The Refocusing Model: A Means of Realising the National Acute Inpatient Strategy
| Date | 01 March 2003 |
| Published date | 01 March 2003 |
| DOI | https://doi.org/10.1108/13619322200300006 |
| Pages | 27-31 |
| Author | Nick Bowles,Ron Howard |
| Subject Matter | Health & social care |
The Refocusing Model:
A Means of Realising the
National Acute Inpatient Strategy
Nick Bowles
Senior Lecturer, University of Bradford
Ron Howard
Head of Joint Services (Bolton),
Salford and Trafford Mental Health Partnership
Focus on…
Introduction
After several years of neglect in respect of both policy
initiatives and research endeavour, acute mental
health inpatient care is now a high priority for the
Department of Health, NSF local implementation
teams, commissioners and trust boards.
In this paper the authors describe the ‘refocusing’
model for change that has impacted positively upon
inpatients and staff with reductions in financial costs
and clinical risk. This model was developed in
Bradford and highlighted as a good practice example
in the Department of Health policy guidance, 2002.
Subsequently it has been implemented in nine acute
wards in three NHS trusts with a further nine wards
coming on stream in 2003, making it the largest, single
practice development project underway in acute
settings within the UK.
Baseline
For a number of years many acute wards have not
been providing either an effective clinical service or a
positive employment environment for the hard-
pressed staff who work within them, despite drawing
around two-thirds of the mental health budget.
There are a number of reasons for the failings of
acute wards, many of them structural and societal. The
pressure on beds has increased steadily over the last
10 years or so. The CMHTs, home treatment and
crisis teams have done a reasonable job of maintaining
in their homes many of those who would once have
been admitted so that the type of patients receiving
inpatient care has shifted to those who are most ill,
vulnerable, disturbed and/or disturbing to workers and
the communities in which they live. An already
complex clinical picture is commonly worsened by
substance use, lack of housing or community
provision, and significant social hardship.
However, while eminently defensible, this
aetiological perspective does not take into account the
interpersonal dynamics of acute wards, environments
which are often emotionally highly charged. In order
to examine this interpersonal climate the experiences
of service users and the ward staff are examined.
Service users commonly receive an impoverished
and substandard service from admission to discharge.
The admission process tends to be poorly expedited;
inadequate time is spent on ‘induction’ despite the
crisis that admission represents in many people’s lives
and only limited information is available. While on the
ward service users commonly report feeling unsafe,
fearing abuse and violence which in some cases is all
too real. Opportunities to leave the ward, even to have
some fresh air, are rarely freely available.
Service users may receive little more than custodial
care with treatment intended to meet only their most
pressing and immediate needs. Many do not have
access to a daily programme of purposeful activities so
that many patients are bored and unsupported for long
periods. Patients are commonly uninvolved in their
plan of care (or discharge planning) and feel they do
not have a say in their care or any influence on the
environment in which they are living.
This is clearly unacceptable, especially for those
The Mental Health Review Volume 8 Issue 1 March 2003 ©Pavilion Publishing (Brighton) 2003 27
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