#42 Visit to Avon and Wiltshire MH Partnership

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24th June 2008

Nicky Bennett: Inpatient Manager

The Old Manor Hospital was originally a private mad-house. It’s a classic large site, which used to include a farm, and where, in keeping with the rather Gothic name, houses across the road were accessed by underground tunnels! The ballroom complete with spring floor (and how we wish every hospital today had a ballroom) had a basement underneath it which was used by the Home Guard as a firing range during the war! (Given how uptight the H&S people get about the risk from tiddly-winks and hamsters, they’d find the presence of so much ammunition on site rather challenging.)

Beechlydene Ward, Salisbury

This is the most beautiful, gorgeous, funky ward I’ve seen. In the 70s, a prefab was put up as temporary home for the acute admissions ward. It was used til 4 years ago when the current jewel was built. It’s amazingly spacious, with loads of natural light, and artwork not only on the walls but also the ceiling and floor. As well as a patient-designed motif within the laminate flooring, there are several pieces of furniture which are as much sculptures as things to stick your bum on. The entrance area has a breathtakingly beautiful series of connected seats, sculpted from wood by designers whose work is in the V&A! There are other trendy seats in the garden, with blue and green swirly metal sides. (Lovelier than it sounds. I need to brush up on, or even acquire some, art review techniques.) And in keeping with the generally arty theme, one of the courtyards is… a sculpture courtyard! There is a large garden at the back, and wisely they haven’t demolished the handsome original summerhouse. (Not least because it’s part of the long garden wall.) The summerhouse must be one of the grandest settings for a ward ping-pong table I’ve ever seen. Unfortunately the wall isn’t high and there’s a railway line on the other side, so patients can’t use the garden without staff present. Creatively, and presumably inspired by Nigel and Lizzy in The Archers, they’re pondering having a ha-ha built.

Despite my Archers’ devotion, I had to ask what this is and, as you’ll know, it I a sort of posh ditch/moat, filled with plants. These could be prickly to deter people vaulting over the wall.

They should charge an entry fee to this marvellous art gallery which doubles as an acute ward. On either side of the nursing station there are windows looking across courtyards to the male ‘spoke’ and the female one. With post-modern humorous irony (I hope), the panes include a frosted one in subtle blue for the male direction and its stereotyped counter-part for the ladies. (Architects were the excellent Hunters.) Nicky explained that the ward was designed as an ‘organic’ concept. I nodded in wise and worldly way but didn’t have a clue what she meant. It’s the Ha-ha all over again.

Other features include:

  • Staff rest room and hand-over room but no office. The Nursing station has high, attractively curved wooden front (I couldn’t be seen!) with 2 see-through panels for shorties.
  • Tribunal/meeting room. Lovely art room with windows right along the curved wall.
  • Fabulous art-work everywhere, including individual pieces in each bedroom. Different sizes (including huge) and all done collaboratively with patients, with some being joint projects with local artists.
  • The sign in the dining/living room, on the wall next to TV says: TV will be turned off during mealtimes.
  • The male/female ‘spokes’ have 4 bedrooms between them, and two sets of connecting doors can be locked to make the rooms part of one side or the other.
  • There are a range of garden games including quoits, petanque and badminton.
  • Nurse therapy assistants split their time between nursing and OT shifts, and work evenings and weekends. Excellent model.
  • Debbie, a staff nurse, is liaising with the local college’s ‘enrichment’ officer who has offered to be a volunteer herself! She’ll be carrying out activities such as jewellery making, photography and pottery.
  • Each ward has 2k to pay for external input eg from amateur dramatic groups, music groups etc. (All has to be cleared by procurement dept re: insurance liability, + CRB nonsense etc.) The Acute Care Forum agrees what therapeutic or social/recreational activities it is to be spent on.  They have a 7 days a week activity programme with 1.5 OTs + OT assistant.
  • The staff try to get as close as possible to patients’ ‘natural’/usual/ home interests and situation as possible.
  • Patients can be referred to the on-site intensive day services, which has additional benefit of them being able to continue going there when are back home.
  • User groups have influenced ward rounds. Patients now have appointment times for seeing SHOs, rather than having to hang around for hours. This also means patients can take s17 leave on ward round days because know what time they’re appointment is. Nurse, consultant and care co-ordinator are all at the meeting.
  • PTE – assessment care planning, risk assessment, some social/ recreational activities, community leave which is ‘facilitated’ rather than patients being ‘escorted’.
  • Anxiety and anger management sessions are provided on ward. They are going to set up a ‘healthy living group’ covering issues like exercise, dental care etc. (First time I’ve come across teeth being mentioned.  Which is a pretty important issue, when you come to think of it.)
  • They are getting in a guide dog – pre-training for puppy. Great idea!
  • A Red Cross beauty therapist comes in. This is a great idea as not only are they skilled in the usual lovely hand massages, make-up advice, etc.  but also in techniques for dealing with self-harming scars, etc.
  • The ward take housing issues very seriously. Housing specialists hold regular sessions. and they have strong links with local housing officers.  They prioritise overnight leave so that people are not ‘absent’ from their homes for a period which puts them at risk of losing their housing. This is one of the most astute and important practices I’ve come across on wards. Ward administrators are knowledgeable about benefits etc. Also brilliant practice.
  • Nurse therapy assistants run a breakfast club and also a cinema event on Wednesday evenings.
  • They have two long-standing volunteers who do groovy art activities with patients, including funky knitting. there are also two part-time volunteer co-ordinators in the trust. Currently they have 50 volunteers and are aiming for 200 by next year. Are having a celebration of volunteers’ contribution as part of NHS 60 year anniversary events.
  • One problem raised by patients I met was the underfloor heating.

Whatever the green benefits, it plays havoc with the feet of people who have poor circulation and other foot problems and can make nonafflicted staff’s feet ache when standing a lot of the day. (They should nick the sprung floor from the ballroom.) Staff are doing psycho-social intervention training (band 5s) for family and carers, in-patients and patients with dual diagnosis. They found it better to create more structured ways of providing PSI on individual rather than group interventions. Protected engagement time in afternoons is ideal opportunity for PSI work. They have previously taken part in Practice Development Units

  • an accreditation scheme run by university of Bournemouth. Frankly, it sounds like it’s a bit of slog and primarily about recording, rather than inspiring, good practice. And sufficiently time-consuming to be a hindrance to achieving this.

Beechlydene ward is the most spectacularly stylish ward I’ve seen. But fortunately it’s got a lot of substance to the style, with some wonderfully innovative and excellent practices.

Not to mention a ha-ha.

All the best