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Introduction
This report supports and informs the Mental Health Delivery Plan and Delivering for Mental Health.
There is a strong focus on acute inpatient care, together with attention and action needed in the community and primary care, with service users and carers around early intervention, better management and treatment.
A new HEAT target has been set on acute inpatient care and there are a number of commitments which will collectively help to address this agenda. These are:
- To reduce the number of re-admissions (within one year) for those that have had a psychiatric hospital admission of over 7 days by 10% by end December 2009. ( NHSHEAT Key Performance Target);
- To develop a tool to assess the degree to which organisations and programmes meet our expectations in respect of equality, social inclusion, recovery and rights ( ROPI). This tool will be piloted in 2007 and be in general use by 2010;
- To have a training programme for Peer Support Workers in place by 2008, with Peer Support Workers being employed in three NHS Board areas by end December 2008;
- To increase the availability of evidence based psychological therapies for all age groups in a range of settings and through a range of providers;
- NHSQIS to develop standards for 5 condition specific ICP's by mid 2007. They will also develop the accreditation process/stages to be rolled out during 2008;
- To have key front line accident and emergency staff, along with key staff in the community/primary care educated and trained in using suicide and self harm assessment/diagnostic tools. 50% of those staff identified to be trained by end December 2010;
- To offer more effective management and care for people in the community and avoid inappropriate admissions by ensuring the published (2006) Crisis Standards and services are in place by end December 2009;
- To reduce admissions of children and young people to adult beds by 50% by 2009 (against a baseline figure for 2005/06 of 69 admissions); and
- To implement the Care Programme Approach for all restricted patients by end December 2008.
There is also a commitment to establish Acute Inpatient Forums ( AIFs) in every NHS Board area by end December 2009. This commitment is addressed in this report.
As well as the targets and commitments, support for delivering change will also be provided in the shape of:
- An Improvement programme;
- A Leadership Programme;
- Commissioned work by NES on training in talking and psychological therapies;
- Benchmarking and information use; and
- Knowledge Exchange.
These support structures will assist NHS Boards and partners to deliver the Delivering for Mental Health targets and commitments including the establishment and running of the Acute Inpatient Forums across the country.
Concerns have been expressed in the past about the state of acute inpatient care and while standards in some areas are excellent, the variation elsewhere needs to be addressed.
The appropriate emphasis on community based mental health services can have unintended consequences for patients who continue to require inpatient care.
A number of organisations and individuals have identified concerns. The 2004 Review of Mental Health Services in Scotland included a section written by service users which supported the view that energy and commitment to change was needed by all if hospital care was to be a more positive experience with positive outcomes. These comments are broadly supported elsewhere but experience has shown insufficient national progress toward change and improvement.
The issues include the physical environment (overcrowding, noise management and access to the outdoors), wider environmental issues (safety, privacy and dignity), work pressures and poor relationships with service users/carers (lack of communication and information).
Early in 2006 representatives of the Royal College of Psychiatrists (Scottish Division) and the Scottish Association of Mental Health ( SAMH) discussed these concerns and raised the issues with the Scottish Executive Health Department Mental Health Division.
SAMH and the Royal College of Psychiatrists were invited by the Mental Health Division
to bring together a group to examine the issues and make recommendations for change and improvement within the acute inpatient sector in psychiatry. A representative Short Life Working Group was established in Spring 2006 (Appendix 1).
The Group set 4 work streams:
- Service user feedback;
- Ward culture and values;
- System related issues; and
- Examples of good practice (see appendix 2).
Progress with each produced the following considerations:
- What should good acute inpatient services look like and how to achieve this?
- What current levers for change exist to produce improvements?
- What single recommendation could improve acute inpatient services?
- What outcome measures could apply?
At the initial meeting members of the group raised concerns about wider aspects of care. These included addressing issues such as: single sex wards; individualised vs. "one size fits all" care; sectorised care delivery; the role of inpatient care, and the values underpinning inpatient care. It was agreed that whilst these should remain on the agenda, the focus of the report should be on the initial four aspects identified by the SEHD.
The remit of the Group extended to intensive psychiatric care units ( IPCU), but not to care of the elderly wards although it is recognised that many of the issues raised will have equal application in that sector.
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