Welcome to the first newsletter of the Quality Network for Medium Secure Units. This is an exciting project that will bring far reaching benefits to participants. I would like in this first Newsletter Editorial to reflect on the factors which drove all those participating in the project to devote time and energy to its creation.

The need for a quality network My own interest started with seemingly innocent questions posed by Ministers in the Depart-ment of Health, such as ‘What is an MSU?’, ‘How do we know it does what it says it does? A definitive answer was not available. Subsequently, The Department of Health began a project to define standards for medium secure units. This coincided with the retraction in the number of high secure beds and a review of capacity planning for secure services, exposing major weaknesses in the govern-ance of the national secure services. Further, each service collects information about its ac-

tivity in its own way, rendering it difficult to get a national picture of activity within medium secure units and forensic services generally. Changes in commissioning arrangements Many mental health services will move to foundation trusts within the next few years. It is national policy that provision of care comes from a variety of providers with a mix of provision through the NHS and independent sector. There will be the additional pres-sure on services to define activity through the discipline of Payment by Results (including a National Tariff for specified services). For England and Wales, there has been a recent review of commis-s ion ing arrangements for specialist services which has proposed radical changes to the way in which secure services will be commissioned in future. If implemented, these recommen-dations should lead to specialist commissioning formally designat-ing provis ion of def ined specialised services. Designation will be based on nationally agreed

EDITORIAL: QUALITY NETWORK FOR MEDIUM SECURE UNITS

By Dr John O’Grady, Consultant Forensic Psychiatrist, Chair of the Network Advisory Group

September 2006

Issue 1

Quality Network for Medium

Secure Units Inside this issue:

Introduction to the Network Dr John O’Grady

1

Key Values for Quality Improvement Sarah Tucker

4

RCP Centre for Quality Improvement Adrian Worrall

6

The London Benchmarking Project Dr Andrew Johns

7

The Interview: Mike Gatsi, Senior Nurse

9

News 10

Links 13

Events 11

criteria through a formal process set by the commissioning bodies. Other recommendations include the establishment of national clinical databases to underpin c o m m i s s i o n i n g a n d t h e development of clinical networks to support the delivery of integrated care. Communication and Support Another major driving force for the creation of the Quality Network for MSUs is the desire for units to learn from each other and to test out their own systems and clinical processes through peer-review. Medium secure units, given their geographical positions, can be isolated and risk becoming insular and inward looking. The opportu-nities for learning, for quality improvement and for collabora-tive work around standards and performance are major incentives to join the network. Those who use MSU services, including general psychiatry services, the criminal justice system, Courts and not least patients and their families will be reassured by referral to a unit that has a robust peer-review quality system in place. The Royal Col lege of Psychiatrists’ Centre for Quality Improvement Those services which have opted to join the network recognise that it is in the best interest of the service to develop robust systems for quality assurance which can feed into the formal designation processes for commissioning. Given the changes occurring to commissioning in England and Wales, it seems inevitable that the

Page 2

Issue 1

future will bring about a need for accreditation of secure services. The question for providers, and indeed Commissioners, is whether this will be through ex-ternal validation or rigorous and robust peer accreditation systems.

The RCP Centre for Quality Improvement seemed a natural home because of its extensive experience in developing quality networks. Formal accreditation systems have emerged from CRU projects, such as the ECT Accreditation service, launched in 2003. Being based in the Centre for Quality Improvement, the Network can work to ensure that quality procedures that will be used in commissioning can be influenced by peer review systems. The Network at present The project was launched in spring 2006. Site visits will begin in October and continue until March 2007, with units receiving a report within six weeks of the peer-review visit. There will be an annual seminar in early 2007 to collate the years experience and plan the following annual cycle. An advisory group is in place for the project which was initially created from interested parties. It is the eventual aim for the advisory group to be maintained by the network itself through a democratic process of appoint-ment.

Quality Network

for Medium

Secure Units

The Project

Team

Sarah Tucker Programme

Manager

0207 977 6661

stucker@cru.rcpsy

ch.ac.uk

Tessa Hughes Quality

Improvement

Worker

0207 977 6665

thughes@cru.rcps

ych.ac.uk

Adrian Worrall Joint head of the

Centre for Quality

Improvement

0207 977 6690

awor-

rall@cru.rcpsych.a

c.uk

Way forward The first wave of recruitment has brought into the network a number of enthusiastic and committed services. We do however, need to expand the network. The advisory group has explored the reasons that some units showing expressions of interest eventually chose not to join. Two main concerns were reported: the cost of membership and the potential multiplicity of quality programmes a service could be subject to. A number of services felt that a collaborative could be maintained at a lesser cost through network arrangements that utilise the in-house resources for each unit, rather than an external body. Experience from others who have tried to develop such networks is not supportive of this. Sustaining over years a collaborative that will command confidence from stakeholders is not easy to achieve unless through a robust organisational framework that ensures its own quality. There is, therefore, a cost associated with membership of the network, the, structure of which the advisory group have examined in detail to ensure that members are getting value for money. In the long run, however, services will need to make a decision as to whether they can maintain and create robust qual i ty assurance programmes within their own organisation and resources or whether they need to join a

network. The alternative will be to have quality assurance and accreditation carried out exter-nal to provider organisations which, although the cost would not appear on their budget, would nevertheless come from the total budget for secure services. DH Support For England and Wales, the Department of Health have been very supportive of the creation of this network and is committed to ensuring that the emerging quality standards that will underpin designation of specialist providers and the development of tariffs can be subsumed within the network’s p e e r r e v i e w s y s t e m s . Commissioners have also indicated that they would be very interested in working with the network to develop national clinical databases that could allow for national planning of services. The latter would also be of immense benefit to research networks and lend itself to collaborative research and audit. This is a new venture which has got off to a very encouraging start, but requires much work to ensure that the network is a success. I hope you enjoy this first Newsletter.

Page 3

Issue 1

Any comments?

If you would like

to respond to

this, or any of

the articles in

this newsletter,

p l e a s e

emailmsu@cru.r

c p s y c h . a c . u k

and we will post

your comments

on our email

d i s c u s s i o n

group.

Involvement and Transpar-ency: Development of Ser-vice Standards

A core element of the new Quality Network for Medium Secure Units (MSUs) is the opportunity that it provides for member services to take ownership of the content, process and strategic development of the quality audit process that their services engage in. Rather than quality assurance and improvement taking the form of the imposition of external regula-tion, it literally becomes an owned process of peer-review. Staff members of another network at the RCP Centre forQuality Improvement say,

“Being part of the network allows us to be confident about what the agreed standards should be for units like ours and so helps us organise our thinking and planning about how to meet these standards. The network members have a broadly shared understanding of the work, a common language and a shared investment in ‘getting it right’…The encouragement of our peers helps staff morale and willingness to embrace change.”

The new network uses service standards for MSUs developed by the Department of Health.

These are augmented with supplementary standards developed at the Centre for Quality Improvement at the Royal College of Psychiatrists. Existing members of the Quality Network for MSUs and other experts in the field have been fully involved in agreeing these supplementary standards for MSUs. This occurred via a Standards Workshop held at the IoP in January 2006 and via postal consultation in June 2006.

Empowerment: Involving Front Line Staff in Peer-review Visits to MSUs

The self-reviews for member MSUs commence in September 2006. Peer-review visits between member MSUs will commence in October 2006. Member MSUs are strongly encouraged to seek the views of front-line staff and patients in the process of completing the self-review workbook. During the peer-review visits meetings are timetabled to gather the views of both front-line staff and service users. These visits provide excellent opportunities for units to learn from each other. Thus staff members from another network at the Centre for Quality Improvement net-work say,

“It encourages those of us who spend our working lives in the

Involvement, Empowerment, Transparency and Collective Responsibility: Key Values for Quality

Improvement Sarah Tucker, Programme Manager, Quality Network for MSUs, illustrates

the core values of the new quality network

“It encourages

those of us

who spend our

working lives

in the rarefied

atmosphere of

an inpatient

unit to get out

more!”

Network

member

Page 4

Issue 1

rarefied atmosphere of an inpatient unit to get out more! We recognise how much we have learned from visits to other units as well from the reviewers who have visited us. This team has benefited considerably from the opportu-nity, provided by membership of [the quality network] to exchange examples of best practice with peers who face challenges similar to those we face.”

Collective Responsibility: Service User Involvement in a Secure Setting

Importantly security issues in MSUs need not present a barrier to service users partici-pating in many aspects of the annual peer-review cycle. The Joint Review and Audit Process for Therapeutic Community Prison’s (HMP Prison Service and Community of Communi-ties) provides examples of good practice which is of interest to members of the Quality Net-work for MSUs. Inmate members have been fully involved in working groups tasked to prepare for the peer-review visit. Membership of such a working group has generally consisted of a mix of representative staff and inmate members. The group has usually been tasked to take a lead on ensuring the self-review workbook is completed in a way that represents all

staff and inmate members’ views. Additionally, they have been given responsibility for ensuring that every member of the unit is aware of what the peer-review is, of the peer-review timetable, of who the peer-review visitors will be, of why they will be there and of what they will be interested in exploring. The working group has encouraged inmate members to use the peer-review experience to speak as openly and frankly as they wish about anything they wish. In this way, such working groups have managed to go as far as they can to ensure that all members a re p repa red emotionally and practically for the audit and can subsequently participate in it in an informed way.

Following the peer-review visit, once the peer-review report has been prepared, such working groups have been tasked to take a lead on communicating to the wider unit areas that were considered to be an achievement. They have been given responsibility for making action plans for ensuring that areas identified for improve-ment are addressed where it is in the unit’s power to effect change. Such involvement of inmate members in the prepa-ration for and follow-up of the peer-review visits has been in-tended to foster a culture in which members of the prison therapeutic communities feel empowered to take part in improving the quality of their unit.

“Inmate

members have

been fully

involved in

working

groups tasked

to prepare for

the peer-

review visit”

Programme

Manager Sarah

Tucker,

reporting on

experiences

from reviews in

Therapeutic

Community

Prisons

Page 5

Issue 1

The new College Centre for Quality Improvement aims to help front-line staff raise standards of mental healthcare.

New policy will not lead to improvement unless front-line staff are fully involved in the process of change. Over the past seven years, the Royal College of Psychiatrists’ Research and Training Unit, has established a number of innovative national projects designed to engage and support front-line staff of all professions working in the NHS and independent sector. These include

• National quality improvement networks for:

- Services for people who self-harm

- Therapeutic communities - Child and adolescent psychiatric

units - Community child and adolescent

mental health services - Medium secure psychiatric units • Accreditation of: - Acute psychiatric wards - Electroconvulsive therapy clinics • National audit of violence in in-patient settings

• The UK Prescribing Observatory for Mental Health

The College has now brought these initiatives together into a new Centre for Quality Improve-ment. Projects involve large num-bers of mental health services (nationally and internationally) in

standards-based quality im-provement work. Currently, these projects collectively en-gage with approximately 90% of UK providers of mental health services.

Dr Paul Lelliott, Director of the College Research and Training Unit said: “Policy rarely sup-ports front-line staff and in fact, paradoxically, it can tie up middle managers to such an extent that they can no longer support their staff. Our projects are led by front-line staff and directly help them to work more effectively with pa-tients. We recognise that im-provement takes time and - unlike the Department of Health and Government – we can maintain our focus until we can see that our work has been effective. One of the great strengths is our ability to be flexible: increasingly, the Centre for Quality Improve-ment will be able to respond to changing needs of our mem-bership.”

For further information phone Rehana Meghji at the Centre for Quality Improvement on 0207 977 6644.

Royal College of Psychiatrists launches Centre for Quality Improvement Adrian Worrall, Joint Head of Centre

“ Our projects

are led by front-

line staff and

directly help

them to work

more effectively

with patients.”

Dr Paul Lelliott,

Director of the

College

Research and

Training Unit

Page 6

Issue 1

Benchmarking of London’s Secure Units

An overview of this exciting new endeavour,

from Dr Andrew Johns, Consultant Forensic Psychiatrist—Denis Hill Medium Secure Unit

“NHS MSU

beds

increased by

280% over

the last

decade –

despite this

260 patients

continue to

be detained

in out-of-

area

placements

(OATS)”

Page 7

Issue 1

Over the past decade there has been a considerable increase in secure forensic provision in London. Yet this has occurred in the absence of any London wide perspective on the overall level of demand, likely growth, or impact of national policy decisions. PCTs are aware of the comparatively high cost of these services without any information on the relative costs, efficiency and health impact of the individual services.

A benchmarking survey was designed and carried out in order to describe the character-istics of London’s forensic patients, the activity and costs of secure units and the NHS usage of private sector beds. This survey was commissioned by Alison Armstrong, Director of London wide programs, and carried out by Dr Annie Bartlett, Dr Andrew Johns, and Harmy Jhawar. We obtained data from all 7 NHS secure units within the M25, and data on all detained patients. The preliminary analysis was presented to providers and commissioners in June and to the Chief Executives in July 2006.

There are about 750 patients

detained in these secure units – a third have carried out homicide or other serious violence, 20% less serious violence and 10% sexual offences. Prison is the main source of admissions for 40%, with 20% from other MSUs, 10% from high secure and 10% from general settings. A major psychosis is diagnosed in 80%, with less than 5% being diagnosed with personality disorder. Regarding ethnicity, 44% are Afro-Caribbean, 39% white and 7% Asian. The average length of stay was 26 months.

The secure units comprise 570 medium secure, and 180 low secure beds of which 670 are for men and 80 are for women. There has been much recent expansion in that NHS MSU beds increased by 280% over the last decade – despite this 260 patients continue to be deta ined in out-of-area placements (OATS). Some sectors have continuing reliance on high numbers of OATS, whilst others with similar demographic profile, have negli-g i b l e numbers . Women comprise 20% of OATs com-pared with 11% of local provi-sion which suggests that NHS

Page 8

Issue 1

services are not able to cope locally with the range of women’s forensic needs and make proportionally greater use of the private sector.

Commissioning arrangements show no accepted way of dealing with growth, or of allocating the financial risk of OATS patients and how entry to OATs is determined. The unit bed costs varied between £356 and £460 a day but these stated costs are not transparent. Costing assumptions differ and do not allow for like-for-like comparisons. All services offered male medium and low-secure care for men; women’s services are very patchy. There are modest centrally funded pilots for personality disorder and adolescents, and very little provision for learning disability and sex-offenders. It proved difficult to make informed comparisons of unit activity given the range of provision. All units had data on discharges but the length-of-stay data was variable in quality and requires further clarification.

Some data is available on community forensic provision and it is clear that very different models of provision apply. For example the proportion of restricted patients varies from 20-60%, but this requires further analysis.

Regarding staffing, the ratio of beds/nursing staff varies from 1.6 to 2.2 and consultants are in general responsible for 14 to 16 beds. Given the wide range of daily bed costs it is of interest that for most of the London units, their staffing ratios are roughly equivalent. Some units had poor data on staff sickness and the reasons for this. There is data on the frequency of untoward events such as assaults and absconsions but this requires further work to understand unit to unit variation.

The final report is currently being completed and this will be made available to service providers and commissioners. It i s i n t e n d e d t o i n v i t e independent providers to participate and further surveys are planned on cost benefits and patient pathways.

Current areas of good practice at Three Bridges

Mike highlighted the following:

Clinical Improvement Groups

User Forums, both trustwide and by directorate

Clinical Governance Structures

Development of High Dependency Unit

Cluster working and by catchment areas (geographical)

Recent good news for Three Bridges Exciting developments are underway at Three Bridges. An Adolescent Unit was recently opened and there are plans to open an MSU for women. Future developments are set to be well informed by the recently com-pleted needs assessment for the community. The existing patients of Three Bridges can also look forward to service improvement, such as the integration of psychological and rehabilitation therapies and the work that is currently being un-dertaken towards standardised risk assessment e.g. HCR20. A family therapy service has also been developed. The rehab work at Three Bridges is something that Mike draws par-ticular attention to, for example Café on the Hill, which employs patients as part of Rehab, and workshops including printing and car valeting.

The Editor’s Interview

Mike Gatsi, Senior Nurse at Three Bridges Regional Secure Unit, West London Mental Health NHS Trust

Background:

Three Bridges RSU

in Southall is part

of the Forensic

Division of WLMH.

The unit provides

medium secure

psychiatric

services for people

from north-west

London,

Hertfordshire and

south

Bedfordshire. It

has 124 beds on 8

wards (4 male

wards and 4 mixed

wards) as well as

Butler House, a 12

bedded

rehabilitation unit.

Page 9

Issue 1

Mike Gatsi has been Senior Nurse at the Three Bridges Unit, a member unit of the Quality Network, for over two and a half years. He currently manages six clinical areas, as well as holding trustwide responsibilities. Mike is a member of the Advisory Group for the Quality Network for MSUs, providing a representative for nursing staff in MSUs.

Secure settings have not always been Mike’s place of work. Prior to entering the world of forensic settings in 1995, Mike worked as a PE teacher, specialising in sport and coaching football, field hockey, cricket and rugby. He has on occasion managed to successfully combine the two ca-reer paths, for example captaining the WLMHT cricket team.

What is enjoyable about working at Three Bridges? It is multi-professional working to achieve the same goal that really drives Mike at Three Bridges. He enjoys being involved in a diverse range of oppor-tunities and being supported in his career pathway. Gaining exposure and insight in service provision both locally and nationally has been very positive.

And what are some of the most difficult problems a Senior Nurse in a medium secure setting faces? Performance management issues is something that Mike has to deal with. It is also his responsibility to handle crisis management.

Mike finds it difficult to be faced with a lack of clear patient standards and set pathways.

⇒ Latest developments on amending the Mental Health

Act 1983, DH Read more

⇒ 99% of female inmates on drugs, says prison boss, Press Association Read more

⇒ Tribunals to review involuntary definition of mental

health patients Press Association Read more

⇒ Psychiatric hospital campaigners’ bed push challenge Press Association Read more

⇒ Why was tabloid tosh met with silence? The Guardian Read

more

⇒ Patient Safety Observatory Report 2. With Safety in

Mind: Mental Health Services and Patient Safety. NHS

National Patient Safety Agency. Read more

⇒ First steps to work – A Study at Broadmoor Hospital. The Sainsbury Centre for Mental Health Read more

⇒ Safety for psychiatrists. Royal College of Psychiatrists Report CR134

Read more

⇒ Consensus statement on high-dose antipsychotic

medication Royal College of Psychiatrists Report CR1348 Read more

⇒ Mental health law DH Read more

⇒ Social Security Benefits from April 2006 for patient

detained under sections 45A and 47 of the Mental

Health Act 1983. DH Read more

⇒ London’s prison mental health services: A review The

Sainsbury Centre for Mental Health Read more

⇒ No refuge, no shelter—The secret scandal in the

health service affecting some of Britain’s most vulner-

able patients. The Observer Read more

MSU News

‘Why was

tabloid

tosh met

with

silence?’

Find out here

Page 10

Issue 1

⇒ UK Accreditation Forum (UKAF) - Looking to the future of

healthcare assessment. An expert seminar on standard-based

peer review. 26th September 2006 www.rsm.ac.uk/quality

⇒ Implementing the Mental Health Bill. A practical one day

guide to implementing the Revised Mental Health Bill 27th Sep-

tember 2006. https://secure.healthcare-events.co.uk/conferences/

confdisplay.asp?id=544

⇒ The 4th National Conference: Research in Medium Secure Units. Institute of Psychiatry, Kings College London. 16th Janu-ary 2007. CALL FOR ABSTRACTS, due 29th September 2006 http://www.iop.kcl.ac.uk/iopweb/events/internal/?event=319

⇒ Personality Disorder: Current Issues in Assessment & Treatment. Multidisciplinary conference organised by West Lon-don Mental Health Trust in conjunction with Imperial College London. 11th October 2006. For more info email forensic-education@wlmht.nhs.uk or call 020 8354 8683

⇒ Royal Australian and New Zealand College of Psychia-trists, Section of Forensic Psychiatry. Annual Conference: Epidemics in Psychiatry. 12th—14th October 2006. http://www.rcpsych.ac.uk/pdf/RANZCP%20Conference%20Sydney%20Oct%2006.pdf

⇒ Professor Christopher Patrick Starke R. Hathaway Distin-guished Professor University of Minnesota, Lecture Series at the IOP 16th –20th October. Email dinah.konadu@iop.kcl.ac.uk

⇒ Celebrating Excellence In Prison Healthcare Research & Delivery. The Prison Health Research Network’s 2006 confer-ence. 20th October 2006 http://www.phrn.nhs.uk/conferences/

⇒ Improving healthcare: the challenge of continuous

change. 23rd International Conference—The International Soci-

ety for Quality in Health Care. Provides a stimulating annual fo-

rum with exchange of information and updates on practice and

policy development 22nd—25th October 2006 http://

www.isqua.org/isquaPages/london06.html

⇒ RCN Prison Nursing Forum conference and exhibition. A collaborative event for prison nurses, forensic nurses, police custody nurses and nurses working in secure environments. October 31st 2006. http://www.rcn.org.uk/events/display.php?ID=2494&StartPoint=10&O=StartDate

Events Page 11

Issue 1

RCN Prison

Nursing:

Forum,

conference

and exhibition

for nurses in

forensic

settings.

October 31st 2006,

see link opposite

Events continued ⇒ Hope and Hate—Working with the Forensic Patient.

International Association for Forensic Psychotherapy 16th

Annual Meeting. Call for abstracts by 31st October 2006.

Event 29th-31st March 2007.http://www.forensicpsychotherapy.com/

⇒ Prominence, delusions and threat. Forensic Psychiatry Re-search Society Meeting, 3rd November 2006 http://www.fprs.org/

⇒ Violence Risk Assessment: An update on research and good practice. Workshop providing already experienced practi-tioners with up to date information about research and good practice in violence risk assessment in mental health services. 8th November 2006. For more info email jane.senior@merseycare.nhs.uk or call 0151 471 2351

⇒ The National Forensic Mental Health R&D Conference. The FMH Programme is hosting a national conference focusing on interventions in forensic mental health. 23rd November 2006. www.nfmhp.org.uk

⇒ Making your in-patient settings THERAPEUTIC. This day conference will consist of debates, discussions and workshops on factors that promote a therapeutic outcome in in-patient adult and forensic mental health settings. Friday December 1st 2006 http://www.isps.org/index.asp?id=1008

⇒ Personal Development Courses for Psychiatrists A range of courses from the RCP Education and Training Centre, such is de-cision-making and emotional intelligence, designed to improve personal performance. Various dates 2006/2007http://www.rcpsych.ac.uk/educationandtrainingcentre.aspx

⇒ The Mental Capacity Act Training with Richard Jones Pres-entation of the legal relevance of this new important piece of legislation. Various dates 2006/2007 http://www.rcpsych.ac.uk/crtu/educationandtrainingcentre.aspx

⇒ Royal College of Psychiatrists Forensic Faculty Annual Meeting. The next Annual Meeting of the Forensic Faculty will take place in a hotel in the old town centre in Prague. The theme will be ‘Forensic Psychiatry in 2020’ 7th—9th February 2007 http://www.rcpsych.ac.uk/docs/Prague flyer.doc

⇒ Quality Network for Medium Secure Units—Annual Members’ Seminar. A day for members of the network to come together and hear the findings from the first annual cycle, in addition to presenting their own areas of good practice and quality improvement. 20th March 2007 email stucker@cru.rcpsych.ac.uk

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Issue 1

Quality Network

for Medium Secure Units:

1st Annual

Seminar. 20th March 2007

To book, contact t thughes@cru. rcpsych.ac.uk

Useful links ⇒ DPSD – Home Office Dangerous and Severe Personality

D i s o r d e r P r o g r a m m e h t t p : / /www.dspdprogramme.gov.uk/home_flash/index.php

⇒ Department of Health http://www.doh.gov.uk/

⇒ The Forensic Directory - Provided by the St Andrews group of hospitals, this is an up to date resource detailing forensic and other secure mental health services in the UK, provided by both the NHS and Inde-pendent Sectors.http://www.theforensicdirectory.info/

⇒ Forensic Psychiatric Nurses' Association (FPNA) Aims to promote the art and science of forensic psychiatric nursing, thereby improving the quality of care to patients http://www.fpna.co.uk/

⇒ Health and Social Care Advisory Service An evidenced based service development organisation working in all aspects of mental health and older people’s services across the health and social care continuum http://www.hascas.org.uk/

⇒ Healthcare Commission - promotes improvement in the quality of the NHS and independent healthcare h t t p : / / w w w . h e a l t h c a r e c o m m i s s i o n . o r g . u k /homepage.cfm

⇒ Institute of Psychiatry - largest academic community in Europe devoted to the study and prevention of mental health problems http://www.iop.kcl.ac.uk/

⇒ National Forensic Mental Health R&D Programme - funds research which supports the provision of mental health services for people with mental disorders who are offenders or at risk of offending http://www.nfmhp.org.uk/

⇒ National Institute for Health and Clinical Excel-lence an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Includes the National Collaborating Centre for Mental Health (NCCMH), a partnership between the RCP and BPS http://www.nice.org.uk/

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Useful links

⇒ National Institute for Mental Health in England—responsible for supporting the implementation of positive change in mental health and mental health services. Part of the Care Services Improvement Partnership. www.nimhe.org.uk

⇒ National Offender Management Service (NOMS)- brings together the work of the correctional services http://www.noms.homeoffice.gov.uk/

⇒ Prison Health -a partnership between the Prison Service and the Department of Health working to im-prove the standard of health care in prisonshttp://w w w . d h . g o v . u k / P o l i c y A n d G u i d a n c e /HealthAndSocialCareTopics/PrisonHealth/fs/en

⇒ Prison Health Research Network— DH funded initiative, led jointly by the Universities of Manchester, Southampton and Sheffield, and the Institute of Psychiatry http://www.phrn.nhs.uk/

⇒ RCP Centre for Quality Improvement homepage h t t p : / / w w w . r c p s y c h . a c . u k / c r t u /centreforqualityimprovement.aspx

⇒ RCP Education and Training Centre Offers courses for professional development in mental health care h t t p : / / w w w . r c p s y c h . a c . u k / c r t u /educationandtrainingcentre.aspx

⇒ Sainsbury’s Centre for Mental Health - an independ-ent charity that seeks to influence mental health policy and practice and enable the development of excellent mental health services through a programme of research, training and development. http://www.scmh.org.uk/

⇒ Social Perspectives Network—Women in Secure Settings coalition of service users / survivors, carers, policy makers, academics, students, and practitioners interested in how social factors both contribute to people becoming distressed, and play a crucial part in promot-ing people’s recovery.http://www.spn.org.uk/index.php?

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Royal College of Psychiatrists' Centre for Quality Improvement, 4th Floor Standon House 21 Mansell Street London E1 8AA

Phone: 0207 977 6665 E-mail: thughes@cru.rcpsych.ac.uk

Q U A L I T Y N E T W O R K F O R

M E D I U M S E C U R E U N I T S

feedback about perform-ance in nine domains that consultants themselves have identified as being important e.g. Communica-tion, Decision Making and R e l a t i o n s h i p s w i t h Colleagues/Patients. The tools used for the assess-ment, sample reports and enrolment forms can all be v i e w e d a t w w w . r c p s y c h . a c . u k /acp360.

Appraisal is part of the working life of every con-sultant psychiatrist, and 360-degree feedback is rap-idly gaining significance as a vital component of any rounded appraisal. ACP 360 is the Royal College of Psy-chiatrists’ 360-degree ap-praisal system and over 350 consultants have registered since its launch in summer 2005.

The purpose of ACP 360 is formative; it is to enable personal development. The system provides structured

RCP’s 360-degree appraisal system