High Quality Patient Care and Treatment
In this section:
- Clinical Governance
- Clinical Governance Group
- Risk Management
- Child and Adult Protection
- Clean Environment
- Infection Control
- Information Governance
- Information Technology
- Security
- Forensic Medium and High Secure Care Standards
- Prevention & Management of Violence & Aggression (PMVA)
- Learning from External Inquiry Reports
Clinical governance covers activities that help sustain and improve high standards of patient care. It provides a system through which clinicians and managers are jointly accountable for patient safety and quality care.
The Clinical Governance Committee oversees clinical governance arrangements, and assures the Board that effective clinical governance mechanisms are in place.
The Clinical Governance Annual Report for 2018/19 provides a comprehensive overview of clinical governance activity.
The Clinical Forum continues to act as a professional advisory group.
The Clinical Governance Group has a quality assurance / improvement remit. Key areas of focus in 2018/19 included:
- Leading on the Staff and Patient Safety project.
- Progressing the 15 recommendations of the Supporting Healthy Choices workstream.
- Improving the patients’ care pathway through clinical outcome measures.
- Review and implementation where relevant of national standards and guidelines.
- Monitoring progress of the Patients Day Project.
- Implementing dynamic assessments of patient risk on a daily basis.
- Supporting quality improvement and assurance, and realistic medicine.
- Overseeing monitoring reports for the Clinical Governance Committee.
- Overseeing the work of the Mental Health Practice Steering Group.
In 2018/19 quarterly risk management reports provided an overview of risk management activity across incidents, enhanced reviews, complaints and claims.
The Risk, Finance and Performance group was established in August 2018 with the aim of monitoring corporate risks, finance and performance information. The group met on three occasions during the reporting period.
In 2018/19 there were 2,345 incidents; a slight increase from 2,310 in 2017/18.
Health and safety incidents remained the highest category of reported incidents throughout the year:
Three Category 1 investigations and nine Category 2 investigations were commissioned over the 12 months (Enhanced Adverse Event Reviews).
The number of Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDORs) reduced from 37 in 2017/18 to 28 in 2018/19.
The Hospital’s risk register process was reviewed in February 2018 with the 10 recommendations for improvement being progressed in 2018/19.
Resilience priorities during the year related to a review of the updated NHS Standards for Organisational Resilience (2018) and EU exit planning.
Steady progress continued to be made across all five of the agreed national workstreams relating to the Scottish Patient Safety Programme for Mental Health (SPSP-MH). Successful initiatives undertaken in 2018/19 included:
- A qualitative case study, a quantitative research paper, a GAP analysis, and a number of pilot projects in support of the Improving Observation Practice (IOP) workstream.
- The introduction of Patient Support Plans together with an individually tailored guide promoting person centred care (Communication at Transition workstream).
- The implementation of the electronic PRN Form across all wards (Safer Medicines Management workstream).
- Roll-out to all Hubs of the Clinical Pause (Least Restrictive Practice workstream).
- Programme of Leadership Walkrounds.
- Alignment of existing work with the five new national Safety Principles launched in February 2018.
- Continued production of a Risk Management 12 monthly update report.
During the year, work continued in an inter-agency manner to promote the safety and wellbeing of children, both within the Hospital led by the Child and Adult Protection Forum, and as part of South Lanarkshire Council’s Multi-Agency Child Protection Framework.
During the 2018/19 reporting period: six patients (parents of children) had some form of child contact, 56 children were approved to have some form of contact with a State Hospital patient, and 82 child visits took place.
The State Hospital supported National Adult Protection Day on 20 February 2018 to help raise awareness of adult protection issues, and to ensure that staff were fully aware of their responsibility to report adult protection concerns.
Corporate Parenting
State Hospital Corporate Parenting Plan 2018/20 (January 2018)
Corporate Parenting (June 2018) - Patient Information Sheet (Social Work)
Child Protection
Child Contact (November 2018) - Patient Visitor Information Sheet (Social Work)
Keeping Children Safe Policy 2017/20
Protection of Children (Scotland) Act 2003
Adult Support & Protection
Named Person (February 2019) - Patient Visitor Information Sheet (Social Work)
Appropriate Adult Scheme (July 2018) - Patient Information Sheet (Social Work)
Adult Support & Protection (Scotland) Act 2007 (June 2018) - Patient Information Sheet (Social Work)
Adult Support & Protection (Scotland) Act 2007 (June 2018) - Staff Information Sheet (Social Work)
Adult Support & Protection Policy 2017/20
Adult Support and Protection Act (Scotland) 2007
Social Work Service
Social Work Service (July 2018) - Patient Information Sheet (Social Work)
During the year ending 31 March 2019, protocols continued to be deployed to ensure a safe and clean environment. As a result, the Hospital achieved an above 95% compliance / satisfaction rate for both national audit systems for cleanliness and estate monitoring; a 5% increase from 90% in 2017/18.
NHSScotland Assests and Facilities Report 2015
Environment & Sustainable Development Policy Statement December 2017)
Property & Asset Management Strategy (PAMS) 2017/22 (Note - all property owned by the Hospital is contained within the Hospital campus). PAMS Interim Update Report - June 2019
The State Hospital is a comprehensive smoke free environment. See the Hospital's Case Study (February 2012) which
provides an account of the journey undertaken to become smoke free.
Infection prevention and control practices are embedded within policy and procedure to maintain a safe environment for everyone by reducing the risk of the potential spread of disease. Around 200 Infection Control audits take place each year to ensure a clean and safe environment. These audits are varied and include everything from hand washing, to clinical waste and sharps, to Health and Safety eControl book.
In 2018/19:
- Healthcare waste pertaining to sharps was consistent at 100%.
- Compliance relating to the safe management of linen required improvement.
- In terms of hand hygiene, the Health Centre consistently achieved 100% compliance, ward nursing staff constantly attained over 95%, and raising compliance levels within the Skye Centre patient activity areas remained a priority.
- There was an increase in the uptake of flu vaccinations for Nursing staff.
- An audit of the Uniform Policy was undertaken in August 2018 with positive results.
- Amendments were made to the Acute Boarding Out Leave (ABOL) Protocol to include Dynamic Appraisal of Situational Aggression (DASA) which is a tool to assess the likelihood that a patient will become aggressive within a psychiatric inpatient environment.
- Blood Borne Virus (BBV) testing was incorporated into admission blood screening, resulting in a high uptake by patients.
The State Hospital has a three year Healthcare Acquired Infection (HAI) Education Training Plan which is reviewed every six months.
Together We Can Fight Infection: How to hand wash with gel (July 2010) and How to hand wash with water (May 2011)
Infection Control Leaflets: Syphilis, Clostridium Difficile, Chlamydia, Gonorrhoea, Healthcare Associated Infections (HAI), Hand Washing, Hepatitis B, Hepatitis C, HIV/AIDS, MRSA and Norovirus
The Data Protection Act 2018 and the EU’s General Data Protection Regulation (GDPR) came into force in May 2018. In support of this:
- Privacy Notices were issued to all individuals having personal information processed by the Hospital.
- Personal data breaches were recorded and the Information Commissioner’s Office was notified as appropriate.
- A single point of contact for Information Governance and Data Protection matters was made available on The State Hospital’s website.
Additionally in 2018/19:
- The Hospital ensured compliance and development of Information Governance overall through the work of its well established Information Governance Group.
- Representation on various national NHS information governance groups was maintained, thus promoting alignment across Scotland for privacy matters.
- Bulk shredding to securely destroy obsolete records took place on two occasions, furthering the Records Management Plan.
- Procedures relating to Subject Access Requests and Health Records were updated to reflect the new statutory requirements.
- Freedom of Information (FOI) and Subject Access Requests were monitored; with compliance rates for both increasing to 94%.
- Privacy and Caldicott issues, including incident report monitoring and relevant training for staff, were attended to.
Your Personal Health Information Fact Sheet (February 2018)
Key eHealth projects completed in 2018/19 included:
- Development and rollout of the Business Intelligence platform.
- Development and rollout of the Records Management Plan.
- Pilot for Patient Internet Shopping.
- Ground work for Data Centre upgrade.
The State Hospital is committed to maintaining a modern, effective, and robust security infrastructure that enables the safe delivery of patient care within a high secure environment. The Hospital’s secure environment is provided by three domains of security:
- Physical security - provided through high quality physical barriers and sophisticated electronic detection and observation systems.
- Procedural security - provided through policies, procedures and working practice.
- Relational security - provided by clinical staff working closely with patients to deal with illness and offending behaviour.
The Hospital has its own Security Standards, which are aligned to the national High Secure Care Standards produced by the Forensic Network and adopted as national policy. Compliance with Security Standards is audited by the Forensic Network and an external advisor. The most recent audit took place in April 2018. A small percentage of non-compliant areas were identified and have since been addressed. None presented any significant risk to the security or safety of the Hospital.
During the year:
- Planned upgrades to Hospital's security systems commenced through a tendering process by Public Contracts Scotland.
- Policies and procedures continued to be reviewed and updated.
- Police Scotland were assisted with negotiator training on three occasions, with excellent feedback being received from both students and tutors alike.
- A pilot of a new search technique was conducted, with focus groups planned for 2019/20.
- A project was initiated to make improvements to Modified Safe Rooms (MSRs).
- A new Director of Security, Facilities and Estates was appointed, establishing links with the three English Special Hospitals, Police Scotland and the Scottish Prison Service.
Forensic Medium and High Secure Care Standards
Every three years, The State Hospital is assessed against the Forensic Medium and High Secure Care Standards relating to assessment, care planning and treatment, physical health, risk management, physical environment & teams, and skills & staffing. The last assessment took place in April 2018.
We continue to learn from other organisations by reflecting on and improving current practice within The State Hospital.
Review into Cultural Issues related to allegations of a bullying culture at NHS Highland - The Sturrock Report (April 2019) and The Scottish Government Response to the Sturrock Report (May 2019)
Vale of Leven Inquiry Report (December 2014)
Mental Welfare Commission Report: Mr O - Hard to Help (August 2012)
Learning from External Inquiry Reports - Overview (February 2011):
- Investigation into Mid Staffordshire NHS Foundation Trust - May 2013 August 2010
- Independent inquiry into the
care and treatment of Peter
Bryan and Richard Loudwell (NHS London) (September 2009)
- Investigation into West London Mental Health NHS Trust (July 2009)