Damning report for Dorchester mental health unit

SAFETY CONCERNS: The Forston Clinic

SAFETY CONCERNS: The Forston Clinic

First published in News Dorset Echo: Photograph of the Author by , Senior Reporter

A PRISON' and 'a concentration camp' are some of the 'damning' criticisms of a Dorchester mental health ward in a report published by a health watchdog today. (weds27)

The Minterne Ward at the Forston Clinic failed to meet all 10 of the national standards of quality and safety in an inspection by the Care Quality Commission (CQC).

The watchdog said it is now considering further action over the failings.

The report slated the locked unit, which cared for people with acute mental health difficulties until it was closed after the inspection in November, as reported in the Echo.

Inspectors said that three patients described the ward, on Herrison Road, Charminster, as 'a prison' or 'a concentration camp', and one patient remarked 'I spend every waking hour planning how to escape from here because there is nothing to do'.

Staff added the ward was 'regime orientated'.

The report also found: “One patient told us they felt intimidated by two patients who were 'very verbal'.

“Another patient told us they did not feel safe.

“A relative of one patient expressed concerns about the safety of female patients at night.”

Empty bookcases, dirty toilets and tepid water on the ward were also noted.

James Barton, director of mental health services at Dorset HealthCare, admitted the report was 'damning' but said work has been underway since the inspection to improve the service with a view to re-opening the ward in April.

The CQC carried out the routine, unannounced inspection in November.

The other ward at the Forston Clinic, Melstock House, was also inspected but is not connected to the criticisms made of the Minterne Ward.

Ian Biggs, deputy director of CQC in the south, said the concerns should have been dealt with 'some time ago'.

He said: “This is not the first time we have told the trust it must make improvements at this service.

“It is a matter of some concern that the trust has failed to address these issues.

“We found that patients were still not being treated with consideration and respect.

“There was a blanket ban on caffeinated drinks, or the use of aerosols or proper cutlery.

“While only little things in themselves, they are an indication of a culture which is not interested in people's dignity or personal choices.”

He added: “It was apparent the ward was failing on many levels. Patients were not receiving appropriate and safe care because the trust didn't have effective systems in place to deliver what was needed. “This can't continue.

“Where we have continuing concerns, we have a range of powers we can use to protect the safety and welfare of people who use this service.

“We will consider further action and publish information about this in due course.”

The report found the Minterne Ward failed in the following areas: Respecting and involving people who use services - patients were not treated with consideration or respect, and their dignity was not maintained.

Consent to care and treatment - regular reviews of patients' mental capacity to consent to treatment did not take place.

Care and welfare of people who use services - risk assessments were incomplete, and activities were limited and restrictive.

Safeguarding people - patients were not protected against the risk of abuse, were not protected against unlawful or excessive use of control and restraint, and the use of restraint was not always properly documented.

Safety and suitability of the premises - hot taps in some rooms supplied orange-coloured water and the seclusion facility designated as not fit for purpose was still in use.

Staffing - ward staff said there were not enough nursing staff to cover at times, especially when new patients were brought in during the night.

Cleanliness and infection control - effective systems were not in place to maintain appropriate standards of cleanliness and hygiene.

Management of medicine - medicines were not handled safely, securely and appropriately and no clear procedures were in place for medicine handling.

Supporting workers - staff were not properly trained, supervised or appraised.

Assessing and monitoring the quality of service provision - patients did not receive safe quality care, treatment and support because effective systems were not in place for the management of risks to their health, welfare and safety.

James Barton, director of mental health services at Dorset HealthCare, which is responsible for the Minterne Ward, said 'substantial improvements' have been made since the CQC first undertook its report, including taking on extra staff, more staff training, providing more activities and putting more feedback procedures in place.

“We want to provide inpatient care that we can be proud of, which is why we've invested a huge amount of time, energy and resource to make sure the ward, when it reopens in April, will be a service we can take pride in.

“More than £1million has been invested since the inspection in refurbishing the ward and building a new seclusion facility to comply with all the latest requirements.

“We are confident that, as a trust, we have responded in a very positive manner to the feedback from the CQC.

“We are sorry that the standards of care sometimes weren't as high as patients always deserve, which is why we've worked hard to address all the issues raised.

“We are determined to ensure the best possible inpatient care for our patients at what is a very worrying and vulnerable time for them.

“This is clearly a damning report, but I really think that with clinical leaders making sure that every day, we are providing a service they would want to receive themselves, that we can make sure this never happens again.”

Comments (20)

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9:21am Wed 27 Feb 13

Chav_Scum says...

When will these spokespeople realise we don't want to hear all the pathetic 'we feel we've acted in a positive way etc'. Clearly, this ward had very poor management. I'm pro-public funded services but only if they can learn from the private sector when needs be - if this were a private firm the leadership team would be sacked!
So, can Dorset HealthCare confirm the incompetents have been removed?
When will these spokespeople realise we don't want to hear all the pathetic 'we feel we've acted in a positive way etc'. Clearly, this ward had very poor management. I'm pro-public funded services but only if they can learn from the private sector when needs be - if this were a private firm the leadership team would be sacked! So, can Dorset HealthCare confirm the incompetents have been removed? Chav_Scum
  • Score: 0

9:35am Wed 27 Feb 13

stench says...

That's crazy...

or Damning as the Echo says ;)
That's crazy... or Damning as the Echo says ;) stench
  • Score: 0

11:52am Wed 27 Feb 13

sparkleeye says...

Chav_Scum wrote:
When will these spokespeople realise we don't want to hear all the pathetic 'we feel we've acted in a positive way etc'. Clearly, this ward had very poor management. I'm pro-public funded services but only if they can learn from the private sector when needs be - if this were a private firm the leadership team would be sacked!
So, can Dorset HealthCare confirm the incompetents have been removed?
I agree, we also need to go through our entire civil service, from this to education, health everything and those who do not come up to private company standards are fired. After all they are the ones who expect private company wages and benefits, they can accept private levels of accountability..some
thing there is none of in the civil service.
[quote][p][bold]Chav_Scum[/bold] wrote: When will these spokespeople realise we don't want to hear all the pathetic 'we feel we've acted in a positive way etc'. Clearly, this ward had very poor management. I'm pro-public funded services but only if they can learn from the private sector when needs be - if this were a private firm the leadership team would be sacked! So, can Dorset HealthCare confirm the incompetents have been removed?[/p][/quote]I agree, we also need to go through our entire civil service, from this to education, health everything and those who do not come up to private company standards are fired. After all they are the ones who expect private company wages and benefits, they can accept private levels of accountability..some thing there is none of in the civil service. sparkleeye
  • Score: -1

1:59pm Wed 27 Feb 13

kimweighill says...

I cannot see the point of another inspection they were told almost the same things at the coroners inquest over a year ago obviously didn't take any notice that time why should they now,if they can get away with a patient dying in their care they can get away with anything
I cannot see the point of another inspection they were told almost the same things at the coroners inquest over a year ago obviously didn't take any notice that time why should they now,if they can get away with a patient dying in their care they can get away with anything kimweighill
  • Score: 0

7:31pm Wed 27 Feb 13

patience567 says...

I can see the rationale behind not using aerosols as they can be used to harm self or others...many patients used to smash crockery and then use the sharp broken bits to harm themselves. I suppose that it would be dangerous to inhale aerosol gases deliberately.
I can see the rationale behind not using aerosols as they can be used to harm self or others...many patients used to smash crockery and then use the sharp broken bits to harm themselves. I suppose that it would be dangerous to inhale aerosol gases deliberately. patience567
  • Score: 0

9:07pm Wed 27 Feb 13

suemar12 says...

I think it's a real shame that this article only focuses on the negative and fails to mention all the good work that this unit has done over the years. Let's not forget that it is a locked ward for people who are very unwell and often need a low stimuli enviroment(caffeine being a stimulant) and routine(regime). These things can be key factors in recovery and actually without some restrictions in place the acute phase of illness can be prolonged.
I have visited my husband here many times and the majority of the staff were very skilled individuals who always acted responsibly and the key focus was always on the fastest route to recovery.
I'm sure there were patients that felt threatened by the aggression of other patients, but maybe they were placed in a unit not appropriate to their needs, due to a shortage of available beds. This will only get worse with the closure of 2 more units shortly.
I think it's a real shame that this article only focuses on the negative and fails to mention all the good work that this unit has done over the years. Let's not forget that it is a locked ward for people who are very unwell and often need a low stimuli enviroment(caffeine being a stimulant) and routine(regime). These things can be key factors in recovery and actually without some restrictions in place the acute phase of illness can be prolonged. I have visited my husband here many times and the majority of the staff were very skilled individuals who always acted responsibly and the key focus was always on the fastest route to recovery. I'm sure there were patients that felt threatened by the aggression of other patients, but maybe they were placed in a unit not appropriate to their needs, due to a shortage of available beds. This will only get worse with the closure of 2 more units shortly. suemar12
  • Score: 0

10:40pm Wed 27 Feb 13

Leftrealist says...

The investment of £1m to rectify the damning state of provision comes not from trust 'profits' but from closing more public provision in bridport and Sherborne.
The investment of £1m to rectify the damning state of provision comes not from trust 'profits' but from closing more public provision in bridport and Sherborne. Leftrealist
  • Score: 0

9:16pm Thu 28 Feb 13

nk2gether says...

kimweighill wrote:
I cannot see the point of another inspection they were told almost the same things at the coroners inquest over a year ago obviously didn't take any notice that time why should they now,if they can get away with a patient dying in their care they can get away with anything
I know this is a damming report but this had nothing to do with my daughters death 2 years ago..i thought the staff worked very hard and cared for my daughter ....people are very quick to judge as from the comment from kimweighill above
[quote][p][bold]kimweighill[/bold] wrote: I cannot see the point of another inspection they were told almost the same things at the coroners inquest over a year ago obviously didn't take any notice that time why should they now,if they can get away with a patient dying in their care they can get away with anything[/p][/quote]I know this is a damming report but this had nothing to do with my daughters death 2 years ago..i thought the staff worked very hard and cared for my daughter ....people are very quick to judge as from the comment from kimweighill above nk2gether
  • Score: 0

5:52pm Sat 2 Mar 13

patience567 says...

A staff member who tells the victim of an assault where a patient tried to break the neck of another to 'forget it' is not a skilled individual.
A staff member who tells the victim of an assault where a patient tried to break the neck of another to 'forget it' is not a skilled individual. patience567
  • Score: 0

5:24pm Mon 4 Mar 13

patience567 says...

I think this style of journalism, based on high impact and emotive headlines without reference to specifics is not really helpful. What about the staff who do their best? I can certainly say that the CQC have not really been that effective in the past, and that the salaries of the inspectors is more than most staff; money which could be spent more effectively on training the staff. Confident staff, trained for all eventualities with faith in their leaders, and then this will flow on to the patients. Dumb martinets who are incessantly critical, out of touch with the realities on the wards and are more interested in PR initiatives will destroy morale.
I think this style of journalism, based on high impact and emotive headlines without reference to specifics is not really helpful. What about the staff who do their best? I can certainly say that the CQC have not really been that effective in the past, and that the salaries of the inspectors is more than most staff; money which could be spent more effectively on training the staff. Confident staff, trained for all eventualities with faith in their leaders, and then this will flow on to the patients. Dumb martinets who are incessantly critical, out of touch with the realities on the wards and are more interested in PR initiatives will destroy morale. patience567
  • Score: 0

6:09pm Wed 6 Mar 13

suemar12 says...

patience567 wrote:
A staff member who tells the victim of an assault where a patient tried to break the neck of another to 'forget it' is not a skilled individual.
I said the majority of staff were skilled individuals and I would totally agree with you that a member of staff who told you to forget something like that are not skilled.
[quote][p][bold]patience567[/bold] wrote: A staff member who tells the victim of an assault where a patient tried to break the neck of another to 'forget it' is not a skilled individual.[/p][/quote]I said the majority of staff were skilled individuals and I would totally agree with you that a member of staff who told you to forget something like that are not skilled. suemar12
  • Score: 0

10:22am Thu 7 Mar 13

patience567 says...

The practicalities of managing a ward like this are very difficult.
The practicalities of managing a ward like this are very difficult. patience567
  • Score: 0

1:58pm Mon 11 Mar 13

patience567 says...

The chair of Dorset Mental Health Forum worked in Melstock house next door to Minterne for 6 years. It does raise questions as to whether the Forum really represents service users or not, if so many of their staff are ex NHS/social services.
The chair of Dorset Mental Health Forum worked in Melstock house next door to Minterne for 6 years. It does raise questions as to whether the Forum really represents service users or not, if so many of their staff are ex NHS/social services. patience567
  • Score: 0

10:52am Thu 14 Mar 13

patience567 says...

The Hidden Talents project allows staff with mental health problems to lead what goes on at the Forum, and there is a 'we know best' way of communicating. It might also be said that the mistakes in the service are replicated in the so-called user lead Forum, giving a minority two bites of the cherry and drowning any novel ideas under a barrage of professional waffle. We already have statutory services, I don't want two services the same.
The Hidden Talents project allows staff with mental health problems to lead what goes on at the Forum, and there is a 'we know best' way of communicating. It might also be said that the mistakes in the service are replicated in the so-called user lead Forum, giving a minority two bites of the cherry and drowning any novel ideas under a barrage of professional waffle. We already have statutory services, I don't want two services the same. patience567
  • Score: 0

4:45pm Thu 14 Mar 13

Piglet292 says...

I have been following these comments with interest, particularly the ones from patience567 about the Dorset Mental Health Forum. I will be writing to the Echo to respond in full, as I am not certain that this thread is an appropriate place to do so. I will respond within 24 hours.
Chair, Dorset Mental Health Forum
I have been following these comments with interest, particularly the ones from patience567 about the Dorset Mental Health Forum. I will be writing to the Echo to respond in full, as I am not certain that this thread is an appropriate place to do so. I will respond within 24 hours. Chair, Dorset Mental Health Forum Piglet292
  • Score: 0

10:43am Fri 15 Mar 13

patience567 says...

That would be great, because I am not the only person - patient or carer - who feels that the Forum has lost interest in local people in pursuit of National agendas. And I am probably not the only person to experience the Hidden Talents project as controversial nor be alarmed at their apparent influence at the Forum. If a person feels they have been treated unfairly who do they turn to?
That would be great, because I am not the only person - patient or carer - who feels that the Forum has lost interest in local people in pursuit of National agendas. And I am probably not the only person to experience the Hidden Talents project as controversial nor be alarmed at their apparent influence at the Forum. If a person feels they have been treated unfairly who do they turn to? patience567
  • Score: 0

4:49pm Fri 15 Mar 13

patience567 says...

The question is this: if I become unwell am I going to get treatment quickly? That becomes before promoting Recovery (a vague concept) or fighting stigma in the NHS. I don't want to know about insular navel gazing; fighting stigma is the job of selection panels, personal supervision, or, if necessary, disciplinary action. Fighting stigma nationally or internationally may be a noble cause, but is it one that should consume resources better spent on local provision?
Another consideration is whether staff with mental health problems are an asset or a liability. In truth, they can be both. It can be very validating for some to have their experiences shared or a sense of panic because they lose their sense of control.(The well staff being their anchor). Staff with mental health problems are more likely to experience stress or take sick leave. When people experience too much stress they cannot function well. This causes disruption, leads to cancelled appointments, and increases the risks to patient safety.
The effect of cancelling appointments or having to wait longer for treatment is devastating for patients. Surely this is more important than anything else?
Lastly, I think it is only right and proper that the independence of the Forum management is subjected to appropriate scrutiny and that the safety and rights of patients are protected. I am only saying aloud what people may think privately, and with so much at stake I am not going to be bullied into accepting reassurances I do not feel comfortable with.
The question is this: if I become unwell am I going to get treatment quickly? That becomes before promoting Recovery (a vague concept) or fighting stigma in the NHS. I don't want to know about insular navel gazing; fighting stigma is the job of selection panels, personal supervision, or, if necessary, disciplinary action. Fighting stigma nationally or internationally may be a noble cause, but is it one that should consume resources better spent on local provision? Another consideration is whether staff with mental health problems are an asset or a liability. In truth, they can be both. It can be very validating for some to have their experiences shared or a sense of panic because they lose their sense of control.(The well staff being their anchor). Staff with mental health problems are more likely to experience stress or take sick leave. When people experience too much stress they cannot function well. This causes disruption, leads to cancelled appointments, and increases the risks to patient safety. The effect of cancelling appointments or having to wait longer for treatment is devastating for patients. Surely this is more important than anything else? Lastly, I think it is only right and proper that the independence of the Forum management is subjected to appropriate scrutiny and that the safety and rights of patients are protected. I am only saying aloud what people may think privately, and with so much at stake I am not going to be bullied into accepting reassurances I do not feel comfortable with. patience567
  • Score: 0

5:33pm Sun 17 Mar 13

patience567 says...

Reflection: If you want to sound authoritative, stick in the word 'clinical'. It has a hypnotising effect, because it refers to something (specialist knowledge) most people don't know about. Is there a danger that it could be used to hoodwink?
Question: Is the closure of psychiatric beds at Bridport really in patients best interests or are we being hoodwinked by clinicians? I believe that the movement towards community based services is backdoor privatisation, and though many more people will benefit, those who are the most vulnerable, who don't have families to support them, will become utilitarian sacrifices.
Reflection: If you want to sound authoritative, stick in the word 'clinical'. It has a hypnotising effect, because it refers to something (specialist knowledge) most people don't know about. Is there a danger that it could be used to hoodwink? Question: Is the closure of psychiatric beds at Bridport really in patients best interests or are we being hoodwinked by clinicians? I believe that the movement towards community based services is backdoor privatisation, and though many more people will benefit, those who are the most vulnerable, who don't have families to support them, will become utilitarian sacrifices. patience567
  • Score: 0

9:18am Mon 18 Mar 13

patience567 says...

Lets just assume that in some wards in this country, staff are disrespectful in their attitudes towards patients. This can create an escalation of emotion: Staff see the patient as becoming more risky and start talking of injections; the patient sees the staff as threatening them with treatments they think are harmful. Also, the patient sees the staff as authoritarian and feels outnumbered. Throw in a disrespectful comment by an insecure nurse and the situation tragically explodes.
Lets just assume that in some wards in this country, staff are disrespectful in their attitudes towards patients. This can create an escalation of emotion: Staff see the patient as becoming more risky and start talking of injections; the patient sees the staff as threatening them with treatments they think are harmful. Also, the patient sees the staff as authoritarian and feels outnumbered. Throw in a disrespectful comment by an insecure nurse and the situation tragically explodes. patience567
  • Score: 0

4:23pm Mon 18 Mar 13

patience567 says...

I've seen things you wouldn't believe. Attack ships on fire off the shoulder of Orion. I watched c-beams glitter in the dark near the Tannhauser Gate. All these moments will be lost in time.. like tears in rain. Time to die.
I've seen things you wouldn't believe. Attack ships on fire off the shoulder of Orion. I watched c-beams glitter in the dark near the Tannhauser Gate. All these moments will be lost in time.. like tears in rain. Time to die. patience567
  • Score: 0

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