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Care planning and participation

Care plans are the accepted way by which individual care and treatment can be planned, documented and shared.Care plans and care planning provide a framework for agreeing and reviewing the benefits of a given programme of care, support and treatment to assist in a person's recovery.

Good care planning is essential in supporting recovery.Information sharing and participation is a key factor in ensuring individuals and their carers/named persons feel involved in the care pathway process.

There should be no discrimination because of offending behaviour. Care and treatment needs should be related to the individual's mental disorder and associated assessment of risk.

We would therefore expect greater emphasis to be placed on risk assessment for people within forensic services. During our reviews of care plans we were particularly interested to see how this interacts with the principle of least restriction and the assessment of individual care and treatment needs.

While most people we interviewed told us they were offered information about their illness and said they attended reviews, only half felt that they had a say in their treatment.

There were mixed views from people across services.:

"There are no plans for the future. I am never going to get out of here"

"Can't get any better treatment than I have had here, best in my life"

"There are clear plans in place to support people to move on"

"The staff are really nice here, they're understanding it is a good hostel"

Individual participation and family involvement

With regard to family involvement, encouragingly two-thirds of people felt that family and friends had been involved in the planning of care.  However, people from the following hospitals expressed particular concern over lack of involvement for both themselves and their families:

  • Rowanbank Ayr Clinic
  • Leverndale
  • Dykebar

Whilst we understand that for some people, involvement of family and friends may not be appropriate we do not think this is satisfactory. Being involved in planning your own care is an integral part of recovery. We are concerned that a high proportion of individuals do not feel involved in this aspect of their care and treatment.

It is clear that good named nurse arrangements and access to advocacy are important to improving people's sense of involvement in their care. Five out six people who felt positive about their experience, said they knew who their named nurse was and were very positive about having time to talk about their care, treatment and support. In addition (with the exception of three, who were unable to participate fully in the questionnaire) almost all individuals we spoke to were aware of the advocacy service and had made use of it at sometime during their period of illness.

Delayed Discharges

Some staff we spoke to said that that moving people on from secure services can be difficult.Moving people into more appropriate settings can be hampered by ward staff being required to understand and negotiate a number of different local authority procedures. This affects communication and weakens multi-agency working, which is essential to the moving on process.In discussion with staff, 1 in 3 felt that some people were not appropriately placed and 2 out of 3 that there were obstacles, which slowed down the discharge process and this was impacting on patient care.

"It's difficult to get services to take on care packages for people with forensic issues"