An independent external quality assurance review (published 20 December 2018) can be viewed here.

The formulation of HCR20 risk assessments in the secure services should be aligned to best practice these principles and there should be a quality assurance structure to audit the quality of risk formulations and management plans and ensure they are in line with HCR-20 Version 3 Guide.

The planning of victim safety in partnership with individuals concerned, especially where this involves a family member or partner, must form part of the core risk assessment and treatment planning. On-going contact with family members or partners must form part of the core risk assessment and care planning by the care co-ordinator

Where there is a question of responsibility for the welfare of the child, specific focussed risk assessments must be conducted in partnership with children’s agencies and other statutory agencies with respect to assessing and managing any potential risk towards the child.

There should be a robust risk assessment of lone workers in the community, including any pregnant staff and risk management plans applied.

There should be a programme of training for Section 12 doctors and AMHPs on risk assessment in forensic patients focusing on both the nature and degree of mental disorder.

There should be a trust wide policy on prescribing high dose antipsychotic medication which includes standards for auditing which should be in line with the Royal College of Psychiatrists guidelines.

An audit of the usage of depot medication in the Secure Division should be carried out and anomalies addressed.

NHS Liverpool Clinical Commissioning Group and the Trust should ensure that there is a joint approach to physical health checks, and information sharing between GPs & mental health services.

The Trust should audit compliance with NICE guidelines CG178: Psychosis and schizophrenia in adults: prevention and management, with the Secure Division and implement findings.

The Trust should provide quality performance information on services that consistently appear in the top five or other agreed quantity of quality indicators for two or more quality indicators to systematise the triangulation of performance information.

The Trust should ensure that care plans for patients with schizophrenia who are assessed as at risk of harming family members incorporate learning from the evidence on parricide.