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Standards for People with Learning Disabilities in Medium Secure Care

Editor: Dr Nicola Phillips

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The Development of the Standards for People with Learning Disabilities in Medium Secure Care

These standards have been developed by Dr Nicola Phillips (Specialty Training

Registrar (ST5) in Learning Disability Psychiatry) supervised by Sarah Tucker (Programme Manager, Quality Network for Forensic Mental Health Services) in the following ways and stages:

1. Literature review and review of key documents

A literature search of key relevant academic papers and policy documents was carried out (see References below).

2. First draft of standards On the basis of the literature review, a list of key standard areas were

identified which formed the first draft of the standards.

3. Consultation with an expert panel

The first draft of the standards was discussed by a panel of experts on 17th June 2010 and subsequently with others by telephone (see Appendix

1) and key feedback was noted.

4. Stakeholder group discussions During the three month period from October 2010 to December 2010, staff and patients were consulted at four medium secure services with

wards for patients with learning disabilities. A variety of clinical and managerial staff as well as patients were invited to discuss and feedback

on the first draft of the standards from Northgate Hospital, Morpeth, Northumberland, Tyne and Wear NHS Foundation Trust; Alpha Hospitals, Bury; Calderstones Hospital, Clitheroe, Calderstones Partnership NHS

Foundation Trust, and Little Plumstead Hospital at Broadlands Clinic, Hertfordshire Partnership NHS Foundation Trust. A few other people were

consulted via email (see Appendix 2).

5. Editing list of key areas and formation of a list of standards

On the basis of feedback received during the stakeholder discussion group meetings, the first draft of the standards was edited and re-written into a

second draft of the standards. The British Institute of Learning Disabilities, Mencap, Spiral Skills Case

Advocacy Service and Inclusion North were also informed about the work.

6. Further Consultation The second draft of standards has been further discussed by the panel of experts and sent to all Quality Network members, key stakeholders and

commissioners for consultation. On the basis of comments received the final version was edited.

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Number Standard Add to Quality Network Criteria Number:

STAFF

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Staff working with people with learning disabilities are trained to work with people with learning disabilities

B24, C10

1.1 Managers ensure that all staff receive training in how mental illness presents in people with learning disabilities.

1.2 Managers ensure that all staff receive training in working with people with learning disabilities, autism spectrum conditions and epilepsy.

1.3

Staff demonstrate awareness, understanding and are able to apply established psychological approaches used in working with people with

learning disabilities commensurate to their role.

1.4

Staff receive training at induction that is regularly updated on

communicating with people who have learning disabilities.

2 There is a suitable skill mix of staff

A104

2.1 Senior Clinicians are trained in Learning Disability and Forensic Psychiatry.

2.2 There is a combination of nurses trained in mental health/learning disability.

2.3 There is access to a Speech and Language Therapist with experience in learning disabilities and mental health.

2.4 There is access to an advocacy service which is competent at working with people with learning disabilities in a forensic setting.

2.5 There is a local protocol in place so there is access to an epilepsy specialist (who may be the Responsible Clinician).

SERVICE

3

The service incorporates the aims of Valuing People and Valuing People Now and person centred

planning e.g. with Health Action Plans

INFORMATION

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There is access to clear and easy to understand

information in accessible formats (e.g. leaflets and other media)

D6

4.1 Patient forms are clear and in easy to read format.

4.2

There is information about learning disabilities, autism spectrum

conditions, epilepsy and how mental illness presents in people with learning disabilities.

4.3 Patients are given assistance by staff to help them to understand the information.

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Number Standard Add to Quality Network Criteria Number:

ENVIRONMENT

5

The unit environment is designed with attention to

sensory needs (including noise, light and colour)

F5

5.1

There is access to a range of rooms which have clear and identified purposes and there are specific protocols in place to prescribe their use which means that they meet the needs of the patients e.g. a low stimulus room.

TREATMENT

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The initial assessment includes learning disability

specific information

A85, A95

6.1 The initial assessment includes confirming their diagnosis of a learning disability.

6.2 The initial assessment includes a sensory integration profile.

6.3 The initial assessment includes an assessment of communication skills.

6.4

The initial assessment includes an assessment of the patient’s risk of

choking.

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The individualised treatment programme is timely

and informed by the patient’s cognitive function, communication skills and suitability for

individualised +/- group work

A94

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Care plans include learning disability specific information

A100, B19

8.1

Care plans are informed by the patient’s sensory integration profile where necessary.

8.2 Care plans are informed by the patient’s communication skills.

8.3 Care plans include a risk of choking plan where necessary.

8.4

Care plans include a patient epilepsy management plan where necessary.

8.5

Care plans are in a format which allows them to be understood by patients with learning disabilities.

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References

Care Quality Commission (2010) Care Quality Commission - Position statement and

action plan for mental health 2010-2015

Care Quality Commission (2010) Care Quality Commission – Annual Performance

Assessment 2009/10

Department of Health (1998) The patient’s charter: privacy and dignity and the provision

of single sex accommodation

Department of Health (1998) Signposts for success in commissioning and providing

health services for people with learning disabilities

Department of Health (1999) National service framework for mental health: modern

standards and service models

Department of Health (1999) Facing the Facts - Services for People with Learning

Disabilities – A Policy Impact Study of Social Care and Health Services

Department of Health (2000) Safety, privacy, dignity in mental health units: guidance on

mixed sex accommodation for mental health services

Department of Health (2000) Caring about Carers: the Report of the National Carers

Strategy

Department of Health (2001) Learning Difficulties and Ethnicity

Department of Health (2001) Valuing People

Department of Health (2001) The Mental Health Policy Implementation Guide

Department of Health (2002) Mental health policy implementation guide: national

minimum standards for general adult services in psychiatric intensive care units (PICU)

and low secure environments

Department of Health (2005) Independent investigation of adverse events in mental

health services

Department of Health (2007) Best Practice Guidance – Specification for adult medium-

secure services

Department of Health (2007) Services for people with learning disabilities and

challenging behaviour or mental health needs

Department of Health (2008) Using the Commissioning for Quality and Innovation

(CQUIN) payment framework

Department of Health (2009) Environmental Design Principles – Adult medium secure

units – Proposals for consultation

Department of Health (2009) New Horizons – Towards a shared vision for mental health

Department of Health (2010) Positive Practice Positive Outcomes – A handbook for

Professionals in the Criminal Justice System working with Offenders with Learning

Disabilities

Her Majesty’s Government (2010) Fulfilling and Rewarding Lives

Healthcare Commission (2006) Joint investigation into the provision of services for

people with learning disabilities at Cornwall Partnership NHS Trust

Healthcare Commission (2007) Investigation into the service for people with learning

disabilities provided by Sutton and Merton Primary Care Trust

Healthcare Commission (2008) Count me in 2008

Her Majesty’s Government (2009) Valuing People Now

Learning Disability Practice (2006) Learning disability screening questionnaire

Lord Bradley (2009) The Bradley Report

Mencap (2004) Treat me right! Better healthcare for people with a learning disability

Mencap (2007) Death by Indifference, Campaigns

Prison Reform Trust (2008) No One Knows

Professor Jim Mansell (2010) Raising our sights: services for adults with profound

intellectual and multiple disabilities

Royal college of Psychiatrists (2008) Implementation Criteria for Recommended Medium

Secure specification with Standards for Women in Medium Secure Care eds. Sarah

Tucker and Chris Ince

Royal College of Psychiatrists (2009) Accreditation for Inpatient Mental Health Services –

Learning Disabilities (AIMS-LD)

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Sir Jonathon Michael (2008) Healthcare for All

Foundation for People with Learning Disabilities (2004) Green light for mental health -

how good are your mental health services for people with learning disabilities? - A

service improvement toolkit

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Appendix 1 Panel of Experts

Name Job Title Unit/Service Name

Allison Armstrong Service Manager

Northgate Hospital,

Northumberland Tyne and

Wear NHS Foundation Trust

Dr Dan Dalton Consultant Forensic Psychiatrist

Little Plumstead Hospital,

Hertfordshire Partnership NHS

Foundation Trust

Dr Lorna Duggan Medical Director Kneesworth House Hospital,

Partnerships in Care

Owen Fry Service Manager

Little Plumstead Hospital,

Hertfordshire Partnership NHS

Foundation Trust

Dr Rona Gow Forensic and Learning Disability

Psychiatrist

Rowanbank Clinic, NHS

Greater Glasgow and Clyde

Dr Chris Ince Consultant in Forensic and Forensic

Learning Disability Psychiatry

Northgate Hospital,

Northumberland Tyne and

Wear NHS Foundation Trust

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Appendix 2 Stakeholder Meetings

Name Job Title Unit/Service Name

Dr Ade Adewunmi Clinical Director Calderstones Partnership NHS

Foundation Trust

Louise Amond Day Service Coordinator Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Pauline Bone Clinical Coordinator Northgate Hospital, Northumberland

Tyne and Wear NHS Foundation Trust

Trevor Borthwick-Hare Communication Facilitator Alpha Hospitals Bury

Mel Bowman Forensic Service Manager Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Lynsey Brown Staff Nurse Calderstones Partnership NHS

Foundation Trust

Ben Butler Adult Education Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Johnathan Clitheroe Deputy Clinical Manager Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Vicky Crawley Interpreter Alpha Hospitals Bury

Lindsey Gagan Language and

Communication Therapist Alpha Hospitals Bury

Dana Govindaraj Nurse Practitioner Alpha Hospitals Bury

Pete Hanlon Deputy Clinical Team

Manager

Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Julie Harrison Social Worker Alpha Hospitals Bury

Heidi Henderson Clinical Coordinator Northgate Hospital, Northumberland

Tyne and Wear NHS Foundation Trust

Nicola Hignett Registered Nurse Northgate Hospital, Northumberland

Tyne and Wear NHS Foundation Trust

Nick Horne Nurse Consultant Alpha Hospitals Bury

Will Hough Nurse Specialist Alpha Hospitals Bury

Ruth Hudson Occupational Therapist Alpha Hospitals Bury

Dr Lesley Jenkins Consultant Psychiatrist Calderstones Partnership NHS

Foundation Trust

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Name Job Title Unit/Service Name

Imelda Marshall Consultant Clinical

Psychologist

Northgate Hospital, Northumberland

Tyne and Wear NHS Foundation Trust

Jan Mitchell Speech and Language

Therapist

Northgate Hospital, Northumberland

Tyne and Wear NHS Foundation Trust

Emma Munir Occupational Therapist Northgate Hospital, Northumberland

Tyne and Wear NHS Foundation Trust

Kirstie Perfitt Governance Facilitator Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Frank Robinson Staff Nurse Calderstones Partnership NHS

Foundation Trust

Dr Dharjinder Rooprai Consultant Forensic

Psychiatrist

Blackberry Hill Hospital, Avon and

Wiltshire Mental Health Partnership NHS

Trust

Yvonne Rutherford Lead Nurse Northgate Hospital, Northumberland

Tyne and Wear NHS Foundation Trust

Clare Shard Head of Interpreting

Service Alpha Hospitals Bury

Graham Shelton

Acting Head of Mental

Health and Learning

Disability Commissioning

East of England Specialised

Commissioning Group

Ian Stinson Support Worker Calderstones Partnership NHS

Foundation Trust

Dr Ekkehart

Staufenberg

Consultant Forensic

Neuropsychiatrist

Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Claire Taylor Speech and Language

Therapist

Little Plumstead Hospital, Hertfordshire

Partnership NHS Foundation Trust

Susan Trench Involvement and Inclusion

Facilitator

Northgate Hospital, Northumberland,

Tyne & Wear NHS Foundation Trust

Dr Rob Turner Consultant Forensic

Psychiatrist Alpha Hospitals Bury

Luke van Os Therapy Assistant

Practitioner Alpha Hospitals Bury

Julian Webster Communication Champion Alpha Hospitals Bury

Jim Wilcock Support Worker Calderstones Partnership NHS

Foundation Trust

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Also thanks to patients from Little Plumstead Hospital, Hertfordshire Partnership NHS

Foundation Trust; Northgate Hospital, Northumberland, Tyne & Wear NHS Foundation

Trust; Calderstones Partnership NHS Foundation Trust and Alpha Hospitals, Bury and to

Marina Parkinson, Ellie Edgar and Joanne Ward who were involved in helping me to

arrange my Stakeholder group discussions.

Name Job Title Unit/Service Name

Lynn Williams Ward Manager Northgate Hospital, Northumberland,

Tyne & Wear NHS Foundation Trust

Paul Withers Consultant Clinical

Psychologist

Calderstones Partnership NHS

Foundation Trust

Susan Wrathall Matron Calderstones Partnership NHS

Foundation Trust

Jonathan Young Ward Manager Calderstones Partnership NHS

Foundation Trust

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