Wednesday, 31 December 2014

design of new £3m IPCU at Stratheden Hospital - what about the £1.4m? Are any experts by experience involved? Update

[Update to original blog post about new-build IPCU]

from Fife Herald 26 December 2014

Email response to my questions about £1.4m and patient/carer involvement in design plans, from Dr Brian Montgomery, Interim Chief Executive, NHS Fife, on 30 December 2014, my responding Email follows:

"Dear Mrs Muirhead

Thank you for your enquiry.

The total funding associated with the IPCU has not changed and remains at £4.4 million,  However there is more than one element to it and it is also being phased over more than one financial year.

I can confirm that service users including patients in IPCU and the low secure unit were involved in the early stages of the design.  The Board has now enlisted the assistance of Circle network to identify previous service users to work with us on the next stage.

Artist drawings were on display in the staff dining room for a period of time.  More detailed floor plans have been drawn up and will be considered when the Project Board meets in January.

Once the business case is approved there will be public engagement sessions.

Brian Montgomery"

My response in an Email, this morning, 31 December 2014:

Subject line: Re: what about the other £1.4million? I am still none the wiser. Staff centred services, no surprise there then. Hierarchical shenanigans and uncivil servants.

"Dear Dr Montgomery

Thanks for your response re the £1.4m enquiry and the question about meaningful involvement of experts by experience in the new build IPCU designs.

I am still none the wiser, regarding the £1.4million and what it is to be used for.  "more than one element" and "phased over more than one financial year" doesn't tell me, or any other non-NHS Fife health board folk, what is happening.  I would have appreciated some detail rather than what appears to be a fobbing-off reply.  As if you and the board are not going to tell a carer, activist and campaigner in Fife what is really going on. 

It's disappointing but not surprising.  I've sat through a number of health board meetings now and know the score.  Graphs and statistics that do their best to obscure the facts except when a point is being made.  Handpicked patient stories to praise services or government/parliament initiatives.

As for the "involvement" of patients and carers, I see none of the latter and the former doesn't appear to be either meaningful or rigorous in its execution.  As usual it's staff at the centre. getting the drawings on display for "a period of time".  Staff-centred services at Stratheden Hospital, what I have been used to, over the years since 1995/6 when my oldest son was an inpatient of Lomond Ward, was injured, had a critical incident with ECT, rushed to Ninewells, and I had to make complaints.  What's new?

"public engagement sessions" are not the same as consultations (mind you, to be honest, the government consultations haven't been the best use of my time, the civil/uncivil servants just write their own stuff anyway).  It sounds like asking for approval after the gate has shut, the horse has bolted.  Please do correct me if I'm wrong?  I speak as a community development worker of over 30 years. 

Where I was involved in setting up grassroots community projects (not mental health specific), involving stakeholders from the offset, empowering individuals and being empowered.  Working in partnership with statutory agencies, in South Lanarkshire, throughout the 1980's.  But things were different on coming to NE Fife in 1990.  It has to be said.  Like stepping back in time.  Since 1990 I've worked in paid posts (not mental health specific) in Fife and in Perth, the latter was more like the Lanarkshire experience.  More level playing fields and multi-disciplinary working. 

However since 2008 and setting up Peer Support Fife it soon became very clear to me that Fife mental health services were a top-down affair with little if any meaningful involvement of the real experts by experience.  The national situation wasn't and isn't that much better.  Hierarchical shenanigans, tokenistic involvement and cronyism abounding.  You can only climb the ladder of success if you tell them what they want to hear and keep quiet about your real opinions.  Otherwise exclusion.

I will put your response and mine into a blog post for others to see, 

Yours sincerely"


13 December 2014
I just came upon this information about the new IPCU planned for Stratheden Hospital, by chance when searching the internet:

"NHS Fife - Stratheden IPCU, Cupar

As part of the Graham Construction PSCP team under the HFS Framework Scotland 2 we are undertaking the design of a new £3m Intensive Psychiatric Care Unit for NHS Fife at Stratheden Hospital in Cupar. Construction works are scheduled to start on site in early Spring 2015."

So I have sent an Email to the NHS Fife Chief Executive Dr Brian Montgomery, saying:

"Can you please let me know where I can view the plans for this development?  I would like to be informed, particularly considering my activism in this area.  I am sure that others will also be interested.

I would like to know if any patients, carers, service users, people with experience of psychiatric settings from the customer perspective, have been involved in the design and planning process?  I haven't heard anything on the grapevine or from colleagues. 

I do hope that people like me are having a say from the beginning.  That our voices and experience are being recognised and respected.  I think it makes sense to invite us in rather than have us only spectating on the sidelines.  After all, we are the ones who may be having to engage with the service, support our family members who may find themselves detained in the IPCU.

I will put this link on my Stratheden Hospital blog in the expectation of hearing more from you .."

[the original amount promised by Scottish Government was reported as £4.4million so I have sent another Email asking "what about the other £1.4m?", what is it being used for?  Eg Lomond Ward which is in need of restructuring, internally, so that female patients are not sleeping in dormitory accommodation overlooked by male patients in single rooms down the same corridor.]

Saturday, 27 December 2014

'New psychiatric unit under way' Fife Herald, 26 December 2014

Just read this article in the Fife Herald, 26 December 2014: 'New psychiatric unit under way':

It says "The design and construction of the new IPCU has been strongly influenced by patients and staff across Fife".  My comment?  Well that's news to me as neither I nor my son were asked for our views on the new build unit.

There is no mention of money although I had read on the architect website that it was to cost £3 million and not the £4.4m as promised previously.  See my blog post about this.  I'm still waiting for a response from NHS Fife senior managers about this although my MSP Roderick Campbell has responded in an Email, saying he notes my request.

I read that Mary Porter, NHS Fife General Manager, says "Improving mental health facilities is a key priority" which I am glad to hear and I hope that this includes Lomond Ward, Stratheden, where the female dormitory beds are overlooked by single rooms which in the past had male patients in them.  Very risky if no nurses around to keep an eye on behaviours.

Ms Porter also talks about ensuring "our patients can receive high quality care in a modern, safe, secure and therapeutic environment".  My response to this comment?  The feedback from all patients and carers will tell us if psychiatric services in Fife are safe, secure and therapeutic.  

Just because NHS Fife senior managers say all is well does not mean that all is well, mental health service wise.  I've learned this to my cost and that of my family, over the years.  I am looking for evidence of good practice and Mental Health Act safeguards that are safe.  

I've been picking up the pieces for nearly 3 years.  On £61/week Carers Allowance with no other support from statutory agencies.  Instead there have been attempts made to lay the blame at my door for system failure and buildings unfit for purpose.  It's disgraceful when you think of the work I've done with Peer Support Fife and before that as a community worker in various settings, in Fife.

[I'll be sending this blog post to NHS Fife mental health managers for some holiday reading and to rattle cages]

Saturday, 20 December 2014

my experiences of OT in Stratheden, Fife, compared to Carseview, Dundee, and in the communities

"STRICTLY STAFF ONLY PLEASE" toilet Ceres Centre, Stratheden Hospital (taken Dec12)

I remember meeting with the head of OT for mental health (AHP Clinical Services Manager) in Stratheden Hospital, Ceres Centre (patients' cafe here), where she was based, late 2010 think it was.  I was unhappy about the lack of OT group activities in Lomond Ward when my son was a patient that summer.  I'd also asked for a meeting with the head of psychology (Head of Service, Clinical Psychology), for the same reason.  

I had witnessed there being no therapeutic activities in the wards for patients who were detained or restricted and thought this was detrimental to recovery and to the wellbeing of patients.  I'd noticed patients pacing in the wards, up and down, and going round in circles even.  Nothing to do.  Aimless and restless due to the medication/drugs. 

As a community education worker group work was central to what we did to empower and encourage learning in communities, of children, young people and adults.  From 1980 I'd been involved in grassroots initiatives, being part of groups, helping set them up and also leading from the front.  In 1998 I gained a postgraduate qualification to back up my work experience.

Therefore when I met with the OT head it was from a knowledge that groupwork was of real benefit.  However during the meeting of 2 hours and more I met with resistance from the offset.  There was no shifting her stance.  My words fell on deaf ears.  

In February 2012 my son became an inpatient of the Stratheden IPCU where the ward situation was dire.  An activity room locked for long periods, only getting pens to write with if two nurses were available to oversee.  Where were the OTs?  I saw one of them at the clinical meeting on occasion but never saw any working with patients. 

Then in late December 2012 another son of mine became an inpatient of the Carseview IPCU, then the open ward and eventually into the community, using day services.  I witnessed OT groupwork in a variety of situations, in the wards and in the community.  This is what I'd been looking for in Stratheden but didn't find.

In the Carseview IPCU there was an art group held regularly by an OT and I noticed this happening on one occasion when visiting, my son being part of the activity.  I saw the conversations and sharing of information, relationships formed and the art work was a bonus.  

There was a greenhouse out in the Carseview IPCU patio where a volunteer, a retired gentleman, planted out seedlings and patients occasionally helped while others smoked and observed from a distance.  Once a patient was allowed out of the ward they could join a horticultural group in the building, and my son did this although not a gardener in "real" life.  The main benefit to him and others, so I heard, was the human interaction.

The OTs were involved in helping patients to budget, to plan meals, to prepare for discharge, and sometimes went on buses down town with them so as to help build confidence and/or to find out information.  The engagement with patients and planning of activities was done in the ward.  

Unlike in Stratheden where appointments were made in the ward, to go to the Ceres Centre, and often the patients didn't turn up on the day because they didn't feel like it or weren't well enough.  I witnessed this happening and thought it wasn't a good use of time.  On occasion I tried to contact OTs at Stratheden but when I phoned the OT office was told that there was no diary for OTs so no-one appeared to know where any of them were.  Nice job if you can get it was my thought.  A service run for the staff.

My son has been using the Dundonald Centre services in Dundee since discharge from Carseview where there are a range of activities going on, by OTs and nurses who work together therapeutically with the people who use services.  Again there are volunteers involved in leading eg a weekly art group in the Centre.  The programme is flexible and adaptable.  Service users are able to join groups, to play pool, to get themselves a tea or coffee.  I've visited on occasion and the atmosphere is non-clinical even although nurse managed.

It hasn't been like this in Stratheden or in Weston Day Hospital, the latter of which lost the OT input a number of years back.  Not sure why.  It seemed that the OT strategy in NE Fife was to withdraw from involvement in clinical settings and to concentrate more on one-to-one work with patients, occasional groups in the community and management tasks.  This has been detrimental to patients and service users.

However it's been my experience that in Fife psychiatric services any negative or critical feedback from carers, patients or service users is met with defensive attacks and a refusal to engage further.  They do not listen to the voices of experience and have been allowed to do what they like in and with their service, and not be accountable.  Great job if you can get it.

This is what was going on in the Stratheden IPCU in February 2012, I contend.  They had been getting away with it for years.  Using a locked seclusion room with no toilet or drinking water.  Leaving patients locked in for hours at a time, unobserved.  Locking other rooms in the ward, not allowing patients in to their bedrooms through the day so they had to lie down wherever they could find a space eg the corridor in my son's case.

I believe that the OTs were taken out of the Stratheden wards because of the dire state of affairs going on there.  Abandon ship.  Rather than stay onboard and try to sort out the problem, repair the holes, get everything shipshape.  Leaving the patients to suffer for it.  And the carers.  Well it's just not good enough, in my opinion. 

The failures in the wards at Stratheden Hospital are the responsibility of all the staff working there.  It's a corporate affair and you can't just turn a blind eye to human rights abuses, saying it's nothing to do with me.  Yes it is if you're on the payroll.  If patients are not being allowed pens to write with in the Stratheden IPCU, no freedom of expression, then the OTs and others who attend clinical meetings in the IPCU are witnesses and involved.

I will be sending this blog post, as usual, to the senior mental health managers employed by NHS Fife and based at Stratheden Hospital and to the heads of OT and clinical psychology, for their information.  If I receive any responses I will publish them.  So far I have had no response.  I would prefer a dialogue or a debate but I have no power to make this happen.