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Redevelopment of State Hospital
06/03/2008
In a statement in the Scottish Parliament, Health Secretary Nicola Sturgeon explained the situation regarding the planned redevelopment of the State Hospital at Carstairs.
She said:
"Recent media coverage has raised questions about the decision to reduce the number of beds at the State Hospital as part of a planned redevelopment of that facility. I welcome the opportunity today to provide reassurance to Parliament and to explain exactly what is happening.
"The current policy on the management of mentally disordered offenders was established in January 1999 and is outlined in the document Health, Social Work and related services for Mentally Disordered Offenders in Scotland.
"That document established a number of key principles intended to provide protection to the public and to ensure the provision of appropriate care and treatment services.
Four key principles were articulated. These are that mentally disordered offenders should be cared for:
- with regard to quality of care and their needs as individuals
- as far as possible in the community rather than institutional settings
- under conditions of no greater security than is justified by the degree of danger they present to themselves or to others
- in such a way as to maximise rehabilitation and their chances of sustaining an independent life as near as possible to their own homes and families
"It is these principles which have informed the development of the forensic mental health services in Scotland since 1999.
"The third principle has since been enshrined in section 1(4) of the Mental Health (Care and Treatment) (Scotland) Act 2003. It states that functions under the Act should be discharged in a "manner that involves the minimum restriction of the freedom of the patient that is necessary in the circumstances."
"We are rightly proud of our mental health legislation and in opposition I was pleased to support it. It gives appropriate consideration both to public protection and to the care and treatment of the individual.
"In 1999 when our current policy was developed it was clear that the NHS estate which offered secure care for mentally disordered offenders did not comply with these principles. With the exception of the high security service offered by the State Hospital, all other mentally disordered offenders who were cared for in inpatient settings were in low secure settings.
"There was no intermediate step between high security and low security, meaning that patients were spending longer at the State Hospital than was necessary for their rehabilitation or for public safety, but also that when they transferred on to another hospital they were making a greater step down than in some cases might have been desirable.
"The direction of policy since 1999 has therefore resulted in the creation of two regional facilities which provide treatment in conditions of 'medium security' i.e. somewhere between the level of security of the State Hospital and the security of a locked ward.
"The Orchard Clinic, which opened in 2000 in Edinburgh, provides 50 medium secure beds primarily for the population of the East of Scotland. The Rowanbank Clinic opened last year in Glasgow and provides 74 beds, primarily for the West of Scotland. Plans are in hand to establish a similar facility for the North of Scotland.
"These units have been specially designed and built to conform to an agreed environmental, procedural and relational model of security within mental health services.
"Each medium secure unit is designed to meet and operate within exacting standards ensuring that patients are cared for in conditions appropriate to the level of risk they are assessed as presenting.
"With the creation of these new units we have seen a reduction in the number of beds required at the State Hospital. Work was taken forward by the Forensic Network, the three regional planning partnerships and the Scottish Government to model the future requirement for beds and the outcome of that work was published as a health department letter in 2006.
"The reduction in the number of beds required enabled the previous administration to agree that the business plan for the redevelopment of the State Hospital should include a planned reduction from 240 beds to 140 beds.
"Good progress has been made so far in the careful and considered planning for the redevelopment and modernisation of the State Hospital. When complete in 2011 it will be an institution that offers a standard of care and accommodation appropriate to the age that we live in and the expectations that we have of modern healthcare facilities. My colleague, the Minister for Public Health, Shona Robison will be attending the ceremony next month to mark the start of the building works.
"The State Hospital staff, I know, welcome this development and it fits with their focus on modern care in a safe, secure environment where the objective remain to match the care and level of security to each patient.
"Now, it is important to stress that this redevelopment will not, as some have suggested, result in some sudden, exodus of 100 patients from the State Hospital.
"Nevertheless, recent coverage has prompted discussion about the process for transfer of patients from the State Hospital. I will set out the legal and policy position.
"Many patients entering the State Hospital are very ill and for that reason present a high level of risk at the time of committal. However, with modern treatment, both through drugs and therapies, their mental illness can be treated and managed and the level of risk they present reduced. In such circumstances it is appropriate that they be considered for a move to lower security.
"However, while we want patients to make progress, the process for managing the rehabilitation of patients from the State Hospital is a careful one. No patient is transferred from the State Hospital unless a robust risk assessment has been carried out for the patient and there is clinical agreement that the level of risk which the patient presents can be managed by the receiving hospital.
"For restricted patients I personally take the decision on that transfer and will want to assure myself that appropriate arrangements have been made and that safe care will be provided following the transfer. Scottish Ministers' consent is required under section 218 of the Mental Health (Care and Treatment) (Scotland) Act 2003 and that section allows for no exceptions.
"The Mental Health (Care and Treatment) (Scotland) Act 2003 creates a parallel process to the transfer process in allowing patients to appeal against being held in conditions of excessive security at the State Hospital.
"All appeals are carefully considered by the Mental Health Tribunal and only where the tribunal is satisfied that the patient no longer requires to be detained on the grounds of risk in the special security of the State Hospital, will they find that the patient is being detained in conditions of excessive security.
"If successful a patient is generally transferred to a medium secure unit but, in the case of restricted patients, this still requires the consent of Scottish Ministers.
"In addition to our role in respect of the transfer, Scottish Ministers also have the right to be represented in any appeal by a patient and to argue that the conditions are not excessive and that the patient is appropriately detained in the State Hospital.
"We recently introduced a further requirement that all restricted patients from the time they enter the mental health system should be managed through a robust Care Programme Approach with care plans developed and monitored by a multi-disciplinary care team including the police. It is the responsibility of all NHS Boards to ensure that the CPA regime is effectively implemented for all such patients in their care and for other cases where there are concerns about the risk posed by a patient.
"I hope that members are reassured that the current developments in the physical forensic estate are part of a long standing policy to ensure that public safety is protected and that mentally disordered offenders are properly cared for and managed in settings appropriate to the level of risk they present. "