8.53 Hospital managers will need to consider what arrangements should be put in place to protect the safety of patients who are not subject to enhanced security.
8.54 Patients admitted to acute wards, whether or not they are formally detained there, will have complex and specific needs. In such an environment, ward staff will need to balance competing priorities and interests when determining what safety measures are necessary. This should not amount to a blanket locked door policy (see
paragraphs 8.10 – 8.15 above).
8.55 The intention should be to protect patients, in particular those who are at risk of suicide, self-harm, accidents or inflicting harm on others unless they are
prevented from leaving the ward. Arrangements should also aim not to impose any unnecessary or disproportionate restrictions on patients or to make them feel as though they are subject to such restrictions. It may also be necessary to have in place arrangements for protecting patients and others from people whose mere presence on a ward may pose a risk to their health or safety.
8.56 It should be borne in mind that the nature of engagement with patients and of therapeutic interventions and the structure and quality of life on the ward are
important factors in encouraging patients to remain in the ward and in minimising a culture of containment.
8
8.57 All patients should have regular access to outside space. Locking doors, placing staff on reception to control entry to particular areas, and the use of electronic swipe cards, electronic key fobs and other technological innovations of this sort are all methods that providers should consider to manage entry to and exit from clinical areas to ensure the safety of their patients and of others.
8.58 If providers are to manage entry to and exit from the ward effectively, they will need to have a policy for doing so. A written policy that sets out precisely what the ward arrangements are and how patients can exit from the ward, if they are legally free to leave, should be drawn up and given to all patients in the ward. The policy should be explained to patients on admission and to their visitors. In addition to producing the policy in English, providers may need to consider drawing it up it in other languages if these are in common use in the local area, as well as in accessible formats.
8.59 If managing entry and exit by means of locked external doors (or other physical barriers) is considered to be an appropriate way to maintain safety, the practice adopted should be reviewed regularly to ensure that there are clear benefits for patients and that it is not being used for the convenience of staff. It is never acceptable to lock patients and others in clinical areas simply because of inadequate staffing levels. In conjunction with clinical staff, managers should regularly review and evaluate the mix of patients (there may, for example, be some patients who ought to be in a more secure environment), staffing levels and the skills mix and training needs of staff.
Related material
• Using Mobile Phones in NHS Hospitals. Best practice guidance. Department of Health. 2009. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/ www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/ digitalasset/dh_092812.pdf
• Guidance on the High Security Psychiatric Services (arrangements for safety and security) Directions. 2013. https://www.gov.uk/government/publications/high- security-psychiatric-services-directions
• The High Security Psychiatric Services (Arrangements for Safety and Security) Directions. 2013. https://www.gov.uk/government/publications/high-security- psychiatric-services-directions
• Eliminating Mixed Sex Accommodation. Department of Health. 2009. PL/ CNO/2009/2. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/200215/CNO_note_dh_098893.pdf
• Eliminating Mixed Sex Accommodation. Department of Health. 2010. PL/ CNO/2010/3. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/215932/dh_121860.pdf
Why read this chapter?
9.1 This chapter gives guidance on statements by patients who are subject to compulsory measures under the Act about their preferences for what they would, or would not, like to happen if particular situations arise in future. Advance statements and decisions strengthen patients’ participation in their treatment and recovery and help them to feel more empowered about what may happen to them should they lack mental capacity to make decisions about their care and treatment in the future.
9.2 Advance statements do not legally compel professionals to meet patients’ stated preferences, though they should be taken into account when making decisions about care and treatment. Advance decisions to refuse treatment are legally binding. Such decisions must be recorded and documented. Advance decisions are concerned only with refusal of medical treatment and are made in advance by a person with the mental capacity to do so. The chapter details the circumstances when clinicians may lawfully treat a patent compulsorily under the Act.
Definitions
9.3 This chapter distinguishes between advance decisions to refuse medical treatment and other statements of views, wishes and feelings that patients make in advance. 9.4 An advance decision means a decision to refuse specified medical treatment made
in advance by a person who has the mental capacity to do so. They are a way in which people can refuse medical treatment at a time in the future when they may lack the capacity to consent to or refuse that treatment.
9.5 Advance decisions are concerned only with refusal of medical treatment. Other advance expressions of views, wishes and feelings, often referred to as advance statements, may be about preferred medical treatment or other wishes and
preferences not directly related to care, and may be about what the patient wants to happen as much as what they would prefer not to happen.
9 Wishes expressed in advance
Wishes expressed in advance