"doesn't involve me in my care plans"

Thank you for taking the time to share your thoughts about your care, continuity of care, running of your ward, availability of therapies and staffing resources. One of the values of the Trust is that People are central to everything we do. With this in mind, our ongoing commitment is to listen and learn from our patients, carers and staff and ensure that we live by our values in a real and meaningful way

I am sad to hear that feel you are not involved in producing your care plans and in planning for the future. We believe that it is only by your multi-professional clinical team and staff working in partnership with you that the quality of your health, care and recovery will improve. I am however aware that it takes time to build a trusting therapeutic relationship with your team especially if you are at the beginning of your engagement with mental health services on an admission ward. I am pleased that the relationship is going in the positive direction as you said there are some staff who you trust and can talk to about your care.

Staff having personal discussions among themselves and not responding to your needs is unacceptable. I would encourage you to present your concerns about staff to the ward manager, independent advocate or any member of the clinical team. I am aware that the Topaz ward manager with the support of the team leaders is working hard to create a safe, healthy atmosphere to enable you and the other patients to engage in your assessment and care. He has therefore ensured that there is a weekly ward community meeting attended by both patients. He also regularly attends to facilitate difficult and/or sensitive issues to be safely and openly discussed and then for the attendees to agree a mutual way forward. If you are unable to discuss your concerns about staff attitude and behaviours openly please request to see the ward manager who will respect your wish for privacy and confidentiality ensuring that actions are taken to resolve the issues. The options for resolving the issues may include the ward manager speaking with the identified staff, presenting the issues to the monthly ward staff meetings and/or weekly ward community meetings and request for the issues to be resolved by the patient and groups together. The ward manager will ensure that the identity of the person who has raised the issues is protected and respected.

In response to your concern that there is a lack of consistency on the ward, I am aware that recently the ward has been unsettled partly due to new admissions and anxieties of those patients who have completed their assessment but are fearful of going onto the treatment stage. This is not surprising in this dynamic trauma informed environment. I think however that you will agree that the Topaz ward clinical team and nursing team working collaboratively with patients have effectively and safely improved the atmosphere to such an extent that it is once again a safe, therapeutic environment for patients to engage in their assessment and care in order to progress to their treatment programmes in another setting.

More support has been given to patients by providing more activity and focus groups. Staff also have been afforded more time to engage in both individual and group supervision. In addition the ward manager has drafted a ward manual to ensure that all staff and patients are aware of the expected local procedures and practices to ensure that the ward is safe physically, procedurally and emotionally for all patients, staff and visitors to the ward. He will be sharing contents of the ward manual with patients via ward community meetings and staff meetings. Then he will present it to the Senior Management and Clinicians for approval before he publishes and circulates it.

Thank you for highlighting the need to recruit staff. Against a backdrop of austerity, national financial constraints and nursing shortages, the hospital management and clinicians have a robust recruitment programme whereby we are interviewing for new staff on a monthly basis. Other initiatives include assessing how the nursing workforce needs to be more adaptable, to be more flexible and have skills to support patients presenting ever increasing and different complex, challenging behaviours For example the ward managers across the hospital meet to explore new ways of working so that the wards are run effectively and efficiently. They have also met with other ward managers in the other two high secure hospitals to share good practice. We are also looking at ways we can get patients more involved in ensuring that we continue to have a competent workforce that delivers recovery focused patient centred care. I am therefore delighted to inform you that patients have been trained to interview and are active participants on all the recruitment interview panels for nursing staff. In essence I am truly amazed and grateful at how in spite of national financial constraints, staff continue to deliver high quality care and how patients continue to take an active role in their individual care and in improving service delivery.

As you are probably aware that the hospital reviewed the activity programmes so that each patient has a weekly meaningful activities programme. Please contact your named nurse, your ward manager and/or any member of your clinical team if you have any concerns about your care, treatment including therapies and your daily activities.

I am delighted that you enjoy attending and participating in activities offered by the Diamond Resource Centre, the day care services for women. Please be actively involved in the reviewing and planning of the activities so that they remain relevant and engaging.

Thank you