Recovery at Rampton Hospital

Introduction

This report describes the Trust Recovery Strategy and its application in the Forensic Division together with the associated governance structure. This paper also summarises the many aspects of the Recovery related work taking place within Rampton Hospital at directorate, service and ward level.

Trust Recovery Strategy

Nottinghamshire Healthcare NHS Foundation Trust has embraced the concept of Recovery over the past 7 years and Recovery principles are key for the development of the culture and practice within the hospital.

The Trust has had two Recovery Strategies, the first from 2009 – 12 and the second in 2012. The third strategy ‘Changing the Conversation’ was launched in January 2017 and builds on the achievements of the last 7 years and is in line with the Strategic Vison of the Organisation as a whole.

Changing the Conversation involves 3 core domains, changing the conversation between health workers and the people they support, including the individual and their family and friends. The second domain is about changing the conversation between services and the people who use them towards co-production and co-delivered services. The last domain focuses on changing the conversation between services and communities; towards merging services and communities and community resources.

Forensic Recovery Steering Group

The Forensic Recovery Steering Group oversees the implementation of the Recovery Strategy within the Forensic Division. Membership includes high, medium, low secure and community services, as well as Offender Health. The group is chaired by the Forensic Associate Director of Nursing, Quality and Patient Experience and is attended by the various Service Recovery Leads and others. The meeting takes place on a quarterly basis to share progress with implementation of Recovery in their services and is a forum for sharing good practice.

Within each of the services in Rampton hospital there are identified Recovery Leads with the Modern Matrons taking the lead for Directorate patient involvement and experience. Each Directorate has specific meetings with patients and staff focusing on Recovery and Involvement initiatives in their areas.

Implementing Recovery through Organisational Change (ImROC)

The Forensic Division has links with ImROC and the Trust Recovery Learning and Development Team and have focused the implementation of Recovery within the Division around the seven ImROC areas identified to bring around the change to a more for Recovery focused service:

  1. Ensuring organisational commitment and changing the culture
  2. Delivering comprehensive, co-produced education for people using the service in Recovery Colleges
  3. Transforming the workforce: providing access to lived experience of mental health problems through peer support and peer support workers
  4. Changing the way we approach risk assessment and management
  5. Supporting staff in their Recovery Journeys
  6. Increasing opportunities for building ‘a life beyond illness’
  7. Supporting families, friends and carers of patients with mental health problems and working in collaboration with them as experts in their own experience

The Division has developed and delivered an action plan around these seven areas with the final sign off at the Forensic Division Management Group Meeting in late autumn 2016.

The Division is about to launch the 2016 Recovery Strategy with a conference ‘Changing the Conversation in the Forensic Division’, that is specifically focused on celebrating the achievement made to date and how we go forward with implementing the Strategy. The conference will be taking place at Rampton Hospital on March 27th 2017.

ImROC held their annual 2017 conference at Broadmoor Hospital in January with the focus being on secure services. At this conference several of the workshops were facilitated by Rampton Hospital clinicians with the key note speech being given by one of the Forensic Consultant Psychiatrists.

Organisation Commitment and changing the Culture

Each service has an identified Recovery Lead and a dedicated Recovery and Involvement meeting/forum held in collaboration with patients to discuss how they take initiatives forward. Staff Recovery Champions are identified on each ward with some services having patient Recovery Champions.

The RecoveryWell-being Education Consultant from LearningDevelopmentprovides invaluable advice and guidance. Recovery Champion Action Learning Sets for staff takes place on a regular basis. Here ward based Champions have the opportunity to share practice with each session focusing on a specific Recovery related topics. Learning Set topics planned for this year include, collaborative care, and strengths based language and recovery outcomes.

Recovery masterclasses have taken place in Nottingham for two years with some staff from the Forensic Division attending. Forensic Masterclasses how now been scheduled to take place at Rampton Hospital in 2017. They are aimed at anyone who wants to listen to, debate and critically explore contemporary issues surrounding Recovery. They are facilitated by local, national and international speakers. Sessions for 2017 include, Coaching for Recovery, Open Dialogue, Trauma Informed Approaches to Care, and Risk, Safety and Restricted Practice. The first Forensic Masterclass scheduled to take place in February is already fully booked.

The Forensic Division has had three Recovery Conferences, two held at Rampton Hospital and one at Wathwood Regional Secure Unit. The conferences are for both staff and patients with staff and patients delivering presentations. A cartoonist attended the second conference held in March 2016 where the event was captured in a ‘Forensic Recovery Poster’; the poster is displayed on the Main Corridor in the hospital near the Medical/Health Centre. The conference was also video recorded and patients were able to view the event on the Distributed TV.

Joint working takes place with Rosewood Involvement Centre staff with the Involvement Workers delivering a presentation on the first day of the hospital induction for new staff. The Involvement Workers talk about their Recovery stories and the work that they do with the staff and patients in the hospital. Recovery is a topic that is covered in the Mandatory training for all staff, here the concept of Recovery is explored and it application and meaning in a high secure setting, the successes and challenges.

Courses of longer duration are available for staff in the Learning and Development Recovery Prospectus. The prospectus gives information and details about recovery focused courses and workshops. Course currently available include, Recovery Principles in Practice, Introduction to Coaching Skills for Recovery, Supporting People to Develop and use Personal Recovery and Wellness Plans, Using Life Story Work to support Recovery, Improving Mental Wellbeing through Physical Health as well as course for individuals who wish to become Peer Support Workers.

Delivering Comprehensive, Co-produced Education for People Using the Service in Recovery Colleges

The hospital recently relaunched the Recovery College and seconded a Recovery College Co-ordinator for a year to oversee the process. The Hospital has four identified Recovery College Classrooms;

  • Southwell Day Centre for patients from the male MH and LD Directorate
  • Peaks Central Resource Building (CRB) for male patients from Peaks and male PD Service
  • Diamond Resource Centre (DRC) for female patients
  • Recovery College room with the Patients Education Centre.

Course have run since April 2016 with the majority being co-produced and co-delivered with patients from across the hospital receiving bespoke ‘Train the Trainers’ course to enable them to teach.

Courses available to patients include;

  • An Introduction to Creative Writing – a one off taster session designed to introduce the concepts and skills that are required to start writing creatively and how this can play a role in your recovery journey.
  • Sharing Your Recovery Stories – learning from other people’s experiences and stories can play an important part in our own recovery journeys. During the course staying safe is addressed, enabling the story teller to remain in control of what to share about yourself and others.
  • Food and Mood – in this course how foods can help you feel is considered. It looks at how a healthy balanced diet is important for both physical and mental health and wellbeing, in a fun and interactive way.
  • Mindfulness – a chance to engage in and apply skills to help keep you well on your recovery journey. The course introduces the concept of mindfulness to the learner. Together the group explore the theory and skills of mindfulness and then have the opportunity to experience the practical application.
  • Everyday Gym – this course explores ways in which you can increase your physical activity in your day to day life and consider why physical health in important.
  • Understanding Distress – a three session course discussing what distress is and what it means to you, how to recognise distress in others and looking at providing you with tools and coping mechanisms to deal with it.
  • Hearing Voices and Recovery – Hearing voices and unusual beliefs or experiences is not uncommon, and are not always part of mental illness. This course will help you to develop confidence about voices, about acceptance, about coping and understanding, and how we can all recover.
  • Spirituality and Wellbeing – during the course we explore what spirituality might mean to you and how it can be helpful for both wellbeing and recovery. It is open to everyone with beliefs and non-beliefs. During these sessions we create a respectful space where we can share, learn from one another, reflect and try out some techniques which can be helpful for wellbeing, such as meditation and mindfulness.
  • The Power of Sleep – sleep is complex process during which our body undertakes a number of essential activities. The aim of this course is for students to increase their knowledge, awareness and skills on the topic of sleep. During the course learners will explore the definition of sleep, sleep stages and look at the benefits and consequences of poor sleep. We will work towards creating a plan to apply some strategies that promote good sleep.
  • Recovery and History – this session will look at the history of forensic mental health care and Rampton Hospital. It is designed to help you to learn about the history of the hospital and to explore where recovery sits in the past as well as the here and now and your own individual recovery.
  • Exploring Belief and Culture – This course looks at the way in which different beliefs and cultures influence the way we think, talk, and live in the world. Each one of us has beliefs that affect our approach to life, whether those beliefs are something political or religious, or in our personal philosophy about what is right or wrong. Similarly, we all have a ‘culture’, whether that be about our nationality, geographical place of birth, family roots, or spirituality. Our belief and culture is expressed in things like clothing, music, attitudes, food, religion, language, hairstyles, families, approaches to relationships, and even our approach to Mental Health.

In our multi-cultural, multi-religious, diverse society, it is good to understand our own beliefs and culture, as well as those of the people we live alongside. Many of the difficulties that arise between individuals and groups are because of misunderstandings that arise in belief and culture. The aim of this course is for us to better understand ourselves and others in order to find the most positive ways to share the journey of recovery and life together.

  • Managing Feelings – Would you like the opportunity to learn how to recognise and explore different feelings and be able to look at the skills and tools required to help you to then manage them?

The taster session is an opportunity for the learner to be introduced to the concept of Managing Feelings and then look at applying the skills to help keep you well on your recovery journey. The group will consider what feelings are and how we use them. We will then explore the skills we can draw upon to effectively manage feelings to protect ourselves against extreme emotions and how we react to them.

A Rampton Hospital Recovery College Action Group has been formed to oversee the running and governance of the College. The Group meet three times a year and report to the Forensic Recovery Steering Group and the Nottingham Recovery College Service Delivery Board.

In addition to the Rampton Group, Recovery College Leads have the opportunity to meet with colleagues in medium and low secure care in the Division to learn and share new ideas and ways of working. The meetings take place in the format of an Action Learning Set.

Transforming the Workforce: providing access to lived experience of mental health problems through peer support and peer support workers

Recovery and Involvement Leads regularly attend Rosewood Involvement Centre in Ollerton. Meetings take place on a monthly basis. Meetings are focused on the involvement work that is currently taking place and part of the meeting is dedicated to how peer working and the peer support worker agenda can be taken forward within the Division.

Services are currently in the process of considering how our patients can be better supported and given the opportunity to utilise peer support roles in the hospital. Patients have been asked how they would like peer support to take place. An option currently being explored is utilising the Recovery College to provide training for patients and they are being asked about what type of training they would find useful.

Rosewood Involvement Workers work assisting staff and helping patients to complete SUCE (service user and carer experience) feedback forms. Patients have also been able to have their questions asked at the Trust AGM with Rosewood Involvement Workers asking questions of the Trust Executives on behalf of the patients.

Staff have received training to assist them to complete Patient Opinion postings on behalf of patients. This has increased the number and quality of postings. This has enabled the stories of Rampton Hospital patients and their experiences to be shared more widely.

Changing the Way we Approach Risk Assessment and Management

The hospital’s CPA documentation has been amended to enable improved collaborative working. The changes have been based on the ‘My Shared Pathway’ work in medium secure services and the main change is the named nurse report which is now written by both the nurse and the patient. Different versions of the Named Nurse and Patient CPA Report have been developed for patients with reduced intellectual disabilities.

Recovery headings have been incorporated into CPA documentation and some care planning documentation. The documentation now includes the following heading, managing mental health, physical health, relationships, risk and responsibility, social lifemeaningful activity, trust and hope and moving on. Some guidance to assist nursing staff with the completion of these CPA documents is in the final stages of development and is hoped to be available from late March onwards.

A variety of wellness plans are available for patients to use to promote responsibility and self-management, these include a Forensic version of the Trust’s Recovery Booklets and Distress Signatures Booklets for WS and PD services. Patients within the LD Service can use Communication Passports and adapted Wellness Plans/Health Action Plans, whilst the deaf patients on Grampian Ward have access to the ‘All about Me’ national recovery document.

Supporting staff in their Recovery Journeys

The sickness policy has been updated and training is available for managers about ensuring the continued welfare of their staff and supporting them whilst they are off of work. All staff have ‘My Annual Reviews’ and where required are offered the opportunity to have Workforce Wellbeing and Support Plans and return to work documents to encourage the use of adjustments for example phased return to work.

The hospital is well resourced with regard to services available to support the wellbeing of staff including, Staff Counselling Service and other psychological services available, Occupational health and Fast Track Physiotherapy. In addition Workplace Health Champions have been recruited to improve health and wellbeing in the workplace. The Champions have been supported by a level 2 Health training course and in addition other wellbeing related training is available, such as basic counselling and mental health first responder training.

The Forensic Recovery Conferences have done much to promote the ethos that individuals with mental health problems have much to contribute and that it is possible to have a mental disorder and still work. Rosewood Involvement Workers deliver presentations and share their personal recovery story narratives to patients, new staff and staff currently employed. Staff members with existing mental health problems have told their recovery stories to patients and staff.