Official Sensitive THE STATE HOSPITALS BOARD FOR SCOTLAND CARSTAIRS, LANARK COVID-19 REMOBILISATION PLAN SEPTEMBER 20 - MARCH 21 GARY JENKINS: CHIEF EXECUTIVE Page 1 of 42 Official Sensitive TABLE OF CONTENTS 1. INTRODUCTION PAGE 1 2. ACHIEVING INTEGRATION ACROSS NHS SCOTLAND FORENSIC MH SERVICES PAGE 2 3. COVID-19: THE STATE HOSPITAL ADAPTING TO CREATE A SAFE ENVIRONMENT PAGE 5 4. COVID-19: INFECTION CONTROL & REDUCING THE RISK OF NOSOCOMIAL INFECTION PAGE 9 5. TESTING OF HEALTHCARE WORKERS AND PATIENTS PAGE 10 6. COVID-19: PATIENTS & STAFF PAGE 12 7. MAINTAINING COVID-19 CAPACITY PAGE 13 8. VIRTUAL AND IN PERSON VISITING PAGE 13 9. LEARNING FROM FEEDBACK PAGE 14 10. STAFF WELLBEING AND HUMAN RESOURCES PAGE 17 11. THE STATE HOSPITAL: INTERNAL RESTART PAGE 23 12. THE SKYE CENTRE PAGE 24 13. DIGITAL TRANSFORMATION PAGE 27 14. RESILIENCE PLANNING PAGE 29 15. SECURITY UPGRADE PAGE 30 16. CORPORATE GOVERNANCE PAGE 31 17. FINANCE PAGE 33 Page 2 of 42 Official Sensitive 1. INTRODUCTION This plan describes the way in which The State Hospitals Board for Scotland (TSH) is approaching remobilisation for the period August 2020 to March 2021. All aspects of the Boards remobilisation are aligned and reflective of the key principles outlined in The Framework for NHS Scotland: ‘Re-mobilise, Recover, Redesign’. The plan incorporates service provision from the high secure estate at Carstairs, linkage with associated partnership agencies and stakeholders. However, unlike many NHS Boards and healthcare providers, the core clinical function of TSH ‘providing high secure care and treatment’ has remained unchanged throughout the covid-19 pandemic. Referral routes from the justiciary, prisons and other NHS providers have been maintained. The major change relates to how care and treatment is delivered, supported by a safe clinical environment, where infection prevention and control is central to all decision making. The risk of covid-19 infection will remain for the foreseeable future and until such times as a vaccine is available. Adaptability and flexibility will continue across the organisation with a key focus on the ongoing infection risks. TSH will continue to prioritise preventing infection, to rapidly respond when infection does present, manage any active cases, and ensure the overall safety and wellbeing of staff, patients and visitors alike. Unlike other patient facing NHS Boards, TSH does not have out-patient services, elective waiting lists or day- case services. The plan is therefore written to reflect the individual and unique nature of a high security mental healthcare provider. 2. ACHIEVING INTEGRATION ACROSS NHS SCOTLAND FORENSIC SERVICES 2.1) TSH is the national high security hospital for Scotland and Northern Ireland. The hospital has continued to provide specialist individualised assessment, treatment and care, in conditions of high security for male patients with major mental disorders and intellectual disabilities. The patients, because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting. There are three other high security forensic mental health providers in the United Kingdom: Broadmoor, Rampton, and Ashworth, all of which are situated in England. TSH has maintained its core function throughout the pandemic. Any patient who required admission for high security mental health care and treatment has been accepted and admitted. 2.1.1) TSH has strengthened relationships with other NHS Scotland Forensic Mental Health service providers. Throughout the covid-19 pandemic, high, medium, low and community services have engaged in regular ongoing dialogue through scheduled conference meetings. These conference meetings align forensic mental health services together with the Scottish Government Mental Health Directorate, The Forensic Network for Scotland, the Mental Welfare Commission for Scotland, The Ayr Clinic (private provider) and other low secure care providers. This mechanism has enabled integrative planning discussions, debate on common challenges, sharing of knowledge, and monitoring around the overall scale of patient flow challenges across the forensic estate. Collaboration with those partnership agencies has remained successful and positive. 2.1.2) In terms of collaborative working, a short life working group was led by representatives of TSH involving West, East and North Medium and Low Secure care providers. The work was sponsored by the Mental Health Directorate team. The primary aim of the SLWG was to consider the view that the flow of patients across the levels of security, and through to the community, had stagnated from April onwards due to covid-19 related circumstances. A detailed analysis of all patients in the system and their expected pathways across the estate was undertaken. The aim of the analysis was to determine: Page 3 of 42 Official Sensitive The current occupancy and flow challenges across the NHS Estate (High, Medium and Low Secure) Barriers and opportunities and improve integrative working and resolve any immediate flow issues Possible ‘system challenges’ for patients in low security (awaiting community discharge or placements) Recommend any restart opportunities across the Forensic Estate Consider a common approach to testing within the Forensic Estate A matrix of the overall bed status (table 1) was reviewed in the context of the points above. A ‘Forensic Mental Health Estate Overview Report’ was developed and presented in the last week of July. Several barriers and opportunities were noted across the estate overall. The provision of common testing approach within the forensic estate was also reviewed. The outcome is detailed in section 5 of this plan. Table 1 2.1.3) Relevant to TSH, it was recognised that ‘if all theoretical moves were possible (across all levels of security) there should be adequate capacity within High Security at The State Hospital. This is essentially the same position that existed pre covid-19, albeit the bottlenecks are significantly greater as a result of minimal patient transfers out from The State Hospital and across other services. Of note, there are 22 patients on the transfer list.’ These patients could be transferred if beds were available in other services. 2.1.4) To address the wider challenge, the following defined issues are actively being progressed through a national collaborative short life working group: Admission to secure mental health services Transfer between hospitals and services and levels of security Suspension of detention processes Preparation for, and moving into the community The SLWG commenced in August and enables wider system common approaches over the next three month period to resolve the transfer and flow challenges. Of note, the work will focus on the covid-19 associated issues and will not cross-cut the ongoing work of the Independent Review of Forensic Mental Health Services. Page 4 of 42 Official Sensitive 2.2) In relation to wider national processes, TSH remains aligned to: The Independent Review of Forensic Mental Health Services led by Mr Derek Barron. This work was paused on 23 March due to the onset of covid-19. Correspondence has been received indicating that a virtual meeting will take place on 26 August to reflect and consider the next steps. Future dates for tentative meetings have been indicated. It is likely that a date for publication of the final report will be announced in October following discussion with Scottish Ministers. TSH will participate with this process and proactively work with the review team in the restart process. An interim report from the Scottish Mental Health Law Review was published in May 2020. This review is led by Mr John Scott QC. TSH has representation on the review process. The principle aim of the review is to ‘improve the rights and protections of persons who may be subject to the existing provisions of mental health, incapacity, or adult support and protection legislation as a consequence of having a mental disorder, and remove barriers to those caring for their health and welfare.’ Due to covid-19, much of the review has been undertaken virtually. It is noted that a further interim report will be published around December 2020. TSH will participate accordingly with the various phases of the review process. TSH will participate as the NHS representative in the ‘Custody Court Short Life Delivery Group’. This process has been established in relation to the creation of virtual court appearances. The Forensic Mental Health Network (hosted by TSH) assess transfer issues from prison in the forensic estates. TSH continues to work alongside the Network to ensure there are no excessive waits for prison transfer. The above represents the key national linkage and integration processes for TSH in the context of the next three to six months. 3. COVID-19: THE STATE HOSPITAL ADAPTING TO CREATE A SAFE AND EFFECTIVE ENVIRONMENT 3.1) TSH has continued to manage service delivery through a command structure. The command structure was established on 16 March in response to the onset of the global pandemic and NHS Scotland moving on to an emergency footing. There have been modifications to the schedule of meetings based on the urgency and immediacy of matters presenting. The organisation remains aligned to the direction of NHS Scotland. Each of the corporate directors and CEO are represented on the key national interface groups; this will continue going forward. Those linkages are described in appendix 1 of this plan, appendix 2 details the command levels. 3.2) As NHS Scotland moves through phase 3 of the Scottish Government routemap and into phase 4, along with the future removal of the emergency footing status for NHS Scotland, TSH will transition the command structure across to the following mirrored alignment: Command Structure Post Command Structure (to March 21) Gold Corporate Management Team Silver Organisational Management Team Bronze Hospital Management Team The revised structure will enable refreshed decision making authority within each of the organisation. The model will adopt the lessons learned from the command structure debrief event held on 07 August.