Independent investigation: Rosalind McManus, Birch Hill H, Rochdale, Lancs (2007)

The Trust should review the emergency out of hours procedures and protocols and make formal written arrangements with each of the „blue light‟ services.

The Trust should remove the old nursing station and provide a seating area for patients and staff.

The Trust should commission and develop a multi-disciplinary (MDT) and clinical skills programme specifically designed to focus on the complexity of cases with: asylum seeker status; Post Traumatic Stress Disorder in terms of assessment, diagnosis, formulation, care and treatment.

The Trust should continue implementing New Ways of Working (NWW) in all acute wards to ensure an effective full daily multidisciplinary team (MDT) review of all patients‟ care and treatment. In order to achieve this the MDT will also need to: be subject to a full skill mix review which is undertaken in conjunction with commissioning bodies; consider how best to deliver a comprehensive range of evidence-based care and treatments in line with the National Institute for Health and Clinical Excellence (NICE) Guidance. This to include the challenges of incorporating a wider skill mix to comprise occupational and psychological therapy.

The Trust should ensure that the MDT review encourages collaborative decision making whilst maintaining clear lines of accountability and responsibility for both the overall care and treatment plan and the individual elements of it.

The Trust should ensure the implementation of the electronic care record supports and enhances MDT working.

The Trust review should examine the effectiveness of the MDT process six months post implementation/following the publication of this report, whichever occurs first.

The Trust should consider making the distinction between Voluntary and Informal patients on admission documentation. This to include: policy revision and documentation revision as required; the requirement for the assessment and documentation of capacity of all service users on admission who are not admitted under detention.

The Trust should implement the recommendations and action plan of the CPA steering group and re audit compliance 12 months following its implementation/ or the publication of this report, whichever comes first. This review should: ensure that service users who are previously unknown to the service and make their first contact via an inpatient admission receive CPA as required in a timely manner; ensure that assessments are holistic and address needs that are both social and cultural; ensure that care planning is patient-centred and involves the service user as much as possible.

The Trust should extend the terms of reference of the CPA steering group to include processes relating to the new Trust Approved Risk Assessment (TARA) and the new Trust-wide Pennine Assessment Document (PAD). This to include: a restating of the clinical roles and responsibilities of all clinical staff, both individually, and as a part of the MDT, to take part in risk assessment. This to include the requirement of the utilisation of formal Trust documentation; an audit to establish both the compliance to and the quality of risk assessment processes.

The Trust should provide training to highlight the importance, during assessment, diagnosis and treatment, of the patient‟s cultural background. This to include the requirement for: a secondary literature review to be conducted if required; specialist referral if required.

The Trust should develop a system to provide the clinical team with access to any required cultural information and external support agencies. The Trust should: develop community outreach and inreach initiatives with the local community in order to establish culturally appropriate liaison; ensure appropriate links are made with different faith groups to ensure that the chaplaincy service represents the needs of service users; provide literature and advice notes in a range of appropriate languages; arrange more timely interpreter access.

The Trust should consider rolling out the Productive Ward and STAR Wards initiative to all other inpatient units within the Trust.

The Trust should audit the effectiveness of the new electronic record system on a random sampling basis at six monthly intervals for the first year of running and on an annual basis thereafter.

The Trust should ensure that policies and procedures are developed with: the „blue light services‟ and that arrangements are formally agreed with them; and that the revised policies and procedures are incorporated into all statutory training events; and protocols to support emergency actions are produced on a simple A4 format and placed in an easily accessible place in each clinical area.

The Trust should ensure that all Trust employees are aware of the requirement to take part in clinical supervision. This requirement should be made explicit and compliance should also be audited on a regular basis.