Quality in Medium Secure Units
| Published date | 01 September 2005 |
| Date | 01 September 2005 |
| Pages | 21-24 |
| DOI | https://doi.org/10.1108/13619322200500025 |
| Author | Ian Allured |
| Subject Matter | Health & social care |
Quality in Medium
Secure Units
Ian Allured
Service Development Adviser
Adult Mental Health, HASCAS
Introduction
National mental health policy developments place
new demands on medium secure units (MSUs) to
provide a ‘quality service’ for specific client groups,
including women, people no longer requiring
treatment and care in the high secure hospitals, and
people with dangerous and severepersonality
disorders (Department of Health & Home Office,
1992; Department of Health, 2000a; 2000b). In
addition, the clinical governance agenda places greater
emphasis on quality issues, with the establishment of
‘evidence-based practice’ in forensic and secure
services as elsewherein the NHS.
Commissioners in health authorities felt they did
not really understand the work of MSUs, and were
eager to learn more about their role and the system in
which they operated. The units tended to ‘manage
themselves’ and to deliver their service in isolation
from commissioners, who themselves were fearful that
large sums of money were spent to accommodate
people in emergency situations, often with no clear
careplan or well defined care pathway towards an
agreed objective.
In May 2002 the Health AdvisoryService (HAS),
the forerunner of HASCAS, was commissioned by the
NHS South East Region to develop quality standards
for the four MSUs within the region. A working group
was established comprising commissioners, forensic
psychiatrists, psychologists, nurses, occupational
therapists and service managers drawn from the
region, including the four medium secureunits to be
reviewed. This group worked with Geoff Shepherd,
then the chief executive of HAS, Ian Allured and Kim
Goddard(both service development advisers) to
develop a set of quality standards for reviewing the
work of the MSUs.
The standards
It was agreed at the outset that the standards should
cover all aspects of the MSUs’ work, that they should
be based on accepted good practice, and that they
should meet the requirements of the Department of
Health with regard to governance arrangements and
the defined role of forensic services (Department of
Health, 1999). The standards are only intended to
measure quality and to indicate improvement or
deterioration over time within one unit. They were
not intended, and cannot be reliably used, to compare
units due to the units’ verydissimilar histories, the
different ways in which they work and the overall
system environments in which they function. The
standards were to be deliberately aspirational in
nature; they were to be used to take a ‘snapshot’ of the
quality of the work of each MSU at a particular time,
and to provide a benchmark position of where each
MSU stood in respect of the standards.
The 14 quality standards are shown below:
1 the existence of a clearly defined process for
the admission of people to the unit
2 effective local arrangements in place for liaison
with referring agencies
3 protocols in place that clearly define the process
for discharge, transfer and follow-up of service
users
4 the physical environment is suitable for the
provision of services to people requiring
medium securecare
5the availability of a range of therapeutic
interventions
6opportunities for patients to participate in a
wide range of vocational, leisure, educational
and living skills activities according to the
individual needs of each service user
The Mental Health Review Volume 10 Issue 3 September 2005 ©Pavilion Publishing (Brighton) 2005 21
Case Study 2
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