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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
1
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
4
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