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Activities

Providing a programme of activity for individuals in this client group, who may be in hospital for very long periods of time, is essential. Activities should reflect all areas of an individual's life - self care, productivity, education and leisure. Activity may be generally therapeutic in nature and provide occupation; it may be physical in nature and help to maintain health, or it can be designed specifically to address identified psychological or behavioural needs. All these are essential components on the pathway to recovery.

Availability of all types of activity, with the involvement of staff from different disciplines would be an indicator of a well run service.A service will not be fulfilling its potential or responsibility to aid recovery if it provides the majority of activity in just one of these areas, or where this is left solely to nursing staff or an occupational therapist (OT) to provide most or all activity.

"When the OT is off no activities occur on the ward"

"Would not say activities were organised. It seems to be up to the nurse."Too busy" is often the response"

Individuals' views

We asked a range of questions about people's experience of activities on offer to them.69% told us that activities were arranged on the ward. Others were either unaware that activities were arranged or believed that no activities had been offered since admission.Some of those who were aware that activities are arranged, told us that they chose not to engage with them, whilst others were currently too unwell. However, 57% told us they participated in a programme of activities.

Many of the comments record that in most wards activity focuses on cookery and gardening, walking in the grounds or into town, playing games such as pool, or using gym equipment. However, 33% told us that they also engaged in a fuller range of educational or work based activities

"College course, shopping, library, OT session weekly approximately, also outing with physio (fitness instructor) e.g. golf range, badminton, and other outings with nursing staff"

"Activities include: keep fit, walking group, art classes, problem solving and anger management, IT at college, voluntary work"

We also asked people if they had the opportunity to take part in activities outside the ward and over half said that they had. Half told us they were allowed off the ward almost daily, although this might just involve a short time in the hospital grounds. However, it appeared from notes and interviews that 6 people had not been off their ward for over a month. Half of these individuals had not been out of the ward for much longer periods. One person told us that he had not been off the ward for over a year.

Staffing issues were occasionally blamed for limits put on time off the ward.

Nevertheless, some individuals acknowledged that there were clinical reasons why some had their time off the ward restricted.

Staff views

In five of the wards we visited, staff told us that organisation of activities was left to the occupational therapy (OT) department. Ten wards reported that a combination of nursing and OT staff organised activities, and in seven it was a combination of nursing, OT, and other members of the multi-disciplinary team. One hospital reported having a designated activity nurse.

Two wards (Boulevard, Leverndale and Great Western Lodge, Aberdeen) had an ethos that all activities take place off the ward. These wards were designated as "forensic rehabilitation" wards. Most others have a mixture, with some activities taking place on the ward and some in other areas both in and out of the hospital.Some wards have dedicated space for activities such as multi-gyms which encourage fitness. In six wards there was no dedicated space for activities. The range of activity available varied but on the whole seemed appropriate:

"Within the unit activities occur in the kitchen, the recreational hall nearby (badminton and soft ball), on the football pitch outside the hospital. The Gym and Fitness Centre run classes, there are technical college courses, sports courses at the Community Hall and staff take the patients out when time permits for cycling, walking, hill walking and swimming".

Staff felt that motivating individuals was sometimes difficult and some were exercising their choice not to engage in activities, but only 4 wards reported that one or more people refused entirely to engage with the activities available.

Two wards were unable to provide any evidence on the day of the visit that the programme of activities were reviewed. It is clear that not all services have access to specialist OT input.

The information we have does not allow us to determine whether those services that do have access to an OT have a measurably better programme of appropriate activities than those who do not. Nevertheless, occupational therapy is a core part of a multidisciplinary approach to care and should be available to all those who require it.