2012 TGU PATIENT SATISFACTION SURVEY: DEVELOPMENT AND RESULTS Dr. Lona Lockerbie Athena Duffy

Trevor Gibbens Unit Medium Secure (65 beds across 6 wards) Acute (Male) Sub-Acute (Male) Rehabilitation (Male) Pre-Discharge (Male) Acute & Rehabilitation (Female) Pre-Discharge (Female) Provide assessment, treatment and rehabilitation for mentally Disordered Offenders (Male and Female)

Survey Development The CQC consider service user satisfaction as one of the indicators of a successful service. Annual CQC national survey on satisfaction of people who use Community Mental Health Services. This survey does not consider forensic mental health services. But patients discharged from our services would have received the survey.

Survey Development KMPT felt it was important to explore the experiences of their own forensic inpatient population. Also measure whether the service is meeting set standards and collect patient suggestions of improvements. Included areas identified by the CQC standards and the Royal College of Psychiatry Quality Network Standards. Developed in 2008 by TGU staff and was reviewed by patients in 2012.

Survey Topics Patient Information Mental Health Act Do you know how to get the information you need about visits? Mental Health Act Have you had an explanation about why detained in hospital? Quality of Care and Treatment Do you have opportunities to discuss treatment and progress with clinical team? Medication and Diagnosis Have you had your diagnosis explained to you in a way you can understand? Finance Do you have any difficulties in accessing your money? Service-user involvement Are you aware of the role of the patients’ council?

Survey Topics Cont… Medication Records and Information management Do you know how to see your medical records? Staff Have you found the staff approachable and friendly? Environment Do you feel safe in the TGU Grounds? Personal Dignity, Social and Cultural Needs Do you think the staff understand your cultural background? Physical Care Have you been able to see the unit GP in a reasonable time of requesting to see one? Food Do you think the food is a good standard in terms of quality?

Aims To look at areas of change in satisfaction/knowledge and implementation of the action plan from the previous audit. To compare the results to standards set by the Quality Network for Forensic Mental Health Services (2011-2012). To establish the level of satisfaction/knowledge patients have about issues relating to their care and detention. To identify which aspects of TGU patients are most and least satisfied with.

Method Patients invited to a PSS survey group on ward Presented using Turning Point Non-attendees approached individually with paper version

Patient Involvement Patients were invited to become involved in the delivery and revisions of the survey. Informed at each ward’s community meeting. Volunteers were selected via discussions with their MDT. Patients were involved in either : The delivery of the survey to other patients The action planning from the results.

Response Rate 49% across the TGU (n = 31) Ward Response Rate Male Acute 6.5% Sub-Acute 22.6% Rehabilitation 19.4% Pre-discharge 12.9% Female Acute & Rehabilitation 29.0% 9.7%

Satisfaction Rating System: Satisfaction = >70% of the sample indicating satisfaction/knowledge Dissatisfaction = <30% of the sample indicating satisfaction/knowledge

Results 87% of survey questions obtained a satisfaction / knowledge score over 70% 56.4% of areas had shown an improvement on the previous year’s survey 36.2% areas had declined.

Least Satisfied Areas Do you know how to access the Patient Liaison Service (32%) Do you know name of Care Coordinator (36%) Do you know what the Patient Liaison Service is (39%) Have you been asked to sign care plan (52%) Have you experienced harm? (58%) Do you know how to view medical records (61%) Do you have opportunities to develop work skills (68%) Know how to access the Independent Mental Health Advocacy Service (68%)

Average Satisfaction/Knowledge Scores across Question Categories

Experts by Experience (EbE) Group Group made up of service users and ex-patients. Their involvement with the 2012 TGU PSS included: Feeding back the survey findings to the TGU patients Working with the TGU patient group to gather their views about improvements and what they would like to see on the subsequent Action Plan. Shared in Patient Experience Meeting Held Focus Groups Made Posters

Action Plan Finding Action Evidence Timescale 32% of patients know how to access the Patient Liaison Service (PALS)   Advise PALS, ask how they want to address this. Consider removing related questions from the survey and handing responsibility back to PALS. Consider re-wording questions to capture satisfaction levels rather than level of knowledge. i.e. ‘Have you used PALS before?’ ‘If yes, how satisfied with their service were you?’ Receive feedback from PALS on how they will monitor this. Amended future Patient Satisfaction survey End of Jan 2013  End of Jan 2013 36% of patients know the name of their Care Co-ordinator Removing this terminology from the survey except for those about to be discharged into the community, thus reflecting recovery. Making it clear to patients they have the opportunity to change their Care Co-Ordinator (including other MDT professionals). This can be made explicit in the patients’ handbook. Updated patient Handbook.    39% of patients know what the Patient Liaison Service is (PALS) Consider removing related questions from the survey and handing responsibility back to PALS so they can produce their own survey to measure satisfaction of their service. 68% of patients feel they have the opportunity to express their sexual orientation To hold some focus groups on the expression of sexuality. Future Patient Satisfaction Survey. Feed back into Patient Experience meetings.

Finding Action Evidence Timescale 50% of patients have been asked to sign a copy of their care plan   Remind clinical teams that patients should be asked to sign their MDT Care Plan. The TGU is currently changing the way they approach care plans and the CPA process, so these sections in survey need to reflect this Athena Duffy to email all clinical teams asking them to discuss at their next meeting. Amended future Patient Satisfaction Survey CPA Review CPA Audit End of Jan 2013 Ongoing 58% of patients reported they have experienced harm at TGU. Inform clinical teams at Clinical Governance. Review the results in accordance with the ‘Exit Interview’ findings. Consider removing from annual Patient Satisfaction Survey and focusing of ‘Exit Interview’ to ensure more frequent monitoring. Feedback results of the ‘Exit Interview’ in Patient Experience meetings. Monitor complaints and Serious Incident’s through Patient Safety meetings. Amended future Patient Satisfaction Survey. End Of March 2013 Ongoing (SI’s)    61% of patients know how to review their medical records Feedback to Clinical Governance to consider To differentiate between levels of satisfaction and knowledge, this question will need to be altered accordingly for future surveys. i.e. ‘Have you ever asked to see your medical records?’ ‘If yes, were you satisfied with how your request was dealt with?’ Add information on access to medical records to service user handbook. (End Jan 2013) Make a DVD with this information (end of Marc 2013) Amend future Patient Satisfaction Survey. Revised Patient Handbook Information to be available on DVD on all wards as well as in patient portfolio End of March 2013

Finding Action Evidence Timescale 39% of patients are not satisfied with the food in terms of choice; quantity and quality. There are ongoing audits of the quality of the new food menu which was implemented November 2010. Continue to liaise with Trust catering manager to review food provision and source new provider. Complete food audit after 1 year of new menu. Future Patient Satisfaction Survey. Ongoing 67% of patients have had the opportunity to develop my work skills   Ask TAT what is currently available. Ask patients what they want. Make clear the process of how to gain work opportunities. Circulate current job descriptions across wards. Produce article for TGU Enquirer magazine about the Lakeside Café & associated work opportunities. Audit around vocational skills to gain a better understanding of skill and needs set. Therapeutic Activities Quarterly Review (TAQR) - 68% of patients know how to access IMHA Advise IMHA of this and ask how they want to address this. Consider removing questions from survey and handing responsibility back to IMHA to produce their own survey to measure satisfaction of their service. Consider re-wording questions to capture satisfaction levels rather than knowledge. i.e. ‘Have you used IMHA before?’ ‘If yes, how satisfied with their service were you?’ Provide information on the DVD. Receive feedback from IMHA on how they will monitor this. Amended Patient Satisfaction Survey. Information to be available on DVD on all wards as well as in patient portfolio End of Jan 2013 End of March

Summary Overall there is a high level of patient satisfaction at the TGU. Suggests that the TGU is reaching CQC standards. Allows the TGU to make changes where possible to improve the experiences of being a service-user of the TGU. Next Steps: Survey modified to ensure levels of satisfaction are measured as opposed to amount of knowledge. Questions relating to externally contracted services need to be reviewed. Follow set Action Plan. Continue to assess annually.

Trevor Gibbens Unit, Hermitage Lane, Maidstone, Kent, ME16 9PH, UK Thank You! For further information, please contact: Lona Lockerbie (Service Line Lead for Psychological Practice - lona.lockerbie@kmpt.nhs.uk) Rachel Quinn (Assistant Psychologist - rachel.quinn@kmpt.nhs.uk) Trevor Gibbens Unit, Hermitage Lane, Maidstone, Kent, ME16 9PH, UK