The State Hospital

The State Hospital, Carstairs, Lanark ML11 8RP
Phone: 01555 840293 Fax: 01555 840024 email: tsh.info@nhs.net

High Quality Patient Care and Treatment

In this section:

Photo: Campus

 

Care and Treatment

Care and Treatment Planning

The Board is committed to providing expert, high quality treatment and care delivered by multi-professional teams in a safe and secure setting. Detailed strategies, plans and frameworks take account of relevant national standards and guidance.  They set out the approach to delivery of a quality service and lay down requirements for continuous review of policy, systems and processes.  For example, there is a co-ordinated approach to annual and intermediate reviews, the Care Programme Approach (CPA), clinical risk assessments, and Integrated Care Pathways (ICPs).

Multi-disciplinary clinical teams comprise a wide range of highly skilled professional staff in the fields of psychiatry, nursing, occupational therapy, pharmacy, psychology, activity and recreation, social work and security. 

All patients are assigned a Key Worker on admission to the Hospital. The Key Worker is an experienced Registered Nurse who, in collaboration with the patient, is responsible for the assessment, planning, implementation and evaluation of the day to day care of the patient. As the identified practitioner for a small group of patients, the Key Worker will develop a positive, caring, and therapeutic relationship over time with each of their patients and their family or carers. 

The local target of patients having their care and treatment plans reviewed at six monthly intervals is 100%.  2016/17 saw fluctuations in performance with the figure for March 2017 being 91% compared to 98% in the previous year.

In terms of patients having their clinical risk assessment reviewed annually, performance throughout the year remained slightly below the 100% target.

Attendance by Clinical Staff at Case Reviews

The table below provides comparative data on the extent to which professions met the ‘attendance by clinical staff at case reviews’ Local Delivery Plan (LDP) target:

LDP Target

Target

2016/17

 2015/16

RMO

90.0%

96.8%

95.4%

Medical

100.0%

99.5%

99.1%

Key Worker / Associate Worker

80.0%

71.8%

74.8%

Nursing

100.0%

97.3%

95.9%

OT

80.0%

47.9%

48.6%

Pharmacy

60.0%

74.5%

75.7%

Clinical Psychologist

80.0%

72.3%

74.3%

Psychology

100.0%

96.2%

97.2%

Security

60.0%

59.6%

70.6%

Social Work

80.0%

75.5%

78.4%

 

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Clinical Model

Care and treatment in the Hospital follows a well-established Clinical ModelOpens in a new window based on nine principles:

  • Integration
  • Patient-Focused Care
  • Individualised Care Pathways
  • Positive Therapeutic Milieu
  • Supporting Staff
  • Strengthen Multi-Disciplinary Working
  • Violence Risk Assessment and Management
  • Comprehensive Mental & Physical Health Care and Treatment
  • Clinical Governance Strengthens and Informs Care

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Photo: Hub ReceptionPhoto: Hub Corridor

 

 

 

 


 

 

Medicines Management

In 2016/17, Clinical Pharmacists monitored the safe and effective use of medicines to optimise the benefit and minimise the risk for the patient, and Pharmacy staff continued to ensure that each ward received appropriate stocks of medicine.

There was also successful implementation of the first Pharmacist Independent Prescriber and increased Pharmacy presence to support the GP Clinic. Collaboration work via the Forensic Network Pharmacy Group also grew.

Individualised information on medicines (both psychiatric and physical health) is offered to all patients on a regular basis with carers able to access the Choice and Medication website via NHS Inform.

In terms of ensuring the best use of resources associated with the purchasing and administering of medicines, significant work associated with the Medicines Committee continued on a number of fronts:

  • Update and implementation of a number of medicine policies including Safe Use of Medicines and Treatment of Acute Behavioural Disturbance.
  • Extensive Clinical Audit programme of work including both local and participation with national benchmarking prescribing audits via the Prescribing Observatory in Mental Health (POMH-UK).
  • Supporting involvement of the Hospital with the national business case and implementation plan for Hospital Electronic Prescribing and Medicine Administration (HEPMA).

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Psychological Therapies

The purpose of the psychological therapies service at The State Hospital is to provide psychological interventions that promote good psychological wellbeing in a safe, efficient and effective way. This Psychological Therapies Annual Report (January to December 2016) presents an overview of the psychological therapies delivered to patients. This includes clinical assessments (including risk assessment and formulation), the provision of psychological therapies, enhancing the therapeutic milieu, multi-disciplinary working within the clinical teams, training, evaluation and research.  In 2016:

  • Every patient had been involved in a psychological intervention.
  • On average 88% of patients were engaged in psychological interventions at any one time over the year.
  • All patients commenced psychological therapies <18 weeks from referral date.
  • The PTS Referrals and Guidance booklet was revised.
  • A Specialist Nurse Practitioner was engaged in some work to support the integration of the psychological formulations into nursing care plans, including the delivery of a one day training followed by individual support. An evaluation of this is underway.
  • The Healthy Living Weight Management Group was revised in tandem with the “Slim and Trim” Group to provide a package where the Healthy Living Group will become the core weight management intervention and the Slim and Trim Group will become the maintenance group.
  • The Healthy Psychology trainee supported work to improve the uptake of bowel screening and developed a group framework for patients with diabetes. Following on from this, the service has been successful in its bid to host a further trainee in 2017/18.
  • The National Forensic Matrix Implementation Group commissioned and reviewed a number of psychological interventions with contributions from The State Hospital.
  • Revision of the “Tune in”, “Relating well” and “Making healthy changes” programmes took place following successful pilots in the Hospital and elsewhere.

In January 2017, The State Hospital was one of the pilot sites for “Planning the Future”, the new Recovery and Relapse Prevention Programme for patients who are ready to move on. A joint evaluation of this programme will be undertaken with Greater Glasgow and Clyde forensic services.

A preliminary audit of the level of trauma experienced by patients revealed that 24 out of 35 patients in one hub reported and / or experienced significant trauma with 15 experiencing more than one type of trauma. The issue of how best to deliver “trauma informed care” in a high secure setting continues to be a challenge.

State Hospital Fact Sheet - 'Psychological Therapies' (October 2016)Opens in a new window.

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Rehabilitation Therapies

Therapies and activities are an important part of care and treatment at The State Hospital. Taking part can promote patient recovery and contribute towards achieving individual patient care and treatment goals. The Skye Centre (for patient therapy and activity) has a wide range of therapies and activities as shown below as well as a Health Centre and Atrium where patients can access the activity group room, café, library, shop and bank:

  • Crafts & Creative Expression.
  • Education & Learning.
  • Life Skills.
  • Physical Health & Fitness.
  • Recreation.
  • Mental Health & Recovery.
  • Vocation & Working Activities.

The year saw 170 referrals received for 117 patients to attend a range of activities; an increase from last year’s figures of 136 referrals received for 58 patients.

Performance remains at a similar level with between 79.3% of patients engaged in activities, compared with 81% in the previous year. A service improvement approach to the delivery of an Active Day Model for patients is progressing.

Commencing in June 2017, this will deliver an integrated staffing model to improve access to activity for patients.  The outcome of this should be increased access to, and uptake of activities.

The staffing model and activities provided within the Skye Centre has been reviewed, focused on the re-provision of woodwork department as a multi-function space.

The Skye Centre Annual Report (June 2016 to May 2017) provides an update on patient activity services within the Skye Centre (for patient therapy and activity) and details service activity levels and key achievements for the period.

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