Quality and Excellence in Specialist Dementia Care (QESDC): baseline one-off self-assessment tool and reporting arrangements

Outcome 1. Legal matters and safeguards

Promote a culture that ensures that staff language and behaviours are respectful, enhance dignity and promote zero tolerance of derogatory and discriminatory language and behaviours. Promote a culture that all staff understand and apply principles, practices and values of human-rights-based care and treatment in line with the Charter of Rights, including issues of consent and capacity.

The NHS boards demonstrate a strong understanding of their legal responsibilities, with evidence across boards of activity to align and comply with legal safeguards. Several describe measures taken in relation to the certificate of incapacity under Section 47 of the Adults with Incapacity (Scotland) Act 2000. NHS Grampian, for instance, carried out an audit at the Royal Cornhill Hospital in May 2014 which indicated that 98% of patients had valid Section 47 Certificates. The audit highlighted, however, that while 95% had accompanying treatment plans, only 54% of the plans covered all prescribed treatments. An improvement plan was consequently developed and a second audit planned for 2015.

All patients in NHS Lothian have a Section 47 in place with an appropriate treatment plan, a finding that was commented on by the Mental Welfare Commission. The Mental Welfare Commission also commented on the high Section 47 compliance with appropriate treatment plans in place for patients being cared for in the elderly mental health service in NHS Ayrshire & Arran.

NHS Lanarkshire carried out mock inspections in 2014 that evidenced good compliance with Section 47 and Part 5 of the Mental Health (Care and Treatment) (Scotland) Act 2003. Treatment plans were completed where appropriate and family members were included in the process of care-planning.

Advocacy is a recurrent theme in the survey returns, with boards taking measures to ensure patients and relatives have information about local services available to them. In NHS Western Isles, a generic advocacy service is available locally and the ward information leaflet is being updated to reflect the availability of this service, while staff in NHS Forth Valley can access independent advocacy services for patients in their care, downloading patient-information leaflets from the board intranet. Independent advocates have visited wards in NHS Lothian to keep staff informed about their services.

NHS Lanarkshire has developed and implemented a training programme for adult support and protection and the Mental Health (Care and Treatment) (Scotland) Act 2003 across services, involving both face-to-face and LearnPro activity. Staff in NHS Lothian have opportunities to access LearnPro modules on issues such as public protection, capacity and consent, and adult support and protection. Training sessions on the Adults with Incapacity (Scotland) Act 2000 were available for staff in NHS Forth Valley during 2014; the need for further training has been identified as a priority, particularly in relation to medical staff induction programmes and nursing staff updates.

The pattern regarding locked-door policies appears mixed. Locked-door procedures are in place for all wards in NHS Fife and in NHS Grampian, for example, with information displayed clearly on ward doors where necessary, but NHS Dumfries & Galloway has no locked-door policy.