High Quality Patient Care and Treatment
In this section:
- Clinical Governance
- Clinical Governance Group
- Risk and Resilience
- Covid-19 Response
- EU Exit
- Duty of Candour
- Realistic Medicine
- Child and Adult Protection
- Infection Control
- Information Governance
- Information Technology
- Medical Education
- Security
- Forensic Network Medium and High Secure Care Review Visit - Action Plan
- Prevention & Management of Violence & Aggression (PMVA)
- Learning from External Inquiry Reports
Clinical Governance is the framework to support the Board’s statutory responsibility to deliver high quality care. The Clinical Governance Committee ensures that the quality of care is underpinned by the effectiveness of clinical care and treatment, and that this evolves to meet the needs of both patients and staff. The Committee is supported by the Clinical Governance Group which has a quality assurance / improvement remit, and the Clinical Forum which continues to act as a professional advisory group. The Clinical Governance Annual Report for 2020/21 provides a comprehensive overview of clinical governance activity.
As well as overseeing the reports that go to the Clinical Governance Committee, other key pieces of work have included MCCB / Copyright issues, challenges with the completion of PANSS, Skye Activity Centre quarterly reports, trauma informed care, approval of the Clinical Effectiveness Annual Report and the Person Centred Improvement Service 12 month update report, reports on exceptional circumstances and the Hospital’s response to Covid-19.
The Risk & Resilience Annual Report 2020/21 highlights positive outcomes captured during the year:
- A significant reduction of incidents reported via Datix (the Hospital’s electronic incident reporting system) from 1,435 in 2019/20 to 943 in 2020/21.
- Improved delivery of Cat 1 and 2 reports ensuring timely completion.
- Strong evidence on learning from incidents, with local action being taken to minimise recurrences.
- High compliance with all aspects / forms of risk and resilience training.
- Completion of implementation of RSM audit recommendations.
- Continued development of the Corporate Risk Register and Local Risk Registers.
- Effective monitoring of risk information by groups and committees, and regular monitoring of patient-specific risks by clinical teams.
- Continued support to the Covid-19 Support Team in response to the pandemic.
- Root Cause Analysis Training completed.
Throughout 2020/21, The State Hospital responded to the unprecedented global pandemic through the prioritisation of strategies to protect the health and wellbeing of patients and staff, and to minimise as far as possible, the risk of transmission of the virus through staff and patient populations. Governance structures and operational actions were taken to meet the twin aims of health protection and prevention of infection, and to assure the Board on the situational analysis including Board governance, the incident command structure, and national guidance.
Within this framework and to provide Board assurance, the following areas were continually monitored, reviewed and reported on:
- Interim Clinical and Support Services Operational Policy.
- Infection Control.
- Clinical Care Guidance for Covid-19 patients.
- Personal Protective Equipment.
- Patient Flow.
- Attendance Management.
- Planning for Extreme Loss of Staff.
- Staff Recruitment.
- Staff Health and Wellbeing.
- Staff Testing for Covid-19.
- Communication.
- Impact of response to Covid-19 on business continuity.
The Corporate Risk Register was updated during the year to include the risk of Covid-19 with all risks on the register being reviewed in respect of this. A desktop planning exercise was undertaken in May 2020 to test the Hospital’s Extreme Loss of Staff Plan. The Medical Emergency Policy and Procedure also underwent extensive review in relation to Covid-19 with the revised policy being launched in June 2020.
Informed by The State Hospital Road Map, a Remobilisation Plan was developed outlining the Hospital’s approach to remobilisation for the period August 2020 to March 2021. A Recovery & Innovation Group was established to oversee key actions within the plan including patient, carer and volunteer engagement as well as communication and digital technology.
The State Hospital maintained links with National Board colleagues and contributed to the National Board Recovery Plan. Collaborative working with the Scottish Government and the wider Forensic Network to enable patient flow across the forensic estate was ongoing.
A presentation was delivered to the Board in October 2020 on The State Hospital’s preparedness for exit from the EU. This included an overview of national Reasonable Worst Case Scenarios (RWCS) from Covid-19 and economic instability to supply chains and capacity challenges. RWCS affecting The State Hospital related to food supplies, fuel, water, chemicals, medicines, and the NHS workforce. In response to these issues, the Hospital continued to build on work already undertaken by reviewing RWCS plans and maintaining links with both the Scottish Government Health Resilience Unit and Lanarkshire Resilience Partnership.
The State Hospital has robust systems in place to ensure that all incidents which may cause potential or actual harm are identified, investigated and where appropriate action taken to prevent a recurrence. During 2020/21 there were no incidents that met the criteria for Duty of Candour. The Duty of Candour Annual Report 2020/21 is due to be published in October 2021.
In addition to other quality improvement workstreams, a Realistic Medicine Action Plan was developed in March 2021 to help the Hospital develop and improve as a service. The action plan covered a broad range of projects and initiatives which will be taken forward in 2021/22:
- Improving Observation Practice (IOP).
- Skye Centre activity redesign.
- Patient and carer centred improvement projects.
- Clinical outcome measures.
- Review of Care Programme Approach (CPA) processes.
- Staff wellbeing initiatives.
- Quality Improvement (QI) training.
- Engaging with the wider Forensic Network.
Work and priorities are overseen and driven by the Child and Adult Protection Forum within The State Hospital and as part of South Lanarkshire Council’s Multi-Agency Child Protection Framework. Education and awareness sessions for staff are ongoing.
During the reporting period of 1 October 2019 to 30 September 2020:
- All commitments in respect of the Keeping Children Safe agenda were met with child contact assessments, reviews and child protection summaries being completed and stored electronically for easy access by clinical teams.
- Of the patients who are parents, three had some form of contact with their child. In total, 26 patients were authorised to have some form of child contact which is consistent with previous years.
- Child visits reduced to 28 attributable to the Covid-19 pandemic. In order to mitigate the impact of this, 11 patients had child contact via video visits with this figure expected to increase.
- 13 child contact applications were received, and four children were removed from the list as a result of patient transfers or a transition to adult visiting.
- At 30 September 2020, 74 children were approved to have some form of contact with a State Hospital patient - an increase of 18 from last year.
- No patients under the age of 18 years were admitted.
- There were two notifications of Child Protection concerns which were managed appropriately.
All Adult Support and Protection referrals and inquiries proceeded in accordance with policy and procedure and no patient was negatively impacted as a consequence. From 1 October 2019 to 30 September 2020, there were 12 Adult Protection inquiries; a significant reduction from the previous year.
Corporate Parenting
State Hospital Corporate Parenting Plan 2021/23 (October 2021)
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)
The focus of the year was on minimising the risk of Covid-19 transmission. A Covid-19 Support Team was established with the Senior Nurse for Infection Control playing a critical role. In terms of Test & Protect, the Covid-19 Support Team acted on symptoms rather than waiting until a positive result was obtained. This enabled quick identification of contacts and interventions which contributed to low infection rates. During the year, 265 staff tests were conducted, of which 42 staff tested positive for Covid-19. One patient was required to be treated out with The State Hospital due to complications of Covid-19.
During March and April 2020 there were five Covid-19 outbreaks on wards with eight patients confirmed as positive at this time. In January 2021 there was an outbreak involving two wards with four patients testing positive. In February 2021 an outbreak on two wards saw two patients testing positive.
A programme of Face Fit testing ran from April to October 2020. A Covid-19 Vaccination Programme for patients and staff commenced in December 2020 with positive results in uptake.
Additionally:
- A Scientific and Technical Advisory Group (STAG) was formed in April 2020 to ensure operational compliance with all relevant guidance and current scientific literature.
- An Interim Clinical Operational Policy was introduced to ensure infection prevention and control measures were prioritised.
- The Infection Control Committee resumed in July 2020 with a review of the work programme.
- A Covid-19 audit tool was developed and implemented from November 2020.
- A peer vaccinator model was introduced for seasonal flu vaccination with positive results.
- In January 2021 voluntary lateral flow device testing was introduced for staff who had direct / social interactions with patients.
- An Equality Impact Assessment & Data Protection Impact Assessment (DPIA) for the suite of infection control policies was approved in March 2021.
- 55 infection control incidents were recorded in year. Of these, 40 were clinical waste Incidents of which 36 related to laundry.
- A number of infection control clinical audits were undertaken in year, suggesting that staff were responding positively and complying with policy and guidance.
- A key focus during the year was on the correct use of Personal Protective Equipment (PPE) and staff completion of infection control online modules.
The Infection Control Annual Report 2020/21 summarises core activity over the last 12 months.
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.
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
Focus over the course of 2020/21 was on improving Information Governance standards and practices across the Hospital to ensure compliance with the national Information Governance Framework. Matters relating to data protection, records management, Caldicott issues (including incident reporting), and mandatory training remained a top priority as did the monitoring of Freedom of Information (FOI) and Subject Access Requests.
Your Personal Health Information (February 2021) - Patient Information Sheet (Health Records)
Another significant achievement in 2020/21 related to The State Hospital becoming a digitally enabled organisation. Key successes within this workstream were in respect of migration to Office 365 for all staff, and as a result of the Covid-19 pandemic, accelerated implementation of Microsoft Teams and remote working. Work also commenced across the site to implement Windows 10.
The General Medical Council (GMC) Quality Improvement Framework for Undergraduate and Postgraduate Medical Education in the UK sets out expectations for the governance of medical education and training. The continuing high standard of undergraduate and postgraduate medical training provided by The State Hospital was acknowledged during 2020/21 with the award of a Good Practice Recognition from NHS Education for Scotland for the training provided to Core Trainees, for the second consecutive year.
Following the outbreak of Covid-19, it was anticipated the Security Refresh project would be suspended. However, following the Covid-19 construction sector guidance issued on 6 April 2020, a revised phased programme was developed and progressed during the year. Work included the installation and testing of Fibre Network across the site, the installation of CCTV in patient areas, and the tubestile replacement programme which was completed ahead of schedule.
Forensic Network Medium and High Secure Care Review Visit – Action Plan
From the original 37 actions, six of the 10 outstanding actions were closed off during 2020/21 with work in progress to complete the remaining four
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)