"Inequality and unfair restrictions"

About: Arnold Lodge Regional Secure Unit

(as a staff member posting for a patient/service user),

Posted by the advocacy service on behalf of the patient in their own words;

I am a service user at Arnold lodge on a personality disorder (PD) ward. There are 2 issues I want to bring to your attention.

The first issue is telephone access, there are 7 wards on this unit; 3 mental illness wards, 2 female wards and 2 PD wards. When I attended the patients forum some months ago it was mentioned that all the other wards could use the telephone freely with no time restrictions during the day so long as it didn't get in the way of treatment. The PD wards have 15minutes maximum per day (incoming and outgoing calls combined) and only after 6pm until 9pm. It has also been raised in the Patient Satisfaction Survey and nothing has been done about it. The Mental Health Act Code of Practice says (16. 3) 'Hospitals should make every effort to support the patient in making and maintaining contact with family and friends' (16. 4) 'The principle that should underpin hospital or ward policies on all telephone use is that detained patients are not, of course, free to leave the premises and that individual freedom to communicate with family and friends should therefore be maintained as far as possible. Any restrictions imposed should be the minimum necessary, so as to ensure this principle is adhered to. ' (19. 4) 'Patients should have readily accessible and appropriate daytime telephone facilities'

I believe the restrictions placed on patients with BPD is unfair and discriminates against patients with a personality disorder.

The second thing is the patients on the PD wards are not allowed food brought in by visitors either to eat during the visit or to bring back to the ward. As far as I am aware, all other wards do not have this restriction. I believe again that this is unfair and nothing has been done about it when we have raised it as a complaint.

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Responses

Response from Jane Danforth, Involvement Team , Involvement & Experience, Nottinghamshire Healthcare NHS Trust

picture of Jane Danforth

Dear 1N1

Thank you for your feedback. We appreciate you taking the time to tell us how you feel.

I have forwarded your posting to Arnold Lodge General Manager and our Involvement Lead for comment and we will get back to you.

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Response from Jennie Palmer-Vines, Therapy Services Manager & Involvement Lead, Arnold Lodge, Nottinghamshire Healthcare NHS trust

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Dear 1N1

Thank you for taking the time to post your story on the Patient Opinion website. It is always good to hear what patients have to say, whether it be complimentary or critical, as that is how we continue to develop as a service. Please accept my apologies for the delay in my response on this occasion.

I am aware that both of the issues that you have raised, i.e. telephone access and visitors bringing in food, have been of concern to the male PD patients for some time and are regularly mentioned at the Patients’ Forum. I also know that you have had responses from the PD Clinical Team regarding both issues but you are not satisfied with their reply. As you are aware, Arnold Lodge provides a range of treatment services to patients with different clinical needs, the therapeutic needs of whom are often different and the ward rules and procedures therefore vary accordingly. That said, I’m aware that you believe that the restrictions imposed within the PD service are both inequitable and unjustifiable in comparison to the other services within Arnold Lodge.

I would like to discuss the issues you have raised with the Arnold Lodge Management Team so that we can review what we provide as a whole unit rather than just focussing on the male PD service, as you have raised some very fair questions in your posting regarding equity of service provision . Our next Management Team meeting is on Monday 10th September and I have asked for your posting to be one of the agenda items, after which I will respond again and report to you any decisions that have been made.

Kind regards

Jennie Palmer-Vines

Therapy Services Manager and Involvement Lead - Arnold Lodge

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Response from Jennie Palmer-Vines, Therapy Services Manager & Involvement Lead, Arnold Lodge, Nottinghamshire Healthcare NHS trust We have made a change

picture of Jennie Palmer-Vines

Dear 1N1

Thank you for your posting and please accept our apologies for the delay in responding. As you raised issues concerning equity of service, we felt it was important that we discussed these issues as a Management Team rather than just within the PD carestream, especially as there were potential implications for patients across the unit. As you are aware, the Management Team met on Monday 10th September and discussed your posting in the presence of Maxine Whale, one of the patients’ advocates. We discussed both of the issues in depth and agreed the following.

Firstly, regarding telephone access, it became apparent that there is some discrepancy regarding telephone access between Ridgeway and Cannock Wards. We felt that this was unjustifiable within the same carestream and have agreed that the timings should be consistent across both wards. We also felt that this should include an extension to the time allowed to access the telephone in the evening. We have recommended that the time allowed is increased from 3 hours to 3.5 hours so that all patients can have their allotted 15 minute telephone call if required. We have asked the Ward Managers to agree these times between themselves and to feedback to patients when a decision has been made. We felt that 15 minutes was sufficient and reasonable and will not be making a recommendation to increase this allowance.

We discussed access to the telephone at lunchtime and agree with the decision made by the PD Service clinical team that social phone calls should not detract from treatment programmes in any way. However, patients can request an exception to this for special circumstances which must be agreed by the Clinical Team. In urgent situations, this decision can be made by the Nurse in Charge.

Secondly, regarding Cannock and Ridgeway patient visitors being unable to bring food in to eat on visits. It was considered that this is a reasonable precaution within a secure unit in order to prevent contraband being brought into the unit, although we considered it unfair to only apply the restriction to one group of patient visitors for reasons of security. We will therefore review the practice of any visitors bringing in food and drink items for any patients within the unit. The only exception to this restriction will be food brought in by visitors for special occasions such as birthdays or religious festivals. This will need to be agreed with the Clinical Team in advance and unconsumed items will not be able to be taken back to the ward for later consumption. It was considered that all patients could pre-plan for their visit and buy confectionery, snacks and drinks whilst on leave or from the patients’ shop to share with their visitors. Tea, coffee, squash and water are already provided for visitors.

Thank you for bringing these issues to our attention.

Kind regards

Hazel Hayward (General Manager) and Steve Geelan (Clinical Director)

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Update posted by 1N1 (a staff member posting for a patient/service user)

Posted by the advocacy service on behalf of the patient in their own words;

Thank you for your reply dated 25/9/12.

I am very unhappy with your response as you appear to have disregarded the Mental Health Act code of practice 16. 3, 'Hospitals should make every effort to support the patient in making and maintaining contact with family and friends’

16. 4. '’The principle that should underpin hospital or ward policies on all telephone use is that detained patients are not, of course, free to leave the premises and that individual freedom to communicate with family and friends should therefore be maintained as far as possible. Any restrictions imposed should be the minimum necessary, so as to ensure this principle is adhered to. ’

19. 4 ‘Patients should have readily accessible and appropriate daytime telephone facilities’

In addition I would like to point out the following;

1. in your reply to PD wards patients telephone access the only difference between Cannock and Ridgeway is the timing of the access; Cannock is 6. 30pm-9. 30pm and Ridgeway is 6pm-9pm. Giving or allowing an extra extension of 30mins isn’t in line with the rest of the hospital and wards. For your information the extra 30 mins has not been implemented.

2. Regardless of the increase to ensure ‘consistency’ across both wards patients will not have their allotted 15 mins access increased in any way.

3. All wards at Arnold Lodge have treatment and structure to their day on a week to week basis, to say for PD services to have access during the daytime would detract from our treatment programmes is wholly unjustified, unfair and cannot be right.

4. We are care planned throughout our treatment and treatment programmes and if use of the phone was to become therapy interfering we would be stopped from using it as would happen with individual patients on any other ward.

5. Why should we be treated differently to all other wards? Why can we not be given the opportunity to show we can make this work?

6. Surely increased daytime access to the telephone for patients on the PD wards can be managed as it is throughout the unit on all other wards.

FOOD

1. Regarding food being brought in for patients via visitors, this is still continuing and not just for consumption during visits. Food items are still going up to the wards except PD wards. This is wholly unfair to the male PD wards.

2. The policy was until recently factory sealed items of food only and this has only on very rare occasions caused a problem of security regarding contraband.

3. The same could apply to other items brought in by visitors for patients I. e. Clothes, shoes, DVDs, CDs toiletries etc? Are you going to ban them as well?

4. All items should be thoroughly checked and searched before being given to patients no matter what ward they are on or what care stream they come under?

Response from Involvement Team , Involvement & Experience, Nottinghamshire Healthcare NHS Trust

I am sorry that you are unhappy with my last response. I disagree with your statement that we have disregarded the Mental Health Act code of practice in relation to ‘supporting the patient in making and maintaining contact with family and friends’. As you are aware, we facilitate social visits from family and friends as well as telephone contact and we also host regular Carer’s Open Days, the next one being on Saturday 15th December. We also believe that the restrictions imposed on telephone access on all wards are the minimum necessary required for those patient groups and the restrictions are therefore justifiable on clinical grounds.

Regarding the additional time for telephone access on Ridgeway and Cannock wards, there has been a delay in implementing this as we needed to ensure that all staff were aware of this change beforehand, as alterations had to be made to the Ward’s Departmental Instructions. There will not be an increase to the 15 minutes allotted telephone access time for individual patients, but the additional 30 minutes added to the time available will ensure that all patients can utilise their 15 minutes during that period of time, thereby giving a bit more flexibility. The telephone access times in the evenings are now as follows: Ridgeway 5.30pm – 9pm and Cannock 6pm – 9.30pm. As stated in my previous posting, patients can request an exception to be made to allow telephone access at other times for special circumstances which must be agreed by the Clinical Team. In urgent situations, this decision can be made by the Nurse in Charge.

Regarding food being brought in for patients by visitors, this has also taken some time to implement as all patients, visitors and staff had to be informed of this change before its implementation. Staff and patients are now aware and all visitors have been sent a newsletter to inform them of this change and a poster displayed in reception. The unit ban on visitors bringing in food and drink for patients across the service is being implemented from Saturday 1st December. The reason for this change is predominantly security related but also for reasons of healthy living. As stated previously, exceptions may be made regarding food and drink brought in by visitors for special occasions such as birthdays and religious festivals and this will need to be agreed by the Clinical Team in advance of the visit. We are not currently thinking of stopping non-food items being brought in by visitors as you suggest, I.e. clothes, shoes, DVD’s CD’s, toiletries, etc, but we will keep this under constant review.

Thank you again for bringing these issues to our attention. Given that I have responded to all of your points in detail, I now consider this matter closed.

Kind regards- Hazel Hayward (General Manager)