The State Hospital
In this section:
Although The State Hospital shares the same values, aims and challenges as the rest of the NHS in Scotland, it is unique because it has the dual responsibility of caring for very ill, detained patients as well as protecting them, the public and staff from harm.’
In 1994 legislation went through Parliament to bring The State Hospital legally into the National Health Service in Scotland as a Special Health Board – The State Hospitals Board for Scotland – accountable to Scottish Ministers through the Scottish Government.
The State Hospital is one of four high secure hospitals in the UK. Located in South Lanarkshire in central Scotland, it is a national service for Scotland and Northern Ireland and one part of the pathway of care that should be available for those with secure care needs. The principal aim is to rehabilitate patients, ensuring safe transfer to appropriate lower levels of security.
There are 140 high-secure beds (plus four beds for emergency use) for male patients requiring maximum secure care: 12 beds specifically for patients with an intellectual disability. A range of therapeutic, educational, diversional and recreational services including a Health Centre is provided.
Partnership working with South Lanarkshire Council is well established and provides social work services for patients and their families in addition to liaising with patients’ designated Mental Health Officers (MHOs) across the country.
The Forensic Mental Health Services Managed Care Network (Forensic Network) is hosted by The State Hospital.
Well developed relationships exist with the Mental Health Tribunal Service for Scotland and the Mental Welfare Commission for Scotland, and good partnership working is in place across the Forensic Network to ensure these patients are transferred as required.
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Our Vision, Values, Aims and Strategy
“To excel in the provision of high secure forensic mental health services, to develop and support the work of the Forensic Network, and to strive at being an exemplar employer.”
Values and Aims
The State Hospital has adopted the core values of NHSScotland which are:
- Care and compassion.
- Dignity and respect.
- Openness, honesty and responsibility.
- Quality and teamwork.
Primary twin aims are:
- Provision of high quality, person centred, safe and effective care and treatment.
- Maintenance of a safe and secure environment that protects patients, staff and the public.
Strategic Priorities and Objectives
A strategy session takes place annually to review and re-confirm or amend the long-term direction of the Hospital. Following the 2017 session, a three year Service Strategy (2017/20) was developed, identifying three strategic priorities critical to the success of the organisation and ensuring high quality care:
- Health Inequalities.
- Staff attendance and resilience.
- Efficient use of our resources.
A set of strategic objectives (aligned to State Hospital Quality Ambitions) has been established to support these three strategic priorities:
- Reduce obesity and increase physical activity.
- Complete implementation of the “Patients’ Day” project.
- Reduce the use of additional hours.
- Optimise efficiency in clinical practice and clinical service delivery.
- Transform services to optimise efficiency whilst maintaining quality.
- Identify ways of generating more income.
- Promote attendance and reduce sickness absence.
- Support a forward looking culture.
- Create conditions for supporting quality assurance, quality improvement and change.
- Look at ways of better utilising technology to support the national digital agenda.
- Explore more cost effective stewardship of assets and resources.
- Develop effective workforce and succession planning strategies and measures that will address identified rapid turnover in the future.
- Explore options for effective shared services and resilience building through enhanced collaborative working both internally and externally.
- Ensure opportunities to develop the whole workforce are maximised; focussing on leadership development and the review of workforce models to ensure a sustainable, skilled and competent workforce.
State Hospital’s Clinical Model
Care and treatment in the Hospital follows a well-established Clinical Model based on nine principles:
- Patient-Focused Care.
- Individualised Care Pathways.
- Positive Therapeutic Milieu.
- Supporting Staff.
- Strengthen Multi-Disciplinary Working.
- Violence Risk Assessment and Management.
- Comprehensive Mental & Physical Health Care and Treatment.
- Clinical Governance Strengthens and Informs Care.
Safety data were reviewed during July and August 2018, building on from a readiness to change survey that was carried out with staff in May 2018. Data analysis was undertaken to: understand more fully staff feedback on safety, to explore trends in data, and to consider further exploration of the delivery of the Clinical Model.
A stakeholder engagement exercise on the Clinical Model principles in October 2018 identified the principles as remaining relevant to the care delivered. However there was a view that the model for care delivery / the patient pathway through the Hospital, should be reviewed to ensure that it was safe, effective and person-centred. To this end, further stakeholder engagement took place in January and February 2019 resulting in the development of options for changing the delivery of clinical care. Engagement surrounding these options continues into 2019/20.
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Patients / Staff
Patients are admitted to the Hospital under The Mental Health (Care and Treatment) (Scotland) Act 2003 / 2015 and other related legislation because of their dangerous, violent or criminal propensities. Patients without convictions will have displayed seriously aggressive behaviours, usually including violence.
During 2018/19 there were 34 patient admissions and 33 patient discharges.
The majority of admissions were from courts and prisons.
While the majority of admissions were from the courts and prisons, the majority of discharges were to other NHS hospitals and prisons.
75.2% of the patients are ‘restricted’ patients within the jurisdiction of Scottish Ministers. That is a patient who because of the nature of his offence and antecedents, and the risk that as a result of his mental disorder he would commit an offence if set at large, is made subject to special restrictions without limit of time in order to protect the public from serious harm. This number also includes patients undergoing criminal court proceedings who are also subject to the supervision of the Scottish Ministers.
All patients are male, with an average age of 41. The most common primary diagnosis is schizophrenia. The current average length of stay is six years, with individual lengths of stay ranging from less than one month to over 30 years.
As at 31 March 2019, 653 staff worked at The State Hospital.
“The State Hospital provides the skills, culture, rehabilitation ethos and fit-for-purpose physical facilities necessary for high quality care of forensic patients.”
Wards are in four units (hubs and clusters) with each unit comprising three 12-bedded areas (i.e. 36 beds per hub). Clinical team offices, admin support and staff facilities are provided within an office accommodation block in each unit to facilitate multi-disciplinary engagement. An activity hub in each unit allows wards to share a range of facilities including day spaces, group treatment / therapy facilities and multi-function spaces. All wards have domestic kitchens and laundry areas that support patients in maintaining and developing activities of daily living skills. Privacy and dignity is promoted with en suite facilities for all patients and the facility to have a key to their bedroom. Patients are able to access outdoor spaces including ward gardens and hub gardens.
All patient therapy and activity is under the one roof within the Skye Centre. The Family Centre for child visiting reflects the needs of patients, carers and children.
All facilities have a functional design to maximise observation, and optimise safety and security, whilst maintaining a therapeutic balance.
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The Hospital has achieved a number of major awards:
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State Hospital ‘About Us’ (general information) November 2018.
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