1st Class Arnold Lodge’s 6 monthly Involvement, Experience and volunteering report

In our Trust we recive 2 Involvemnt and expernce reports each year from all our Forensic Services.

The Head and Deputy head of Involvement along with myself review all these reports and feedback on them. This time we were very very impressed with the high standard from Arnold Lodge. The report was generated by Dr Patrick Sims Head of Therapies/Lead Psychologist/Consultant Clinical Psychologist who is also the Involvement Lead at Arnold Lodge and is supported with Involvement across the site. Excellent . Nigel Groves  , Involvement Lead for Forensic services.

Arnold Lodge’s 6 monthly IEV report up to August 2020, like so many services, saw a number of challenges to ensure the patient voice remains supported and clear. The report looks to recognise the importance of keeping in touch with friends and family, being as involved as possible in decision making and plans to improve the quality of services during such anxious times, not forgetting how important keeping physically safe and well is, and the value of looking forward – especially to the employment of our first peer support worker.

We think our aims can be achieved by having a team approach from psychology (me), OT (Fiona Evriviades), nursing (Emma Gough) and social worker (Dan Griffin) with a lot of support from Together Independent Patient advocacy (Maxine Whale) and our General Manager (Coumar).

Dr Patrick Sims

HEADLINES

SIX-MONTHLY DIRECTORATE IEV REPORT
Directorate/Locality	Forensic: Arnold Lodge
Reporting period	FEBRUARY – AUGUST 2020

1. Increased family and friends contact via skype when visits have not been possible – ward tablets have enabled increased contact opportunities.

• Varied ways to access physical activity due to covid limitations – changes to practice by Sports, Fitness and Well-being staff has enabled more access alongside using ward-based equipment.

• Increased patient involvement at division-wide meetings to have more first-hand experience of progress and issues for other services.

• Increased involvement in multi-disciplinary decision making meetings – feedback has been positive in widening access, though keeping individualised feedback has been appreciated if the individuals find the meetings a bit daunting.

• Peer Support worker to join our service – we have now appointed a peer support worker and everyone is looking forward to them starting very soon.

CHALLENGES

• All the stresses and strains we have all felt with the pandemic
• Limits of Trust IT in enabling progress in a wide range of aspirations.

Peer Support Worker (PSW) employment.	Patients have been involved in the development of the post(s) to work initially on the bank. It was agreed that one post would be established but in discussion with patients, when covid limitations for the first person resulted in them struggling to attend, we have appointed a second person.	Patients have continued to feel engaged in the process of how the PSW will work in the service, especially in terms support for peers at forum and their role in developing and providing courses in the Recovery College.	Service delivery Resources
CPA Document Review	CPA Recovery Care Plans reviewed at a mid-point in the CPA review period was an ongoing project previously.	Patients report that the process of attending ward rounds that include a focus on the overall treatment aims is helpful.	Service delivery Communication
Establishing a 2-year involvement and implementation strategy	We had planned to have an Open Space Event on 1st April 2020 to review progress, but as this was not possible, due to covid, we have asked for comments from ward reps and we now review it at each of the monthly Patient Forums.	Patients have expressed their view that having a forward plan, for a longer period than the rolling 6 monthly Involvement Action Plan. promotes a belief in the value of looking further ahead.	Service delivery Communication Culture
A joint patient-staff forum to focus on Information Technology (IT) and patient care.	Patients continue to express their concern that more can be done to keep up with technological advances. A number of issues are addressed at the Patient Forum and in the advances in least restrictive practice but a dedicated forum is a better way forward.	Patients report that being able to address their hopes and aims regarding advances, such as introducing mobile phones, with staff who have higher levels of technological knowledge is really helpful.	Service delivery Communication

AUDITS AND CARE REVIEWS
CPA report reviews pre-CPA Review meetings	An initial audit found that there was scope for patients to review their reports earlier with the clinician author.	The reports are now more often reviewed at a helpful time before the CPA review. There is an audit plan to review how this is being maintained	Service delivery. Communication.
Blanket Rules – The Least Restrictive Practice (LRP) Forum though not meeting until this month as a specific forum is currently reviewing the ‘blanket rules’ in place on each of the 7 wards to understand more fully which ones relate to the specific ward, the care stream or the whole hospital.	The Least Restrictive Practice (LRP) Forum, though not meeting until this month as a specific forum, has been undertaking a major review of blanket rules. The Lead, Beth Francomb, now receives feedback from ward community meetings and has developed a log of changes recently reviewed at the division-wide involvement forum.	Patients have reported a greater sense of engagement in change or if not change a clearer understanding of the rationale for the rules that are in place.   Feedback from one patient rep at the August 2020 forensic division-wide involvement forum and from the most recent community meeting on 11th September for both of the Personality Disorder wards, where a number of blanket rules had been in place, was how much it had improved their overall care and treatment.	Service delivery communication

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SERVICE IMPROVEMENT PROJECTS (INCLUDING QI PROJECTS)
Thornton Ward – Enhancing contact and communication with family and friends QI Project – This is a project to further enhance communication between patients and friends and family on Thornton ward, and to increase privacy, convenience, etc.	Patients are involved in the QI project, and patient representatives form part of the QI team. Carer opinions have been sampled by the completion of a survey and questionnaires regarding their views on current methods of communication, and on the prospect of extending this to patient access to mobile phones. There is an intention that further carer involvement is necessary to evaluate the relevant outcomes of this project.	Carers indicated that the telephone was their preferred means of indirect contact. Carers were also positive regarding patient use of mobile phones. Patient involvement is currently focused on managing the balance between the advantages of mobile phone access, and the risk / responsibilities aspects of this. Negotiation of access to personal (phone) data necessary to inform the evaluation aspect of QI is also underway.   The project is all set to go, just delayed by some relatively minor  issues re purchasing and storage.	Policy/procedure/strategy Communication
WEMSS QI project increasing collaborative work on reducing self-harm.  Specifically working toward improving collaborative risk assessment and risk management of self-harm on Coniston, and to develop this in alignment with the treatment stages model operating on the ward.	Patients have been involved in discussion of their experiences in how self-harm is currently managed, their opinions on matters relevant to improving collaborative approaches to therapeutic management of self-harm, etc.	Patients’ views have contributed to a process mapping exercise involving the MDT and Ward staff, and that the combination of inputs will inform the improvement strategy. It is intended that patients will be involved in different aspects of the strategy and its implementation.	Service Delivery Communication Staff Training
Sports, Fitness & Well-Being Dept QI The development of increased individualised well-being programmes and referral plan -developing on the CQUIN initiative that focuses on healthy living.	Patients have been involved with staff in developing innovative programmes, given covid limitations regarding leave and mixing with other wards.	The project is led by Ashley Willan and his Sports, Fitness and Well-Being team who seek and obtain regular feedback on the changes.	Service delivery Resource
Rutland QI project -Improving the admission process to Rutland Ward. Based on a Trauma-informed approach, the QI project is focused on improving the patients’ experience and reaction to admission to an acute ward. The focus runs from referral / request of nursing assessment, through the admission process, and extends to a patient’s first CPA.	This project is at its earliest stage. However, considering the nature of the project and its aims to redesign the admission process (involving environment, procedures, information, etc), a high level of patient involvement is being sort.	This project is currently considering the most appropriate and beneficial ways of involving (and supporting the involvement of) patients (current and previous).	Service Delivery Communication Staff Training
Ridgeway ward – Improving admission process to the PD Service	This project for the Personality Disorder service is following the above project aims on Rutland ward	The project lead, WM Emily Farrow, is consulting with patients to inform developments.	Service Delivery Communication Staff Training
Tamar Ward QI project to reduce the number of violent, aggressive and self-harm incidents, by providing evening activities for patients. intervention.	Patients were involved in discussions relating to preferred evening activities, and were collaboratively engaged to determine a balance between preference and feasibility	The projects measurable outcome (number of incidents), has shown a significant decrease since the introduction of the structured evening activity. Patients are more occupied in the evening and have expressed how they enjoy having an evening activity.	Service delivery

Ridgeway ward – Animal care for the ward	As well as cross-service access to the great benefits of animals for therapy, Ridgeway ward are in the process of obtaining a tortoise or perhaps two who will be specifically for the ward.	The project is led by Ward Manager Emily Farrow with the hope that this can be considered for other wards wherever possible	Service delivery
‘Achieving a healthy weight in secure mental health services’	Patients from all services in the service  have attended monthly ‘CQUIN Oversight Group’ (COG) and contributed to the development and roll-out of initiatives to help patients lead a healthy lifestyle.  Carers have also been recruited to the COG.	Patients and Carers have provided important insights into where the priorities are for CQUIN interventions; the collaboration between staff and patients has been key to the success of on-ward initiatives.	Service Delivery Communication

WORKING SPECIFICALLY WITH CARERS/FAMILIES/FRIENDS

1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter. This is has continued to be routine practice at the point of assessment or admission. The social work team work closely alongside carers and the family and friends of carers as part of their role.

• Staff are ‘carer aware’ and trained in carer engagement strategies.  This is embedded in the Arnold Lodge induction and additional carer awareness training is available via learning and development.

• Policy and practice protocols re: confidentiality and sharing information are in place.  This is in place and Arnold Lodge promotes the Trust quick carers guide and the carers confidentiality cards, as well as where necessary carers contact care plans.

• Defined post(s) responsible for carers are in place.  Arnold Lodge has a Carers Lead who attends the carers connect network meeting and is in contact with carers support services. 

• A carer introduction to the service and staff is available, with a relevant range of information across the care pathway. Carers are sent an initial letter from Arnold Lodge at this point they are provided with an information pack about the service and information about their rights, who to contact within the unit etc. Carers are also met by a member of the senior nursing team for a face to face introduction on their first visit to the unit. Carers are encouraged to be in frequent contact with the social work team.

• A range of carer support services is available. Arnold Lodge provides a quarterly carers support group and is well linked with the Trust involvement centre. Carers newsletters are now sent quarterly as opposed to biannually. We have to carers events per year (winter and summer) that are well attended. 

 VOLUNTEERING

Our befriender service continues to be ready to provide high quality support to those patients who have few or no supportive friends and family.	Patients have reported feeling less isolated and lonely and having someone to talk to as others do who have visits from friends and family.	Communication
Involvement volunteers attend Patients Forum	Normally we would add that collection of surveys would be part of the feedback and this will be the case in the future we are sure. Until then it has been attendance via MST Teams to support and add their valuable contributions	Communication Service delivery