To be continued

The Star Wards blog is now part of the main Star Wards site. For Marion’s latest musings, the latest news, from Star Wards and many other Star Wards resources go to:

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Hallam Street Hospital, gazebos, hugging and more

Had a wonderful visit to Hallam Street Hospital in West Bromwich, thanks to the fab ward manager of Friar House, Lisa McGowan. Although I was dazzled by the ultra-impressive activities patients can do in the computer room and recording studio (!!), the strongest impression came from staff attitudes. Us patients are a reasonable bunch, and when asked what we want from our time in hospital, top of the list is to be able to talk with empathetic staff. Look no further than Friar House! Lisa’s palpable commitment to and warmth with patients provides the best possible role-modelling. One aspect that particularly interested me is that Lisa encourages staff to have (appropriate!) physical contact with patients. Amidst what a modern matron I hugely respect refers to as ‘risk mania’, it is very common for staff to avoid touching patients. This is compounded on (the happily reducing number of) wards which have a quaintly old-fashioned culture of ‘observing’ rather than ‘engaging with’ patients.

But go to Friar House and if you’re upset, a member of staff will put their arms around you, if that’s what you want and need. So huiman. So comforting. So boundary-blurring – which makes it riskier for staff but even more reassuring for patients.

When you need more than a hug, and only a ciggy will do, you’re likely to be exiled to the garden, and will definitely be from next July. You won’t particularly appreciate the severe, ugly ‘protection’ of the bus-shelter excuse for a smoking refuge, looking something like this:
http://www.wivenhoe.gov.uk/WTC/2005/BusShelter2.JPG
How much nicer to have a piece of furniture which is not only a pleasant environment for smokers to enjoy our addiction, but one that also enhances the look and feel of the garden for everyone. Friar House has an elegant structure something like:

http://www.summergardenbuildings.co.uk/showprod.php?ref=GARDEN-GAZEBOS-802126&ptx=GAZEBOS-PERGOLAS

The perfect place to have a fag and a comforting hug.

Translation for non-English speaking patients

Lisa McGowan at Hallam Street Hospital, Sandwell, is the sort of ward manager that every patient would like. Very warm, personable, committed, focused on what patients need, and also great with staff. I arrived in the middle of a fairly ‘average’ struggle to get the next shift covered, Lisa doing some nifty negotiations with her colleagues. What was particularly impressive was that she maintained her good-humour and didn’t resort to strong arm tactics. But above all, when she explained to me that the extra staffing was needed because two patients were in a very bad state, she explained this in terms of how unfortunate it was for the two men to be in such a bad way. Nothing about the inconvenience, risk to staff etc. A truly caring professional!

Patients at Hallam Street have access to a computer suite, which includes a keyboard machine. The multi-talented instructor, Graham, demonstrated just how amazing a keyboard rigged-up to a computer can be. He played and recorded a tune in piano mode, and then a harmony in flute, one on guitar and finally the string accompaniment. A couple of clicks and there was a full orchestral version of the tune.

To reach the title of this blog…. Graham then showed me something which could be revolutionary for wards who have patients who don’t speak English, and who have reasonable literacy in their mother tongue. You can get software which translates text into different languages! Obviously not The Answer to being able to communicate with all patients, but definitely something worth considering, especially when an interpreter isn’t available, or for particularly important documents like CPA stuff or medication leaflets.
Here’s one software product. Small print/disclaimer: I’ve no idea how good it is, but it will give you an idea about what I’m on about.

http://www.babylon.com/display.php?id=14&tree=3&level=2

Wotton Lawn Hospital

A visit to another amazing hospital. It can be done! And interestingly, not only by wards that take on an overarching model like Refocusing or the Tidal Model. There’s a short piece about Wotton Lawn Hospital in an earlier blog (sports therapists). But it was pretty mind-blowing visiting and finding out in more detail the extraordinary range and quality of services they provide.

Wotton Lawn Hospital is in Gloucester and I was very fortunate to be able to spend the afternoon seeing some of its work, thanks to the Matron Manager (or the Matron formerly known as Modern), Alan Metherall. The afternoon began in a representatively impressive way, with 7 healthcare assistants giving a presentation about the training they’d recently completed and being awarded their certificates. Any training for this much neglected professional group is to be welcomed, but especially one with the depth and values of the Gloucester training. As well as the valuable content (ranging from ethics, gender issues and recovery  models to the Mental Health Act and de-escalation), the training process is impressive. It includes structured, supportive training sessions, mentoring, observation of work practice, written assignments, discussion and projects.

A member of staff said that the training made him feel “more confident and more involved, and more aware of different situations.”

It’s true, and important to note and advocate, that the hospital has the benefit of some great facilities, including a large gym, physio room, therapy suite – oh, and the glorious Gloucestershire countryside on their doorstep. But other hospitals have equivalent or better services and don’t convert them nearly as effectively into excellent services for patients. Two of the things that impressed me most were improvisations. One of the dynamic HCAs who is an activity co-ordinator on the PICU described how there was a rather lethargic atmosphere on the ward one day. Spontaneously she found a paper plate and suddenly there was an animated game of indoor Frisbee!

And a ward with a kitchen which has no oven (excessively risk averse planning, presumably) hasn’t stopped the creative ward manager from regular cooking sessions for patients. They use a bread-making machine, make microwave and freezer cakes and harness the relaxed sociable potential of communal meals there.

The same ward has visitors from Pets As Therapy (www.petsastherapy.org), staff leads in areas as diverse as women’s issues and sports, and an impressive green philosophy. Even tea-bags go to the composter… and I sheepishly removed the plastic cup I’d chucked out, when they diplomatically mentioned that these get used to grow seeds. For the sensory  garden that patients and staff are designing and developing. While I was on the ward it was lovely to see a fragile-looking patient absorbed in potting up small plants. And it gets better and better. Patients go to the local garden centre to choose plants, books, brochures and folders about gardening have been resourcefully sought from local gardening clubs, there’s a sheet on the noticeboard where patients have written their ideas for the garden….

I have pages of notes about the superb practice from this ward alone, so do let me know if you’d like more details.

Still on the gardening theme, the Low Support Unit (whose energetic manager would prefer it to be called the Recovery Unit) is setting up not just a gardening group, but a social business based on the garden’s produce. They’ve transformed the over-run area that was previously used for ‘horticultural therapy’ and it’s an obviously great opportunity for the men to channel their strength and time. A former service-user who handily is a gardener helps out, which must be inspiring for the current patients as well as rewarding for the volunteer.

As with the acute ward briefly described above, there’s much too much great practice in this ward to include here. And while I can list some of the impressive features, it’s the staff attitude to and relationship with patients which is hardest to do justice to. Perhaps it boils down to the staff really liking and enjoying being with patients. (And of course not exactly a mellow, biddable group of patients. 12 people who have experienced the full range of incarceration, rejection and stigmatisation.)

And then there’s the therapies unit. A dance and movement session was going on in the gym when we visited, led by a specialist in this important combination of art and exercise. The artwork done achieves numerous objectives, ranging from an opportunity for a non-intrusive, relaxed OT assessment to producing truly high quality (luxury shop standard) products which are used on wards or can be taken to patients’ homes or given to their families. How much nicer to return home with a beautiful ceramic you’ve created yourself rather than just a CPA form?

Line dancing, exploring leisure sessions, peer supported substance misuse groups, making everything from dolls houses to greetings’ cards, going to the local tennis club and pool, museums and places of interest, total well-being sessions, ‘wake and shake’ start to the day with the sports therapist and/or physio…. Just an incredible range of high quality, enjoyable, esteem-building, sustainable activities.

Some of this is about resources, but mainly it’s about:

1. staff feeling that patients deserve and can make good use of a full range of activities, 7 days a week
2. recruiting, supporting and retaining great staff
3. having some seriously outstanding managers, including Alan

The Caludon Centre

There’s fantastic work going on in Coventry, at the Caludon Centre. There’s probably masses and masses, by nurses, healthcare assistants, psychiatrists, psychologists (OK, you get the picture.) But I was fortunate enough to be able to spend a bit of time with two of the dynamic and hyper-talented activity facilitators, Ellie and Tom. I won’t give their surnames as the Caludon Centre won’t thank me for getting them headhunted by hospitals around the country.

To give you a flavour of the imagination, ambition, commitment and effectiveness of their work, Ellie was talking for a few minutes about the lovely pampering sessions that the run for patients. She mentioned a make-over session, and only when I asked a few questions did it emerge that the free snazzy clothes that patients could choose to own weren’t got from Oxfam or even M&S. But were donated by Paul Smith, Vivienne Westwood and other designers!! Amazing. Not just that psychiatric patients are now some of the hippest dressers in the West Midlands, but that it gives an incredible message to the patients, and those around them, about how they’re valued.

There’s much too much to tell in a blog, and I’m hoping that Ellie, Tom and colleagues will provide us with a Caludon feature for our website. Not least because you have to see for yourselves the stunning creations that they’ve made with and for patients. Ellie is an artist, and this is reflected in not just the arts’ activities, but in the vibrancy and richness of the rooms in the wards. (Er, not the smoking rooms which are as bleak and off-putting as in all other inpatient units.) In addition to arts activities, they run crafts, textiles, writing, recreational, health and well-being, relaxation, outdoor and exercise sessions. It’s truly an exemplary model of how an activities programme should be.

Hartlepool and Star Wards

I’m very grateful to Ian Trodden from Hartlepool, not only for the latest benchmarking tool, but also for the first account we’ve received of which Star Wards’ ideas have been implemented. Ian writes: “We are using tweaking, turning and transforming as categories.  The tweaking is done within 3 months; the

turning has a six month standard and the transforming up to twelve months.  Obviously if we can get them done sooner then great but it gives us a standard for each category.  We have completed our self assessment in conjunction with the patients on the ward and relatives.   We have already started to make quick wins and the initiative is driven via our acute care forum.” 

And those quick wins are: “Comedy evening every Wednesday as decided by the ward patients (at present videos but looking into local comedians); library novels and magazines; walking groups; Daily diaries and personal recovery packs; self-help books and tapes /dvds and computers and internet access.  The last one is about patients also having access to their bank accounts etc as well as all the stuff we use

computers for.  More recently we have secured some land that will be used as allotments for patients across the system of care.  This is a very exciting prospect in that patients can grow the vegetables that they can then cook them back at the unit. We are also in the process of linking in with Hartlepool football club (they are on 600 yards from our unit) so that we can raise awareness about stigma etc via them and visit them and them us.  The lads (and some of the lasses) will love that!!!”

Edgware Community Hospital

I was fortunate to visit the snazzy new Edgware Community Hospital in north London, with the fabulous chair of Barnet Primary Care Trust, Sally Malin.  Among many other impressive services provided, they’ve got a stunning advice and information suite, including a huge library. And whereas traditionally hospital libraries are limited to staff use, this one welcomes patients, which include those from the on-site mental health services. Star Wards is full of stuff about giving patients access to information, including on the ward, and Edgware is an amazing example of really embracing and fulfilling this need.

Another exemplary feature that the advice and information centre has is a group of meeting groups used on a sort of time-share basis by local voluntary organisations. The link below includes some of those organisations, but there are many more (about 30 or so) including lots of BME specialist organisations eg those providing counselling in mother tongue languages.

http://www.barnetpct.nhs.uk/sites_services/edgware/advice_information_centre.shtm

Sports therapists

I wasn’t sure how over-optimistic I was suggesting sports therapists as possible contributors to or even fully-fledged staff for acute wards. But it turns out that at least one hospital already employs sports therapists. Alan Metherall from Wotton Lawn Hospital in Gloucester (which, incidentaly has a seven, yes seven day a week programme of activities for patients) gave me this information:

 

The sport therapists came about through an inability to recruit registered physiotherapists. What a blessing this has been. Subsequent recruitment has also been fairly easy because of the impact the staff have had on our open wards and PICU and LSU. Sports therapy and physiotherapy compliment each other in a mutually beneficial way.

Interventions include individual and Group sessions of:

Health education and promotion

Healthy Eating

Benefits of Exercise

Individual and Group sessions of circuit training,

trampoline,

badminton,

Walking groups

Canoeing

cycling

Swimming

Patient holidays

and others

Often interventions are initially provided within the hospital site (except swimming) but wherever possible activities are also provided in local community facilities. Free membership for service users has also been agreed with the local council for use of the gym where our staff also undertake the induction in that facility with the service user.

We have also been able to provide student placements for student sport therapists from our local university.

How amazing is that?? The hospital is also one of just a handful of mental health hospitals to have its own website:

http://www.wottonlawnhospital.info/