the harbour - lancashire care nhs foundation trust harbour... · the harbour is predominately a...

TheHarbourWindmill Rise BlackpoolFY4 4FE

This document does not replace standard operating procedures

WL/x/orgchange/in-patients/harbor 5 fin/31.12.14

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Distribution list for comments Date sent Version

Paula Field 11/11/14 V1

Amanda Thornton, Alistair Rose, Jane Seddon, Caroline Johnson, Sheila Kasaven, Lorraine McDonald-Johnson, Tim Swales, Cath Fewster, Paul Hopley, Emma Forsyth

12/11/14 V1

Sue Moore, Paula Field 18/11/14 V2

In-patient Transition Programme Board 24/11/14 V3

Paula Field, Amanda Thornton. 29/12/14 V4

Version Significant differences from previous version

2 Move of Main Entrance & Reception section to before information about in-patient facilities. General in-patient information previously repeated under ward headings grouped together before specific information. Inclusion of another floor plan showing the location of the street. Correction of details about uniforms and who wears them. Changes to hours of reception and matron shifts

3 Correction of typing errors and corrections in relation to facilities from ‘Main Entrance and the Street’, ‘Hotel Services’ and ‘Estates Services’. Updated floor plans Inclusion of information on energy production Changed to Trust brand

4 Additional detail on the leadership, care philosophy and management of the Harbour added to a new section entitled Leadership & Care philosophy New front cover

5 Final version to all Inpatient Transition Board members for general release.

Sign Off Date

In-patient Transition Board November 2014

Review

On opening March 2014

Source documents Date

Whole Hospital Operating Policy and Client Brief Appendices October 2011

Arts & Healing programme summary October 2014

EMT Paper – proposal for design of the Harbour Workforce Model April 2014

Dementia & Mental Health Services in Lancashire Jan 2014

The New In-patient Mental Health Model Feb 2013

Leadership & Governance Structure for the Harbour Dec 2014


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Contents INTRODUCTION ............................................................................................................................. 4 BACKGROUND ............................................................................................................................... 4 Arts & the therapeutic environment ............................................................................................... 5 MAIN ENTRANCE AND RECEPTION ......................................................................................... 6 A Welcoming Philosophy ............................................................................................................... 7 CARE MODEL AND LEADERSHIP OF THE HARBOUR ......................................................... 8 Model of Care ................................................................................................................................... 8 Philosophy of care ........................................................................................................................... 8 Leadership & Staffing Model .......................................................................................................... 9 Uniforms .......................................................................................................................................... 10 IN-PATIENT UNITS ....................................................................................................................... 11 Physical Ward Environment ......................................................................................................... 11 Role & function of the ward .......................................................................................................... 11 Therapeutic Interventions ............................................................................................................. 12 Physical Care ................................................................................................................................. 12 Principles of care ........................................................................................................................... 12 Philosophy of admission to in-patient services ......................................................................... 13 Ward Information Booklets ........................................................................................................... 13 Primary health care ....................................................................................................................... 13 Technology ..................................................................................................................................... 13 Medicine Management .................................................................................................................. 13 FUNCTIONAL WARDS ................................................................................................................. 15 Aim ................................................................................................................................................... 15 Role & function of the ward .......................................................................................................... 15 ADVANCED CARE WARDS ........................................................................................................ 16 Aims ................................................................................................................................................. 16 Roles & function of the wards ...................................................................................................... 16 Physical Healthcare ....................................................................................................................... 16 DEMENTIA UNIT ........................................................................................................................... 17 Aims ................................................................................................................................................. 17 Roles & Function ............................................................................................................................ 17 Physical Healthcare ....................................................................................................................... 17 PSYCHIATRIC INTENSIVE CARE UNIT (PICU) ..................................................................... 17 Aims ................................................................................................................................................. 17 Roles & Function ............................................................................................................................ 17 Referrals .......................................................................................................................................... 17 PICU admission process .............................................................................................................. 18 SECTION 136 SUITE .................................................................................................................... 18


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FACILITIES FLOWING FROM MAIN ENTRANCE AND THE ‘STREET’ ............................. 19 Sparky’s Café ................................................................................................................................. 19 Shop ................................................................................................................................................. 19 Patient Affairs /General Office ..................................................................................................... 19 Multi-use room ................................................................................................................................ 19 Fitness Room ................................................................................................................................. 19 Reflective Space ............................................................................................................................ 20 Family visiting facilities .................................................................................................................. 20 Mental Health Act Suite ................................................................................................................ 20 ADMINISTRATION SUITE INCLUDING TRAINING FACILITIES ......................................... 20 Large open plan area .................................................................................................................... 20 Large meeting/training room ........................................................................................................ 20 Small Training Room ..................................................................................................................... 20 Library .............................................................................................................................................. 20 Staff rest and changing facilities .................................................................................................. 20 HOTEL SERVICES ....................................................................................................................... 21 Cleaning services .......................................................................................................................... 21 Laundry Servicers .......................................................................................................................... 21 Catering ........................................................................................................................................... 21 Meal times ....................................................................................................................................... 21 Vending service .............................................................................................................................. 21 Portering services .......................................................................................................................... 21 Window cleaning ............................................................................................................................ 21 CCTV ............................................................................................................................................... 21 ESTATES SERVICES................................................................................................................... 22 Energy Provision ............................................................................................................................ 22 Medical Gas/Oxygen Store .......................................................................................................... 22 CAR PARKING ............................................................................................................................... 22


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INTRODUCTION The Harbour is a new 154 bedded mental health hospital situated on Preston New Road (A583) just off junction 4 of the M55 at Blackpool. It is a no smoking building. The hospital was designed with extensive input from service users and clinicians and is based on good practice guidance and 'safety by design' to ensure that it can provide high quality care. The ethos of the unit is to provide therapeutic care which is empowering, person centered and needs led, and focuses on promoting recovery and independence. It supports the model of care which places the emphasis on community based care rather than hospital stays. For the few who do require an in-patient stay, their care provided in the Harbour, will continue to focus on the wellbeing and positive outcomes for that user. The Harbour is predominately a single story building with 154 beds in 10 ward units each situated on the ground floor with access to external areas. Each unit is made up of a series of ground floor single rooms with en-suite bathrooms and toilets. Each room has natural daylight and a view outside of the building, as highlighted by service users as important. Each bedroom is fitted with a TV. Landscapes and gardens are recognised for their therapeutic and healing properties and imaginative design has been incorporated in. Therefore each ward has a discreet courtyard area accessible from the lounge area and access to gardens designed to promote calm, contemplation, relaxation and interaction with nature. Emphasis has been placed upon the use of texture, scents, colours and wildlife attracting plants. The garden around the dementia unit also includes a ‘wander’ path to promote purposeful walking. Some wards share external facilities and all areas are landscaped and monitored by CCTV. The external perimeter protects against intrusion from outside and provides a sense of sanctuary for users. Where possible the planting and hedging is used to soften the perimeter. This document tries to outline some of the details about which services will be provided at the Harbour and how it will work. It does not replace any of the standard clinical or operational procedures or policies.

BACKGROUND A public consultation in 2006 led to the establishment of the 'Mental Health Matters' programme which over a 10 year period would see the Trust invest in the region of £117m in new in-patient facilities. This programme will transform the Trust's acute mental health services to provide the best possible experience and outcome for people with mental health needs in Lancashire. This plan, the associated strategic outline case (SOC) and subsequent business cases were supported by the five PCTs in Lancashire and now by all the Clinical Commissioning Groups. Since the production of the SOC, developments in care pathways have shown that greater emphasis on care in the community has reduced the need for in-patient beds. The 2010 General Election resulted in significant changes to procurement routes for provider services with the removal of PCTs and SHAs and the empowering of General Practice Surgeries (in Group Practices) to undertake commissioning. These events have resulted in the need for necessary changes to be made to the original SOC of 2007 and a Strategic Outline Programme (2011) was published to replace it following a retesting of the assumptions undertaken by stakeholders which were finalised in May 2011. These are outlined below.


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Fylde Coast 154 Whyndyke Farm, Blackpool. (Now named the Harbour)

Lancaster and Morecambe 18 beds Pathfinders Drive, Lancaster. (Now named the Orchard)

Central Lancashire 18 beds. Site to be determined

East Lancashire 72 beds. Blackburn proposed As a network of specialist in-patient facilities the ethos for the new in-patient services is to deliver therapeutic care which is empowering, person centered, needs-led, and focused on promoting recovery and independence. Respecting privacy and dignity is an essential element, whilst providing care which is responsive and accommodating of extra needs such as physical health care issues. The Trust is committed to the development of recovery oriented services that can be used by people as tools to support their recovery. It is recognised that attitudes, beliefs and prejudices are important influences on recovery including respect for diversity of values and lifestyles. Thus the culture and leadership of the unit is as critical as the new building that care will be delivered within.

Arts & the therapeutic environment In addition to involving service users in the design of the building, the Trust has had an extensive art programme to involve them and local community arts groups in the art work around the Harbour. Art and engagement in art is recognised to help develop self-esteem and confidence and nurtures skills which can lead to further training and employment opportunities. Working in partnership with service users, community art projects and local artists this programme has been responsible for the signage art work as well as work in both public and therapeutic areas.


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MAIN ENTRANCE AND RECEPTION The operating hours for in-patient services at the Harbour are 24 hours per day 365 days per year. The main reception near the front entrance is staffed from 08.30 to 20.30 hrs to provide a meet and greet point for staff and visitors to ensure people experience a positive first impression and experience. This includes registering visitors upon arrival for fire safety (including issuing visitor badges), notifying staff of visitors to be received or escorted and providing directions. The main reception will operate the electronic door entry system into the 'street’ and administrative/training areas. The main entrance is the point of entry into the building for staff and visitors (except Facilities Management staff who have their own entrance to FM services) during these opening hours. There is a separate ‘section 136’ entrance that also serves for ‘out of hours’ access. Between the hours of 20.30 – 08.30 calls will be diverted to each ward administrative base using a menu of options offered on the phone. Visitors will be directed by intercom and signs to the designated out of area entrance which is the 136 Suite as the reception area is unmanned and not accessible. Out of hours there will be a number of staff who will respond to any visitors and permit access to the building once identity and the purpose of their visit is confirmed. The hospital entrance and concourse is the principle access point to the main hospital building for service users, visitors, most non-emergency admissions and for business visitors; it is also used as a staff entrance. The following facilities will be available within the main entrance:

Lobby

Public telephone

Information Terminal

Main Reception

Public Toilets

Waiting Area

Café

Shop From the concourse, communication routes lead to all appropriate wards and departments within the building complex.

Main Entrance

Main Entrance


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A Welcoming Philosophy The first impression gained by service users and visitors entering the main entrance to the hospital is of fundamental importance, and therefore its design, including the reception and waiting areas is warm, inviting and welcoming. The reception/waiting area is well-lit by natural light and is designed to create a spacious and welcoming atmosphere .The waiting area is comfortable and appropriate seating is provided. This area provides space for service user artwork and information to be displayed. Male and female toilets as well as disabled access toilets and nappy change are located within this area. Accessible from the reception area and clearly sign posted are a number of different support areas for both service user and management activities. All signage to these areas will be clear, concise, and easily understandable throughout the hospital and will conform to the 'Way finder' principles.

Dementia Wards Advance Care Wards

136 Suite PICU

Functional Wards

Advanced Care Wards

136 Suite PICU

Dementia Wards


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CARE MODEL AND LEADERSHIP OF THE HARBOUR

Model of Care The model of care will be a person centred needs led service delivered by a multidisciplinary team using a physical, psychological and social approach. The model will be delivered in an environment which is conducive to the cultural and spiritual needs of the service user. The overall goals of any admission might be defined as falling into four areas: 1. Reducing distress and disabling symptoms in a contained and safe environment through

focussed, first-line treatments and interventions, until a degree of self-confidence, stability and functioning is achieved.

2. Develop a shared bio-psycho-social formulation or narrative that satisfactorily explains the person’s current experience in terms that are meaningful to the service user, and that help indicate appropriate interventions for the team.

3. Prepare for, and initiate interventions that will promote optimal recovery in the longer term through forming therapeutic relationships, and using opportunistic engagement in appropriate therapies.

4. Mitigate for the potential harm that an admission may cause for the individual in terms of trauma, emotional vulnerability, and interruption to usual roles, responsibilities, familial and social networks.

All the goals will be personalised as necessary and the weight placed on any of the above will vary between individuals over time, as they move towards recovery.

Philosophy of care In addition to the Trust’s Values which underpin all that we do, the Trust’s value statement emphasises our journey to create an organisational culture that supports the delivery of high quality care. Supporting patients with mental health needs has changed a lot over the last 100 years. Following extensive patient and carer engagement, and recognising best practise, services are now designed to keep people in their home instead of bringing them into hospital. This is because firstly, it is what patients tell us they want, and secondly because it makes sense clinically to provide some consistency, normality and continued connections with the persons resources in their family or community. In all the care we provide, be that at home or in our in-patient units, we ensure that the patient is at the centre of care and decision making and their families, friends and communities are seen to be a key sources of support and knowledge. Over recent years we have paid close attention to quality and safety, getting stronger and better at this year on year which will continue. Our leadership, culture, morale, and consequently service user experience will continue to encompass the 6cs of: care, compassion, competence, communication, courage and commitment as described by the Chief Nursing officer for England in ‘Compassion in Practice’ to evidence that we are a caring and compassionate organisation with quality and the service user experience at the heart of all we do.


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The Harbour environment supports the implementation of a least restrictive ‘safewards’1 approach and our staff are trained and supported to give them the confidence and breadth of understanding as to how to intervene before or at specific flashpoints to avoid situations escalating on to trigger conflict. There is also an increased level of staffing, with nurses changing to a 3 shift pattern to ensure a crossover period with high numbers of staff available to be with patients and provide therapeutic interventions. Clinical Leadership, as described below, will be highly visible to provide the best clinical decision making for all patients cared for at the Harbour. Teamwork and excellence in communication and competence will ensure that service users and carers experience the best care and treatment.

Leadership & Staffing Model The Harbour is led by a tripartite clinical leadership team made up of the Senior Matron, Lead Medic and Clinical Business Manager. This team will have the authority to make decisions to ensure clinical and operational safety resolving issues timely and effectively. They will be responsible for reporting and giving assurance to the strategic management team – this will highlight areas of good practice, areas for improvement or any issues of concern within the unit. This is a new management structure and as such it will be formally reviewed quarterly to ensure it is fit for purpose. The Senior Matron will be the most senior clinical member of staff onsite and will be responsible for the clinical standards to maintain safety and clinical effectiveness of service delivery across the ten wards, Section 136 and Bed Management team. The senior matron will operationally clinically, leading and managing the matrons, each of whom will lead a specialty and ensuring the implementation of the clinical operating procedures and the model of care to ensure that service users, carers and staff have a positive care experience. The Business Manager will be responsible for the operational and site management. The role will take the lead and report on all performance indicators and quality schedules for the services and will manage the strategic requirements for ongoing development and service improvement. The business manager will support strategically the resource and infrastructure needs of the Harbour and ensure that these support the clinical model. The Lead Medic will be responsible for the clinical leadership of the Medical team and escalate medical governance practice through to the Clinical Director; the role will work at a strategic level to ensure that the Harbour is a clinically led and effective quality service provider within the tripartite team. The post holder there will work closely with colleagues from other specialties and networks to ensure the highest quality of care throughout. Individual patient care is provided by a multidisciplinary team (MDT) made up of Occupational Therapists, Nurses, Psychiatrists, Psychologists, Social Workers and Pharmacists with commissioned access to the wider MDT as needed including Physiotherapists, Dieticians, Infection Control Specialists and Tissue Viability Specialists, etc. The core ward teams consists of the Medical, Nursing, OT, Psychology, Therapeutic Activity Workers and Pharmacy staff and will deliver effective multi-disciplinary assessment, formulation and care-planning with dedicated staff based on site. All staff will be available 7 days per week with the exception of the Consultant Psychiatrist, Psychologist, Physiotherapist and Pharmacy staff who will be available from Monday to Friday with emergency cover provided by an on call system. The leadership team of each ward consists of a Ward Sister/Charge Nurse and the Consultant Psychiatrist.

1 www.safewards.net


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Modern Matrons will operate 7 days per week covering 08.00 to 20.30 hrs on a shift system to provide operational oversight and clinical leadership. They will be empowered to support admission, discharge and other clinical decisions with on call support at weekends and out of hours. The key responsibilities of a matron are to:

Lead by example.

Ensure patients receive good Quality care.

Ensure staff levels are appropriate to patient care.

Empower nurses to take on wider ranges of clinical tasks.

Improve hospital cleanliness.

Ensure nutritional needs are met.

Improve wards for patients.

Make sure patients are treated with respect.

Prevent hospital infections.

Resolve concerns for patients and relatives by building closer relationships. Ward sisters/Charge nurses are responsible for the clinical standards and operational 24 hour cover for the running of their respective ward including patients, staff, environment, governance. They are the visible practical leaders and will role model the behaviours and expected values for all staff. Day to day they will ensure the safe staffing, quality care delivery, safe and appropriate environment – monitoring any defects/deficits and leading the solutions with Estates and matron leads. On a day to day basis they report to the duty matron. Registered General Nurses (RGN’s) will also be available to oversee and support delivery of physical health care by mental health trained staff. They will lead delivery of enhanced physical care to enable vulnerable service users to be appropriately cared for whilst preventing or shortening transfers to acute hospitals.

Uniforms Most ward staff at the Harbour wear uniforms. Matrons – grey with red piping Ward Sister/Charge Nurse – navy blue with red piping Deputy Ward Sister/Deputy Charge Nurse – navy blue with white piping Staff Nurse – mid blue with white piping Nursing Assistant – pale blue with navy piping Administrative staff – TBC Housekeeper – burgundy with white piping Occupational therapist – white with green piping Therapy assistant – green with white piping Medics and psychologists do not wear uniform but will be clearly identifiable through the trust identity badges.


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IN-PATIENT UNITS The in-patient units in the Harbour consist of

4 x 18 bedded adult functional wards (2 male & 2 female) There is a design solution to allow for flexibility in use of beds between the male and female wards (swing beds)

2 x 18 bedded advanced care wards (1 male & 1 female)

2 x 15 bedded dementia wards (1 male & 1 female)

2 x 8 bedded psychiatric intensive care unit (PICU) (1 male & 1 female) All the wards will be in operation 24 hours a day 7 days of the week.

Physical Ward Environment Each ward unit consists of bedrooms with en-suite facilities. The design of the rooms reflects the balance between the need for privacy for the individual and observation by nursing staff. Bedrooms have been designed to promote a relaxing environment and fitted out with appropriate fixtures including facilities for TVs and computers and a lockable mediation locker (other than in PICU units). Rooms are lockable by service users but can be opened outwards if needed. All en-suite facilities are anti-ligature and accessible to staff if required. Each ward has a lounge dining area with direct access to an internal courtyard. It is designed to feel light and airy and combine both a living and dining space. A beverage bay is provided to ensure service users have access to drinks 24 hours a day and the dining area is located next to the unit kitchen with food being service from a hatch or trolley. Furniture within this area includes sofas, easy chairs, lockable and open shelving units with space for TV/stereo/ games in the living areas and dining room tables and chairs in the dining areas. There are also a number of quiet rooms where service users can relax and have some ‘quiet time’ along with rooms for use by multidisciplinary team meetings, for group work, interviewing and ward administration. In addition to the en-suite facilities each unit has several domestic style bathrooms and access to a larger bathroom in which additional assistance can be provided. The dementia and advanced care wards are fitted with bespoke assisted baths to facilitate safe moves of service users with physical disabilities, and can be raised or lowered to minimize any risk of injury to staff, i.e. back injury through bending. Significant attention has been given to fixtures, fittings and aids to everyday living – to both facilitate independence and ensure the ongoing delivery of harm-free care. For example all communal comfy chairs fitted with pressure relieving memory foam, lightweight cutlery, and wheelchair accessible dining facilities.

Role & Function of the Ward The wards provide multi-disciplinary team (MDT) care for people who require assessment and treatment for mental illness within an in-patient facility. The admission pathway to these wards will ensure a holistic and thorough approach to identify the strengths and needs of each service user, ensuring the service user, and when applicable, their carer or family, are involved throughout this process. The MDT identified for each of these wards, will carry out a daily review of the ward population to ensure the individualised care plans are meeting current need and that this plan of care reflects the needs and services required for a successful and supported discharge.


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Therapeutic Interventions Interventions will be sufficiently flexible to meet a wide range of need and offer opportunities to provide meaningful activities and social inclusion with each service user having an individual therapy programme as agreed with the care team. Within the first week of admission, each service user will have an individualised nursing assessment commenced to address their health and social care needs and an individualised occupational therapy assessment commenced to address their occupational needs. A wide range of treatment options will be available dependent on the individual’s care plan at each phase of their mental health recovery. These will include some or all of the following:

Mental health assessment and intervention which may include the use of pharmacology;

Psychological assessment and intervention;

Occupational assessment and intervention;

Pharmacological assessment and advice including reconciliation of medication on admission and discharge.

Ongoing assessment and intervention by other members of the team;

Ward community meetings

1:1 sessions with clinical practitioners

Physical health checks/ promotion (including physiotherapy)

Health promotion and information on medication and treatments

Service user/ carer involvement in care planning

Group and diversional activities

Specialist assessment

Complementary therapies

Other specialist services.

Physical Care On admission, and regularly throughout the admission, physical health monitoring and health promotion will be implemented. According to individual need this will include:

Full blood count, ECG and screening

Pulse, respiration, blood pressure, temperature, and oxygen saturation

BMI monitoring

Physical examination

Gender specific screening Any issues identified will be monitored further as required. The wards have facilities to accommodate service users with physical disabilities. Although if the disability is not manageable on one of the functional wards, or the MDT do not have the skills and knowledge to manage and cater for identified needs, alternative care arrangements and transfer will be carried out.

Principles of care Service users will have individual care plans tailored to meet their needs. However there are certain elements of care that every service user will receive. These will include:

Appointment times for their activities. (In order to aid therapeutic recovery it is important that service users, carers and staff know when activity is planned).

1:1 time with a professionally qualified member of staff on a daily basis, which will be identified in the care plan.


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To be allocated a named worker who is responsible for their care and discharge planning.

Access to a doctor when appropriate.

To meet with a mental health pharmacist during admission.

To have their care discussed in a multidisciplinary meeting daily.

Access to OT, social worker, physiotherapy, advocacy, psychology and pharmacy when needs are identified.

Philosophy of admission to in-patient services All referrals for admission will be accessed through the Crisis Resolution/Home Treatment

Teams (CRHT)/ Intermediate Support Team (IST).

In-patient admissions should be used only when all other potential services and settings have been explored. The in-patient resource is used as a support to community services.

Service users should be admitted for the shortest possible time and treated in a way, which creates least disruption to their lives with access to most appropriate therapeutic, medication and treatment programmes.

In-patients will remain linked, as previously, to their community services and returned to their care as soon as possible.

Some staff should be able to work flexibly across wards and community settings according to clinical need.

Services will engage clients in appropriate meaningful therapeutic activities.

Ward Information Booklets Each ward provides written information for services users detailing the facilities available, meal times, visiting times, identification of staff and what to expect on admission and during the stay etc.

Primary health care Most service users will have reason to also attend to their physical health needs. Mental health admission prevents service users from receiving usual community care for the normal range of primary care physical health presentations and that care may already be suboptimal because of mental health problems. The Trust is therefore committed to providing a high standard of primary care management for those subject to an in-patient stay that will reduce physical health complications and inappropriate reliance on acute hospital provision.

Technology Across the Trust, therapy and care is supported wherever possible, by the use of the best technology. For the Harbour this includes the use of electronic care records, ‘patient status at a glance’ boards, nurse assist system and the planned introduction of an electronic prescribing system and full task allocation system. Technology will also be mobilised to allow service users and their families to stay in touch, including WIFI hotspots on wards to allow access to Skype/FaceTime or other virtual communication opportunities.

Medicine Management The aim of medicines management within the Harbour is to ensure high quality safe dispensing and administration of medicines which respects the individual’s privacy and dignity while supporting and enhancing skills and confidence in relation to their control of their own medications. Pharmacists will be available on each unit to advice on medication therapies and all service users will be assessed in relation to their competence, understanding and risk with regards to their medications. Administration of medications will take place in the most appropriate venue to meet the needs of that individual and where possible respect service user choice.


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Service users will be empowered to retain responsibility for their medication by encouraging self-medication wherever possible

Escorting The building is designed in such a way, that once the main reception have opened the 'street' door leading to in-patient areas, most visitors can walk freely along the main street until they arrive at the entrance reception to the in-patient ward they are visiting. Anyone requiring physical assistance to walk to the ward areas may request an escort at the main reception, who will make the necessary arrangements. New people being admitted as in-patients, may either be admitted via the main entrance or section 136 suite, or will be escorted by the staff accompanying them to the ward to which they are being admitted. Those individuals staying on the in-patient wards will be assessed as to whether they require escorting or not to use facilities such as the Patient affairs/general office, contemplation room, sports facilities or cafe etc., as per current Trust policy.

PICU 136 SUITE


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FUNCTIONAL WARDS (Churchill, Orwell, Shakespeare & Stevenson Wards)

Aim These wards will provide on-going assessment and treatment for people aged 18 and over requiring acute in-patient mental health support and 24 hour care. The service will empower the individual through the initial stage of their journey of recovery.

Role & function of the ward The wards provide multi-disciplinary team (MDT) care for people who require assessment and treatment for mental illness within an in-patient facility. These 4 wards have 18 beds each (2 male and 2 female) but this unit also includes the ability to alter the number of male and female beds through the use of a ‘swing bed’ facility.

LCFT recognises that needs change with age but that while chronological age can be one predictor of need there is no universal single age at which a different specialist service is required. For those under the age of 60 the Functional wards would be the usual place of admission unless a PICU bed is required. For those between 60 and 75, when considering where care could best be provided for a service user being admitted, the following will also be considered;

Do they have a diagnosed co-morbid dementia?

Is this a first onset of psychosis for those aged over 65 yrs.?

Do the mental health symptoms relate to organic brain disorder usually associated with ageing or late life, e.g. stroke, Parkinson’s, frontotemporal dementia? (This does not include those organic conditions that might be acquired at any time in life such as acquired brain injury, substance or alcohol misuse, infection etc. where other determinants should also be considered).

Do they have significant physical disability from stroke, Parkinson’s or other late onset chronic physical health disorder?

Swing beds


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Do they have physical frailty relating primarily to ageing with a history of falls and high likelihood of injury?

Are they ordinarily resident in an EMD or EMI home?

Would they or their family or carers define themselves as ‘elderly’ by usual cultural values (elderly role, isolated, functionally declined, retired, bereaved, sensory impaired, etc.)?

‘Yes’ to any of the criteria above indicate that Older Adult/‘Advanced Care’ might best meet initial need.

Other service users including those over 75 would expect to have their needs met in the ‘All Age’ services especially if they are already under the care of a working age adult community team. A lack of complex physical co-morbidity or multiple physical health medications, having dependent children, and still being employed or not having reached usual retirement age are other indicators.

ADVANCED CARE WARDS (Austen & Dickens Wards)

Aims These two wards will provide for the assessment and treatment of individuals requiring a focus on mental health conditions where there is also physical health co-morbidity increasing vulnerability or risk and/or problems related to being at a later point in their life cycle. These problems might relate to psychological and social deficits, disability and lifestyle changes. This includes people who require specific services from other agencies that are directed more towards the needs of Older People, for example particular types of social care, care homes and sheltered living arrangements.

Roles & function of the wards These 2 wards, 1 male; 1 female, will cater for those with a complex combination of mental health needs and other needs such as those related to physical co-morbidity and/or issues relating to later life stages. This would include those with mild cognitive impairment where the principal presentation is with a mental health problem such as psychosis, mood disorder or similarly severe condition. Not all those who have a moderate to severe mental health problem and coincidental physical co-morbidity or disability will require admission to this specialist unit if their needs are better met within a standard ‘functional’ ward.

Physical Healthcare These wards will have a heightened awareness and ability to manage more complex physical health care needs because of the nature of the service user group. The wards will be able to accommodate most people with physical disabilities within the specialist provisions of this care environment and the competency of the ward care team. There may be occasional individuals where the complexity of the care needed and level of expertise and skill required is beyond the capability of the mental health team. As a general rule those who require on-going physical health care interventions of the kind that are usually managed whilst in the community will continue to receive that care within these wards with the support of specialists for example Diabetic Nurse, MacMillan Nurse, Continence Advisor, Physician, Oncologist, Podiatrist, etc. Links with primary care and acute medical services will provide support and advice regarding physical health care of the service users. Service users will be supported in maintaining links with their usual physical health providers through attendance at out-patient appointments, dentist etc.


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DEMENTIA UNIT (Wordsworth & Bronte Wards)

Aims The Dementia Units will deliver a full range of service functions for assessment within a modern person-centred environment for people with moderate to severe dementia. The ultimate aim of this service is to provide care which will enable a person to live their life to their full potential in the most appropriate environment. This will be achieved through the provision of a safe therapeutic environment for the assessment and treatment of people with moderate to severe dementias. All care will be delivered by an experienced team of multidisciplinary staff through a holistic model which will focus on person centred care and maintenance of living skills. The privacy and dignity of the individual will be central to care at all times.

Roles & Function The ward will provide 24 hour on-going assessment, treatment and care to people who have Dementia, involving relatives, carers and friends to suit the needs of each individual. It will consist of one male and one female ward, each with 15 beds per unit. Activities will be provided on the ward which may be for males or females alone or be mixed.

Physical Healthcare Physical health care includes a preventative and promotional element as well as dealing with existing physical conditions.

PSYCHIATRIC INTENSIVE CARE UNIT (PICU) (Keats & Byron Wards)

Aims The PICU will provide a safe, therapeutic environment for service users detained under the mental health act, in an acute phase of mental illness. The service users may be experiencing a loss of capacity for self-control with corresponding increase in risk, which does not enable their safe, therapeutic management and treatment in an acute setting. A return to a less restrictive environment will be sought as soon as clinical presentation and risk allow.

Roles & Function The PICU will provide assessment and treatment that is service user centred, intensive, comprehensive and collaborative.

The PICU is a low secure environment

A multidisciplinary and multi-agency environment will be provided, designed to encourage the participation of service users in a planned programme of individual and group therapies, so those service users may return to a less restrictive environment at the earliest opportunity

Provide intensive care and treatment to acutely disturbed service users

Provide thorough risk assessment and management of associated risk

Referrals There may be occasions when admission is requested directly from the community, (from home address/police cells/Accident and Emergency), to the Bed Management Team based on the service users behaviour/mental state at the time. Other referrals may be from a Crisis Team or from other


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in-patient facility. Requests for PICU beds via the courts will be based on clinical appropriateness. All referrals have to be based on an accurate and current risk assessment. Attempts will always be made to manage the individual in the least restrictive environment as far as it is practicable to do so.

PICU admission process The process for admission to the PICU is different from other units due to the needs of the service user so they will be greeted in a safe place and shown to the interview room. There will be an initial introduction and discussion to determine mental state needs and risks. A search of belongings and the person will be carried out and belongings will be placed in the designated bedroom. Valuables and prohibited items will be stored in the patient affairs/general office. Service users will see a doctor in the treatment room for physical assessment. There will be an introduction to the named nurse team and an opportunity to orientate self to unit. Staff will complete admission pathways and begin to compile information and a safety profile.

SECTION 136 SUITE The Section 136 Suite is a dedicated suite for the reception and assessment of service users bought to the Harbour under the auspices of Section 136 of the Mental Health Act. It is located adjacent to the PICUs allowing easy access to the north end of the street and the functional wards. There is a designated drop off point in this area, in addition to the PICU drop off zone, to enable access to male and female wards independently and will operate 24 hrs, seven days a week. The staff team are hosted by the PICU reporting to that units Matron and accountable to the Senior Matron. The role of the team will be to lead and manage clinical response to Section 136s presenting at the Harbour and when not required in the suite to provide additional support to other wards as and where it would further enhance patient care. It will operate within the remit of LCFT Section 136 Policy. It will work closely with the Mental Health Liaison Team. It will be a designated place of safety.

Main Entrance

The Street


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FACILITIES FLOWING FROM MAIN ENTRANCE AND THE ‘STREET’ The hospital is designed with a concourse/street of which there are a range of public facilities and non-clinical and clinical areas. This section details the public and nonclinical areas at or leading from the main entrance. A list of these is as follows:

Café

Run by the Richmond Fellowship as a social enterprise and offering apprenticeship and volunteering opportunities to service users and disabled people. Open from 08.00 to 20.00 hrs 7 days per week and offering a full range of drinks and snacks including a ‘homeward bound’ pack for service users being discharged (if requested/needed) and night staff meal pack.

Shop

Also run by the Richmond Fellowship and providing a newsagent function including sale of, magazines, toiletries, snacks and personal care goods, etc., typical of a small hospital shop. The shop will not sell any ‘over the counter’ medications (eg paracetamol or cough linctus) or tobacco products (including E cigarettes).

Patient Affairs /General Office

This area deals with administrative aspects of service user affairs including storage of cash and valuables. At specific times during the day service users can access their cash and the hospital’s petty cash service will be provided. There is a facility for 'out of hours' depositing of service user cash and valuables. Service user and petty cash monies for all clinical/departmental areas are centralised and managed by this office within the building in accordance with Trust Standing Financial Instructions, and supporting procedures.

Multi-use room

This space is large and adaptable enough for groups of service users /staff and others to be able to use it in a flexible way, either for a range of functions e.g.

Yoga

Meditation I relaxation classes

5 aside Football, Basketball & Badminton

Staff training i.e. MOVA

Fund raising events and small fayres. A multi-media system will also be installed in this room for both visual and audio capable of supporting presentations, video, television and cinema displays.

Fitness Room

Adjacent to the Multi-Use Room/Sports Hall will be a fitness suite. Access to general health facilities is recognised as being difficult for people with severe mental illness. The introduction of some medication has resulted in excessive weight gain in some service users. It is therefore an important part of their treatment programme that this is managed to prevent any deterioration in the physical wellbeing of service users. The benefits of exercise are recognised. Programmes of exercise will be facilitated by trained health and leisure co-ordinators/teachers or trainers who may be in-house specialist staff, or visiting therapists.


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Reflective Space This room will be open to allow free access to those who require it. This means that service users who have been risk assessed as being able to be in the hospital ‘street’ can use the facility as required. With appropriate facilities (including ablutions area) this room will be used for contemplation/prayer as required and will be accessible to all service users/staff and visitors regardless of faith. A Qibla indicator identifies the direction of prayer for specific faiths.

Family visiting facilities

Two family visiting rooms suitable for children are available close to main reception which staff can book via reception. Children visiting will take place on a pre-arranged basis as per Trust policy. Both rooms are bright, have toys available for smaller children, are furnished with comfortable seating and have an area where visitors and service users can make hot and cold drinks.

Mental Health Act Suite

The Mental Health Act suite will comprise of two meeting rooms and associated interview rooms for Mental Health Act Tribunals and associated meetings. This area also provides office accommodation for the Mental Health Act Administrator and support staff. The tribunal rooms are located adjacent to interview rooms so that solicitors and other professionals can have private conversations with their clients. Used primarily for tribunals and managers appeals, and also for general meetings and conferencing, these rooms are designed to accommodate up to a maximum of 16 people, seated at a boardroom style table.

ADMINISTRATION SUITE INCLUDING TRAINING FACILITIES The second floor of the building contains the administration suite including training facilities Entry to this area, located on the first floor is via stairs I lift from the reception concourse. This is a non--service user area. It consists of a:

Large open plan area

Suitable to be used by a range of staff who will embrace the 'Agile' and 'Anchor' principle of desk allocation. A 'hot desk 'provision is included for visiting staff of all disciplines.

Large meeting/training room

This room can be divided into two (with a flexible room divider) and is fitted at each end with wall mounted Digital Plasma Screens to enable laptops or other media devices to be used at both ends of the room if divided .A portable teleconferencing facility is also available.

Small Training Room Includes audio equipment and plasma screen.

Library (learning resource center)

With 8 computer and terminals and a core selection of standard texts.

Staff rest and changing facilities

Area including showers, lockers and toilet facilities.


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HOTEL SERVICES

Cleaning services Units will have their own dedicated domestic staff in order to maintain high standards of cleanliness within both clinical environments and other areas of the unit.

Laundry Servicers Linen is provided to and, once soiled, collected from clinical areas. Facilities for laundering service user’s personal belongings will be available on each ward

Catering Nutritionally balanced meals will be available (in addition to the Cafe) for service users, staff and visitors. For service users breakfast will be continental style with other meals provided on a 3 week menu cycle offering a minimum of four choices, changing regularly to avoid menu fatigue. The agreed standard menu will incorporate most common therapeutic diets, e.g. diabetic, soft, vegetarian options. In addition other specific diets, special occasions, ad hoc and emergency catering will also be provided. Each ward will have a small pantry with a toaster and microwave capable of providing drinks and snacks. Nursing staff will be responsible for assisting service users eating meals on the ward.

Meal times Breakfast will be available around 0800, lunch between 1200 and 1300 and the evening meal between 1700 and 1800.

Vending service These will be available 24 hours per days, 365 days per year and include

Hot drinks machine- coffee, tea, hot chocolate, soup

Chilled drinks

Snacks- crisps & confectionary

Portering services Portering services are provided and include

Delivering and removing meal trolleys, linen and waste,

Sorting and delivering stores, mail and pharmacy bags and

Moving furniture and equipment.

Window cleaning Both internal and external window cleaning will be carried out quarterly and managed by the Facilities Department

CCTV Parking, drop off and access areas are covered by the external CCTV as with other external areas. Sensitive areas adjacent to site e.g. children's nursery, private gardens will be protected from view by ensuring that physical shields are in place for any cameras that may be capable of observing the adjacent site. Coverage of the internal CCTV system includes all areas which service user access such as ward areas, receptions, main street corridor, courtyard areas and all entry/exit points to the building.


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ESTATES SERVICES All estates services are provided under contract and managed by our property services team. The contract is currently with Rydon Maintenance Ltd. This is a full Estate Management service including the maintenance of all buildings, associated plant and equipment, as well as all related professional and technical support and advice. The team is based at Guild Park supported by mobile skilled maintenance operatives, and specialist sub-contractors. The list of services provided by Rydon Maintenance Ltd includes:

Fire and security systems

Firefighting equipment

Lifts

Air conditioning equipment

Generators

CCTV

Lightning conductors

Compressors

Un-interruptible power supply systems;

Nurse call, cardiac and emergency alarm systems and equipment;

Specialist fridges and freezers;

Building Management System;

Water treatment plant (chloride dioxide, copper/silver ionization)

The Rydon Helpdesk (01772 866570) will be the primary interface between Trust staff and Rydon

Maintenance Ltd and provides a single contact number for all service requests, 24 hrs a day 365 days per year.

Energy Provision The Trust’s commitment to using low carbon technologies is reflected in the specification and implementation of a modern biomass fuelled boiler plant. This cuts CO2 dramatically compared to traditional fossil fuels. The Harbour will achieve a reduction in yearly carbon emissions of approximately 72%. The fuel is also sourced from a local supplier further minimizing the environmental impact.

Medical Gas/Oxygen Store A piped system of medical gases does not exist within this hospital. Medical gases for use in the various treatments will be provided by mobile bottles with regulators. These bottles will be stored in a secure naturally ventilated location adjacent to the Energy Centre and compliant with SMS guidance.

CAR PARKING Cycle, car and motor bike parking spaces are provided free of charge on the hospital site for visitors, service users and staff (including visiting professionals). There are 4 Ambulance drop off points identified, at the main entrance, north end of the hospital, main entrance, south end of the hospital, and the 136 suite I PICU area. Disabled car parking spaces, large enough to allow wheelchair users to access their vehicles are also available. This scheme includes a Section 136 facility which enables 24/7 access to the site, and is the out of hours access point. There are specific designated drop off points for the 136 suite and PICU to enable access to male and female wards independently.

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