Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

State Hospitals Board for Scotland

Initial thoughts

The State Hospital's function working with mentally disordered offenders is specific, but many of the physical as well as mental health issues related to geographical health boards are relevant to the State Hospital and Realistic Medicine is an important document in considering the future for care of patients in the State Hospital.

What have we done so far?

The Forensic Network has been crucial in improving the care of patients within Forensic services. The network was built on research that pre-dated Realistic Medicine but echoes its themes.

At present, all patients in the State Hospital are invited to attend their Care Programme Approach review alongside an advocate - with the aim of sharing the decision making process with patients and their carers as far as possible.

Monitoring variation in practice is also a core part of ongoing work. An annual census was established in 2013 to gather information about all forensic inpatients across Scotland. This was developed into a Network database, thereby allowing units to access their own data and compare reports with different areas. Every new patient coming into the system will now be logged into the database. Units will be able to see their own patient data and the national host will be able to see all data. This will go live in early 2017 with catch-up work to collect data on all patients.

The most recent Forensic Network annual report describes improvement work in depth. An integration group with joint guidance has been developed and a matrix to allow spread implemented. Guidance from Healthcare Improvement Scotland has been sought in the area of Quality Improvement, and this has resulted in self-generated improvement plans. A conference was then held looking at new improvement ideas and a further Quality Improvement cycle is underway.

Education is also important given the nature of the work in the State Hospital: staff must be able to work on a multidisciplinary basis and a Scotland-Wide training scheme in Forensic Psychiatry has been created to foster these links, hosted by the State Hospital. This enhances clinicans' ability to provide truly individual care.

What next?

The annual census is important to continue developing. This means that shared learning about issues such as length of stay and risk management can go ahead. As mentioned, the patient database will be key in allowing this work.

A joint referral and admission criteria is being developed: this will provide a structure that allows variation at the point of admission to be researched and addressed.

Final thoughts

The State Hospitals Board for Scotland is closely interlinked with the Forensic Network, and this provides a mechanism though which to tackle issues and to communicate. It also helps remove territorial barriers with an emphasis on improving care through networking and education with a person-centred focus.

The State Hospital: Structure of the Forensic Network in Scotland.