The State Hospitals Board for Scotland
ANNUAL REPORT 2005/2006 Index
01 About the State Hospital 1
02 Foreword by the Chairperson 2
03 Chief Executive’s Report 4
04 Governance 6
05 Clinical Governance 8
06 Staff Governance 14
07 Patient Focus Public Involvement (PFPI) 18
08 Diversity 22
09 Corporate Governance 24 01 ABOUT THE STATE HOSPITAL
The Hospital provides assessment, treatment and care in conditions of special security for individuals with mental disorder who, because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting. It is a national service for Scotland and Northern Ireland.
• There are 11 wards on our 60 acre campus and patients have daily access to a range of therapeutic, educational, diversional and recreational services. There are dedicated services for women and for people with a learning disability. • We work in partnership with South Lanarkshire Council to provide social care services for patients and their families.
About Our Patients • Patients are admitted to the Hospital under the requirements of the Mental Health (Care and Treatment) (Scotland) Act 2003 (the new Mental About Us Health Act) and related legislation. • The State Hospitals Board for Scotland is a Special • 60% of patients have a primary diagnosis of Health Board accountable to the First Minister for schizophrenia, 24% have another primary diagnosis, Scotland through the Scottish Executive for the and 16% have multiple diagnoses. quality of care and the efficient use of clinical, • Around 95% are male and 5% are female. financial and staff resources. • Average age is 40 years. • The role of the Board is to provide strategic • Patients spend on average around 7 years in the State leadership, direction, support and guidance to the Hospital, ranging from around four weeks to 38 years. Hospital and promote commitment to its core • 68% of patients are restricted (meaning under direct values, policies and objectives. jurisdiction of the First Minister) and 32% are non- • The State Hospital is one of four high secure hospitals restricted. in the UK - the only one of its kind within Scotland. It is • 33 patients were admitted during the year (2005- a national service for Scotland and Northern Ireland. 2006): 9 from other NHS Hospitals (27%), 14 from • Just under 700 staff (630.89wte) provide care and prisons (43%), 9 from the courts (27%) and one from treatment in conditions of special security at the the community (3%). State Hospital for around 240 patients with mental • 48 patients were discharged during the year (2005- disorders. 2006): 32 to other NHS Hospitals (67%), 7 to prison • Our purpose is both to provide care and treatment (14%), 6 to court (13%), and 3 to the community (6%). of the highest standards and to ensure public safety. • On average, at any one time around 50 patients • We help patients to recover from or cope with their are prepared and assessed as ready to leave but illness so they can live their lives as fully as possible. often wait longer than necessary because of a • The Hospital is located in Lanarkshire in central current lack of appropriate facilities. Scotland, midway between the cities of Edinburgh and Glasgow.
1 02 FOREWORD BY THE CHAIRPERSON
The State Hospital is committed to redesigning its services to ensure that patients’ needs are placed at the centre of service provision.
It is important to us that patients are able to move on to more appropriate forms of care in local settings when they no longer need care and treatment in the special security of the State Hospital. To this end, we continue to develop links with other Health Boards and services to ensure that patients do not remain at the State Hospital longer than necessary.
The new Mental Health Act came into effect on 5 October 2005. Significant preparations towards bringing the Act and its provisions into force were undertaken. Of particular note is the identification of named persons within the Act. The establishment of designated Mental Health Officers (MHOs) was achieved through strong partnership working with the 32 local authorities.
In preparation for the Act we have provided facilities for We are pushing ahead with our ambitious change Mental Health Tribunals to take place in the Hospital, agenda to see service delivery completely transformed, and an Open Day in the new Tribunal Centre took in improved patient accommodation on a redeveloped place in November 2005. In the context of “least site, as part of the development of an integral forensic restriction”, from May 2006 patients will be able to service nationally. appeal against being detained in excessive levels of security. Relations with the Tribunal and Mental Welfare The State Hospital’s Chief Executive, Andreana Commission are healthy and positive. Adamson, leads the Forensic Mental Health Services Managed Care Network (Forensic Network), which has During the year, governance standards were met been operating since the autumn of 2003, providing a through the delivery of both national and local key strategic overview and direction for the development of objectives. We welcome the new NHSScotland specialist services. The network has successfully strategic planning and performance management engaged multi-disciplinary professionals across Scotland arrangements and associated local delivery plans that and we have welcomed this approach to joint working. were introduced from April 2006. These will supersede this year’s local health plan and performance assessment framework. The Board acknowledges the importance of engaging with key stakeholders in the development of strategic plans.
2 Having appropriately trained staff is crucial to the On the same note, the Board welcomes the Hospital meeting its objectives. The year saw staff teams appointments of Dr John Crichton (Medical Director), being strengthened through recruitment and individual Hazel Soutar (Finance Director) and Dr Archie Fleming staff training and development plans allowing them (Non-Executive Director). I am confident that we will opportunities to deliver care in the wider NHS. benefit from their invaluable input.
Not only do improved working patterns and practices The Board’s performance is reviewed each year allow staff more flexibility to balance their careers and through an Annual Review meeting with senior Scottish home lives, our management style has never been Executive Health Department officials. Following this more open. We have in place mechanisms for staff to year’s meeting, I am delighted to report good progress raise concerns over any aspect of service delivery on a wide and varied agenda. which they feel is having a detrimental effect on patient care. We look forward to embracing the challenges we still face and pay tribute to our staff and partners who are The opening of our Carers’ Centre in April 2006 will helping us achieve our goals. enhance visiting arrangements for carers and families. In consultation with patients, their families and friends, we will continue to review the services and facilities available.
During August 2005 we were delighted to host a visit Gordon Craig from Lewis McDonald, Deputy Minister for Health and Chairperson Community Care. October 2006
On behalf of the Board, I would like to express my sincere thanks to departing Board Members - Jane Davidson (Finance Director) and Dr Isabelle Low (Non- Executive Director) for their valuable contribution to the Hospital over the years. Tribute is also paid to Dr Steve Young, who undertook the role of Interim Medical Director until 30 September 2005.
Campus
3 03 CHIEF EXECUTIVE’S REPORT
Improving services for patients continues to be a priority and we have made enormous progress in the last twelve months.
We continue to deliver our programme of capital works to improve and maintain the fabric and function of the estate in parallel with the redevelopment of the Hospital. Over the next two years our Capital Programme will focus more on enabling and supporting works for the Hospital’s redevelopment.
Progress with the Forensic Network continues. The outcomes of a considerable body of work were launched as part of a National Plan at the Forensic Network Conference, ‘Beyond Walls’ in October 2005.
We continue to put patients first through the further development of patient treatment and care pathways which focus on timeous and appropriate admission, treatment and transfer/discharge of patients. At the The future of the service is starting to take shape as we Hospital all patients are cared for in a framework continue to progress our plans for redeveloping the derived from an accurate diagnosis and assessment of Hospital. This is an exciting period and I am in no doubt treatment needs, delivered in a multi-disciplinary setting that we will rise to the challenges that lie ahead. by means of regular reviews of progress. Much of this can only be done effectively in conjunction with partner State Hospital patients present a complex and difficult agencies. mixture of needs. Our aim is to ensure patients are treated in accommodation appropriate to their needs Investing in new technology is of importance. During and in an environment that supports rehabilitation. The the year substantial progress was made in delivering redevelopment is necessary due to the poor physical elements of our 2004-2006 Information Strategy and our condition of the estate and our obligations to meet Intranet was redesigned and relaunched to meet the statutory requirements. changing communication needs of the Hospital.
In particular, considerable work has gone into developing our ‘Model of Care’ which sets out the care principles that will guide the redevelopment of the State Hospital and will serve as the foundation for the operational policies that will be developed throughout the Hospital’s rebuild. Construction is due to commence in 2007. Patient services should move into the new Hospital in 2010 with the final landscaping work completed in 2011.
4 Our public accountability for the protection and safety The clinical care and management of State Hospital of patients, staff and the public is accepted. A safe patients can present severe and challenging therapeutic environment where clinicians are able to behaviours. Once again, gratitude is expressed to our deliver the best care possible is maintained. staff who we recognise work under difficult circumstances in providing a specialised role for a We always encourage patients to become involved in group of very ill patients. their care planning, and to express their views so these can be taken into account when examining practice. We are clear and focused on our direction for the future We communicate with patients, their family and friends and will continue to consult widely on our plans. in a number of ways in order to ensure that they are aware of the full opportunities available to them in the Hospital.
Partnership working is key to helping us modernise Andreana Adamson services and improve patient care. Partnership values Chief Executive have been put into practice and partnership working October 2006 continues to be promoted, effective and shared across the Hospital.
In May 2005 the State Hospital held a national initiatives consultation event to gain staff feedback on three key national consultation documents: Improving Mental Health Services in Scotland, a Mental Health Information Strategy for Scotland, and the Clinical Governance & Risk Management draft national standards.
Steve Shon, Redevelopment Project Manager
5 04 GOVERNANCE
The governing body of the Hospital is the Board which provides strategic leadership, direction, support and guidance to the Hospital and promotes commitment to its core values, policies and objectives.
The final National Clinical Governance and Risk Management Standards were issued by NHS Quality Improvement Scotland (NHS QIS) in October 2005.
Review of the Hospital’s performance is scheduled for January 2007, and work continues to ensure we meet the requirements of the standards.
Staff Governance Staff Governance is defined as “a system of corporate accountability for the fair and effective management of all staff”. The State Hospital has in place arrangements for the good governance of staff, Campus allowing for staff governance to be monitored and
There are three statutory governance strands for NHS improved. Audit Scotland, together with the national bodies to embrace: Clinical Governance, Staff Staff Governance and Workforce Committee (SWAG), Governance and Corporate Governance. There are audits the process. many linkages between these strands and a range of supporting plans, strategies and frameworks to support The Staff Governance Committee together with the delivery of good standards of governance. Risk Clinical Governance and Audit Committees forms the Management and Performance Management bring all full governance framework of the Board. The Hospital’s the elements together. Partnership Forum focuses on operational Staff Governance compliance issues. Clinical Governance The Board has a statutory responsibility to establish clinical governance arrangements that will improve the quality of care and treatment for State Hospital patients.
The Board is part of Lothian NHS Board’s Ethics Committee. The function of this Committee is to provide independent advice as to whether a given piece of research is ethical, and whether the dignity, rights, safety and well-being of individuals who are the subject of research, are adequately protected. All research proposals within the State Hospital are reviewed by the Research Committee and must obtain approval from the relevant Ethics Committee. The Clinical Governance Committee overseas research activities within the Hospital. Lomond Ward
6 Delivering strategic aims ensures that national priorities are met.
Corporate Governance The Clinical Governance and Risk Management Corporate Governance is a system by which Standards are being reviewed during 2006-2007 and organisations are directed and controlled. The focus is already much preparatory work has been undertaken. on structures and processes for decision making and accountability, controls and behaviours at the top of These external assessments are extremely useful for organisations. The spotlight is on the Board. providing a benchmark of the Hospital’s level of achievement in relation to national standards and Key Performance Indicators / performance nationally. The results provide a guide to Performance Assessment Framework effectiveness and efficiency, enabling us to further Key performance indicators (KPIs) have been improve the quality of multi-disciplinary care and developed in collaboration with clinical staff for a range treatment delivered to patients. of services; indicators that will impact most on the quality of care for patients. Annual Review Our performance is monitored by the Scottish Executive
These KPIs are linked to the Performance Assessment through a process known as the Annual Review. Our Framework (PAF) - the means for assessing 2005-2006 Annual Review took place with members of organisational performance during 2005-2006. For 2006- the Board meeting with Lewis Macdonald, Deputy 2007 this is changing to the Local Delivery Plan (LDP) Minister for Health and Community Care and Dr Kevin and associated targets and measures. Woods, Chief Executive of the NHS in Scotland and other Scottish Executive colleagues. The public were
All the KPIs in the current PAF have been aligned to the invited to attend the Review as observers. Overall, strategic aims of the State Hospital and our there has been good progress during 2005-2006 by the Performance Report to end March 2006 shows very Hospital and the Scottish Executive Health Department strong progress on a number of fronts. Areas for jointly. See Appendix for details of feedback. improvement have been identified, and plans and robust monitoring arrangements are in place to deal with these issues.
National Standards - NHS Quality Improvement Scotland (NHS QIS) Standards A number of groups are in place to address specific areas of the NHS QIS agenda. In particular, standards, best practice statements and guidelines.
During 2005-2006 the Hospital was assessed on both the Food, Fluid and Nutritional Care standards and the clinical indicators for Learning Disabilities. State Hospital Annual Review with Lewis MacDonald, Deputy Minister for Health & Community Care
7 05 CLINICAL GOVERNANCE
Over the years Clinical Governance has gathered momentum and become an integral part of the vision, systems and processes to deliver services.
At an individual patient level, it is clear that tangible improvements in care are being delivered. Our aim is to continuously improve the quality of services provided to patients.
Clinical Teams Clinical teams are multi-disciplinary comprising 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. Each team ensures that all aspects of patients’ needs are considered and takes responsibility as a team for decisions made.
Individual team members work effectively with others, contributing to the team and its goals, behaving in ways that encourage commitment and active participation Dr John Crichton, Medical Director from others, maximising the power of the group to perform. The Hospital developed a Clinical Governance Strategy in 2002, which has guided the work of the organisation over a three year period. During this time, significant progress was made in developing governance systems, and evaluating the effectiveness and impact of these systems on improving the quality of patient care.
Our 2005-2006 Clinical Governance Annual Report provides a comprehensive overview of Clinical Governance arrangements in the State Hospital.
The strategy was reviewed in 2005 to support improved compliance with the standards and to address local clinical governance issues. The new strategy for 2005- 2008 and associated action plan builds on the strong culture of quality improvement that exists at the Hospital and is closely aligned to the set of principles that form the vision of the Board.
Dr Steve Young, Associate Medical Director
8 It is recognised that physical health has a positive effect on mental health.
All patients are assigned to a Clinical Team and have In particular, there will be continued focused working an up-to-date care and treatment plan whereby with the Forensic Network to achieve added progress is monitored continuously and reassessed to improvement in working relationships specifically ensure patient progress and clinical efficacy. through further ICP and protocol work.
The Clinical Team has a full account of the patient’s psychiatric, forensic and social history and a full description of the circumstances that led to the referral.
The different disciplines bring their clinical expertise, impartiality and objectivity to the functioning of the team.
Reconfiguration of the site will enable the Hospital to maximise its desired service model based on multi- disciplinary Clinical Teams organised around patient care and need. Workforce plans will be developed based on this model, identifying future skill requirements for each team.
Our focus continues to be on multi-disciplinary working and training. Peter Clarke, CPA Co-ordinator
Integrated Care Pathways (ICPs) Care Programme Approach (CPA) We continue to focus on patient needs. ICPs help map A combination of a rigorous application of the out milestones in the patient’s journey from admission Admissions policy and improved discharge/transfer of through to continuing care, rehabilitation and ultimate patients ready to leave the State Hospital has been transfer/discharge. successful over the year. Social Work took a leading role in co-ordinating many of these transfers and discharges They ensure patients get the treatment they need, through the Care Programme Approach (CPA) process when they need it, from all the professions involved in but all involved multi-agency care planning. their care. They are also used as a tool to incorporate local and national guidelines into everyday practice, The number of admissions has reduced by 20% from last manage clinical risk and meet the requirements of year. The number of discharges/transfers is 7% higher clinical governance. than last year. Patients waiting longer than three months for transfer or discharge reduced by 11%. The This year saw the welcomed development of an ICP number of occupied beds reduced by 13 reflecting an database, which has enabled monthly reporting and incremental move toward ensuring the State Hospital variance analysis to Clinical Teams. A review of systems concentrates its efforts on patients requiring high and processes associated with ICPs has provided security. valuable insights and many solutions that will drive how ICPs are taken forward.
9 The opening of the Shannon Clinic in Belfast, Northern Ireland has also had a beneficial effect with patients Mental Health transferring over the course of the year.
During the year the Consultant:patient ratio improved Currently, Hospital policy is for all transfer and from 25 patients per Consultant to 19 and the discharges to be co-ordinated through CPA; a Consultant complement increased from 8.8 to 11.50wte. systematic approach to involving patients, their carers and professional care staff in planning patients’ transfer The importance of understanding the complexities of arrangements from the Hospital. patients’ case histories and their therapeutic experience is by integrating and combining learning from the various The application of CPA has increased on a year on year treatment programmes to which a patient is exposed. basis with the number of meetings more than doubling Within the Hospital, this is consolidated in the provision of from 25 in 2003 to 58 in 2005. psychology input to Clinical Teams and programmes.
There has been a high level of patient participation Demand for psychological input and intervention has within the CPA. A user feedback form is routinely issued steadily increased as the benefits have become more to patients to illicit their views of the process and to widely understood and appreciated. Our contribute to continuous improvement. On the whole, psychological therapies have become more co- positive feedback of CPA has been received from ordinated, are linked to clear individual patient needs’ patients. assessments and have agreed success measures.
Over time, the size and complexity of the patient There has been a substantial increase in the number of population will change significantly and this will be patients taking part in the programmes: the number in achieved in conjunction with a wide range of partner treatment has increased from 106 in April 2005 to 147 in agencies. All of this is set in the context of the work of March 2006. the Forensic Network and the new Mental Health Act.
Through continued working with the Forensic Network Psychological therapies include: there will be improved transfer/discharge of patients at the right time to the right place. • Anger programme with adaptations for learning disabilities and relapse prevention. • Drug & Alcohol programmes: Education & Awareness; and Saying No to Alcohol & Drugs/Relapse Prevention. • Cognitive Behavioural Therapy for Psychosis and Coping with Mental Illness programmes. • Sex Offending programmes, including Core 2000 protocols, adaptations for learning disabilities and relapse prevention. • Dialectical Behavioural Therapy for Borderline Personality Disorder. • Fire Raising. • Reasoning & Rehabilitation programme.
Programmes are based on published protocols. They ensure consistency of practice, form a sound basis for training and can be subjected to external expert peer review. Protocols are judged against best practice guidelines.
Tribunal Centre
10 As members of the Clinical Team, nurses are As part of the developing Forensic Network, female instrumental in providing care through Key Worker and patients will no longer be cared for at the State Hospital. Nursing Care Plan systems. Nurses also contribute to the Instead, they will be treated and cared for by delivery of psychological therapies. appropriate regional and local facilities. In preparation for this, we continue to work with the Forensic Network to In addition to the on-ward care and treatment, a wide redesign this national service, thus ensuring effective and range of therapeutic, vocational, recreational and consistent ongoing care and treatment for our patients. social activities is provided to patients. This off-ward activity plays an important role in the care and A peer review of the quality indicators for people with treatment of each patient. At any one time, up to 140 learning disabilities within the State Hospital was patients could be engaged in this activity. There are undertaken in March 2005. Overall feedback was nine Activity Centres and these are split into three units: positive, a reflection of the energy and effort that staff put into their daily work. However, it is recognised that • Health and Recreational Unit (Community Centre, further improvement can always be made. The review Health Centre and Sports & Fitness Centre). helped identify a number of challenges, and during the • Learning & Creative Development Unit (Craft & year we made considerable progress on tackling these. Design Centre, Education Centre and Social In particular, we have reviewed how information is Centre). provided to patients, ensuring that it is accessible and • Vocational Skills Unit (Gardens & Pet Therapy Centre, appropriate to their levels of understanding. Laundry Centre and Woodcraft Centre). Psychological therapies, specifically adapted for patients with a learning disability, remained an integral The Social Work service within the Hospital continues to part of their overall care and treatment. be provided by South Lanarkshire Council (SLC). The Social Work Services at SLC recently participated in one Every effort continues to be made to move individual of three pilot performance inspections of local authority patients fit for transfer on to appropriate facilities. social work services throughout Scotland by the Social Work Inspection Agency (SWIA). The State Hospital Security Social Work Service was included as part of the The State Hospital maintains a safe and secure inspection. Overall, the evaluation for the State Hospital environment that enables effective patient care and was positive and work will commence to address areas treatment, and support to staff. The most important of improvement identified in the report. and effective measure in ensuring the long term safety and health of the patient is relational security (achieved Social Work team members are skilled in risk assessment through therapeutic engagement) in combination with and all of the elements of forensic social work which both physical security (knowledge of patient and reflect their broad pool of professional experience in aggregated patient risk) and procedural security Child Protection, Criminal Justice Services and (policies/procedures). Community Care (Learning Disability and Mental Health). They complete assessments on all new patients. All access, egress and movement within the Hospital is supervised 24 hours a day. Contingency planning is an Social Work continues to progress actions that are integral part of our security arrangements. All systems required to ensure compliance with the requirements of and procedures are operational and are supportive to the new Mental Health Act, and contributes to other staff. Security Liaison Managers are dedicated to, and developments and services within the Hospital including contribute as, full members of Clinical Teams. Discharge/Transfer, Child Protection, the Carers Initiative, Human Rights, Risk Assessment and the Forensic Network.
11 Clinical Effectiveness - Audit and Research Current areas of research include: Our extensive programme of clinical research and clinical effectiveness continues in order to ensure • Anger management consistent high quality standards of evidenced-based • Neuropsychology care for all patients. • Physical health • Post Traumatic Stress Disorder Through our Clinical Effectiveness Strategy and • Psychoeducation programme of work we give reassurance to patients, • Psychosis clinicians and managers that an agreed quality of • Risk assessment and management service is being provided. Over the past year our efforts • Sex offending have focused on reviewing and developing practice • Substance misuse against the NHS QIS standards, improving treatment • Treatment resistant schizophrenia planning, and Integrated Care Pathways - variance analysis and reporting. Physical Health In undertaking a monitoring role, the Clinical Governance Committee ensures that the quality of State Hospital patients have very significant physical health care is underpinned by the effectiveness of health needs. Lack of exercise, obesity, consequences clinical care and treatment. The aim of research and of a self-selected poor diet complicated by the effects clinical audit activity within the State Hospital is to of medication, require monitoring. In common with ensure clinical effectiveness, and activity continues to other groups of psychiatric patients, a very high be prioritised to address national and local agendas, percentage of State Hospital patients smoke. and supports the effective delivery of the clinical governance agenda. The Physical Health Steering Group reviews physical health standards set by NHS Quality Improvement We promote best practice and clinical excellence Scotland (NHS QIS) and prioritises and co-ordinates through the development of clinical guidelines and physical health activities and health improvement protocols, and through the implementation of activities. systematic clinical audit. Over the past year audit projects have been undertaken in collaboration with In particular, work continues to tackle the key risk factors clinical staff covering a wide range of topics including: of smoking, obesity and physical activity. patients’ access to fresh air, clinical waste and sharps, and multi-disciplinary documentation. Weight Management An audit undertaken in June 2005 identified that 80% of As a Hospital we recognise the importance of research patients were overweight. This is not surprising given the to advance and promote clinical and evidence based impact of the negative symptoms of mental illness such practice. Academic links have been developed with as lethargy, lack of motivation, interest and apathy. universities. Through our research strategy we continue However, it was clear that we could do much more in to improve the quality of care and treatment of patients supporting patients to deal with these issues and by creating an environment within which we question ultimately reduce their weight and the impact it was what we do and the reasons why we do it. By such having on their physical well-being. In support of this, a questioning, specific research projects may be Weight Management Strategy and a Nutritional policy is developed, and evidence gathered to implement being developed. change in practice. Investment and recruitment has enabled the Research within the State Hospital is organised by the commencement of a Healthy Eating and Physical Clinical Research Committee. It has a clinical bias, and Activity Research Project focusing on weight clinicians use research findings in order to provide the management. The project runs from February to highest standards of care. December 2006.
12 Further investment has procured an IT system that In taking this positive approach to the promotion of calculates the nutritional menu content of the food physical health and well-being, we believe we can help given to patients as well as facilitating healthier menus. patients improve their overall quality of life and avoid This will be crucial to the overall Weight Management chronic ill health in later life. Strategy. An audit is planned for late 2006 to measure uptake, The patients’ shop has enhanced its range of healthier impact, satisfaction levels and to review targets. food and drink options, and patient visitors have been encouraged to bring in healthier food gifts. Education Health Centre and awareness raising has also taken place with Clinical The Health Centre continues to offer a full range of Teams and a physical health assessment (including primary health care comprising a GP (General weight) is now required as part of every patient’s care Practitioner) service and clinics in Dentistry, Podiatry, and treatment plan. Ophthalmic, Surgical, Diabetic, ENT (ear, nose and throat), Urology and Well Women. Additionally, nurse led clinics have been developed.
The Health Centre patient administration system (GPASS) was implemented in November 2005. The system is used on a daily basis for recording patients’ physical health care, both within and outwith the Health Centre. Further engagement with Clinical Teams is a priority for 2006-2007.
Smoking Cessation During the year we started our smoking cessation initiative which has reduced the rate of smokers
Dietetics staff amongst patients by 10% (from 84% to 74%). A reasonable achievement with much more to be done. Physical Activity The target for 2006-2007 is to at least maintain this In recognition of the impact of physical inactivity on improvement and to strive for further reductions. obesity and ill health, we have set a challenging target of 30 minutes of appropriate physical activity for all The Smoking Cessation Strategy continues to be patients at least five days every week. implemented. We have 15 nursing staff trained as Smoking Cessation Advisors and four Smoking Cessation A Physical Activity Facilitator has been appointed to Groups have been completed, with a fifth underway at work with patients on a 1:1 basis on the wards. The present. One to one interventions for patients who result has been positive with some patients now require individual support is ongoing. attending the Sports & Fitness Centre and undertaking other associated activities. In light of new smoke-free laws, a Tobacco Control policy was introduced from March 2006. It does not Yoga began on the wards in February 2006 and group change the position for staff as they were not previously sessions take place in the Sports & Fitness Centre every permitted to smoke on site. Changes were introduced six weeks. for patients. Operational guidelines are in place to support implementation of the policy. Bicycles are provided for patients for use on our cycle track although they tend to be used in the summer months. New sports equipment has been purchased for the Sports & Fitness Centre and wards. A training programme is in place.
13 06 STAFF GOVERNANCE
We are committed to creating a working environment with equality of opportunity, respecting a diverse workforce and each individual’s contribution to the aims, values and goals of the Hospital.
This has been translated into a Staff Charter. It puts a Staff Survey spotlight on how staff are managed and places The views of staff are important to the Hospital and partnership working at the heart of all employment issues. provide useful feedback on performance against the staff governance standards. The Staff Survey also helps The Staff Governance Committee’s work continues to us to review our Staff Charter. be determined by national standards for effective staff governance that seek to ensure staff are well informed, A local staff survey was undertaken in May 2005 to test appropriately trained, involved in decisions which affect whether performance had improved in key areas of them, treated fairly and consistently, and provided with concern identified in the previous 2003 survey, and to a safe working environment. review both the Staff Charter and pilot Core Brief system. Although the results were good with Working in Partnership demonstrable improvements across the board, steps Many services are provided in partnership with other continue to be taken to enable further improvement. agencies. Of greater importance are the improved working arrangements at an operational level and the Additionally, a national Staff Survey was undertaken in improved relationships, understanding and joint working March 2006 by NHSScotland - the results of which will not in tackling together what are often common agendas. be known until later in the year. We are confident these will be in line with other NHSScotland organisations. The Hospital is committed to ensuring that partnership values are put into practice. Reporting directly to the Staff Governance Committee, the Partnership Forum also has a key operational role to ensure partnership working is promoted, effective and shared across the Hospital. The Forum encourages staff involvement and consultation in influencing how the State Hospital works towards achieving its objectives, and supports us in meeting the requirements of the national staff governance framework at a local level.
Dr Ian Jones, Lead Director for Staff Governance
14 State Hospital 2006 30701 19/10/06 4:20 pm Page 17
The principles of partnership working are being embedded across all our activities.
Learning and Development The interface between the development of the individual and the development of the service has perhaps never been as important as it is today. Resources available for learning and development are being reorganised and enhanced to improve focus on this area of activity.
The corporate Training Plan will continue to develop, ensuring compliance with mandatory training
Pat McGlone – Employee Director requirements.
It is acknowledged that every member of staff needs to Pay Modernisation have an agreed Personal Development Plan. Pay Modernisation is one of the most important elements of the NHS Modernisation agenda and is both Practice Education Facilitators (PEFs) continue to a driver and facilitator for service and system support practice education by providing co-ordination, modernisation and redesign. facilitation and support for mentors, student nurses and other nursing staff. Key result areas include an All Consultants are now employed under the new improved environment for more student nurses and Consultant Contract. The job plan review exercise for more approved placement areas. Additionally, the role 2005-2006 is complete. A huge amount of time and of the mentor has been re-established, ensuring that effort continues to be devoted to the implementation support and training is now being planned and of Agenda for Change. delivered in a supportive and co-ordinated fashion.
Implementation of the Knowledge and Skills Framework (KSF) will be a major task for 2006-2007. Work commenced in November 2005 with KSF awareness sessions for staff. KSF provides an NHS-wide framework that can be used consistently across the service to support personal development in post, career development and service development. Successful implementation of this framework is central to future success in modernising services.
Delivering benefits from the substantial investment in pay is critical. The Hospital submitted an initial Pay Modernisation Benefits Realisation plan during 2005-2006 and is monitoring progress. Realisation of the benefits of Pay Modernisation will not be fully appreciated until implementation is complete. Staff Learning Centre
15 Communications Through the Staff Charter, the Hospital is committed to ensure that ‘communication and involvement are two- way processes that are effective, open, honest, clear and timely’. The Staff Charter guides, monitors and improves the way that staff communicate and engage with each other.
An Internal Communications Strategy supports the Charter and the ‘well informed’ aspects of the Staff Governance Standard. It provides a framework for describing the process of communication, consultation
Kay Sandilands, Workforce Planning Manager and involvement in all the Hospital’s activities and ensures openness, transparency, visibility and partnership working in practice.
Workforce Planning The launch of our redesigned Intranet was without The provision of quality forensic mental health care in doubt the single most significant communications the Hospital is dependant not only on having the right achievement of the year. Favourable feedback has number of staff but staff with the right skills and been received from staff. competencies; achieving this requires effective workforce planning. This is complex because factors Positive about Disability impacting on supply and demand constantly change. We have maintained the ‘Positive about Disability’ Award which supports good employment practice in The Hospital is currently involved in a national initiative to relation to the recruitment and retention of disabled develop a robust workload and dependency assessment staff. In particular, to support, retrain and re-deploy staff tool to assist in determining local workforce requirements suffering injury or sickness during their employment that for nursing, which will inform the wider workforce plan. leads to a form of disability. The Hospital is ‘growing’ Registered Nurses through the HNC Route to the Registration Programme.
Attendance Management The Scottish Executive recognises the effects of absence on the NHS in Scotland. A crucial issue is the need for a reduction in absence.
We are striving to develop a positive attendance culture, which motivates and supports staff to attend work regularly.
A corporate action plan is in place to drive improvement, which includes more rigorous and consistent application of the policy, customising information reporting, coaching and training for line managers, and an emphasis on changing culture.
Campus
16 Occupational Health Service (OHS) Health Promotion There is widespread support to promote and maintain Scotland’s Health at Work the physical, mental and social well-being of all staff. (SHAW) scheme sets out a range of good practice in relation to Within the State Hospital this is provided by the health promotion and a healthy Occupational Health Service through a range of workplace. The Hospital is proud services including health surveillance, immunisation, to have achieved the Gold follow up of injuries / traumatic incidents, counselling, Award for Health Promotion workplace assessment, health promotion, delivery of within the workplace. We information and training on health and safety issues, continue to demonstrate long- monitoring of compliance with health and safety term commitment to improving legislation, and policy formulation. One-hour Fitech health within the workplace and beyond through a (health, fitness and lifestyle) assessments continue to be number of planned activities and events throughout the popular with staff. year. This ensures a culture of health promotion for staff remains an integral part of how we operate. As part of our ongoing commitment to be proactive as well as reactive, we continue to identify and control known or suspected work factors that contribute to ill health.
Sports and Fitness Centre
Occupational Health staff
17 07 PATIENT FOCUS PUBLIC INVOLVEMENT (PFPI)
Patient Focus Public Involvement (PFPI) incorporates all themes subsumed under the Equality and Diversity agenda.
Patient Partnership Group Our Patient Partnership Group is working well having developed over the years. Today it is seen as an important vehicle for informing and consulting patients. The group includes a patient from each ward and these patients are supported by staff and lay members of the public. Through ward community meetings, patients are sharing responsibility for their own agenda.
Focus during the year continued on communications (a patients’ newsletter ‘For You’ was launched), the new Mental Health Act specifically around Named Persons and Advance Statements, and the Hospital’s redevelopment programme looking at different parts of the new build.
On a national basis, the group continues to be involved Dr John McGinley, Lead Director for PFPI with the work of the National Anti-Stigma Campaign around mental health issues (See me). These themes include Complaints, Disability, Race, Ethnicity, Human Rights, Age, Lesbian Gay Bisexual and Patient Learning Transgender (LGBT) rights, and social inclusion generally. The benefits of patient learning are well recognised across the professions within the Hospital. The We must also address the interface with NHS Quality contribution for patients to progress through the Improvement Scotland (NHS QIS), Scottish Health development of new skills, understanding and Council (SHC), Citizen Advice Bureaux (CAB) and knowledge are well appreciated and can be corporate risks in general. evidenced.
A PFPI Co-ordinator has been appointed and the post is Nevertheless, there is a need to provide a focus and being developed to support all strands of PFPI. The direction to patient learning; to develop existing approach being taken is to mainstream the whole practice and introduce new approaches. During 2006- agenda. 2007 patient learning will be developed, drawing from the outcomes of consultation during 2005.
18 Concentrating care to each patient on an individual basis is of paramount importance.
Anne-Marie Long, Carer Co-ordinator Advocacy staff
Carers Advocacy The Hospital recognises the importance of effectively The new Mental Health Act came into effect in October engaging with patients, their families and carers. A 2005 enabling all patients within the State Hospital the Carer Co-ordinator was appointed during the year and legal right to access the support of an independent as a result, links with the wider community have grown advocate. considerably in accessing services for relatives and named persons. Good links have also been forged with Advocates have been linking to each ward and volunteer groups and previous links with equality groups continue to work with patients enabling them to have been maintained. become more involved in their care and treatment; to have a better chance to make informed decisions, Carers’ meetings have been going well over the past have their views listened to, have their wishes vigorously twelve months, with carers sharing responsibility for their pursued, and gain more control of their lives. Principal own agenda. The newly constructed Carers’ Centre emphasis this year has been on supporting patients in became operational during the year providing relation to the new Mental Health Act. improved family friendly facilities for carers. During the year Advocacy worked with 176 patients, made 750 visits to patients and attended 118 case reviews.
The Patients’ Advocacy Service within the State Hospital continues to be managed independently by the Scottish Council for Voluntary Organisations via a voluntary management committee.
An independent evaluation of the service has commenced and will report during 2006-2007. Carers’ Centre
19 Spirituality The Hospital is committed to meeting the spiritual and pastoral needs of patients and staff. A Spiritual and Pastoral Care Team is well established and is clearly visible through regular visits to wards. They work with patients, their families and staff in the Hospital and organise visits from various faith representatives.
It is recognised that spirituality, although not necessarily religious or denominational, can play an important role in the rehabilitation of many patients. Spiritual and pastoral care within the State Hospital forms part of the total care programme offered to each patient.
Volunteers The Hospital has actively recruited a number of volunteers to provide a befriending service for patients who have reduced contact with family and friends. The service is aimed at enhancing the mental health and well-being of these patients through reducing social isolation.
Complaints During the year the revised NHS Complaints Procedure was launched. This highlighted our need to listen to service users and to learn lessons from any complaints, concerns, comments or any other sources of feedback. Awareness of the complaints process is a core It also supported our continued approach to local component of staff induction programmes. This year resolution. The majority of issues were resolved in this has seen a 25% reduction in the total number of formal way in an open, honest and comprehensive manner. complaints received for investigation, although the percentage upheld or partially upheld has increased Encouraging feedback on the service we provide helps from 41% to 51%. The number and sources of formal to inform the review and development of services. A complaints are shown below: range of opportunities exist for patients and carers to raise and discuss issues as shown above right: Source of complaint 2003 2004 2005 (157) 147) (103) Patient 23% 43% 41% Relative 6% 5% 8% Patients’ Advocacy Service 68% 49% 49% Other 3% 3% 2%
20 The top six issues raised by patients and carers were: Formal Complaint Outcomes Subject/Issue Percentage 2005-2006 Staff attitude / behaviours 12 Communication 10 14% 22% Catering 11 Privacy / dignity 12 Patient property / funds 10 Clinical treatment 22 These issues as % of total 77
16% During the year 18 compliments were recorded. Of 48% these, 54% of the communications relating to catering were compliments.
Upheld Year on year, we continue to improve on the average Part Upheld time taken to respond to a complaint: 18.6 days (2005- Not Upheld 2006), 21 days (2004-2005) and 22 days (2003-2004). The Withdrawn national target response time is 20 days.
During the year the Scottish Public Services Ombudsman provided monthly commentaries on the outcomes of complaints from NHS and other public services.
The lessons learned from these commentaries are checked for relevancy and any appropriate actions within the Hospital are addressed.
Issues Raised Attitude/Behaviours 2005-2006 Shortage/Availability Communication (Written) 14% 1% Communication (Oral) 23% 4% Admission/transfers/discharge procedure Premises (including access) 6% 2% Aids and appliances/equipment Catering 2% 0% Cleanliness/laundry 0% Patient privacy/dignity 6% Patient property/expenses 1% Personal records 6% Failure to follow agreed procedure 10% Policy and commercial decisions 12% 10% 3% Board purchasing Clinical treatment (all aspects)
21 08 DIVERSITY
Our patient population is diverse. Our aim is therefore to provide services that are individually sensitive and in doing so promote equality of access.
The Rapid Equality and Diversity Impact Assessment toolkit will be applied to all policies and functions during 2006-2007.
Disability In line with the requirements of the Disability Discrimination Act (DDA), the State Hospital continues to improve access to goods and services for people with a disability whether they are patients, carers or employees with physical and/or sensory impairments.
This work is led by the Disability Access Action Group (DAAG) which continues to monitor DDA compliance and identifies how best to support patients’ needs. An assessment of individual patient needs is conducted annually.
Stephen Milloy, Lead Director for Diversity Access to services has undoubtedly improved within the Hospital as a result of modifications especially to ward and off-ward patient areas. This is a commitment both as a provider of services and as an employer.
To this end, we are committed to ensuring equality and diversity is recognised in all activities. We have in place a Race Equality Scheme which sets out our actions over the coming years.
Part of this commitment is staff training and awareness. Our approach to training is multi-dimensional and mainstreamed and includes all aspects of human rights, diversity and equality. Disability awareness is included in the diversity and human rights training programme and a dedicated e-learning pack is to be developed.
Additionally, Race Equality inductions took place during the year in conjunction with the Child Protection inductions offered to new staff.
Carers’ Centre – disabled parking is well catered for
22 Its overall aim is to ensure access to quality health care that is culturally and linguistically appropriate.
All buildings are compliant with the key loop system for hearing impairment. We have used colour coding systems in patient buildings to demark doorways and to mark hazards. The Occupational Therapy department supports Clinical Teams with any particular disability issues.
There are particular support needs that people with a disability require to enable them to live as independently as possible. Communication, including the provision of information in accessible formats, has been identified as an area of importance; thus helping everyone to improve their communication with people with a disability.
We are committed to ensuring that patients and carers with a disability are able to get information about the West Wing Hall – ramps comply with disability legislation services that are available to support them, quickly, easily and in a format and language that they can In terms of access to services such as psychological understand. therapies, we provide interpreting facilities and support for sign language as required by individual patients. Through training, this information is provided by We have staff trained in sign language. Our core informed staff who have a clear awareness of the induction service covers disability issues, as does our problems and barriers faced by people with a disability. equality and diversity training.
A number of our patients suffer from physical disabilities and sensory impairments as well as mental illness. To meet the needs of these individuals, a policy on provision of assistive equipment/structural alteration to the environment for users with physical disabilities or sensory problems has been introduced. Additionally, all new capital works continue to be monitored for DDA compliance.
It is recognised that numbers alone are not the only determinants of priorities. Everyone is entitled to fair access to health care and the right to opportunities for better health – this is the founding principle of the NHS.
Cromarty Ward – IDDS (for patients with a learning disability)
23 09 CORPORATE GOVERNANCE
The Hospital has a corporate Risk Management Strategy for the improvement of risk management arrangements.
The therapeutic aim of inpatient forensic services is to address violent, aggressive and offending behaviour. In addition, the Hospital has a duty of care to ensure all reasonable efforts are made to reduce the risk to patients, staff, visitors and the public from violence and aggression. Approaches to minimising violence and aggression must reflect most recent guidelines and research. Despite good progress being made in a number of areas, the number of aggressive incidents and therefore injuries remained high last year.
The table below shows a breakdown of aggressive incidents during the year by financial quarter - 269 (Quarter 1), 448 (Quarter 2), 250 (Quarter 3) and 444 (Quarter 4) - 1411 (total for 2005-2006):
AGGRESSIVE INCIDENTS Hazel Soutar, Finance & Performance Management Director 500 450 Risk Management 38 400 97 74 Our Risk Register records identified and assessed risks 350 47 50 along with plans for the improvement of controls. Risk 300 69 250 54 141 63 management training is provided to all staff as part of 200 29 17 induction, and includes an overview of complaints 150 22 97 81 100 219 handling, health and safety, fire safety, and manual Number of Incidents 21 25 134 50 68 64 handling. 0
QTR 1 QTR 2 QTR 3 QTR 4 Health and Safety (H&S) Financial Quarter 2005-2006 Investing in health and safety continues to be a priority. The Health & Safety Committee continues to action Near Miss improvements, audits and inspections. We do this by Other Aggressive Incidents Discriminatory Incidents promoting the adoption of the principles of risk Self Harm assessment thus ensuring the health, safety and welfare Behaviour of staff, patients and visitors. Assault - Patient to patient
Assault - Patient to staff
24 Risk management procedures are very much a part of everyday life in the State Hospital.
There was a significant increase in aggressive incidents Pharmacy in the last financial quarter - in particular patient to staff Medicines expenditure has fallen significantly below assault and aggressive behaviour. Self-harm also budget this year. This is primarily due to a newly increased in the last quarter - this rise mainly related to negotiated national generic clozapine contract. Some female patients and patients with a learning disability. of these savings will be re-invested by way of an expansion of the clinical pharmacy service, more robust Child Protection formulary management and reporting, and increased The issue of child welfare and protection is taken pharmacy technician time to support reporting from the seriously. We continue to work with partner agencies to pharmacy medication database. ensure the Hospital can meet the statutory responsibilities for Health as outlined in “Protection of All of these investments build on the good work that is Children - A Shared Responsibility” and the findings of already taking place. For example, more detailed the national audit and review “It’s everyone’s job to medicine prescribing reports were introduced during make sure I’m alright”. the year. As a result, Consultants now have access to prescribing data per patient, per ward or the Hospital as a whole in relation to items dispensed and the cost. In particular, these reports have been valuable in highlighting prescribing patterns and ward variation in expenditure.
Children’s play area within the Carers’ Centre
25 Board Committees The Board met six times during the year to progress its strategy and performance, and continued to hold its meetings in public, outwith the State Hospital. One of the meetings was held in Belfast, Northern Ireland.
The Board is supported in its work by a number of Committees:
• Clinical Governance • Audit • Staff Governance • Remuneration
Campus The structure of these Committees during the year 2005- 2006 is set out below:
CLINICAL GOVERNANCE COMMITTEE Membership Role
S Cameron To ensure that clinical governance mechanisms are in place and effective throughout M Casserly the Board, and to ensure that the principles and standards of clinical governance are J Deffenbaugh applied to the health improvement activities of the Board. The committee met four IM Low (Chair) (until 30 Nov 2005) times during the year. K Rae (Chair) (from 1 Jan 2006)
AUDIT COMMITTEE Membership Role
S Cameron (Chair) To oversee arrangements for external and internal audit of the Board’s financial and M Casserly management systems and to advise the Board on the strategic processes for risk, A Fleming (from 23 Jan 2006) control and governance. The committee met four times during the year. IM Low (until 30 Nov 2005) P McGlone
STAFF GOVERNANCE COMMITTEE Membership Role
G Craig (Chair) To ensure that the Board has an effective system of consistency of policy and equity J Deffenbaugh of treatment of staff. Also to encourage, support and monitor partnership working. A Fleming (from 23 Jan 2006) The committee met four times during the year. P McGlone K Rae (until 22 Jan 2006)
REMUNERATION COMMITTEE Membership Role
S Cameron To consider performance-related pay in respect of Senior Managers and employees G Craig of the Board. The committee met four times during the year. J Deffenbaugh (Chair) K Rae
26 Board Members’ and Senior Managers’ Interests The members of the Board and Senior Managers for the year, including their relevant interests, were:
G Craig Employed part time by A Kerr, MSP for East Kilbride as Constituency Chairperson Casework Manager Member of the Board of Studies of the Institute of Counselling
K Rae Board Member of RCN Scotland Voluntary Health Vice Chairperson
S Cameron Executive Director of South Lanarkshire Social Work (until 31 March 2006) Non-Executive Independent Chair of Scottish Institute for Excellence in Social Work Education Chair of Management Committee Scottish Institute for Residential Child Care Visiting Professor at the Glasgow School of Social Work Chair of Association of Drug Action Teams in Scotland Board Member of Forensic Mental Health Services Managed Care Network Chair of the Parole Board for Scotland (from January 2006)
M Casserly Reading and Research for Trish Godman, MSP West Renfrewshire Non-Executive Deputy Presiding Officer of the Scottish Parliament Part time Member of DTI Employment Tribunal Panels Member of the Scottish Association for the Study of Offending
J Deffenbaugh Director of Frontline Consultants Limited Non-Executive Director of St Peter’s Building Preservation Trust Limited
A Fleming Member of the Council of the Royal Philosophical Society of Glasgow Non-Executive (from 23.01.06)
IM Low Deputy Chair of the Accounts Commission for Scotland Non-Executive (until 30.11.05) Member of the Scottish Consumer Council Panel Member for the Financial Director of the Year Award Trustee of David Hume Institute
P McGlone None Employee Director
A Adamson None Chief Executive
J Crichton None Medical Director (from 01.10.05)
J Davidson None Finance Director (until 21.08.05)
D Irwin None Security Director
I Jones Chair of the Board of Trustees for Edinburgh Cyrenians Learning & Development Director
J McGinley None Psychology Director
S Milloy General Member of the Mental Health Tribunal Service for Scotland Nursing Director
H Soutar None Finance Director (from 01.12.05)
S Young None Interim Medical Director (until 30.09.05)
27 Financial targets Clinical, Administration and Non-clinical costs The Board is required to operate within three budget The table below shows the clinical, administration and limits, namely: non-clinical costs, year on year:
• A revenue resource limit - a resource budget for Costs 2005/06 2004/05 Increase / Increase / ongoing operations. (decrease) (decrease) • A capital resource limit - a resource budget for £000 £000 £000 % capital investment. Clinical 30,800 29,035 1,765 6 • A cash requirement - a financing requirement to Administration 779 793 (14) (2) fund the cash consequences of the revenue and Non-clinical 263 281 (18) (7) capital budgets.
Clinical costs have increased in both staffing and In 2005-2006 the Board achieved all three of its financial supplies terms. Staffing costs increased by £1.3m and targets during the year and reported a carry-forward of this reflects general pay awards; costs relating to £2,860k on its revenue resource limit. This will fund Agenda for Change as well as additional staffing costs. planned expenditure on several discrete projects in the coming year, 2006/2007. These projects include Staff numbers have also increased during the year, by provision for project costs relating to the proposed 18wte. This was primarily due to an increase in Nursing Hospital redevelopment (the Full Business Case will be (4wte), Professional & Technical (5wte), Admin & submitted to the Scottish Executive during 2007-2008), Clerical staffing (4wte), Ancillary (3wte) and Secondees funding to support implementation of the new Mental from other NHS boards not included here previously Health Act, the Forensic Network, and the finalisation of (2wte). some small minor capital projects which are non value added schemes. The increase in supplies costs mainly reflects additional costs for Social Work services, Advocacy services, The table below illustrates the Board’s final performance increase in capital charges, additional costs for oil and against the agreed financial targets: electricity, as well as consultancy costs relating to the business case for the Hospital redevelopment. Target Actual C/fwd
£000 £000 £000 The decrease in administration costs reflects a reduction Revenue resource limit 33,959 31,099 2,860 in Board Members’ remuneration due to a part year Capital resource limit 2,102 2,102 - vacancy coupled with an increase in costs for Cash requirement 29,916 29,916 - management consultants.
The operating costs in the Operating Cost Statement The decrease in non-clinical costs mainly reflects a which follows reflect the Board’s role in both managing reduction in the costs of enhanced pensions coupled the organisation and estate together with delivering with an increase in compensation payments. front-line services. The Board’s operating costs are reported in the accounts analysed between clinical, The latest professional NHS estate revaluation of land administration and non-clinical activities. Operating took place in the current year on 31 March 2006. Other costs within the Hospital, in 2005-2006, have increased tangible fixed assets were also revalued under the by £1m over 2004-2005. This reflects a £1.8m increase in rolling programme on the basis of indices at 31 March clinical costs, a reduction of £14k in administration costs, 2006. This increased the value of the estate by around a reduction of £18k in non-clinical costs and an increase £1.4m. in operating income of £738k.
28 Capital 2005-2006 Security: The Board’s Capital Programme for 2005-2006 continued • Costs towards replacing personal attack alarm to develop around the agreed Property Strategy. (PAA) system. Some proposed investment was deferred pending the • Vehicle replacement. development of the Full Business Case but further investment was made in the existing infrastructure. Estate: Further progress was made in improving the fabric and • Resurfacing of roads and landscaping. functionality of the estate in 2005-2006. Development • External improvements to the Gardens area. of a Full Business Case for the rebuilding of the Hospital • Installation of building management communication will continue during 2006-2007. The Capital Programme system. for future years will be developed around the Full • Upgrade of telephone system. Business Case. • Dental equipment. • IT infrastructure and software. Projects completed during 2005-2006 included:
Property Strategy: • New Carers’ Centre. • Upgrade of Ward Kitchens. • Construction of rehabilitation accommodation. • Upgrade of building to incorporate Tribunal Centre. • Refurbishment of Sports Hall. • Relocation of Patients Activity Recreation Services. • Portacabins for temporary office accommodation. • Installation of en-suite showers in some of the patients’ bedrooms. • Installation of cooling system in Medical Division building. • Extension of vehicle compound area.
Campus
29 Summary Financial Statement
OPERATING COST STATEMENT* 2006 2005 FOR THE YEAR ENDED 31 MARCH 2006 £000 £000
Clinical costs 30,800 29,035 Administration costs 779 793 Other non-clinical costs 263 281 GROSS OPERATING COST 31,842 30,109
Less: Miscellaneous income (743) (5)
NET OPERATING COST 31,099 30,104
SUMMARY OF RESOURCE OUTTURN Net operating cost 31,099 30,104 Net resource outturn 31,099 30,104 Revenue resource limit 33,959 32,098
SAVING AGAINST REVENUE RESOURCE LIMIT 2,860 1,994
* Income has increased year on year due to a reclassification of income previously offset against expenditure in prior years. There is a corresponding increase in expenditure.
BALANCE SHEET 2006 2005 AS AT 31 MARCH 2006 £000 £000
Fixed assets 34,051 32,285 Current assets 317 383 Current liabilities (3,802) (3,059) Provisions for liabilities and charges (2,299) (2,596) Net assets 28,267 27,013
FINANCED BY: General fund 21,211 21,350 Revaluation reserve 7,056 5,663
28,267 27,013
CAPITAL EXPENDITURE 2006 2005 £000 £000
Capital spend 2,102 1,044
30 REMUNERATION OF BOARD MEMBERS AND SENIOR EMPLOYEES FOR THE YEAR ENDED 31 MARCH 2006
Remuneration fell within the following bandings:
Salary Real increase Total accrued Cash Cash Real (bands of £5000) in pension at pension equivalent equivalent increase in Benefits age 60 at age 60 transfer value transfer value CETV in in Total remuneration of: (bands of (bands of (CETV) at 31 (CETV) at 31 year kind £5,000) £5,000) March 2005 March 2006 £000 £000 £000 £000 £000 £000 £000
Executive Directors A Adamson 95-100 10-15 40-45 417 747 198 6 Chief Executive J Crichton 15-20 ------Medical Director (from 01.10.05) J Davidson 25-30 0-5 10-15 89 152 23 1 Finance Director (until 21.08.05) H Soutar 15-20 0-5 5-10 127 78 12 - Finance Director (from 01.12.05) S Milloy 60-65 0-5 20-25 245 344 13 - Nursing Director S Young 65-70 0-5 45-50 683 848 (35) - Interim Medical Director (until 30.09.05)
Non-Executive Directors G Craig 20-25 -----2 Chairperson K Rae 5-10 -----1 Vice Chairperson S Cameron 5-10 ------Non-Executive M Casserly 5-10 ------Non-Executive J Deffenbaugh 5-10 ------Non-Executive A Fleming 0-5 ------Non-Executive (from 23.01.06) IM Low 5-10 -----1 Non-Executive (until 30.11.05) P McGlone 5-10 0-5 5-10 69 100 4 - Employee Director
Other Senior Employees D Irwin 65-70 0-5 10-15 139 208 14 5 Security Director I Jones 60-65 0-5 10-15 176 232 - 2 Learning & Development Director J McGinley 70-75 0-5 5-10 157 197 18 3 Psychology Director
TOTALS - - - 2,102 2,906 247 21
31 A full summary of our main financial statements is provided on page 30. A full audited copy of the accounts for 2005-2006 may be obtained by contacting us. Details of how to contact us can be found on the back cover of this report.
Independent Auditor’s Report
Independent Auditor’s Review of the financial statements included in the Annual Report of the State Hospitals Board for Scotland On the basis of my review, the financial information presented in these financial statements for the State Hospital for the year ended 31 March 2006 has been properly prepared from the original audited financial statements. However, in giving this review opinion, I have not considered the effects of any events between the date on which I gave my audit opinion on the audited financial statements of the State Hospital, and the date of this statement.
Lynn Bradley Director of Audit (Health) Audit Scotland 7th Floor, Plaza Tower East Kilbride G74 1LW
October 2006
Campus
32 Appendix
SCOTTISH EXECUTIVE
Deputy Minister for Health &. Community Care St Andrew's House Lewis Macdonald MSP Regent Road Edinburgh EH1 3DG
Mr Gordon Craig Chairperson Telephone: 0845 7741741 110 Lampits Road [email protected] Carstairs http://www .scotland.gov. uk LANARK MLll 8RP
to October 2006
THE STATE HOSPITAL ANNUAL REVIEW: 30 AUGUST 2006
1. I am writing to summarise the main points and actions arising from our discussion at the Annual Review and associated meetings at the State Hospital on 30 August 2006.
2. I would like to thank you, Andreana Adamson and the rest of your team for your effort in organising our visit. The Health Department team and I found the chance to speak to a range of staff and patients, and the constructive nature of our discussions at the various meetings, both interesting and worthwhile. I would ask that you pass on my thanks to your colleagues in the Partnership Forum and the Clinical Advisers meeting as well as the attendees at the Patient Advocacy and Representatives meeting.
Meeting with the Partnership Forum
3. My meeting with the Partnership Forum, including staff and management representatives, was very positive. I was pleased to note the clear and strong sense of the Partnership Forum working with management in a constructive manner in the State Hospital. Staff continued to be involved in the implementation of the Agenda for Change and I was encouraged to hear that the process is progressing as planned. Staff have also been working on the Knowledge and Skills Framework as well as developing an action plan to follow up the results of the Staff Survey. The State Hospital has worked hard over the past year and made significant progress in addressing the level of sick absences, and staff and management are working together to devise solutions to build on the recent progress. There was very positive feedback regarding the role of the Lanarkshire Occupational Health Services which were commended for the specialist and bespoke assistance provided to the State Hospital.
INVE.<;TOR IN PEOPLE Meeting with the Clinical Advisers
4. The meeting with the Clinical Advisers highlighted the excellent engagement and open communication channels among clinicians, ward staff and management that is present in the State HospitaL We had a constructive discussion about the clinical governance structure in the State Hospital and more broadly in instances of multi-agency interaction. The clinical staff have been fully engaged to a detailed level regarding the future plans for the State Hospital and their clinical views impacting on the redevelopment of the Hospital have been taken into consideration.
Patient Representatives and Advocacy
5. I was struck by the clear focus of the patients and advocates regarding the topics they wanted to raise. We discussed issues around patient access to family visits and telephone contact and the importance of these for ongoing rehabilitation. The patients highlighted the therapeutic benefit (in addition to the rehabilitative benefit) of outings into the community. The meeting was positive and everyone participated openly.
Annual Review Meeting
6. After I reported back on the various meetings held earlier in the day, you presented an overview of the State Hospital's performance over 2005/06 and an update on the progress which had been made against the action points in last year's annual review letter. A number of these action points were discussed in detail later in the meeting. You noted that the majority of the action points had been completed but that some required continuing work and ongoing monitoring. I was encouraged to note that you have identified and agreed performance targets and measures for health improvement including weight management, smoking cessation and physical activity. Additionally, you highlighted the State Hospital's benchmarking with other special hospitals better to understand performance and reasons for issues of concern including readmission rates.
7. I provided an update on the action point that was the responsibility of the Health Department. I was pleased to report that the action point had been completed and that an HDL was issued giving clear direction to regional partnerships that they should have a Forensic Sub Group to monitor patients and providing some guidance around how to establish local governance.
8. I asked you about the recently released NHS Scotland quarterly report regarding the cleanliness of the HospitaL The State Hospital had received 84.7% compliance with standards - an amber result. You agreed that this was an area which required attention and noted that you were employing additional staff. You also explained that the results of the Survey also included parts of the Hospital which were not accessible by staff or patients, for example lofts. The areas of the Hospital I had visited appeared to be clean and well maintained and we agreed that in the long term the redevelopment of the hospital would address this issue.
Hospital Redevelopment
9. The plans for the redevelopment of the Hospital continue to progress and you have undertaken considerable work on the project over the year. I look forward to receiving further updates regarding the continued progress of this exciting project.
Implementation of the Mental Health Act 2003
1O. You reported that, through the hard work of staff at all levels and good partnerships among staff, the Act has been implemented successfully in the Hospital. You noted that particular successes were the identification of named persons (159) and the identification of designated Mental Health Officers - total of 193 - which was achieved through strong partnership with the 32 local authorities. Last year the State Hospital identified appeals against excessive security as a significant risk. To date the Mental Health Tribunal has received in excess of 30 applications, 17 of which will be heard in September 2006. I was very pleased to hear that you continue to maintain healthy relationships with the Mental Health Tribunal Scotland and the Mental Welfare Commission. I commend you on your efforts in implementing the new Act and recognise the considerable effort this has taken.
11. I was interested to hear the arrangements you have in place for patients with significant sensory loss. You explained that very few of the patients have sensory loss and that those who do receive individual special care based on their requirements. You noted that a number of staff have been trained in sign language and that you also maintain an open communication channel with facilities in England that have greater expertise in managing patients with sensory loss.
12. I noted the small number of patients who had completed an advance statement (10 of 221 patients). You reminded me that it was the patient's choice to complete the advance statement and that patients were often hesitant to do so as they felt it may impede their transfer from the State Hospital. You agreed that having an advance statement could be valuable for patient care and tbat you would endeavour to broaden patient engagement and understanding in this area.
Health Improvement and Tackling Health Inequalities
13. You reported that physical health is an important aspect of the care provided in tbe State Hospital and that you are focussed on tackling tbe key risk factors associated with smoking, obesity and lack of pbysical activity. During the year, the State Hospital started a smoking cessation programme whicb has reduced the percentage of patients who smoke from 84% to 74%. This is a reasonable achievement with further work to be undertaken. You also reported good progress on the implementation of NHS QIS standards. A Carers' Coordinator and a Patient Focus Involvement Coordinator have recently been appointed and the new Carers' Centre is now functioning with its own security entrance to the Hospital.
14. I was interested to find out more information about patient access to exercise, particularly given sucb a large number of patients in the State Hospital are considered to be obese. You described a two pronged approach to addressing the rate of obesity in the Hospital. The first of these is a research project, funded by the Scottish Executive, which will provide guidance on the best practical techniques to address obesity - including diet modification, increase in physical activity and reduction in food intake. The second project is the appointment of a Physical Activity Coordinator who works to encourage patients to participate in activities both on tbe ward and in the recreation centre and gardens. Some signs of significant improvement have already been observed however the greatest obstacle is lack of patient motivation.
15. I also asked you to explain some of the barriers to smoking cessation among the patient population. A new, more restrictive policy for patient smoking in the Hospital grounds was approved in March 2006. Under the policy, patients are now only allowed to smoke in designated smoking rooms and the bospital grounds. Trained staff in the State Hospital have delivered a smoking cessation programme whicb has included one to one support and group sessions together witb Nicotine Replacement Therapy. Whilst the reduction in the percentage of patients smoking has been relatively small (10%), you noted that there are a large number of patients who stopped smoking for short periods but later resumed. It is boped tbat future attempts for these patients may be successful.
INVESTOR IN PEOPLE Service Redesign
16. You reported that there has been an increase in the resources dedicated to the Care Programme Approach (CPA) and that staff had been receiving training around the new processes. There has been active encouragement for clinicians to work in multi-disciplinary teams, for additional CPA meetings to occur and for all transfers and discharges of patients to be subject to CPA meetings. The Forensic Network, established by the Scottish Executive, is reviewing the CPA process for restricted patients in the context of the new arrangements under the Management of Offenders Act.
17. You highlighted the importance of patient outings as an important part of their care, treatment and rehabilitation. Approximately 20% of patient outings are recorded as cancellations or postponements. Most of the cancellations are for reasons outwith the control of the State Hospital including clinical requirements, patient or carer requests or outside influences. Fourteen percent of cancellations were due to flaws in the process such as lack of paperwork or permissions. This is an area that should be improved upon as cancellation of outings can be very disappointing for patients. The process for approval of outings is currently very time pressured as it involves the Responsible Medical Officer seeking extensive input from the care team, approval by the State Hospital management and approval by the Scottish Executive. You explained that you are trying to revise the process to ensure that fewer outings are cancelled due to time constraints. You also noted that for 23% of cancellations no explanation was recorded and you proposed to start collecting this information to enable more accurate analysis of the data.
18. Throughout the year the State Hospital has continued the effort to address the waiting times for Psychological Therapies. You explained that, in practice, most patients are engaged in therapies while waiting for further work. You agreed that waiting times for Psychological Therapies remain a priority. No patient has been identified who has been waiting longer than six months for engagement in at least one of the programmes to which they have been referred. There has been a 50% increase in the number of patients taking part in programmes and this has been managed concurrently with addressing waiting times.
Resources: Finance and Workforce
19. You reported progress regarding the introduction of the Agenda for Change. The projection for staff to be assimilated and paid by December 2006 is 93%. The remaining seven percent are specialist posts and you are continuing to work to bring these into target. I acknowledged the effort of staff and management in achieving this outcome and the continuing effort to hit the December target. You noted that the Board met all its financial targets during the 2005/06 financial year and has approved a balanced budget for 2006/07. We have agreed your Local Delivery Plan and acknowledge the effort taken to capture the key target measures. The proposed monitoring framework was also very good given the need to develop arrangements appropriate to the State Hospital.
20. I congratulated you on your excellent financial management over the year, especially in light of the continuing implementation of the Agenda for Change.
INVE."iTOR IN PEOPLE Conclusion
21. I concluded the meeting by thanking all present for a well focused review. It was helpful for me and my team to hear of how you are dealing with current issues. I acknowledged the progress you have made and look forward to the State Hospital redevelopment plans being taken forward.
22. I have set out the main action points arising from the Review in the attached Annex.
LEWIS MACDONALD
ANNEX
THE STATE HOSPITAL ANNUAL REVIEW 2006
ACTION POINTS
¥ The State Hospital will continue to make progress on the implementation of Agenda for Change to meet the key national target dates. ¥ The State Hospital shall consider further the outcome of the 2006 national survey findings in respect of bullying, harassment and discrimination and develop an action plan. ¥ The State Hospital shall continue to take action to reduce the sick absence rate with the aim of achieving the national target of 4%. ¥ The State Hospital shall consider local clinical governance arrangements to improve peer to peer work within the Hospital and to improve local understanding of the work that is being taken forward in the different wards. ¥ The State Hospital shall consider what steps might be taken to improve patients contact with their friends and families through the use of telephones and visits. ¥ The State Hospital shall reduce the number of patient outings that are cancelled due to lack of paperwork or permissions ¥ The State Hospital shall continue its work on health improvement to reduce smoking and obesity, improve diet and increase activity. ¥ The State Hospital shall consider what further action might be taken to increase take up of Advance Statements. ¥ The State Hospital, as a centre of national excellence, shall consider how, as the secure estate develops elsewhere in Scotland, its expertise can support improved patient care. ¥ The State Hospital to discuss with NHS QIS the results of the cleanliness survey and how to improve their performance and rating in the future. INVE.STOR IN PEOPLE HOW TO FIND US
Edinburgh M8
Glasgow
A73
A70
M74 Carluke A72 State Hospital
Carnwath A71 Kilmarnock A73 A70 Lanark
The State Hospitals Board for Scotland Carstairs, Lanark ML11 8RP Telephone 01555 840293 Fax 01555 840024 Email: [email protected]