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Inspection report

Date of Inspection: 13 September 2012
Date of Publication: 28 September 2012
Inspection Report published 28 September 2012 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

The provider was meeting this standard. People experienced care, treatment and support that met their individual needs and protected their rights.

User experience

Patients told us that they were treated with respect and were consulted and involved in decisions about their care. One of the four patients we spoke with said they had experienced being secluded. They said they understood why this had happened and that the staff treated them appropriately during their period of seclusion.

We asked patients if they had access to health care services and if they had been able to see a GP if they were unwell. They all said that they had. One patient said they had to wait a day or two for a GP appointment, when they had had minor ailments.

Other evidence

Our inspection of 1 August 2012 found instances when the policy and practice in the hospital was not in line with good practice guidance, with reference to the guidance regarding the short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. At our inspection of 13 August 2012 we saw evidence that the policy and procedure regarding seclusion was under review in relation to how patients were assessed and treated whilst asleep at night. We also noted that improvement in the way records of seclusion were kept provided a clear picture that good practice guidance was followed regarding seclusion.

We spoke with a unit manager who told us the seclusion policy had been reviewed and was part of the reading list for staff. They said a mental health awareness course was to be undertaken by staff in October 2012. This was to cover risk assessments, symptoms, behaviour, care plans and documentation. They added that further training was planned for staff regarding good record keeping and was to be provided in November.

The unit manager explained seclusion procedures. They said that staff used de-escalation techniques in the first instance. They said seclusion was used as a last resort. If a patient was secluded they were observed and observations were recorded every 15 minutes. They said a nursing assessment was undertaken by two qualified nurses after two hours. One nurse was independent (they would not have been involved in seclusion process). Every four hours the patient was seen by a doctor. If the seclusion lasted for 24 hours, a multi-disciplinary team (MDT) meeting was held.

We spoke with a senior nursing assistant, who was also able to explain the seclusion process to us. They told us they acted as a ‘buddy’ for new starters and agency staff. They said they would ensure staff were confident to undertake observations of patients in seclusion. They added that new staff would not observe patients in seclusion for more than an hour and if there were any concerns they would contact the ward for assistance.

Since the last inspection we received information of concern regarding the access patients had to primary care services. Primary care refers to services provided by GP practices, dental practices, community pharmacies and high street optometrists. The main concern we were told about was that there was not sufficient access to GP appointments for patients in the hospital. The person who contacted us also included other concerns about the hospital’s arrangements for health care in emergencies and outside of office hours.

We spoke with two unit managers about what access patients had to health care services. Both said there were no problems in accessing GP appointments when patients were physically unwell. We discussed access to primary care with the hospital director and the director of nursing. They explained that the hospital had a contract with local GPs to provide regular GP surgeries within the hospital. There were also practice nurses available for advice. We met one of the practice nurses who explained their role and the training they had undertaken. They explained the health care services available, including several resources provided by the hospital and those provided by the contracted GPs. They also explained the health checks undertaken for patients when they were admitted and undertaken on a regular basis.

We discussed access to primary care with a manager commissioning places at the hospital for the Secure & Specialist Mental Health Commissioning team for the north of England. They told us they had no concerns regarding this aspect of the service available to patients.