • Discharge pathway • CPA related work and support at tribunals Activity at Rampton Hospital over the last year is shown below: • Patients requested 2853 individual appointments • The Advocacy service received 4477 telephone calls • Advocates facilitated 670 Drop-in Sessions across all wards • Advocates attended 251 Community Meetings • Advocates provided support to patients on 156 occasions during police and internal hospital investigations • The Advocacy services facilitated 12 Patients Council meetings in addition to supporting individual Council Members and facilitating elections IPAS Feedback Over the past six months there have been several main themes from patients within the feedback provided to IPAS. The main one being the lack of nursing staff on wards and the impact this has on their daily life. Patients report they cannot get off ward to activities and sometimes activities are cancelled as the day care staff have to go to work on the wards. Patients report the lack of nursing staff also has an impact on using singleton escort which then has a knock on effect to patients achieving ground access. The DTV system and technology is also an ongoing theme from patients. Patients are aware that technology is moving forward at such a fast pace and they don’t want to get left behind. This is a difficult issue as obviously security has a large impact on what patients can and cannot have access to. Patients feel that the other high secure hospitals have access to more technology and this is raised on a regular basis. The patients’ shop is also an issue that is regularly raised. Patients are unhappy about the pricing of items in the shop, the lack of choice and the lack of stock in the shop. Patients feel they pay premium price for goods and also that stock is sometimes not replenished between wards so there is limited choice for some wards. Catalogues for clothing is also an issue that is frequently raised. Patients feel there is limited choice for them to buy clothes. Unfortunately, due to the policy around catalogues some companies do not want to work with the hospital and some Page 23 of 28

companies are internet based only and do not produce a catalogue. Most recently a large supplier of clothing to patients said they would no longer accept cheques. This has had a massive impact on patients. The hospital are looking at having their own clothing shop where patients can order via an intranet type system but currently there is no timescale on when this will be available. The patients’ menu and Halal meals are also raised as issues. Recently the Patients Council have been informed that a new menu is being put together but there is no timescale when this will be completed. 7.3.6 FEEDBACK FROM HOSPITAL PATIENT’S COUNCIL/DIRECTORATE INVOLVEMENT GROUPS Over the past six months there have been several main themes raised by patients at Patient’s Council Meetings. The main one being the lack of nursing staff on wards and the impact this has on their daily life. Patients report they cannot get off ward to activities and sometimes activities can be cancelled as the day care staff have to go to work on the wards. Patients report the lack of nursing staff also has an impact on using singleton escort which then has a knock on effect to patients achieving ground access. The DTV system and technology is also an ongoing theme from patients. Patients are aware that technology is moving forward at such a fast pace and they do not want to get left behind. This is a difficult issue as security has a large impact on what patients can and cannot have access to. Patients feel that the other high secure hospitals have access to more technology and this raised on a regular basis. The patients’ shop is also an issue that is regularly raised. Patients are unhappy about the pricing of items in the shop, the lack of choice and the lack of stock in the shop. Patients feel they pay premium price for goods and also stock is sometimes not replenished between wards and so there is limited choice for some wards. Catalogues for clothing is also an issue that is frequently raised. Patients feel there is limited choice for them to buy clothes. Unfortunately due to the policy around catalogues, some companies do not want to work with the hospital and some companies are internet based only and do not produce a catalogue. Most recently a large supplier of clothing to patients said they would no longer accept cheques. This has had a massive impact on patients. The hospital are looking at having their own clothing shop where patients can order via an intranet type system but there is no clear timescale on when this will be available. The patients’ menu and Halal meals are also a frequent issue raised. Recently Patients Council have been informed that a new menu is being put together but there is no timescale when this will be completed.

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8.0 MAIN ISSUES FOR THE SERVICE AND ACTION TAKEN OR PLANNED In the table below, we highlight the most prominent issues (selected from the range of feedback presented) raised by patients and their carers’ and families over the last 12 months, and the actions taken or proposed to address these issues. ISSUE

SOURCE

Feedback survey Patient involvement group Lack of access to off ward activities and frequent cancellation of planned sessions

Recovery meeting Ward community meeting Patient complaints

DETAIL

Due to lack of staffing resources and high levels of clinical need, sessions have been cancelled more than we would have preferred. “More off ward sessions but more staff needed for this” “ I feel that more staff are needed and that staff are not taken off us to cover other wards or seclusions, leaving our ward short and the patients unable to achieve the goals set out for them”

ACTION TAKEN/PROPOSED •

Following the relaunch of the patient involvement meetings, an off ward activity timetable has been devised by the patients and both nursing and Therapy Education Department (TED) staff are working collaboratively to facilitate the delivery of these sessions.



Daily staffing meetings are now held jointly with Nursing and TED representatives in attendance in order to share resources and limit the number of cancellations.



Site and Security Liaison Managers (SLM’s) and Central Resource (CRO) are now aware of the planned and ensure staff activity duties are allocated in order to limit the movement of staff to cover the main hospital.



Each ward has a designated ward activity co-ordinator and recovery champion. Their role is to enhance the level of meaningful activity by working collaboratively with the patients on their ward to plan and deliver ward based activities.



Fresh air and walks are provided to all patients daily to both male PD (Personality Disorder) patients in the Chiltern Grounds and female patients in the Diamond Resource Centre Grounds.

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Low staffing levels affecting patients care and treatment

Patient Forums Patient Council

Feedback highlights how low staffing levels impacts on the extent to which patients feel listened to and involved. “More staff, more time. Sometimes don't listen.”



HR Recruitment and retention plan to improve direct staffing levels which means we are currently over establishment by 40 nursing staff, and have appointed 45 qualified nursing staff who will take up post in the next few months . There is an open advert for qualified nursing staff and ‘safe staffing’ reports indicate a significantly improved picture.



A concerted drive to reduce sickness absence across the site is underway.



Revised senior nurse/security structure to coordinate staffing of wards across Rampton Hospital. A dynamic planner has been introduced to assist improved coordination and facilitate the reduction of cancellations of planned activities and out of grounds appointments. This also includes improved governance of site management via a new process of shift change approval.



Following the appointment of a number of new Ward Managers a training event was held which included rostering and implementing HR policies and procedures.



We are evaluating the experience of new staff and patients through surveys with the intention of supporting localised induction on the wards for new nursing staff to improve the attitude, clinical orientation and skills of new starters.

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Staff attitude and restrictive practices

Feedback highlights that some patients feel that treatment is more restrictive than is necessary. Patient “ Sometimes complaints restrictions seem too SUCE survey harsh” “Rampton is like a Patient prison not a hospital.” Forums “Night time confinement but should not be locked in at 8pm and unlocked at 8am.”



Positive and Proactive Task and Finish Group designed to review current practices and implement plans for least restrictive practices. Nine work streams covering areas including seclusion, segregation, de-escalation and debrief have focussed on a range of issues around restrictive practice.



In the Women’s service, ward based nurses, Therapeutic Involvement Workers and the Trauma and Self Injury (TASI) Group collaboratively focused on reducing the number of hours patients in long term segregation spent out of rooms and engaging in meaningful activities.



The Protac SenSit chair has been introduced to 2 female wards as a sensory tool to enable patients who are persistently at high risk to themselves and others to engage safely when practising mindfulness, relaxation, safe space, imagery etc.



Revised Managing Violence and Aggression (MVA) training around least restrictive principles including No Force First approaches and the uses of scenario based MVA training to enable staff to engage in supportive, respectful communication whilst providing safe, high quality care.



We are undertaking a patient survey to understand patients’ experiences of restrictive practice and ‘blanket restrictions’ as part of the Trustwide No Force First initiative.



Managers have been actively supported in challenging poor staff attitude and practice via a range of initiatives including an event facilitated by Geese Theatre. Page 27 of 28

9. MAIN COMPLIMENTS Below are some of the comments from the SUCE survey that illustrate about the main compliments shared about Rampton Hospital: Positive feedback included overall care and treatment with patients acknowledging that the therapy they are receiving is successful and helps them to reduce self-harming behaviour and enhance relationships with others. Patients also reported they felt listened to. •

Staff are very good at involving me in my treatment and care. Due to my illness the staff on the ward have been excellent. (Cheltenham Ward).



Look after me, treat me with respect, Make sure care is good - eating and drinking and taking meds. (Kempton Ward).



The staff take the time to listen. If you give respect they show respect. When you have a problem the staff listen. (Alford).



You keep us in good safe environment and I can't complain about anything really. I feel safe here. I feel there is good medical treatment on hand. The staff will always listen to you and if the member of staff you ask can't listen as they are busy then they will ask another to listen to you. They have a good range of communicative staff including deaf services so I am happy with them. If we give the staff respect they return that respect. We are told about decisions before actions take place but not always for good reasons. The staff are concerned about our physical health as well as our mental health. (Blake Ward).



I feel we are well looked after and treated as well as we can be. I feel my treatment is going well and that is also because of the support and feedback I receive. (Quantock Ward).



Sit and talk to me about things. Staff really good with us. Stop me hurting people. (Emerald B Ward)

10. RECOMMENDATION The Trust Board are asked to note and comment on the paper. Lynne Corcoran Head of Forensic Social Care Amy Gaskin-Williams Involvement and Experience Manager Paul Sanguinazzi Head of Involvement and Experience 28 July 2016

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