GUIDANCE ON THE STRUCTURE OF THE ACUTE INPATIENT FORUM
The report of the Delivering for Mental Health: Psychiatric Inpatient Facilities Working Group was produced in September 2006 for the Delivery Group producing the Scottish Executive's Mental Health Delivery Plan.
That report recommended the creation of Acute Care Forums (a minimum of 1 forum in each health board area), similar but not identical to, those described in the Department of Health Mental Health Policy Implementation Guide in England. It is recommended that this guidance be read in conjunction with the September 2006 report as this contains more detailed guidance on the role of what are now termed Acute Inpatient Forums.
The membership of the Acute Inpatient Forum should be representative of key clinicians involved indelivering acute in-patient care, local authority partners, voluntary organisations and service users and carers. One of the first tasks of the forum will be to clarify the roles of its members and in particular how they will communicate with those they represent. It is also imperative that the Forum builds on existing strategic planning structures and integrates with these.
It is suggested that the following is the minimum membership requirement for each Forum:
- Chair; this needs to be someone in a very senior managerial position within a board. He/she should be seen to be representative across the whole health board area and of sufficient seniority to be able to deliver against the 10 key recommendations of the HOPE report
- Social work representative (should be approved by the local authority Chief Social Work Officer)
- Consultant Psychiatrist
- Clinical psychologist
- Allied health Care professions representative
- Medical Manager
- Nurse manager
- Ward Charge Nurse
- Voluntary organisation representative
- Representatives from local service user groups
- CHP representative
- Advocacy group representative
- CMHT representative
- An educationalist involved in nurse training
It is recognised that this is a large group but it was felt that this group had to contain senior people with the authority to make high level decisions where necessary and at the same time be representative of the large number of stakeholders in this area. Consideration could be given to having a decision making executive within each forum with a working group structure.
The Forum should meet a minimum of five times per year. It is strongly recommended that the Forum visit inpatient facilities that it covers at least once a year.
The Health Board will be responsible for funding the local Acute Inpatient Forum and for providing a suitable venue.
The work of the Acute Inpatient Forum will be overseen at a number of levels. It is anticipated that a strategic group will be set up to continue the work of the Mental Health Delivery Group which will have responsibility for guiding the setting up and development of the Forums. At Health Board level the Forum will report to the Chief Executive who will also ultimately be responsible via the Annual Accountability Review which deals with HEAT targets(one of which pertains to acute in-patient care).The Chief Executive will be responsible for any high level actions arising from the work of the Forum.
The Forum should also be overseen by the local Performance Management ( JLC) process.
Forum minutes and any reports they produce should be sent to the Board Chief Executive, the Local Authority Chief Executive, and to all partner agencies. The Mental Health Division of the Executive should also receive these. Information on the work of the Forum should be available on the locally appropriate websites.
We have no wish to be overly prescriptive with regard to the remit of the Forums as we recognise that they will need to take account of local strengths and weaknesses in prioritising their work. The HOPE report contains more detail on the remit of the Acute Inpatient Forum and suggest 10 key areas on which should direct the work of the Forum. These are:
- Inpatient wards must exhibit a culture that inspires hope, trust, confidence and well-being for both patients and staff.
- All units need to be equipped to a high standard, be clean, adequately furnished and in a good state of repair.
- Patients must have access to a good range of therapeutic activities both in the ward, and be able (where appropriate) to access facilities in the local community.
- There must be appropriate and timely access to the range of skills, experience and expertise that exists within a well developed multidisciplinary/multi-agency service.
- Staff working within acute in-patient settings will receive the right training and supervision to respond effectively to the needs of people they work with.
- All units will have multidisciplinary/agency risk assessment and management structures in place.
- Minimum standards and monitoring mechanisms will be in place for those critical service/service user interfaces; admission/discharge procedures, multidisciplinary note keeping, data collection etc.
- Local services will demonstrate through practice and policy an integrated service that aligns both inpatient and community resources towards a common purpose and priority.
- All acute units will have in place policies on challenging/unacceptable behaviour that clearly sets out the working relationship between staff and service users; one built on trust and respect.
The initial priority of the Forums will be to significantly improve the patient's experience on the ward however the ward does not operate in isolation. We expect the Forum to be fully engaged in wider planning and operational issues concerning the local mental health framework and the integration and redesign of acute care provision. In the fullness of time the Forum should also consider other issues which were deemed to be beyond the remit of the HOPE group including single sex wards, the desirability of sector based services and the notion that "one size fits all" in terms of provision of care within inpatient units - ie is there a need for more specialist units for some clinical sub-groups.
Finally Acute Care Forums will be required to report to the executive by 2009 on what work they have done and what improvements have been achieved. Evidence around this should be validated by service users, carers and staff.