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How can we make this happen?
A number of approaches can be adopted to aid delivery, including:
a. Staff support and training
A high priority should be given to ongoing training for inpatient staff within a learning and improvement culture. Staff should be encouraged to carry out self-audit and evaluation and have annual appraisals. Staff should have a Personal Development Plan identifying training needs. Protected time should be considered to allow time for training, clinical supervision and contact with patients.
b. Clinical Leadership
Strong clinical leadership from doctors and nurses is an important aspect. Consultant Psychiatrists and senior nurses with managerial responsibility for inpatient care need influence and authority to drive change. Links will need to be made to the planned Leadership programme, part of Delivering for Mental Health initiative.
c. Investment in the environment
We believe a national minimum standard for inpatient environments should apply to all units to raise the standards of all units towards those of the best. The Royal College of Psychiatrists Research Unit is currently considering a ward accreditation scheme. Links should be made to this consideration in advancing change.
d. Accountability
NHS Boards are accountable for standards of acute inpatient care. Delivery of acute inpatient care also requires input from agencies other than health - particularly social work, but also housing and education.
Local accountability mechanisms are needed including those at Community Health Partnership level to identify lines of accountability from staff in all relevant agencies to the identified NHS Board senior manager. This should not be delegated beyond those with the authority or resources to make the necessary changes in the whole system.
e. Integration
Acute inpatient services and units should be seen as part of the spectrum of care and not as separate entities from community care. They are an integral and essential element in the local service framework. Their role is to help people recover and move on in their lives. To achieve this, acute units need to reach out to the community and invite the community resources to reach in.
f. Skills
At a time when service users can be vulnerable the best care is needed to support them. Working in acute care settings is a specialised role requiring high levels of skill and experience.
g. Best Practice
Consideration should be given to all arrangements for the sharing of best practice (see Appendix 2) including the merits of an acute care best practice network.
h. Delivering for Mental Health
In Scotland, the commitments in Delivering for Mental Health should help to address these issues which in turn will be part of the NHS Board Chief Executives' agenda.
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