Contents
1 Introduction
Rotherham Doncaster and South Humber NHS Trust (the trust) forensic service comprises of Amber Lodge, a 13 bedded male low secure learning disability unit, which provides specialist assessment, treatment and rehabilitation for adult males detained under the Mental Health Act.
The inpatient units provide care for those who pose a significant risk to others and require physical security that impedes escape from a hospital. Individuals may have been in contact with the criminal justice system and will either have been charged with or convicted of a criminal offence, however, require treatment pathways rather than a custodial sentence.
The goal of the forensic service is to work in partnership with individuals using recovery-based approaches, enabling development to their full potential in all aspects of their lives and supporting individuals to step down to less secure placements positively and safely. All care is delivered in a safe, therapeutic environment with individualised care packages for individuals to address their learning disabilities and levels of challenging behaviours, in the context of mental health needs and offending behaviours.
The forensic service strives to work collaboratively with patients, their family, carers, Commissioning teams, provider collaborative and any other appropriate professional agencies to maintain a safe, positive environment. We work proactively towards reducing restrictive interventions around the environment, property, and person dependent on level of risk.
1.1 Security
Security provides the framework within which care and treatment can be safely provided. Neither patients nor colleagues can engage positively in the activities of the service unless they first feel safe.
Security procedures are paramount within the forensic service and all security measures employed are based upon the “see, think, act” principles which creates a pro-security culture where the responsibility for security is accepted by all. The principles of relational, procedural, and physical security are the core of the training package delivered to colleagues working in the service on an annual basis (See, Think, Act – 3rd Edition) (Royal College of Psychiatrists, 2023).
Security should have a supportive and positive role in the treatment pathways for patients, as it provides structure enabling clinical care to be delivered safely and effectively. The physical aspects of security minimise risks to all colleagues, patients, and visitors but relational aspects of security promote therapeutic relationships, improved communication and working observational practices. Relational security is by far the most important focus of the forensic service and embedded comprehensively will ensure that the whole security system, Physical, procedural and relational is able to work effectively.
1.2 Restrictive practice
Restrictive practice is making someone do something they don’t want to do or stopping someone doing something that they want to do. Restrictive interventions are deliberate acts by professionals that restrict a patient’s movement, liberty and, or freedom to act independently. Interventions like this are required in the forensic service to take immediate control of dangerous situations where there is the real possibility of harm and to prevent situations arising and also to prevent, end or reduce significant danger to patients or others (Department of Health, April 2014).
The forensic service is committed to engaging with reducing restrictive practice and will endeavour to practice to the least restrictive options available in all situations. However due to the nature of the service some procedures may be restrictive in nature to meet the needs of the patient’s group in order to ensure safe, effective and therapeutic care delivery and positive patient experience. Restrictions will be implemented in line with local and national policy and guidelines and following robust individualised assessment and collaboration with patients. All restrictions are agreed with the aim of balancing the rights of individual patients with the requirement to maintain a safe, therapeutic environment within the secure setting.
Due to the requirement for restrictive practice within the Forensic Service robust and clear guidelines on working procedures are available for all colleagues. Mandatory positive behaviour support training is delivered to all colleagues and collaborative engagement with patients to individualise care as much as possible is core to the forensic service. Patient education is essential within this to promote understanding about the required restrictions within the service to enable continued development of therapeutic relationships and safe effective treatment pathways.
2 Purpose
The purpose of the forensic service manual and the linked procedures is to provide clear, concise information and guidance on all working practices within the forensic service for all colleagues working throughout the service. The content of the manual and the linked procedures is based on sound evidenced based practice.
3 Scope
The manual applies to all forensic colleagues, whether in a direct or indirect patient care role. It is also relevant to patients, visitors, contractors and other persons who enter forensic service environments. Adherence to the procedures within this manual is the responsibility of all Forensic and trust colleagues, including agency, locum, bank colleagues and students.
4 Responsibilities, accountabilities and duties
4.1 Board of directors
The board of directors are responsible for the trust having policies and procedures in place which meet national and local requirements and, or legislation in order to provide a service which is based on best practice. The lead director responsible for this is the chief operating officer.
4.2 Directors and heads of service
All directors and heads of service are responsible for:
- monitoring compliance with the procedures within the forensic service manual
- reporting any non-compliance via the trust incident reporting system
- investigating any reported non-compliance
- the implementation of any action plans arising from the audits of the manual and patient feedback
- identifying training needs of colleagues that fall within the remit of this manual and working procedures
- ensuring that a security culture is embedded in day to day operations, with robust security risk assessments in place, evidenced based from the ‘see, think, act’ evidence based training
4.3 Modern matron or service managers
The modern matron is responsible for making colleagues aware of and implementing this manual and for bringing any issues which may affect implementation to the attention of the head of service. Assisting as required with any subsequent investigations and action planning to ensure full compliance with the manual and working practices.
4.4 Senior sister or ward manager
Senior sisters are responsible for making colleagues aware of and implementing this manual and subsequent procedural documents and for bringing any issues which may affect implementation of this manual to the attention of the modern matron or service manager.
4.5 Ward sister or charge nurse
Ward sisters are responsible for supporting the senior sister or ward manager by making colleagues aware and implementing this manual. ward sisters are also accountable for any auditing required with in the service and escalating concerns to the senior sister or ward manager.
4.6 Shift co-ordinator
The shift co-ordinator is responsible for day to day practice within the service environments and must escalate any non-compliance or concerns immediately to line management.
4.7 All Colleagues
All colleagues must adhere to this manual and identified working procedures. Failure by any colleagues to follow the working procedures can lead to a disciplinary process, due to the severity of consequences that may arise within the service if procedures are not complied with. It is the responsibility of each individual member of colleagues to adhere to the requirements set out within this manual.
All colleagues are responsible for reporting non-compliance with this manual and working procedures to line management or the modern matron or service manager.
5 Procedure or implementation
- Accessing keys from the key tracker system forensic service procedure
- Admission of a patient to forensic services procedure
- Control of the airlock forensic service procedure
- Discharge transfer from FS procedure
- Patient escorting procedure v2.3
- Fingerprint access system (FAS) Amber Lodge procedure
- Mobile phones and other devices procedure (management of devices capable of storing, manipulating, recording or transferring personal data)
- Patient escape amber lodge forensic services procedure v2
- When a patient goes absent without leave (AWOL) procedure
- Pornographic and sensitive material management procedure
- Prohibited and restricted items management procedure
- Searching of a person, (patients and visitors) and their property procedure
- Security Amber Lodge procedure
- Wi-fi access and internet enabled devices, Amber Lodge standard operating procedure (this is a local working instruction)
6 Training implications
6.1 Security procedure, all forensic service colleagues
- How often should this be undertaken: Annually.
- Length of training: 2 hour induction, training 3 hours enhanced training (annually once competent in induction training).
- Delivery method: PowerPoint presentation, group work, scenario wall, reflective practice.
- Training delivered by whom: Forensic ward manager.
- Where are the records of attendance held: Electronic staff record system (ESR).
6.2 Positive behaviour support, all forensic service colleagues
- How often should this be undertaken: When commencing employment with the forensic service.
- Length of training: 2 hour training workbook to be completed.
- Delivery method: PowerPoint presentation, group work, workbook.
- Training delivered by whom: Forensic ward manager.
- Where are the records of attendance held: Electronic staff record system (ESR).
6.3 Positive behaviour support, PMVA
- How often should this be undertaken: Annually.
- Length of training: 2 days.
- Delivery method: Face to face.
- Training delivered by whom: Learning and development centre.
- Where are the records of attendance held: Electronic staff record system (ESR).
7 Monitoring arrangements
7.1 Non adherence to the manual and working procedures
- How: Audit and training records.
- Who by: Modern matron.
- Reported to: Head of specialist services.
- Frequency: Various, daily, weekly, monthly, quarterly.
8 Equality impact assessment screening
To access the equality impact assessment associated with this manual please follow the link: Equality impact assessment.
8.1 Privacy, dignity and respect
The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.
As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).
8.1.1 How this will be met
There are no additional requirements in relation to privacy, dignity and respect.
8.2 Mental Capacity Act
Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.
Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.
8.2.1 How this will be met
All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005).
Individual assessment based on personalised care will highlight requirements for capacity assessment. If required these will be undertaken in compliance with the Mental Capacity Act 2005 and appropriate documentation completed for each individualised decision and patient.
9 Links to any other associated documents
This manual policy should be read and implemented in association with the following:
10 References
- Department of Health (2002) National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments.
- Royal College of Psychiatrists (2023). See Think Act Second Edition.
- Forensic Quality Network (June 2012) for Forensic Mental Health Services Standards for forensic mental health services, Fifth Edition.
11 Appendices
11.1 Appendix A Admission to inpatient learning disability forensic services procedure
11.2 Appendix B Approved access to FAS form A
11.3 Appendix C Removal from FAS system form B
11.4 Appendix D Audit approved access to FAS form C
11.5 Appendix E Escort status risk assessment
11.6 Appendix F Home risk assessment
11.7 Appendix G Restricted items
11.8 Appendix H Prohibited items
11.9 Appendix I Pro-active search record
11.10 Appendix J Rub-down search
Permission? Pockets empty? Anything unauthorised?
11.11 Appendix K Receipt booklet order details
The receipt booklet can be ordered via NHS supply chain
order details as follows:
- duplicate book 125mm by 200mm
- product order code, WEL208
- cost per item, 83p
11.12 Appendix L Search box inventory
11.13 Appendix M Patient debrief template
11.14 Appendix N Staff debrief template
11.15 Appendix O Unauthorised absence of a person detained under the mental health act 1983
Document control
- Version: 3.
- Approved by: Clinical policies review and approval group.
- Date approved: 5 March 2024.
- Name of originator or author: Forensic ward manager.
- Name of responsible committee or individual: Executive director of nursing and allied health professionals.
- Unique reference number: 523.
- Date issued: 22 April 2024.
- Review date: 30 April 2027.
- Target audience: All colleagues working in the forensic service.
- Description of changes: Review.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025