AIMING FOR EXCELLENCE Janet Snell meets staff and patients at a mental health unit that has been transformed


North London’s Chase Farm mental health unit experienced a devastating setback in 2008 when a fire started by disaffected patients caused damage costing millions of pounds. In the five years since that low point, staff have managed to transform the unit. Just as the damaged building was restored, staff repaired relationships with patients and introduced a range of improvements, turning negative reports from the Care Quality Commission (CQC) into positive ones. In December last year, during a visit to the unit, RCN general secretary Peter Carter declared: ‘I visit many mental health facilities and some are grim. But this place feels good. It really is impressive.’ The unit has signed up to Nursing Standard’s Care campaign, which promotes the fundamentals of good care. Staff believe that focusing on the essential elements of care, particularly communication and being more responsive to what patients say, has been the Staff at Chase Farm mental health unit in north London have improved the service they provide by focusing on essential elements of care, particularly communication with patients. Director of nursing Mary Sexton put staff development at the heart of her transformation plan, ensuring they know what is expected from them and celebrating their achievements.

foundation for a wider cultural change at the unit. Ward manager Ben Mensah says: ‘We work hard to make sure the relationship between nurses and patients is good and a lot of that is about listening. Patients told us they like to keep busy. Often mental health inpatients do not have much to do in the evenings or weekends, so we make sure there is a programme of activities. ‘For example, our low secure unit staff take people bowling or to the cinema, or even on a day trip to the seaside. Mr Mensah says it is important to show patients you care about them. ‘I tend to stick around after work for a game

of badminton or whatever. I do it because I enjoy it – I like spending time with the patients and I think they can feel that.’

Best practice

Director of nursing, quality and governance Mary Sexton, who moved from an acute general background to run the mental health unit in December 2011, says staff development was at the heart of her transformation plan. ‘It is about trying to clone the best people, iron out inconsistency and make sure good practice is spread across the hospital and not just confined to some areas.’ Ms Sexton says that her general nursing background

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to a general hospital. The main difference is that a lot of patients build long-term relationships with us, and this is why good communication is so vital.’ Shortly after Ms Sexton arrived, the CQC published a report on the trust, which gave her a to-do list of issues she needed to prioritise. It highlighted problems about the quality of record-keeping, medication management, use of seclusion and the lack of activities on some of the wards, and said the quality of food could be improved.

Finding their voice

Chase Farm service user David Hickey (left) with ward manager Darren Savarimuthu

The Care campaign challenge The Care Campaign is a joint initiative between Nursing Standard and the Patients Association. Chase Farm has succeeded in meeting the campaign aim on communication. ✔ Communicate with compassion Assist with toileting, ensuring dignity Relieve pain effectively Encourage adequate nutrition meant she came in ‘with very different eyes’. ‘I could ask questions like: “Why is it done like that?” Mental health is different from other specialties and is often misunderstood. It is not as different as people think. ‘There is a big physical health element that is similar

‘I began by visiting all the areas in the unit to get a sense of what they felt like. I asked the ward managers what kept them awake at night.’ This ranged from concern about patients with complex needs to incidents of violence and aggression and the effects of this on staff and other service users. ‘I asked them what they wanted from me. My focus was “how can I make the voice of the ward leader heard?”’ Initially some staff were reticent, gradually coming on board as Ms Sexton worked with them in teams, developing their practice and ensuring they understood the CQC regulations and what was expected of the unit. ‘I appreciate that we expect a lot of our staff. We try to pick out talent, nurture it and enable people to be the best they can be. ‘Working in mental health is difficult so whenever we can we try and celebrate nursing. That is why I was so pleased that Peter Carter came to visit. It shows staff that they are having an impact and their contribution, day in-day out, is being recognised. ‘We can always do better or do more – of course we can. But the challenge is to maintain momentum and continue to motivate and develop staff. That is what we have been trying to do – working with our clinical

leaders. I am proud of what we have achieved here.’ Patients at Chase Farm, speaking anonymously, comment on the ‘friendly atmosphere’ in the unit and ‘the little things that make a difference’, such as the ward manager spending time with them. ‘You can build up a relationship with staff here,’ says one. Another patient makes a particularly telling observation that suggests the unit is succeeding in one of its core principles of care (see below), by providing hope. ‘It feels like a place where you can move forward,’ says the patient. ‘You don’t feel you are going to be stuck here forever’ NS

A model for positive, compassionate care Chase Farm mental health unit bases its approach to care on the principles of easing distress, providing hope and restoring function. Its end of life care practice illustrates this. In one example, the ward manager co-ordinated the care of a terminally ill forensic patient, spending extra time with them to ensure their individual needs were met and the family fully involved. Forensic staff who had not nursed a terminally ill person before were given extra support. Spiritual needs are respected. If a patient is identified as having particular spiritual needs, his or her care plan will include offering protected time to meet these needs, for example providing a priest or rabbi, and ensuring the patient has opportunities to pray. During Passover this year the dietitian accompanied a Jewish patient to a kosher supermarket to buy Passover food. The food was included in the individual’s diet plan and kept separately from other patients’ food.

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Aiming for excellence.

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