(Jan 2024) Shared Mealtimes
“Do other services encourage/permit shared/communal dining at mealtimes where staff and service users can sit and eat together. If so, what are peoples experiences of this? What benefits have been observed from this? Has it presented any challenges?”
Yes we do – only those staff on enhanced obs cannot eat at the same time as the patient as they need to be supporting the patient. Cygnet Bierley
Yes we regularly eat together, both formally and informally. We prepare food for community meetings which everyone tries. We have themed months (chickpea month, veggie month), and star-rate the food on offer. Our ward is unusual as service-users can prepare their own food when they want. There is a set time the cook-chill arrives, but patients who self-cater can prepare their food when it is convenient for them. Staff will sit on main ward and eat food they have prepared at home, whilst chatting to patients who are eating at the time. It’s a good way to get to know each other and learn about different kinds of food in general. I can’t think of any negative points to this but will ask in today’s community meeting…. Asked everyone at our community meeting (patients and staff) about this issue. They couldn’t find any bad points, and when I kept encouraging people to see if they could think of any they started getting suspicious that we were going to stop everyone eating together. One of the patients turned around and stated, ‘don’t you want us to eat together anymore!!?’ The good points were: ‘it helps us get to know each other’ ‘if staff just stand and watch it feels rude’ ‘when staff and patients eat separately, then there are different rules, whereas when they eat together everyone has to respect the same rules’ (i.e. when and how cutlery are counted out, where you can eat). It encourages everyone to mark events together: Christmas, Easter meals, Summer Barbeques’. Clifton House
Yes our patients and staff do dine together at times, and this has been actively encouraged. It promotes discussion, modelling social norms and enhances observations at high-risk times. In the years this has taken place there has been no adverse impact. Stockton Hall
We do encourage this dining experience here at Forest Lodge as it tends to build rapport and relationship with patients, as well as allow patient to see staff doing an everyday activity where they have both got an equal say. There has been challenges in the past however we have designed a SOP to ensure that all staff are aware of the procedures. The SOP covers things like – how many staff can actually have a meal with patient as we cannot afford for every staff to have a meal on duty. Forest Lodge, Respondent 1
We previously had this arrangement when we did the positive dining experience CQUIN work. Issues with waste management and cost of providing extra meals for staff have been a challenge, alongside covid in recent years. We have tried to look at this again recently but not sure issues around costs and waste management have been resolved. Newton Lodge
It is always a positive experience for both staff and patients. We limit to only staff who are supervising the meals times, which has in the past raised complaints by staff who are not being provided a meal. Otherwise, no issues. Forest Lodge, Respondent 2
We enable staff to eat with patients at mealtimes by providing a therapeutic meal. Problems have arisen when staff expect something that is not on the menu but that is rare. We have a SOP for this if required. Forest Lodge, Respondent 3
At the moment we don’t have collective mealtime, but that is mostly because the hospital does not provide subsidised food for the staff members. When mealtimes were shared in the past I think it was more positive between staff and patients, but I can’t really recall any of the negatives of the situation (other than occasionally there were complaints that the food was not allocated fairly). The only challenge I can foresee from a risk perspective is that cutlery is accessed and therefore if there was tension between a patient and a member of staff this could be a ‘flash point’. From memory over the years, we had joint mealtimes (in both low and medium secure) there was only one serious incident within the dining room. Cheswold Park
(Jan 2024) Information Sharing
“Currently, due to the acuteness of the ward, we have had to remove notice boards on Cedar due to the risk. Please could you advise us on how other hospitals share information within the wards other than notice boards or if other hospitals have alternative boards which don’t pose as such a risk.”
We are currently trialling something new on the ward. We have a tablet with a USB loaded with all the relevant posters and information that loops round. We place this in the nursing office facing out so that everyone can see it. Cygnet Sheffield
We had a similar situation on Thornton several years ago and had to share information on the windows of offices, kitchen, and group rooms. These posters could not be damaged or taken as the rooms were either non-service user areas or were under constant supervision. Moorlands View
We have locked cases on some wards and also utilise displays behind office windows where not impeding site lines. Newton Lodge
Had a poorly patient on my ward, who tore down all my noticeboards. We just had to keep putting them back up until the patient recovered. Forest Lodge
Communicating / keeping patients up to date with ‘what’s going on’ ‘events’ ‘activities’ ‘changes’ etc within secure services is challenging. Notice boards are helpful in displaying information and there are ways of displaying information which minimises risks. Whether that’s using: Velcro tabs (opposed to pins), Chalk boards or white boards, Ward Information folder, Digital display screens. (We have display screens on several of our wards in Ridgeway which we upload information which rotates throughout the day). Roseberry Park
Not a quick or cheap solution but on our new acute wards we have Cowlin systems which are basically iPads in a secure case on the wall. They can be used for tv and music but also have the ability to upload information for patients that may have traditionally been on a notice board. North Lincs
(Jan 2024) Creative Therapies
“Humber inpatient secure (medium and low) are keen to know if other providers employ/use art therapy or other creative therapies. If so, what is their experience of these roles.”
At the Newsam centre we have a music therapist that visits once a week. His sessions are truly amazing and worthwhile, and our service users report to gain a lot from them! Newsam Centre
We don’t use art therapy, but we do have Music Therapy 2 days a week. Moorlands View, Respondent 1
Music therapy – low secure. Invaluable way of offering a way to express self in a non-verbal way. They are instrumental! Couldn’t help the pun hahah. Moorlands View, Respondent 2
Unfortunately not. An art therapist did work in the service many years ago but this post was part of a cost improvement programme and phased out. Newton Lodge
(Jan 2024) CCTV
“Do fellow secure providers have CCTV in seclusion, and if so, is it set to be just a live feed, or can the feed be set to record and how is CCTV used in other areas of secure care? Is it in communal areas? Live Stream/Recording?”
We have CCTV in communal areas in our medium and low secure service. It is recorded but not monitored and we have viewed footage to help with understanding of incidents etc. It is not currently in use in seclusion rooms, and we have a trust group looking at this at the moment as it has been suggested to enhance observations though not to replace observation and engagement, particularly when you have service users who block windows with the mattress impeding view and safety monitoring. It is planned that it will be live feed I believe. It does bring with it lots of considerations with GDPR and processes for requests to view footage needing strong governance. Newton Lodge
We have a live CCTV feed in out seclusion room, which cannot be set to record. For obvious reasons it is not in the en-suite area of the room. The feed can only be viewed from our seclusion observation room and nowhere else on the ward. The purpose is to give observing staff full view of the room. We have CCTV covering all communal areas of the ward. Again, for obvious reasons not in bathrooms, toilets, clinic rooms, bedrooms etc. The footage is recorded for 28 days before being automatically being erased. We have SOPS and Policies, which governs who has access to the system and how we share footage with external agencies, such as the police. We have signs making staff, patients, and visitors aware that we have CCTV. Also, in our admission pack we provide information to our patients about our CCTV system. Forest Lodge, Respondent 1
We have recording CCTV throughout the ward but not in private areas which includes the seclusion room. We have live feed there which is not stored. Forest Lodge, Respondent 2
(June 2023) E-cigarettes
‘Do other hospitals in the area have E-cigarettes. If so, how are they managed on the wards/in the hospital. If not, what has been the justification for not allowing E-cigarettes?’
Yes we do- there are charging stations in the nursing offices, all items are dispensed and then retrieved. On the acute ward someone is allocated to this, on the rehab ward there is more personal responsibility given to the chaps to comply with the rules and someone spot checks. They use little carry baskets to divide them up and label so can always be accounted for. You can’t use them inside- must be used in internal courtyards. Moorlands View
In Sheffield had someone have safety e-cigs which they tested not just one they got from a shop. They could only use then in their bedrooms and in the courtyard. We did find that the E-Cigs did not last long and were expensive for them. Patients were not going out on leave much and would be asking for money of other patient to buy then which led to a lot of safeguarding and they had to limit the amount they could buy in one day. We then had a patient who swallowed one and had to have surgery to remove it at it was really dangerous for them and it has a lithium battery in it. They are good for people who would not be at risk of swallowing, and they don’t have any leave. Cygnet
We do use E-cigarettes here at Forest Lodge Hospital. This is managed however by booking in and out by staff. On the Rehabilitation ward these are booked into the office for charging overnight and can be signed out in the morning by patients. This is kept on their person until the night again. Patients are aware and have agreed that these can be smoked in the courtyard and not on the ward/in bedrooms. On the Assessment ward it is a bit different as these are signed in and out as and when patients need to use them, and again are used in the courtyard. Hope this helps, we have been doing this now since Covid, and is managed really well. Forest Lodge
We have ecigs in our hospital. An approved brand was chosen, being single use non re chargeable. We have had these for a number of years now. They are purchased within the hospital and stored by staff. Signed out using the serial number on them to service users. The product is not without management issue. Being used inappropriately, swapped with others and traded causing safeguarding concern etc. It is expected that if ecigs are being used, other forms of nicotine replacement are not prescribed concurrently. The product is meant to be equivalent to 30 cigs. Our procedure indicates only one per day. This also causes conflict at times. The brand is not popular with service users, and we have asked if we can explore other products given the massive expansion of this market. No progress with this so far! Newton Lodge
We have recently been through a trail of allowing patients to use e-cigs at Stockton hall. We had a vending machine placed near to our entrance, patients were then escorted to and from the machine at allocated times during the day. Patients were allowed to have a maximum of 2 e-cigs per day and had to hand one in to get the next one. They were allowed to use them in their bedrooms and outside ward garden. During the trial, we had a number of issues ranging from – an increase in trading, patients who had not used nicotine before started using them, the cost, patients were spending up to £12 per day to buy them, including complaints from family members about the cost and how much their family members were spending, increase in confrontational situations between staff and patients around e-cigs, the amount of staff time needed to facilitate trips to the vending machine. We had a review after about 18 months and decided to stop the trial and remove the machine and become a nicotine free hospital (again). Initially we had some resistance from patients but on the whole patients have said that they are glad we removed the vending machine. Stockton Hall
We do allow vaping at Amber; we have a policy where if they want to vape, they have to purchase one of 3 risk assessed models at our local vape shop and they can only use liquid purchased from there. They cannot vape inside the building so they must use, or compound and outdoor spaces and they are not allowed to charge their devices in their room instead they hand them in to the nursing office where staff put them on charge to prevent any overheating. Amber Lodge