Service Standards Fifth Edition - Royal College of ... · PDF fileForeword This is the fifth edition of the QNIC standards and this document will be used as QNIC enters its tenth annual

Service Standards Fifth Edition

Editors: Sarah Bacon, Peter Thompson, Jane Solomon

Quality Network for Inpatient CAMHSRoyal College of Psychiatrists’ Centre for Quality Improvement4th Floor, 21 Mansell Street, London E1 8AA

Tel 020 7977 6691/92/93 Fax 020 7481 4831Email [email protected] Web www.qnic.org.uk

Published October 2009. Due for review Summer 2011.Charity registration Number 228636. © 2009 The Royal College of Psychiatrists.

QUALITY NETWORK FOR INPATIENT CAMHS

Contents

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ContentsForeword 05

Introduction 06

Section 1: Environment and Facilities 09

Section 2: Staffing 16

Section 3: Access, Admission and Discharge 24

Section 4: Care and Treatment 28

Section 5: Information, Consent & Confidentiality 34

Section 6: Young People’s Rights and Safeguarding Children 39

Section 7: Clinical Governance 43

Section 8: Location within a public health context and commissioning 47

Bibliography 50

Appendix A: Acknowledgements 53

Appendix B: QNIC Executive Committee 54

Appendix C: QNIC Standards Order Form 55

ForewordThis is the fifth edition of the QNIC standards and this document will be used as QNIC enters its tenth annualcycle of reviews.

The need for a quality network for inpatient CAMHS services was identified from the National Inpatient Childand Adolescent Psychiatry Study (NICAPS) (O’Herlihy et al 2001). The study found that practice and serviceprovision varied greatly across Tier 4 inpatient units in the UK and services were often very isolated with fewopportunities to share best practice and experience with peers.

Nearly a decade later and the picture is very different. With 100 members representing over 90% of services,QNIC units are talking to each other more than ever. The email discussion group continues to thrive, specialevent days such as the recent teachers’ day are very well attended and this year saw our biggest annual forumto date with over 200 attendees.

Of all QNIC’s work however, the standards have provided the most important driver in improving the quality ofcare. The standards are informed by national policy and the evidence base for providing inpatient services foryoung people but also represent what frontline staff, young people and parents believe are the priorities indelivering a quality service. This is why it is especially pleasing that we have seen so many services improvesignificantly in their performance against the QNIC standards over the past decade.

Many units continue to struggle to meet standards which are beyond their local control, for example resource or staffing issues. Therefore, we believe it is more important than ever that members involve theircommissioners and senior managers as much as possible in the QNIC process. This edition of the standardscontains new commissioning criteria which we will be asking both frontline staff and commissioners to score the service against.

Thank you to all the QNIC members who contributed to this revision of the standards and special thanks toCamilla Parker and Kathryn Pugh for their input.

Peter ThompsonSenior Programme ManagerCentre for Quality Improvement, Royal College of Psychiatrists

Foreword

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QNIC Service Standards Fifth edition

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Introduction

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Introduction

BackgroundThe QNIC standards evolved from a set developed to evaluate services as part of the NationalInpatient Child and Adolescent Psychiatry Study (NICAPS) (Ref 96, O’Herlihy et al., 2001). The NICAPSstandards were based on the findings of a literature review and information from an expert panel. Thefirst QNIC standards were developed in 2001 and were revised in 2002, 2004, 2007 and again in2009. This new edition represents the fifth revision of these standards.

The QNIC review processThe standards represent just one part of the QNIC cycle; the real benefit for CAMHS inpatient units isin taking part in the process of QNIC reviews. These reviews aim to gradually improve services usingthe principles of the clinical audit cycle (see figure below). The ninth annual cycle of reviews will runfrom May 2009 to April 2010. For the eighth cycle, 93 inpatient CAMHS units across the UK, Republicof Ireland and Europe took part in the QNIC process. If you are interested in joining QNIC pleasecontact Peter Thompson on 020 7977 6693 or [email protected]

Updating the QNIC StandardsIn previous years the QNIC standards have been mapped against the Standards for Better Health.However, the Standards for Better Health are no longer in use and so these have been removed from Edition 5. Currently the Care Quality Commission (who replaced the Healthcare Commission) is developing a new registration system for implementation in 2010. However, as this is still underdevelopment it was not possible to map to the standards at the time of publication.

This fifth edition of the QNIC standards has been informed by a completely new literature review in order to ensure it is as accurate and as up to date as possible. The literature search consulted a wide range of documents and sources including websites, professional bodies, regulators, policydocuments, and experts. A full list of the literature used can be found in the bibliography at the back of this document.

It is also important to note that some of the standards have been amended and updated in light of theamendments to the Mental Health Act 1983. This takes into consideration, in particular, the duty toprovide age appropriate facilities for young people and access to Independent Mental Health Advocacy.

A standards workshop was held on 6 July 2009, to which all QNIC members were invited to gainexpert opinion and consensus. A good range of units were represented at the workshop, includinggeneral psychiatric units, secure and forensic units, learning disability units, children’s units andadolescent units, from both NHS and independently funded sectors. A wide range of disciplines wasalso represented. Once additions and changes had been proposed there was a wider consultation withall QNIC members and with the QNIC executive committee. A consultation document was sent out to over 300 members via the QNIC email discussion group. The document listed suggested criteriaadditions, changes and removals. We accepted criteria where there was clear consensus; otherwise adecision was negotiated within the project team.

QNIC have also been fortunate enough to have the standards reviewed by the Standards and Workinggroup which is part of the College Centre for Quality Improvement (CCQI) and is made up of expertstaff from the CCQI.

Please note that for this edition of the standards we have made some changes to terminology to make the criteria clearer and more consistent. “Young people” will be used to describe all age groups of service users who access child and adolescent mental health services. We have also used“parents/carers” to identify and acknowledge those who hold parental responsibility but who may notbe the biological parent.

Another significant change to this year’s standards is the numbering of the standards. As a result offeedback from our members, the standards have been re-numbered so that they run in chronologicalorder and are therefore easy to follow. The QNIC team has made a note of the number changes socomparisons will still be able to be made year on year.

As with previous editions of the standards, all the criteria have been rated either “E” for essential/ legalrequirements or “D” for desirable.

AGREESTANDARDS

AGGREGATEDREPORT

COMPILED

ANNUALFORUM

EXTERNALPEER REVIEWS

SELF-REVIEWS

LOCAL REPORTSCOMPILED

THE QNICANNUAL REVIEW

CYCLE

Section 1 Environment and Facilities

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Important noteData collection tools adapted from these standards will be provided with guidance notes to QNICmembers before reviews take place. This document is provided for reference and not for datacollection.

These are best practice statements and consequently we would not expect services to meet everystandard. While there are some statements that are based upon legal requirements, this document isnot intended to act as a legal guide in any way. This is not intended to be a guide to any reviewsconducted by regulatory bodies.

If you have any questions about these standards please contact Peter Thompson on 020 7977 6693or email [email protected]

1 The inpatient unit is well designed and has the necessary facilities and resources

1.1 The unit provides a comfortable environment for young people E

Ref 29: pg 12 “Acute mental health services must be sources of comfort and help.”

Ref 39: pg 24 “The Anshen Dyer team concluded that the key design considerations for children and young people should be:• a welcoming environment.”

1.2 The unit is in a good state of repair and decoration E

1.3 There is indoor space for recreation E

Ref 39: pg 22 “Facilities for play and recreation were high on the wish list.”

1.3a There is outdoor space for exercise and recreation, which is easily accessible E

Ref 10: pg 11 “Children in psychiatric units should have access to some kind of PE facility. Younger pupils should have access to suitable play areas. Access to outside space and access to transport for outings and trips to parks are also essential.”

Ref 42: pg 6 “The recommendations refer to opportunities for moderateto vigorous intensity physical activity. Children and young people should undertake a range of activities at this level for at least 60 minutes over the course of a day.”

Ref 26: pg 37 “...aim to offer all 5-16 year olds 5 hours sporting activity a week.”

Ref 29: pg 25 “Particular attention should be paid to ensuring good access to gardens and outdoor spaces, and to their design.”

1.4 There is a designated dining area where all young people can sit together E

Ref 39: Pg 36 “Hospitals should, wherever practical and possible, ensure that children eat together in a social group. Children should be provided with the opportunity to eat in a dining room or other suitable location which resembles a home rather than a hospital.”

1.5 The unit contains large and small rooms for individual and group meetings E

Ref 45: pg 29, “At least one room per ward is needed for interviewing individual patients and relatives.”

Section 1: Environment and Facilities


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1.12 Each young person has the educational materials required for each Key EStage (or equivalent educational stages outside of England and Wales) e.g. textbooks, DVDs and interactive learning materials/software

Ref 9: Pg 34 “All such pupils should as far as possible receive the same range and quality of educational opportunities as they would have done at their home school.”

1.13 The service entrance and key clinical areas are clearly signposted E

Ref 38: “Sign-posting -• the sign-posting should be an integral part of the wayfinding strategy• routes and sign-posting to and from parking areas and public transport

points should be clear and obvious.”

1.14 There is sufficient car parking space for staff and visitors near the unit D

1.14a Staff and patients may access the unit using public transport E

1.15 The unit is maintained at a high level of cleanliness E

Ref 19: “A clean environment provides the right setting for good patient care practice.”

1.16 Staff members can regulate heating and ventilation through local controls E

Ref 38: 9.8 “The heating, ventilation and air conditioning systems should be logically designed to operate efficiently and provide local control where required.”

1.17 Maintenance is completed in a timely manner D

1.18 All staff have access to IT facilities to support high quality care and the Emonitoring and evaluation of the service

Ref 20: “IT resources and equipment to support high quality care and the monitoring and evaluation of services should be available in all appropriate settings.”

1.19 The unit has age-appropriate games and entertainment for young people, Ee.g. television, DVD, audio system, books, magazines and board games

Ref 39: pg 26 “Young people attending in-patient facilities wanted: appropriateentertainment for all ages.”

1.20 There are facilities for young people to make their own hot and cold drinks Dand snacks where risk permits

1.6 Comfortable waiting rooms/areas are provided E

1.7 Where seclusion is used there is a designated seclusion facility available E

Ref 45: pg.51 Recommendation 27 – “Seclusion facilities should be available in every unit.”

Ref 49: pg 78 “...it is clear that a lack of seclusion facilities... leads to restraint episodes being conducted in full view of the ward...”

1.7a The seclusion room meets all the following requirements E

i. Allows clear observation

ii. Is well insulated and ventilated

iii. Has access to toilet/washing facilities

iv. Is safe and secure – does not contain anything which could cause harm to the young person or others

Ref 24: pp125-126 15.60 “The room used for seclusion should: • provide privacy from other patients, but enable staff to observe the

patient at all times;• be safe and secure and should not contain anything which could cause

harm to the patient or others;• be adequately furnished, heated, lit and ventilated; and • be quiet but not soundproofed and should have some means of calling for

attention (operation of which should be explained to the patient).”

1.8 There is a designated low-stimulus area or ‘safe room’, separate from any Eseclusion room, for the purpose of reducing arousal and/or agitation

1.9 There are age appropriate play or leisure materials which can be used as Ediagnostic and therapeutic tools

Ref 39: Pg 24 “Toys appropriate to the different age groups were also requested.”

1.10 One computer is provided for every two pupils D

1.11 There is designated classroom space for educational activities which can Eaccommodate all young people in the unit

Ref 9: pg 36 “Accommodation should:• Provide sufficient separate teaching and storage space.”


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3.6 The young people do not pass through areas occupied by members of Dthe opposite sex to reach toilets and washing facilities

Ref 40: pg 11 7.2.2 “The layouts of new designs must prevent members of one sex having to walk through an area occupied by the other sex, to reach toilets or bathrooms.”

3.7 The unit has at least one bathroom per 3 young people E

3.8 There is a female only lounge available D

Ref 40: pg 8 5.3.2 “Where possible, women patients should have the opportunity to associate together in women-only lounge areas, if they so wish...”

3.9 The unit has a designated room for physical examination and minor medical Eprocedures

Ref 45: pg.29 “The ward will require treatment room facilities to enable blood samples to be taken, medical examinations to be carried out and minor first aid or other procedures performed.”

3.10 The unit has at least one quiet room other than young people’s bedrooms D

Ref 14: pg 38 24.15, “There are rooms in which children can meet privately with visitors and space for private activities, play and recreation which do not affect other children’s routine activities”

3.11 The unit has private rooms, other than young people’s bedrooms, where Eyoung people may meet relatives and friends

Ref 48: A number of respondents reported that they “require units to provide designated space for time/meetings with parents.”

Ref 24: pg 346 36.74 “Children and young people aged under 18 should also have access to age-appropriate leisure activities and facilities for visits from parents, guardians, siblings or carers.”

3.12 Young people have access to a telephone which can be used in a private area E

Ref 49: pg 64 “The code of practice for England (paragraph 16.3) also states that hospital managers should ensure that patients who use any coin or card operated telephone on the ward can do so in privacy without being overheard.”

3.13 There is a safe place for young people to keep their property E

Ref 24: pg 116 “....giving each patient a defined personal space and a securelocker for the safe keeping of possessions.”

3.14 There is a safe place for staff to keep their property E

2 Children’s units and adolescent units are separate from adult units

2.1 There are policies and procedures to prevent unwanted visitors to the child Eor adolescent unit

Ref 24: Pg 139 16.39 “If hospitals are to manage entry to and exit from the ward effectively, they will need to have a policy for doing so.”

2.2 When a children’s unit or adolescent unit is on the same site as an adult unit, Ethere are policies and procedures to ensure young people are not using shared facilities at the same time as other adults

Ref 50: pg.133 “We recommend that the goal of separate adolescent provision from children and adults should be explored by policy makers and considered actively by management in all hospitals.”

3 Premises are designed and managed so that young people’s rights, privacy and dignity are respected

3.1 All confidential case materials, e.g. notes, are kept in locked cabinets or Elocked offices, in accordance with Caldicott Report (1997)

Ref 12: Pg 106 6.5 “All personal files and confidential information must be kept in secure, environmentally controlled locations when unattended, e.g. in locked storage cabinets, security protected computer systems etc.”

3.2 The environment meets the needs of people with physical disabilities, and Ecomplies with current legislation on disabled access

Ref 30: “From December 2006, the Disability Discrimination Act introduces a duty for public bodies to positively promote disability equality.”

3.3 All young people have the choice of having a single bedroom E

Ref 13: pg.119, M38.2 “All children are admitted to a single room unless there is a specific request or clinical reason to share on a companion basis.”

3.4 All young people may sleep in privacy and sleeping areas are arranged into Eseparate male and female zones

Ref 22: “In practice, good segregation can be achieved if men and women have separate sleeping areas (e.g. single-sex bays).”

Ref 40: pg 7 “As a minimum requirement, male and female patients should have separate sleeping accommodation, separate toilets and separate washing facilities.”

3.5 Separate male and female toilets and washing facilities are available in the Eunit and are clearly labelled male or female


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6.4 An audit of environmental risk is conducted annually and a risk management Estrategy is agreed e.g. possible ligature points are identified and dealt with

Ref 37: “PEAT is an annual assessment, established in 2000, of inpatient healthcare sites in England with more than ten beds.”

4 The unit provides a safe environment for staff and young people

4.1 Drugs are kept in a secure place with the dispensary book in line with the ETrust’s medicine management policy

4.2 Internal doors may be locked if required, e.g. to secure one part of the unit E

Ref 24: pg 139 16.38 “Locking doors, placing staff on reception to control entry to particular areas, and the use of electronic swipe cards, electronic key fobs and other technological innovations of this sort are all methods that hospitals should consider to manage entry to and exit from clinical areas to ensure the safety of their patients and others.”

4.3 Entrances and exits are designed to enable staff to see who is entering or Eleaving and if required CCTV is used to achieve this

Ref 40: pg 14 “In addition, there should be well-located controls/observation bases. Designs should eliminate features which present risks to patients’ safety. Layouts should allow good observation.”

4.4 There are areas with clear lines of sight to enable staff to monitor young Epeople who need closer observation

5 Young people are consulted about the unit environment and have choicewhen this is appropriate

5.1 Staff consult with young people when decisions are made about changes to Dthe unit’s environment that may affect them

5.2 Unit staff encourage young people to personalise their bedroom D

6 There is equipment and there are procedures for dealing with emergencies in the unit

6.1 There is a procedure for evacuation in case of fire which is rehearsed at Eregular intervals

6.2 The unit has resuscitation equipment and its location is clearly identified E

6.3 Staff members can obtain quick assistance in an emergency, e.g. the unit has Ea staff communication system

Ref 40: pg 8 “Security measures, for example alarm systems or call buttons, to alert staff may need to be available and accessible to patients, staff and visitors, and should be checked regularly.”

6.3a There is a way for young people to raise an alarm in an emergency other Dthan shouting e.g. wall alarms

7 The number of nursing staff on the unit is sufficient to safely meet the needs of the young people at all times

Ref 46: pg 36 All criteria are matched to recommendations in ‘Building and sustaining specialist child and adolescent mental health services’

7.1 Where there are high dependency/high acuity cases (e.g. high levels of Eobservation, use of seclusion, increased risk of violence or self harm), there is a minimum ward staff to patient ratio of 1:1 to 3:1 for the most highly disturbed cases

7.1a Where there are medium dependency cases (10-minute checks, intensive Esupport at meal times), there is a ward staff to patient ratio of 1:2

7.1b Where there are general observations, maintenance of safety and during Etherapeutic programme times, there is a ward staff to patient ratio of 1:3

7.2 At night-time in a 10-12 bedded unit with general observations there is a Eminimum of two staff on duty, including one qualified member of staff and access to additional support as appropriate

7.3 There are sufficient staff to ensure that when young people require physical E restraint, it is with the minimum force and risk of injury and in line with trust policy

Ref 44: pg 5 “Good decision-making about restraint, holding still or containing requires that, in all settings where children and young people receive care and treatment, there is: a sufficient number of staff available who are trained and confident in safe andappropriate techniques and in alternatives to restraint, holding and containing of children and young people.”

7.4 The ward manager can arrange for additional staff to cover shifts in Ean emergency

7.5 The unit is staffed by permanent staff, and bank and agency staff are used Eonly in exceptional circumstances e.g. in response to additional clinical need Guidance: A CAMHS inpatient unit is likely to have a problem with over-use of agency nurses if more than 15% of staff are agency staff during a week or if more than one member of staff on a shift are from an agency. Agency staff should also not be used for more than two shifts in a day.

Ref 8: pg 19 “Service user feedback reinforces the importance of a regular and stable workforce which enables the development of therapeutic relationships and trust in providing support at distressing times. The National Audit of Violence (HC 2005) found that lack of leadership, inexperienced ward staff combined with an over reliance on bank and agency staff can have a negative effect upon the continuity of care and overall safety of the acute inpatient ward.”

7.6 Where bank and agency staff are used, they are familiar with the service and Dexperienced in working with young people with mental health problems

Ref 8: pg 19 “An over reliance on bank and agency staff can have a negative effect upon the continuity of care and overall safety of the acute inpatient ward.”

8 There are nurses with a specialist qualification in the unit at all times


8.1 A typical unit with 10-12 places include a minimum of two registered nurses, Ethat have relevant child and young people experience, per day shift and one at night

8.2 A typical unit with 10-12 places includes a 1 WTE Ward Manager whom is a Eregistered nurse (Band 7+) or from another discipline with appropriate expertise

9 The inpatient unit comprises a core multi-disciplinary team


9.1 A typical unit with 10-12 places includes at least 1 WTE consultant child and Eadolescent psychiatrist (which may be provided by two clinicians in a split post)

9.1a A typical unit with 10-12 places includes at least 4 hours per patient per Eweek non-consultant child and adolescent psychiatrist input e.g. staff grade or ST4+ Trainee (or equivalent)

9.2 A typical unit with 10-12 places includes one WTE clinical psychologist; in a Etypical children’s unit 0.8 WTE clinical psychologist input is provided

9.3 A typical unit with 10-12 places includes provision of 0.5 to one WTE ESocial Worker

Section 2 Staffing

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Section 2: Staffing

9.4 A typical unit with 10-12 places includes provision of 0.5 WTE occupational Dtherapy input is provided

9.5 Units that treat young people with eating disorders have input from a dietician E

9.6 Young people may access treatment from a range of other therapists while in Ethe unit including Speech and Language Therapy

9.7 A member of the team has 0.5 WTE protected time to deliver family therapy E

9.8 There is a minimum of one qualified teacher to 4 students per lesson E

Ref 10: pg 11 “...this requires a teacher to pupil ratio of 1:4 or less, the presence of specialist nursing staff or the provision of a room for individual teaching.”

Ref 10: pg 13 “When teaching pupils with mental health problems, a teacher pupil ratio of 1:4 or less is common.”

9.9 Young people have access to teachers of specialist subjects, e.g. language Dtutors and other education professionals, e.g. educational psychologists

Ref 9: pg 11 2.4 “The policy should make links with related services in the local authority such as those for Special Educational Needs and other local authority support services, educational psychologists...”

9.10 There are administrative and secretarial staff to support effective running of Ethe unit

Ref 20: “The administrative workforce should be sufficient to ensure that all necessary administrative functions, including data collection, can be fulfilled.”

9.11 Unit staff have access to input from a pharmacist E

9.12 There is an identified duty doctor to attend the unit, including out of hours E

10 Unit staff work effectively as a multi-disciplinary team

10.1 The unit manager maintains an up to date organisational diagram that shows Eline management within the unit

Ref 29: pg 25 “Key organisational arrangements should include:• single management and unambiguous lines of responsibility.”

Ref 13: pg24 “Ensure job specifications, performance review, appraisal and linemanagement arrangements are defined for all staff.”

10.2 There are regular multi-disciplinary team meetings, that occur at a minimum Eof bi-monthly, for discussion of clinical matters, administrative work and for consulting with the team on relevant management decisions

10.3 Good staff morale is recognised as important and efforts to improve morale Eare made when necessary

Ref 29: pg 13 “... Developing well motivated staff with appropriate skill mix.”

Ref 6: pg 13 “Modern mental health services must be planned and delivered around the needs and aspirations of service users, delivered by a workforce who are skilled, of high morale and able to adopt new ways of working.”

10.3a Unit managers monitor staff morale, e.g. through annual surveys, audits of Esick leave and staff retention and appropriate action is taken when needed

10.4 There are procedures for managing complaints from staff and staff members Eare able to raise concerns without prejudicing their position

Ref 3: pg 4 “The Public Interest Disclosure Act (PIDA) is known in the UK as the whistleblowing law. The Act provides that employers should not victimize any worker who blows the whistle in one of the ways set out in the legislation.”

10.5 All staff are informed that they have a responsibility to critically challenge Edecisions that they feel may not be in the best interests of young people and families

10.6 Legal advice is available for practitioners when needed E

10.7 The team has integrated patient records used by all staff D

10.8 The roles and responsibilities of unit staff are defined, e.g. in up to date job Edescriptions and in operational policy

Ref 7: pg 17 “Staff are clear about and confident with their roles, responsibilities and accountability as part of a distributed responsibility model.”

10.9 There is time scheduled in staff rotas to allow handover sessions between shifts E

10.10 The ward manager ensures that a written review of the unit’s staffing needs Dis completed periodically and when there are changes in service provision

10.11 The team has protected time for informal ‘away days’ to facilitate team building Eand service development. This should occur at a minimum of once a year

Section 2 Staffing

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Section 2 Staffing

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11 All staff have completed mandatory training in line with trust requirements and are able to demonstrate this.

11.1 Staff receive at least 5 days training and continuing professional development Eactivities per year

Ref 29: pg 13 “Staff must be provided with a decent working environment, appropriate training, and defined career development pathways.”

Ref 6: pg 8 “All practitioners should have access to training that helps them develop their capability and no barriers should be placed in the way of furtherdevelopment.”

11.2 The unit has a budget for staff training and development and staff know Ehow this is allocated

Ref 17: Annex C, “The necessary resources to support the training and development requirements of the CAMHS workforce should be available.”

Ref 32: 7.1 “This should represent at least 5 % of the total budget for CAMHS as recommended by Audit Commission report: ‘Children in Need’. This includes cross-agency/ cross-disciplinary training and staff development programmes such as Investors in People.”

12 Training is provided to enable staff to demonstrate the following Core Competencies for CAMHS

Ref 47: All criteria are matched to recommendations in ‘Working within child and adolescent mental health inpatient services - A practitioners handbook’

12.1 Effective communication and engagement with children, young people and Etheir families and carers

12.2 Assessments including risk assessment and management E

12.3 Safeguarding and promoting the welfare of children E

12.4 Care co-ordination E

12.5 Promoting health and wellbeing E

12.6 Supporting transitions E

12.7 Multi-agency working E

12.8 Sharing information E

12.9 Managing relationships and boundaries between young people and staff, Eincluding appropriate touch

12.10 The role of other services and the range of local services and activities D

12.11 Attachment theory E

12.12 Use of formal observations E

12.13 Creating a therapeutic milieu E

12.14 Developing a therapeutic alliance E

12.15 Consent and capacity E

12.16 Understanding of staff dynamics within inpatient treatments E

12.17 Risk assessment and awareness of risk factors in abuse and abuse to others, Eindicators of abuse and procedures for dealing with abuse

12.18 Legal frameworks such as the Children Acts, 2007 amendments to the EMental Health Act 1983, the revised Code of Practice, Disability Discrimination Act and The Mental Capacity Act 2005

12.19 Resuscitation (child and adult) E

12.20 Management of imminent and actual violence, breakaway techniques and E restraint measures

12.21 Non clinical staff have received mental health awareness training D

Further Professional Development -

12.22 Training needs are informed through the skills needed within the unit, staff Eappraisal and individual development plans and support and supervision systems – all have been assessed in the last year

Ref 40: pg 9 “Individual development plans of staff should identify what training is needed or undertaken around these issues.”

12.23 Staff receive training on the evidence underpinning the range of treatments Eprovided (i.e. NICE guidelines, ‘Drawing on the Evidence’ – Wolpert et. al, 2006)

12.24 Audit and research skills D

13 Appropriate training methods are used to ensure staff training is effective

13.1 All staff can access the organisation’s intranet via a computer in the unit E

13.2 All staff have access to books and journals on site E

Ref 6: pg 33 “A range of educational and learning activity is required to improve the skill and knowledge base of practitioners.”

Section 2 Staffing

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13.3 All staff, including temporary staff, have a comprehensive induction to the Eservice which covers key aspects of care

Ref 13: pg 24 “All staff, including agency nurses and locum medical staff, undertake an induction programme which includes awareness of the policies and procedures relevant to their area of work and which is signed off when completed and a record kept.”

13.4 There is protected time and financial support for staff to conduct service Drelevant research and academic activity

14 All staff receive regular supervision totalling at least one hour per month from a person with appropriate experience

Ref 18: pg 34 “Clear clinical and supervisory arrangements and structures are in place for all staff, to ensure accountable and safe service delivery”

14.1 All members of the MDT have access to clinical supervision at a minimum of Eonce every month, or more frequently, as per professional body guidance

Ref 2: Abstract: “Clinical supervision was more positively evaluated where sessions lasted for over one hour, and took place on at least a once-monthly basis.”

14.1a All supervisors receive training in clinical supervision taking into consideration Eprofession-specific guidelines

Ref 6: pg 12 “Staff involved in the delivery of training and supervision in the workplace should be trained and supported in these roles.”

14.1b Supervision includes support about the emotional consequences of any Eserious untoward incidents

Ref 6: pg 12 “The workforce should be trained to deal with the emotional impact of the work and actively seek ongoing support and supervision.”

14.1c The team meet as a group at least once a month to reflect upon the impact Eof working with young people

14.2 All junior clinical staff attend a preceptorship programme, in line with Eprofessional requirements

14.3 Managers appraise staff annually that report to them and ensure they have a Epersonal development plan

Ref 6: pg 37 “Systems for ongoing learning, supervision, training and appraisal should be a fundamental part of the working arrangements of all acute mental health services.”

15 There is a recruitment policy to ensure vacant posts are filled quickly with well qualified and checked candidates

15.1 Young people are involved in and influence the recruitment of unit staff D

15.2 Human resources staff ensure that all unit staff, including temporary staff, Eundergo an Enhanced National Criminal Records Bureau (CRB) check and are checked against the Protection of Children Act (POCA) register before appointment

Ref 13: pg 127 “Routine reference collection before interview, and police checks prior to appointment, are required for all staff with substantial access to children.”

15.3 Human resources staff ensure that all staff with a professional regulatory Ebody are checked for appropriate registration on recruitment and again at renewal date

15.4 When posts are vacant or in the event of long term sickness or maternity Eleave, prompt arrangements are made for temporary staff cover

15.5 Reasons for staff leaving are established, particularly where there is a high Dstaff turnover, e.g. exit questionnaires or interviews are used

15.6 Staff vacancies are advertised as widely as possible D

15.7 Units have a dedicated Human Resources contact who understands the Eneeds of a CAMHS inpatient unit

Section 3 Access, Admission and Discharge

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17.2a Units that fail to meet 19.4a have a plan in place about how to meet Ethe National Service Framework requirements i.e. there is a system of accountable handling of emergencies and staff are aware of where emergency beds can be accessed

18 There is equity of access to inpatient units in relation to ethnic origin, social status, disability, physical health and location of residence

18.1 Consideration is given to the special needs of young people from different Eethnic, cultural or religious backgrounds, e.g. incorporating religious practice into daily living

Ref 39: pg 35 “Consideration should be given to differing cultural requirements.”

Ref 35: pg 23 “A culturally competent mental health service will be prepared to adapt the conventional ways of working to meet the needs of culturally diverse groups of people. Flexibility and adaptability in service provision, as well as awareness of different cultural norms are necessary to achieve this.”

18.2 The unit is able to respond to the physical needs of young people to enable Eadmission, e.g. disabled access

Ref 13: pg 148 H15.7 “Provision is made to meet the needs of children with disabilities.”

18.3 The service is able to overcome barriers to access e.g. by paying travel costs Dor video conferencing

Ref 18: pg 16 “Services need to establish flexible arrangements in order to meet the needs of children, young people and their families who are reluctant to seek help.”

18.4 The unit has access to interpreters and relatives are not used in this role E

Ref 35: pg 23 “For non-English speaking people, the lack of appropriate language skills amongst mental health professionals and difficulties in accessingappropriate interpreter services make mental health care difficult and problematic... therefore the provision of high quality, culturally responsive, and language appropriate mental health services in locations accessible to ethnic minorities is essential to creating a more equitable system.”

Ref 35: pg 26 “All patients presenting with mental health problems are assessed in their preferred language.”

19 Families are involved throughout assessment and treatment

19.1 Children’s units have access to nearby facilities for parents/carers to Estay overnight

Ref 39: pg 25 “The 4-7-year-old children in the Derbyshire project wanted to have their parents near them at all times. The need for good accommodation for families is therefore extremely important.”

16 Provision and procedures ensure that appropriate and timely inpatient care is available to all those who would benefit

16.1 Information and guidance about the unit, including timescales from referral Eto admission and written referral criteria, are readily available to referrers (written or online)

Ref 18: pg 17 “Services agree referral criteria that are explicit and are negotiated between commissioners and providers.”

16.2 The inpatient unit has written criteria for admission. These consider: E i. Age restrictions ii. Psychiatric condition and severity

Ref 18: pg 19 “...clarify the level of service provided and the criteria for referral.”

16.3 Where young people are refused admission to the service, the reasons for Erefusal are explained to the young person, parents/carers and referrer, and they are informed about alternative options

16.4 The unit formally records all referrals with respect to race, gender and Ddisability and acts to support referrals from any under-represented groups

Ref 25: pg 39 “Management information systems should routinely collect data on service users’ race, ethnicity, gender etc, so that the impact and accessibility of service delivery for these groups can be measured and action taken to addressinequalities, where necessary.”

17 Assessment and treatment are offered without unacceptable delay

17.1 Young people do not experience delay in assessment that leads to deterioration Ein health or to care being offered in inappropriate settings e.g. in adult and paediatric wards or as a day patient (2=true, 1=partly true, 0=false)

Ref 29: pg 17 “There is an effective care pathway that ensures that admission to hospital is appropriate and that discharge from hospital is timely.”

17.1a Young people do not experience delay in treatment that leads to deterioration Ein health or to care being offered in inappropriate settings e.g. in adult and paediatric wards or as a day patient (2=true, 1=partly true, 0=false)

Ref 26: pg 59 “It is important to improve the quality of CAMHS experienced by children,young people and families by reducing waiting times from referral to treatment.”

17.2 Young people at severe risk can be admitted as emergencies (i.e. within E24 hours) including out of hours

Ref 18: pg 19 “Arrangements are in place to ensure that 24 hour cover is provided to meet children’s urgent needs.”

Section 3: Access, Admission and Discharge


24

Section 3 Access, Admission and Discharge

27

20.8 Before admission, unit staff agree aftercare pathways with referring teams E

Ref 24: pg 251 27.8 “Although the duty to provide after-care begins when the patient leaves hospital, the planning of after-care needs to start as soon as the patient is admitted to hospital.”

20.9 Where discharge is delayed the reason for the delay is documented and Ethere are processes in place to address the situation

19.2 The unit information leaflet states that the participation of parents/carers Eis expected

19.3 Parents/carers have access to refreshments at the unit D

20 Before discharge, decisions are made about meeting any continuing needs

20.1 Care of all young people takes place within a formal Care Programme EApproach framework (England only) or local equivalent to avoid protracted stays within the inpatient unit

Ref 13: pg 99 “Patients receive treatment and care in line with the Care Programme Approach/Care Management.”

Ref 13: pg 101 M13.1 “There is a single detailed, multi-professional plan of care formulated for each individual patient.”

20.2 Young people have a named worker from the referring agency throughout Etheir stay in the unit, who is identified at admission and who attends all CPA reviews and discharge planning meetings

Ref 18: pg 58 “Children and young people who need more specialised support, and their parents and carers should have a lead person to be their main point of contact.”

20.3 For all young people referred to adult services, the arrangements stipulated Eunder the Care Programme approach are employed i.e. When a young person needs to transfer to adult services a joint review must be undertaken to ensure effective handover takes

Ref 18: pg 5 “When children and young people are discharged from in-patient services into the community and when young people are transferred from child to adult services, their continuity of care is ensured by use of the ‘care programme approach’.”

20.4 A written discharge and aftercare plan is produced for each young person Ewho leaves the unit

Ref 13: pg 106 M21.2 “multi-professional post-discharge plans are devised”

20.5 Young people and parents/carers are invited to CPA meetings and involved in Edecisions about care after discharge from the inpatient unit

Ref 13: pg 106 M21.2 “Patients and carers are involved in discharge planning.”

20.6 Young people and parents/carers know the names of workers involved in Efollow-up after their discharge and have met them prior to discharge

20.7 Young people and parents/carers know before discharge the dates and times Eof appointments with the workers involved in their care after their discharge


26

Section 4 Care and Treatment

29

22.3 A physical examination is conducted within 24 hours of admission E

Ref 31: pg 143 “Ideally, physical examination should be carried out as part of the admission procedure.”

22.4 If part or all of the examination has been refused, the reason why has been Erecorded and repeated attempts have been made to complete this process

Ref 31: pg 143 “Although delay may be justified because of the patient’s mental state, reasons for the delay should be recorded clearly.”

23 A comprehensive range of interventions is available to the young people who are inpatients

23.1 Treatments are provided in accordance with the NICE guidelines E

23.2 Inpatient services have a range of interventions available E

Ref 34: pg 21 “Inpatient services have a range of interventions available including:- medication- individual and group psychological therapies- family support.”

These include:

23.2a Medication E

23.2b Individual psychological therapies E

23.2c Group psychological therapies E

23.2d Family support E

24 There is a structured programme of care and treatment

24.1 A structured therapeutic programme, comprising a mixture of group work Eand individual sessions, is run during weekdays

Ref 13: pg 118 M38.3 “A structured therapeutic programme is run during the day.”

24.2 Activities and outings in the evening and weekends are planned, needs led Eand reviewed regularly

24.3 The therapeutic programme offers a broad range of sessions to suit the Eneeds of the client population

Ref 18: pg 35 “Services ensure that children and young people receivetreatment interventions which are guided by the best available evidence and which take account of their individual needs and circumstances.”

21 There are robust arrangements for collecting information from all agencies involved with the young person and their family

21.1 There is a clear identification of whether the young people or parent/carers Eare involved with or have access to other agencies

Ref 25: pg 28 “Delivering care to people with mental health problems means bringing together information, skills and resources from a range of public, voluntary and other sectors. Information needs to be shared appropriately between organisations and professionals to make sure that people get the services they need.”

21.2 Individuals making an assessment have considered a range of relevant Edocuments from the referrer (social care reports, risk assessments etc.)

21.3 There is evidence of assessment of social care needs E

21.4 Parents/carers are offered a carers assessment, where they are the Eprimary carer

Ref 5: “The law says you have a right to an assessment if you care for someone for ‘a substantial amount of time on a regular basis’. The relevant legislation here is the Carers (Recognition & Services) Act 1995 and the Carers & Disabled Children Act 2000. You may be a carer living with or away from the person you care for, caring full time or combining care with paid work – you will still have a right to a carer’s assessment.”

22 All young people are assessed for their health and social care needs

22.1 Unit staff use a formal risk assessment tool for all young people. Risk is Eassessed on admission and regularly reviewed

Ref 13: pg 100 M12.3 “When a patient is referred for the first time, or transferred from another team, a new clinical assessment is carried out and includes an assessment of risk of harm to self or others by the patient.”

22.2 All pre-admission clinical assessments are conducted and recorded by an Eappropriately experienced staff member and identify the specific risks for every child and young person

Ref 24: pg 112 15.3 “On admission, all patients should be assessed for immediate and potential risks of going missing, suicide, self-harm and possible harm to others, and individual care plans should be developed including actions to be taken should any of these occur.”

Section 4: Care and Treatment


28


31

25.6 Parents/carers are given a copy of the care plan subject to confidentiality E

Ref 24: pg 192 23.48 “Subject to the normal considerations of patient confidentiality, the treatment plan should also be discussed with their carers, with a view to enabling them to contribute to it and express agreement or disagreement.”

25.7 The care plan is reviewed by unit staff at defined and agreed intervals during Eadmission (e.g. ward rounds or CPA reviews)

Ref 13: pg 101 M13.8 “The care plan is subject to regular multi-professional reviews led by the care co-ordinator.”

25.8 If a Local Authority has parental responsibility as a result of a care order, the Ehospital should obtain the local authority’s consent where necessary and consult on the young people’s management or care plan

25.9 When a care order is in place the Local Authority is asked to confirm who Eshould be consulted about treatment decisions and other aspects of the child’s care plan

Ref 24: pg 329 “If the child or young person is subject to a care order, the parents (or others with parental responsibility) share parental responsibility with the local authority, and it will be a matter for negotiation and agreement between them as to who should be consulted about treatment decisions.”

26 Young people can continue with their education when admitted

26.1 The unit provides the full National Curriculum including PE across all key Estages within appropriate teaching facilities

Ref 10: pg 11 “A full curriculum may be accessed by patients with mental health problems.”

26.2 Teaching staff complete an assessment of each young person’s educational Eneeds which is regularly reviewed

Ref 9: pg 13 “A child or young person who is unable to attend school because of medical needs should have their educational needs identified and receive educational support quickly and effectively.”

26.3 If a young person has a learning difficulty or is more than 2 years behind in Etheir education, an individual education plan with clear targets is set with the young person and where appropriate the parents/carers. This is reviewed regularly

Ref 9: pg 22 5.3 “Personal education plans play a vital role in setting out, not only a plan, but also effective liaison strategies.”

24.4 The programme of activities offered is planned in consultation with Eyoung people

Ref 13: pg 91 “the involvement of patients in their individualised care, as well as in planning and implementation of services is seen as an essential component of contemporary mental health care.”

24.5 There are adequate resources and identified budgets to provide the Estructured programme of care and treatment including evening and weekend programmes

24.6 Young people and parents/carers have access to key clinicians and members Eof the MDT as needed e.g. outside of planned meetings

Ref 13: pg 109 “Clinical staff are encouraged to see the families and carers of patients.”

25 All young people have a written care plan as part of the Care Programme Approach

25.1 There is a multidisciplinary, written care plan for every young person that is Ekept with their records

Ref 13: pg 101 “Each patient has a care plan that addresses their needs appropriately.”

25.2 Parents/carers are actively involved in the development of the young Eperson’s care plan

Ref 25: pg 47 “...the need to ensure that the child or young person’s family are involved in the care plan decision making process and have a good quality relationship with the care co-ordinator. CAMHS typically works from a family centred orientation rather than a person centred approach and care must be taken to ensure all relevant family members are included.”

25.3 Care plans are developed collaboratively with the young person E

Ref 25: pg 48 “Young people’s involvement brings advantages in terms of promoting user empowerment and choice. However, to make young people’s involvement in CPA a reality rather than an aspiration careful attention needs to be paid to, for example, the design of paperwork so that service users do not feel excluded.”

25.4 Young people have a copy of their care plan or ready access to it E

Ref 13: pg 101 “A copy of the plan is given to the patient (who should sign it if possible).”

25.5 The plan is signed by the young person, or if they have been assessed as Elacking the ability to make decisions about aspects of their care, the plan is signed by the parent/carer


30


33

27 Outcome measurement is undertaken routinely using validated outcome tools (e.g. HoNOSCA, C-GAS, SDQ)

27.1 A designated person is in place to lead on outcome measurement work E

27.2 Staff have protected time to collect and collate outcome information E

27.3 Outcome is evaluated from the perspective of staff, young people and Eparents/carers

Ref 18: pg 37 “As a minimum, all services evaluate outcome from the perspective of users (including where possible the referred child or young person themselves as well as key family members or carers) and providers of the service.”

27.4 The analysis of outcome measurement data is used to inform service E provision and identify areas for improvement

Ref 13: pg 95 “The views of patients and their carers are routinely sought and are used as an indicator of the quality of services.”

27.5 Case records include the results of measurement using at least one recognised Eoutcome measure e.g. HoNOSCA, C-GAS, SDQ

27.6 Information from outcome measurement is fed back to the whole staff team, Eusers and commissioners

27.7 Units contribute to a national dataset to allow for information sharing e.g. DQNIC ROM

28 All young people at the unit are given a choice of healthy, balanced food

28.1 There is a choice of well prepared food from a menu that suits all nutritional, Eindividual, cultural and clinical dietary needs

Ref 13: pg 24 “Food is nutritious, balanced and varied and meets any special needs of the patient, including age-related requirements for children.”

28.2 The food provided is of a good standard and young people’s feedback is sought E

28.3 Where there is a therapeutic benefit, e.g. when working with young people Ewith eating disorders, staff eat with young people at mealtimes and the cost of the staff meal is covered by the trust/organisation

28.4 Where there is a therapeutic benefit, there are arrangements for families Dto eat with young people at mealtimes e.g. for young people with Eating Disorders prior to discharge and the cost of the family meal is covered by the trust/organisation

26.4 If the young person is at school, educational staff at the unit must liaise with Ethe young person’s own school in order to maintain continuity of education provision

Ref 9: pg 17 4.1 “Effective liaison between the key partners minimises disruption caused by illness to a pupil’s education. It is essential that there is good liaison between the school, parents, hospital.”

Ref 10: pg 7 “Links between the home school and hospital school are important and must be properly established and catered for.”

26.5 Educational staff at the unit assist young people to reintegrate back to their Dlocal educational facility

Ref 9: pg 27 “Each long-term pupil should have an assessment of their situation and the provision of well structured support from the home school in liaison with the hospital and home teaching service and other agencies as necessary, to assist reintegration to school, wherever possible.”

26.6 The unit can cater for diverse educational needs, including the needs of Ethose young people with a moderate learning disability

Ref 13: pg 102 “The rights and needs of patients with developmental disabilities are recognised and addressed.”

26.7 Where the unit caters for 16 to 19 year olds, the unit makes available DA Level subjects or appropriate alternatives

Ref 9: pg 19 4.12 “A young person’s educational needs post-16 should be borne carefully in mind.”

26.8 Educational outings are provided, as appropriate D

26.9 Teachers regularly join multi-disciplinary team meetings E

Ref 9: pg 23 5.4 “Co-operation between education, medical and administrative staff within the hospital is also essential. The aim should be to achieve the greatest possible benefit for the child’s education and health, which should include the creation of an atmosphere conducive to effective learning. It is crucial that hospital teaching staff establish a clear profile within the hospital setting. Service managers need to be pro-active in establishing a multi-disciplinary perspective.”

26.10 The educational staff maintain communication with the young peoples’ parents/carers, e.g. providing progress reports for each CPA review

Ref 9: pg 31 “Parents hold key information and knowledge and have a crucial part to play. They should be full collaborative partners and should be informed about their child’s educational programme and performance.”

26.11 Educational staff are sufficiently supported by the LA (Local Authority) and LSC (Learning Skills Council)


32

Section 5 Information, Consent and Confidentiality

35


34

31 Young people know the names of the staff team looking after them

31.1 Staff wear name badges, so that young people and visitors know who they Dare and for reasons of security

31.2 There is a board on display with the names and photographs of staff D

32 Young people and parents/carers can find out about the inpatient unit before the admission

32.1 Young people and parents can visit the unit and find out about the services Eoffered before agreeing to admission (with the exception of emergency admissions)

Ref 13: pg 118 M38.1 “There is a pre-planned programme and a pre-admissionvisit to allay anxiety on the part of the child, where appropriate.”

32.2 Services provide a website giving information about the unit that young Dpeople and parents/carers can access prior to admission

32.3 At the referral meeting, if admission is considered appropriate, the aims of Dtreatment are discussed (with the exception of emergency admissions where aims should be discussed upon admission)

Ref 40: pg 7 “Information about services should be given prior to admission, if possible”

33 Young people and parents/carers are involved in decisions about their treatment

33.1 Staff provide appropriate information about the young person’s treatment Dand respond to requests for additional information

Ref 24: pg 327 36.4 “Children and young people should always be kept as fullyinformed as possible, just as an adult would be, and should receive clear and detailed information concerning their care and treatment, explained in a way they can understand and in a format that is appropriate to their age.”

33.2 Young people and parents/carers are given a clear explanation of their diagnosis Eor the assessment programme if diagnosis has not been determined on admission

33.3 Staff give young people as much time to make decisions about their treatment Eas is possible and appropriate (i.e. without being detrimental to the young person’s health or welfare)

33.4 Information is provided for parents/carers and young people on how to Eaccess a second opinion

Ref 26: pg 58 5.36 “Children and young people who need more specialised support and their parents and carers should have: clear information about what to do if things don’t go according to plan.”

29 Information is available to young people and parents/carers

29.1 There is a range of age-appropriate leaflets and posters relevant to the services Eoffered by the unit and other health promotion information, that is kept up to date and is readily available

Ref 25: pg 48 “Information leaflets and paperwork should be age-appropriate.”

29.2 Young people are presented with information in a way that they can understand E

Ref 1: pg 24 “The provision of information to young people is essential if they are to be able to be involved in decisions about their care and exercise their rights.”

29.3 When necessary, information is available in languages other than English and Ein forms in which people with sight, learning and other disabilities can use

Ref 35: pg 4 “The organisation produces information about its services in various languages.”

Ref 34: pg 24 “The treatment, care and information provided should be culturally appropriate and accessible to people with additional needs.”

29.4 A welcome pack or introductory booklet is provided when people first use the Eservice, giving specific information about the unit

29.5 Information for families is written with the participation of children, young Dpeople and parents/carers

29.6 Staff regularly update parents/carers on their child’s progress subject to Econfidentiality

30 Each young person has a named nurse/key worker

30.1 The unit allocates a key worker to each young person and makes this known Eto the young person and parent

30.2 The young person’s views are taken into account if they are not satisfied Ewith their key worker and there is a process in place to deal with this

Ref 40: pg 6 4.2.4 “Patients are offered a choice in allocation of a key worker, where possible offering choice of sex of key worker but also considering ethnicity, age and professional issues.”

Section 5: Information, Consent & Confidentiality

Section 5 Information, Consent and ConfidentialityQNIC Service Standards Fifth edition

36 37

35.3 Young people are informed when confidential information about them is to Ebe passed on to other services and agencies, and the reasons why this is important to their continuing care are explained

Ref 15: pg 7 12. “It is extremely important that patients are made aware of informationdisclosures that must take place in order to provide them with high quality care.”

36 All examination and treatment is conducted with the appropriate consent

36.1 Consent to examination or treatment is sought by the staff member who will Ecarry out the procedure

36.2 Young people and their parents or carers are provided with information about Ethe evidence base, risks, benefits and side effects of intervention options and of non-intervention and informed about how to obtain additional information if they want it, for example staff recommended websites or reading material. This should include the use of drugs outside of their marketing authorisation

Ref 13: pg 28 C22.8 “Information is given to patients about the use, benefits and potential harms of medication prescribed.”

Ref 13: pg 102 M14.3 “The medication regime of each patient, and the known side effects and risks, is explained fully to the patient and their carers.”

36.3 The ward staff can access a Trust policy or protocol that describes the legal Eframework for decision making on care and treatment e.g. obtaining written consent, what do when there is a disagreement between parties

Guidance note: Clear information on this can be found in The Legal Aspects of the Care and Treatment of Children and Young people with Mental Disorder. A guide for Professionals

36.4 Staff inform young people both verbally and in writing of their right to agree Eto or refuse treatment and the limits of this

Ref 24: pg 10 2.16 “Patients must be told what the act says about treatment for their mental disorder. In particular they must be told:* The circumstances (if any) in which they can be treated without their consent - and the circumstances in which they have the right to refuse treatment.”

36.5 Staff are proficient in assessing a young person’s ability to consent E

36.6 Young people’s capacity to consent to treatment is assessed in accordance Ewith Mental Capacity Act 2005

Guidance note: See the Code of Practice to the Mental Capacity Act 2005 (Chapter 12)

For under 16’s staff need to be assessing if the child is Gillick competent. See the Legal Guide pg 18

34 Young people and parents/carers have access to their health records

34.1 Young people and parents/carers are aware of their rights to see the young Eperson’s health records

34.2 Where young people have requested access to their health records, they are Eprovided with such information unless the grounds for denying access under the Data Protection Act 1998 are met

Ref 16: pg 10 “Before the patient’s health records are released to the patient or their authorised representative, under the DPA 1998 the GP should ensure theyhave checked them so that the release of them wouldn’t cause the following:-

1. Where the information released may cause serious harm to the physical or mental health or condition of the patient, or any other person.

2. Or where access would disclose information relating to or provided by a third person, this would not be a health professional who had not consented to that disclosure.

Under the Data Protection Act 1998, these are the only two reasons where access could be denied or limited to a patient or their authorised representative.”

34.3 Where a parent requests information on behalf of a young person who is not Eable to understand the nature of the application for access to health records, such information is provided unless it is not considered to be in the young person’s best interests

Ref 16: pg 6 “As a child grows older and gains sufficient understanding, he/she will be able to make decisions about his/her own life. Where a child is considered capable of making decisions about his/her medical treatment, the consent of the child must be sought before a person with parental responsibility can be given access. Where, in the view of the appropriate health professional, the child patient is not capable of understanding the nature of the application, the holder of the record is entitled to deny access if it were not felt to be in the patient’s best interests.”

35 Personal information about young people is kept confidential, unless this is detrimental to their care

35.1 Young people and families are informed of their right to confidentiality E

Ref 24: pg 328 36.4 “Children and young people have as much right to privacy and confidentiality as anyone else.”

Ref 15: pg 8 14. “Patients generally have the right to object to the use and disclosure of confidential information that identifies them, and need to be made aware of this right.”

35.2 Consent is sought prior to the disclosure of case material to parents and Ecarers if the young person is assessed as able to make such a decision

Ref 24: pg 146 “Before considering such disclosure of confidential patient information, the individual’s consent should normally be sought.”

Section 6 Young People’s Rights and Safeguarding Children

39

37 If a young person is formally admitted, the legal authority for admission and treatment is clear

37.1 Staff are aware of the legal status of all young people admitted and the Eimplications of this

37.2 Young people are provided with information about being given treatment Ewithout their consent and the procedures that must take place before such treatment is given

37.3 Staff take time to explain why the young person have been detained and Ehow the Mental Health Act applies to them

37.4 Young people are provided with information about their rights to access a Emental health tribunal and/or managers’ hearings that explains how they can apply to be discharged from detention including the role of the tribunal and the hospital manager, their rights to legal representation, and how long they should expect to wait for a hearing date

Ref 36: pg 51 3.34 “Hospital managers have the primary responsibility for seeing that the requirements of the MHA 1983 are follows. These include

* The right to apply to (and be legally represented at) a Tribunal for a review of the person’s detention.”

Ref 36: pg 74 5.6 “In relation to children and young people who are detained under the MHA 1983, hospital managers should ensure that: they are made aware of their right, and given assistance in applying to hospital managers’ hearings and Tribunals and helped to obtain legal representation at an early stage.”

37.5 Staff explain to the young person who their Nearest Relative is (Mental EHealth Act 1983) and why this is relevant

38 The inpatient unit is patient-centred and respects the rights of young people and their parents/carers

38.1 Young people can ask to see a clinician on their own, e.g. without other Enursing staff or family present, although this may be refused in certain circumstances, e.g. risk to staff

38.2 Young people can access support from a staff member of the gender of Dtheir choice

Section 6: Young People’s Rights and Safeguarding Children


38

36.7 The young person’s consent or refusal is recorded in their notes in addition Eto the treating clinician’s assessment of the patient’s ability to consent to the treatment in question

Ref 24: pg 188 23.29 “When taking decisions about patients under the Mental Health Act, it should be remembered that:• all assessments of a patient’s capacity should be fully recorded in their notes.”

36.8 Where young people are not detained and are assessed as not being able to Econsent, the basis for providing the treatment without the young person’s consent is recorded, and the views of the young person are ascertained and taken into account

Ref 36: pg 13 “Even where a child is assessed as being unable to make a particular decision, their views should still be sought and taken into account.”

36.9 Staff tell young people that their consent to treatment can be withdrawn at Eany time and that fresh consent is required before further treatment can be given or reinstated

Ref 36: pg 55 4.3 “Consent should be sought for each aspect of the child or young person’s treatment as and when it arises.”

36.10 Interventions are only conducted without the consent of young people if Ediscussion and modification of the intervention has been exhausted

36.11 Young people and their parents/carers are informed about the procedures for Eobtaining consent where parental responsibility is held by a third party.

Guidance note: For example parental responsibility will be shared with othersif the young person is subject to a care order (where the local authority has parental responsibility) or a residence order (in which case the person(s) named in the order will have parental responsibility). See the MHA Code 36.8 in relation to local authorities and parental responsibility

36.12 Staff are clear on who has parental responsibility E

Ref 36: pg 14 1.13 “When working with children and young people it is essential to identify the person(s) with parental responsibility for them.”

Section 6 Young People’s Rights and Safeguarding Children

41


40

40 The unit operates within the appropriate legal framework in relation to the use of physical restraint

40.1 Physical restraint is used only when immediate action is needed to prevent Ea young person from significantly injuring themselves or others, or causing serious damage to property

Ref 24: pg 116 15.17 “Interventions such as physical restraint, seclusion or rapid tranquillisation should be considered only if de-escalation and other strategies have failed to calm the patient.”

40.2 After restraint, staff spend time with the young person reflecting on why Eit was necessary and their views are sought and included in post incident analysis

Ref 24: pg 120 15.29 “Hospitals should have in place a system of post-incident support and review which allows the organisation to learn from experience of using physical restraint and which caters for the needs of the patient who has been restrained, any other patients in the area where the restraint occurred, the staff involved in the incident, the restrained patient’s carers and family (whereappropriate) and any visitors who witnessed the incident.”

40.3 The circumstances and justification for using physical restraint are recorded Eimmediately; the RMO is informed and a report is submitted by the nurse in charge to the Trust management in line with Trust incident reporting policy

40.4 The unit follows policies for untoward occurrences, or critical incident reporting E

41 The unit complies with Local Safeguarding Children Board (LSCB) procedures (or equivalent outside of England and Wales) and with the guidance contained in “What to do if you’re worried a child is being abused” (2006) document

41.1 The child protection status of young people is known to staff E

41.2 The unit has a named child protection lead E

41.3 The unit has policies and procedures which are compatible with LSCB Eguidelines, including the conduct of reviews and procedures for “working together”

41.4 LSCB guidelines, Working Together under the Children Act, Clarification of EArrangements, Medical Responsibilities and Guidance to Senior Nurses are available and accessible to all staff members

38.3 Young people’s rights and what they can expect are explained and information Eis accessible and regularly reviewed, e.g. the Headspace Toolkit

Ref 13: pg 107 “Patients are informed about their rights, their treatment and how to obtain independent advocacy.”

38.4 Access to media (e.g. TV, DVDs, audio and internet) is provided and is Eage-appropriate, based on consideration of individual young people, and monitored with safeguards in place

39 Young people and their parents/carers are informed about how to make complaints and seek independent advice

39.1 The method of making a complaint is well publicised to young people and Eparents/carers in information packs and around the unit

Ref 40: pg 8 5.3.5”Patients should be given clear information on how to raise concerns and to whom.”

39.2 There is information available on how to get independent help and advocacy Ein making complaints

Ref 13: pg107 M23.3 “Details of local organisations providing independent advocacy are displayed in the establishment.”

Ref 36: pg 94 “As from April 2009, patients who are liable to be detained in hospital, subject to guardianship or supervised community treatment, will have the right to help from Independent Mental Health Advocates (IMHA).”

39.3 The unit has a formal link with an advocacy service for use by young people E

Ref 25: pg8 “Commissioners and services should recognise the positive role that advocacy can play in enabling effective service user involvement in the development and management of their care and the benefits that a skilled advocate can bring in helping service users engage with what can often feel like an overwhelmingly complicated and intimidating system.”

39.4 Complaints may be made without the knowledge and involvement of the Eperson complained about and with the assurance that they will not be discriminated against if they complain

Ref 33: pg 2 “It is vital that patients feel that they can complain to NHS organisations without prejudicing the healthcare they receive.”

39.5 Young people have access to a telephone helpline on which they may raise E concerns without being overheard e.g. Childline


42

41.5 Staff know what to do if a young person discloses allegations of abuse Eduring and out of working hours

Ref 11: pg 11 “All practitioners working with children and families should... 10.1 be familiar with and follow your organisation’s procedures and protocols for promoting and safeguarding the welfare of children in your area, and know who to contact in your organisation to express concerns about a child’s welfare.”

41.6 If a young person makes an allegation of abuse, staff inform them about Ewhat will happen

42 Unit staff work with the local authority to safeguard and promote the welfare of longer staying young people

42.1 The named child protection lead informs the young person’s local authority if Ea young person remains or is likely to remain an inpatient for a period of over three months (in line with section 85 of the Children Act 2004)

42.2 The local authority is alerted if the whereabouts of the person with parental Eresponsibility is not known or if that person has not visited the young person for a significant period of time

Section 7 Clinical Governance

43

43 All available information is used to evaluate the performance of the unit

43.1 Information from young people and carers is routinely collected to evaluate Ethe unit through a number of means, e.g. suggestion boxes, surveys and user groups, to inform service development

Ref 18: pg 13 “The views of service users are systematically sought and incorporated into reviews of service provision. Service providers and commissioners develop proposals for user involvement, ranging from consultationto participation of children and young people and their parents or carers.”

43.2 Complaints and compliments are used to inform the service evaluation D

Ref 33: “It is vital that the NHS listens to, and learns from, complaints made by patients and their family and carers. Patients are entitled to this. Moreover, complaints are a valuable source of feedback from patients and an important means of improving services.”

43.3 The views of stakeholders are used in the service evaluation D

43.4 The use of procedures for the management of violent young people is monitored D

43.5 The service evaluation includes the views of all unit staff D

44 Unit staff are involved in clinical audit

44.1 A range of audits is conducted and action plans are developed in response Eto the findings and recommendations

44.2 There are dedicated resources, including protected staff time to support Eclinical audit within the directorate or specialist areas

Ref 41: pg 10 “Organisations must recognise that clinical audit requires appropriate funding.”

Ref 41: Pg 2 “Clinical audit must be fully supported by trusts. They should ensure that healthcare professionals have access to the necessary time, facilities, advice, and expertise in order to conduct audit effectively.”

44.3 Practitioners are involved in identifying priority audit topics in line with Dnational and local priorities

Ref 4: “National Standards, Local Action (2005/06 - 2007/08) states that providers should participate fully in comparative clinical audit and take account of the results to support local and national clinical governance.”

Section 7: Clinical Governance

Section 7 Clinical Governance

45

45.6 There are protocols to guide communication with other agencies including Ecommunity based CAMHS, Education, Social Services Departments, A&E departments, police in the event of actual or potential crisis

46 The unit has a comprehensive range of policies and procedures

46.1 New policies are disseminated and easily accessible to all staff E

46.2 There is a written procedure for emergency referrals E

46.3 There are written admission and discharge procedures; including action to be Dtaken in the event of an unplanned discharge

46.4 There are policies and procedures on the management of violence and the Euse of physical restraint, which includes warning the young person before restraint may be needed

Ref 24: pg 113 15.6 “All hospitals should have a policy on the recognition and prevention of disturbed or violent behaviour, as well as risk assessment and management, including the use of de-escalation techniques, enhanced observation, physical intervention, rapid tranquilisation and seclusion. Local policies should suit the needs of the particular groups of patients who may be treated in the hospital.”

46.5 In the unit there are written guidelines for the use of rapid tranquillisation E

Ref 13: pg 116 M35.2 “The policy includes procedures for rapid tranquillisation.”

46.6 There is a policy on clinical risk assessment and management E

46.7 There are written procedures for responding to serious incidents involving Echildren and young people i.e. self harm, accidents, absconding

46.8 The unit has procedures for the management of bullies and for those who Dhave been bullied

Ref 13: pg 7 C2.11 “There are written policies on the prevention of harassmentand bullying of patients by staff and or other patients,”

46.9 There is a locked door policy E

46.10 There are appropriate procedures where units close at weekends E


44

44.4 The quality of the implementation of the Care Programme Approach is Daudited, to ensure consistent and appropriate application

Ref 25: pg 40 “Local audit and monitoring will continue to be essential components of measuring the quality of service provision and CPA.”

44.5 Measures are in place to record and audit refusals, terminated referrals, Dwaiting lists and admissions to inappropriate settings

Ref 1: pg 70 “National monitoring of the numbers of young people admitted on to adult psychiatric wards is essential. It will also be important for this to be monitored at local level.”

45 Unit staff learn from information collected on clinical risks

45.1 The unit has a designated clinical risk management lead D

45.2 The service evaluation includes accident and incident records, key performance Ddata (e.g. waiting times, number of rejected referrals, bed occupancy, non attendance), and the findings of key audits

45.3 Senior managers monitor every incident involving the use of physical restraint Eand investigate units where, for example, there is a pattern of young people absconding or where there is frequent use of physical restraint

Ref 24: pg 117 15.21 “Hospitals’ policies on the management of disturbed behaviour should include clear written policies on the use of restraint and physical interventions, and all relevant staff should be aware of the policies. The policies should include provisions for post-incident reviews.”

45.4 The unit has a risk management strategy and there is written information Eabout how incidents are evaluated and have informed practice

Ref 21: pg 7 “All service providers should have in place a set of policies and procedures relating to the management of risk.”

45.5 Critical incidents are evaluated. Staff meet to review evaluations of serious Euntoward incidents

Ref 21: pg 29 “Things can go wrong even when best practice has been used. If things do go wrong or do not go according to plan it is important to learn why, including identifying any mistakes that were made.”

46.11 There is a clear policy on smoking, e.g. with or without parents/carers’ Epermission, when this is permitted, in what areas and how many cigarettes

46.12 There are clear policies on the use of mobile phones – including camera Ephones – and use of internet at the unit

Ref 24: pg 132 16.5 “Hospital managers should have a policy on the possession and use of mobile phones by patients and their visitors.”

Ref 24: pg 133 16.7 “Managers should also have guidance on patients’ access to e-mail and internet facilities by means of the hospital’s IT infrastructure. This guidance should cover the availability of such facilities and rules prohibiting access to illegal or what would otherwise be considered inappropriate material.”

Ref 23: pg 7 4.3 “NHS trusts should have a written policy regarding the use of mobile and camera phones, cameras and video recording devices. It should be easily accessible to staff, patients and visitors and have the patient at the forefront of any such policy. All staff should be aware of the policy, and its reasons. The policy should be reviewed periodically.”

46.13 There is a policy on the use of drugs and alcohol, and on the management of Eyoung people who may be abusing drugs and alcohol

46.14 There are policies on visiting E

Ref 24: pg 156 19.18 “Local policies should ensure that the best interests and safety of the children and young people concerned are always considered and that visits by or to children and young people are not allowed if they are not in their best interests. However, within that overarching framework, hospitals should do all they can to facilitate the maintenance of children’s and young people’s contact with friends and family and offer privacy within which that can happen.”

46.15 There are policies and procedures regarding searches of young people’s Drooms and of visitors

Ref 24: pg 134 16.10 “Hospital managers should ensure that there is an operational policy on searching patients detained under the Act, their belongings and surroundings and their visitors. When preparing the policy, hospital managers should consider the position of informal patients.”


46

Section 8 Location within a public health context and commissioning

47

47 Adequate levels of local inpatient services are provided for those who require it

47 [c] Any restrictions on admissions to the unit are matched by alternative resources Ewhich are clearly identified and protocols for accessing alternative resources are known to the CAMHS community services, Children’s trusts and out of hours services

47 [c] There are clear protocols in place with local community out of hours and Eadult services to ensure that the new duty to provide age appropriate environments to all under 18 year olds (subject to need) will be met from April 2010. These protocols have been communicated to Local Authorities

Ref 43: pg 39 “Clear care pathways are in place for planned admissions of under 18 year olds.”

47.1 There are clear protocols in place to ensure that the needs of young people Ewho require admission in an emergency are assessed by a person with appropriate expertise to determine the most appropriate place to admit the child or young person

47.1 [c] There are protocols in place to ensure that under 16’s are not accommodated Eor treated with adult mental health patients.

Ref 1: pg 40 “PCTs and mental health trusts should ensure that adult wards are not used for the care and treatment of under 16’s...”

47.1 [c] The commissioning strategy includes inpatient services which are in an Eaccessible location for the population served to allow family contact and interventions

47.2 There are regular meetings between unit staff and representatives from all Drelevant agencies responsible for commissioning the service

Ref 28: pg 7 “Children’s Trust partners actively seek and value the expertise of local clinicians and other professionals, including professionals working with children, young people and their families in health, education, social care and wider services.”

47.3 The service contributes to a local audit of elements of a comprehensive DCAMHS and the mapping of existing services, according to the Department of Health four tiered model

Section 8: Location within a public health context and commissioning


48

Section 8 Location within a public health context and commissioning

49

50 Commissioner-provider relationships are collaborative and effective

50.1 Commissioners work together with inpatient providers to achieve a strategic Eframework that is jointly developed and owned

Ref 43: pg 26 “Local strategic partnerships drive change and service improvement... the aim of a join strategic plan for young people with mental health problems will be to obtain the best possible services for this group.”

50.2 Effective commissioner provider relationships are evidenced by: D

i) A long term approach to service planning and development

ii) Sustained relationships between commissioning and provider managers who meet regularly

51 There is a clear role for the service that is explicitly set in the context of a four-tier CAMHS strategy

51.1 The role of the service is made clear by the service level agreement or Econtract with the commissioning agencies

Guidance: This should plainly state the core business of the service and the functions that it is expected to deliver

48 The inpatient unit contributes to effective multi-disciplinary and multi-agency working, between health, education, and social services

48.1 Inpatient services contribute to the development of Children’s Service Plans, Dtogether with all relevant agencies, youth justice, probation services and the voluntary sector

Ref 18: pg 33 “Tier 4 CAMHS work in collaboration with specialist education, social care and youth justice provision to provide a network of services for children and young people with severe, challenging and complex problems.”

48.2 There is close collaboration with education services E

Ref 28: pg 6 “The Children’s Trust makes particular efforts to engage with core service providers, including schools.”

48.3 There are regular meetings with local authority residential services, e.g. the Dunit offers advice, supervision and training

48.4 The unit is aware of and able to provide information about other types of Eservices available in its locality, in particular about possible sources of support for young people and families post-discharge

Ref 26: pg 72 “Issues that will need to be addressed include the involvement of service users, identifying consistent sources of information, providing support after discharge and ensuring greater equity across the country and between groups of service users.”

49 The inpatient unit liaises effectively within the Health Service and has a goodworking relationship between disciplines, departments and levels of care

49.1 The inpatient team work closely with general paediatric, children’s and adult Epsychiatry services, e.g. there are joint protocols and meet regularly where treatment is jointly provided

Ref 1: pg 113 “Mental health trusts (CAMHS and adult mental health services) and PCTs should work together to ensure they have in place a joint policy or protocol to ensure the safety and protection of young people admitted to adult wards.”

49.2 There are joint protocols between the unit and local adult mental health Eservices to ensure collaborative working and discharge planning using CPA. Units which have a catchment of young people which are outside the local area have agreed protocols for discharge

Ref 18: pg 22 “The Care Programme Approach is used on discharge from in-patient care and on transition from child to adult services.”

Bibliography1. 11 Million (2008) Out of the Shadows? A review of the responses to recommendations made in Pushed

into the Shadow. 11 Million

2. Adams, J. Burnard, P. Cooper, L. Coyle, D. Edwards, D. Fothergill, A. Hanningan, B. (2005) Factorsinfluencing the effectiveness of clinical supervision Journal of Psychiatric & Mental Health Nursing.12(4):405-414

3. British Standards Institution (2008) Whistleblowing Arrangements: Code of practice. British Standards Institution

4. Care Quality Commission (2009) Engagement in clinical audit.www.cqc.org.uk/guidanceforprofessionals/healthcare/nhsstaff/annualhealthcheck2008/09/qualityofservices/exis/engagementinclinicalaudits.cfm

5. Carers UK www.carersuk.org/Information/Helpwithcaring/Carersassessmentguide

6. Clarke, S. (2004) Acute Inpatient Mental Health Care: Education, Training & Continuing ProfessionalDevelopment for All. NIMHE/SCMH

7. CSIP/NIMHE (2007) New Ways of Working for Everyone: A best practice implementation guide.Department of Health

8. CSIP/NIMHE (2007) Onwards and Upwards: Sustaining service improvement in acute care. Making themost of the Healthcare Commission 2006/07 acute inpatient service review.

9. Department for Education and Skills (2001) Access to Education for children and young people withMedical needs. Department for Education and skills

10. Department for Education and Skills (2003) Meeting the educational needs of children and youngpeople in hospital A design guide Building Bulletin 96. Department for Education and Skills

11. Department for Education and Skills (2006) What to do if you’re worried a child is being abused.Department for Education and Skills

12. Department of Health (1997) Report on the review of patient-identifiable information; The CaldicottReport. Department of Health

13. Department of Health (2002) National Minimum Standards and Regulations for Independent HealthCare. Department of Health

14. Department of Health (2002) National Minimum Standards and Regulations for Children’s Homes.Department of Health

15. Department of Health (2003) Confidentiality: NHS Code of Practice. Department of Health

16. Department of Health (2003) Guidance for Access to Health Records Requests under the DataProtection Act 1998. Department of Health

17. Department of Health (2004) Getting the right start: National Service Framework for Children EmergingFindings. Department of Health

18. Department of Health (2004) National Service Framework for Children, Young People and MaternityServices - Standard 9: The Mental Health and Psychological Well-being of Children and Young People.Department of Health

19. Department of Health (2004) Towards cleaner hospitals and lower rates of infection A summary ofaction. Department of Health

20. Department of Health (2007) Appendix 2: A comprehensive CAMHS. Department of Healthwww.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4869049

21. Department of Health (2007) Best Practice in Managing Risk Principles and evidence for best practice inthe assessment and management of risk to self and others in mental health services Department of Health,National risk management programme

22. Department of Health (2007) Privacy and dignity - a report by the Chief Nursing Officer into mixed sexaccommodation in hospitals. Department of health

23. Department of Health (2007) Using mobile phones in NHS hospitals Department of Health

24. Department of Health (2008) Code of Practice Mental Health Act 1983 Published pursuant to section118 of the Act. Department of Health

25. Department of Health (2008) Refocusing the Care Programme Approach; Policy and positive practiceguidance. Department of Health

26. Department of Health (2008) Children and young people in mind: Final report of the National CAMHSreview. Department of Health and the Department for Children, Schools and Families

27. Department of Health (2009) Healthy lives brighter futures; the strategy for children and young people’shealth. Department of Health and Department for children, schools and families

28. Department of Health (2009) Securing better health for children and young people through world classcommissioning: A guide to support delivery of Healthy lives, brighter futures: The strategy for children andyoung people’s health Department of Health and Department for Children, Schools and Families

29. DH Estates and CSIP Acute Care Programme (2008) Laying the Foundations for better Acute MentalHealth Care: A Service Redesign and Capital Investment Workbook. Department of Health.

30. Disability Rights Commission (2006) You can make a difference, improving hospital services for disabledpeople. Department of Healthwww.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4128527.pdf

31. Garden, G. (2005) Physical examination in psychiatric practice Advances in Psychiatric Treatment vol. 11,142-149

32. Health Quality Service and National Children’s Bureau (2000) Child and Adolescent Mental HealthService Standards. London: Health Quality Service

33. Healthcare Commission (2009) Spotlight on complaints Healthcare Commission

34. National Institute for Health and Clinical Excellence (2005) Depression in children and young people;Identification and management in primary, community and secondary care NICE

35. National Institute for Mental Health in England (2003) Inside Outside – Improving Mental HealthServices for Black and Minority Ethnic Communities in England. NIMHE

36. National Institute for Mental Health in England (2009) The Legal Aspects of the Care and Treatment ofChildren and Young People with Mental Disorder: A guide for professionals. DH/NIMHE

37. National Patient Safety Agency (2000)www.npsa.nhs.uk/nrls/improvingpatientsafety/cleaning-and-nutrition/peat/about-peat/

38. NHS Estates (2002) Advice to trusts on the main components of the design brief for healthcare buildingshttp://195.92.246.148/nhsestates/chad/chad_assets/downloads/chad_advice_0902.pdf

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39. NHS Estates (2003) Improving the patient experience; Friendly healthcare environments for children andyoung people. Department of Health

40. NHS Executive (2000) Safety, privacy and dignity in mental health units: Guidance on mixed sexaccommodation for mental health services. Department of Health

41. NICE (2002) Principles for best practice in Clinical Audit Radcliffe Medical press Ltd

42. NICE public health guidance 17 (2009) Promoting physical activity, active play and sport for pre-schooland school-age children and young people in family, pre-school, school and community settings NHS National Institute for Health and Clinical Excellence

43. NMHDU (2009) Working together to provide Age-Appropriate Environments and Services for MentalHealth patients aged under 18 Department of Health/National Mental Health Development Unit

44. Royal College of Nursing (2003) Restraining, holding still and containing children and young peopleGuidance for nursing staff Royal College of Nursing

45. Royal College of Psychiatrists (1998) Not just bricks and mortar: Report of the Royal College ofPsychiatrists Working party, on the Size, Staffing, Structure, Siting and Security of New Acute AdultPsychiatric Inpatient units. Council Report CR62. London: Royal College of Psychiatrists

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47. Sergeant, A. (2009) ‘Working within child and adolescent mental health inpatient services’ - A practitioners handbook. National Workforce Programme Child and Adolescent Mental Health

48. Street C and Svenburg J (2002) Consultation with Young People Report. London: YoungMinds

49. The Mental Health Act Commission (2009) Coercion and consent, monitoring the Mental Health Act2007-2009 Thirteenth biennial report. The Mental Health Act Commission

50. The National Assembly for Wales (2002). Too serious a thing: The review of safeguards for children andyoung people treated and cared for by the NHS in Wales (The Carlile Review). Cardiff: National Assemblyfor Wales

Appendix A – Acknowledgements

Standards Working Group – 6 July 2009Agnes Ayton (Consultant Psychiatrist, Darwin Centre – Stafford)Sarah Bacon (Project Worker, QNIC)Louise Birkett-Swan (Clinical Psychologist, St Andrews)Amanda Cadder (Nurse Manager, Marlborough House)Jane Claxton (Service Manager, Northumberland Tyne and Wear Trusts)Sharon Davies (Consultant Psychiatrist, Wells Unit)Carl Dykes (Clinical Nurse Specialist, Collingham Child and Family Centre)Janice Hutton (Social Worker, Roycroft Unit)Farah Khalid (Research Worker, QNIC)Tim McDougall (Nurse Consultant, Chester YPU)Tracey Newton (Acting Lead Occupational Therapist, St Andrews)Guy Northover (ST5, Berkshire Adolescent Unit)Camilla Parker (Mental Health and Human Rights Consultant)Kathryn Pugh (National Lead for MHA 2007 Implementation, Children and Young People’s Workstream,National Mental Health Development Unit)Gillian Rose (Consultant Psychiatrist, Collingham Child and Family Centre)Angela Sergeant (Consultant Nurse, Leigh House)Jane Solomon (Deputy Programme Manager, QNIC)Janette Steel (Head of Education, Collingham Child and Family Centre) Peter Thompson (Programme Manager, QNIC)Adrian Worrall (Head of CCQI, Royal College of Psychiatrists)

Consultation ResponsesLesley Groucott (Healthcare Governance Lead, St Andrews)Paul Lelliott (Director of the CRTU, Royal College of Psychiatrists)Maureen McGeorge (Head of Development, CCQI, Royal College of Psychiatrists)Camilla Parker (Mental Health and Human Rights Consultant)Gillian Rose (Consultant Psychiatrist, Collingham Child and Family Centre)Angela Sergeant (Consultant Nurse, Leigh House)Ben Sessa (Consultant Psychiatrist, Orchard Lodge)Diane Whiteoak (Hospital Manager, Huntercombe Edinburgh)Simon Wilkinson (Consultant Psychiatrist, Adolescent Psychiatric Unit, Oslo)Adrian Worrall (Head of CCQI, Royal College of Psychiatrists)

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Appendix B – QNIC Executive CommitteeJane ClaxtonService Manager

Agnes AytonChild and Adolescent Psychiatrist

Tim McDougallNurse Consultant

Peter MorrisClinical Psychologist

Marica RytovaaraConsultant Psychotherapist

Janette SteelHead of Education

Ben SessaChild and Adolescent Psychiatrist

Jane WhittakerChild and Adolescent Psychiatrist

Paul LelliottConsultant Psychiatrist/Director of the College Research and Training Unit

Adrian WorrallHead of the College Centre for Quality Improvement

Peter ThompsonProgramme Manager, QNIC

Jane SolomonDeputy Programme Manager, QNIC

Farah KhalidResearch Worker, QNIC

Elizabeth CollinsProject Worker, QNIC

Natasha SmythProject Worker, QNIC

Appendix C – QNIC Standards Order FormFurther copies of these standards can be obtained either by downloading from www.qnic.org.uk or by photocopying and completing the form below:

I would like to order copies of the QNIC Standards at £19.95 each

Title: (Dr, Mr, Mrs, Ms etc.):First name:Surname:Job Title:Organisation Name: Address:

Postcode:Tel: Fax/E-mail:

Please indicate your preferred method of payment:a) I enclose a cheque for £_________ made payable to ‘The Royal College of Psychiatrists’b) Please invoice my organisation for £_________

Today’s Date: _____/_____/_____

Signed:

PLEASE RETURN TO: QNIC, The Royal College of Psychiatrists’ Research and Training Unit, 4th Floor, Standon House, 21 Mansell Street, London E1 8AA.Tel 020 7977 6691/92/93Fax 020 7481 4831Email [email protected]

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Documents

Service Standards Fifth Edition - Royal College of ... · PDF fileForeword This is the fifth edition of the QNIC standards and this document will be used as QNIC enters its tenth annual