Karen Burnett, Senior Infection Control Nurse / Palliative Care Lead

1. The State Hospitals Board for ScotlandPalliative Care in the State Hospital – A Multifaceted Approach Karen Burnett, Senior Infection Control Nurse / Palliative Care Lead The State Hospital

2. AIMSOF THE PRESENTATION • Provide background information on the State Hospital facilities & resources • Share case studies • Discuss the challenges surrounding palliative care nursing and how we have overcome some of these The State Hospital

3. HIGH SECURITY PSYCHIATRIC HOSPITALS • There are four high security (forensic) psychiatric hospitals in the UK: • Broadmoor Hospital in Berkshire. • Rampton Hospital in Nottinghamshire. • Ashworth Hospital in Merseyside. • The State Hospital, Carstairs, Scotland. • The first three service England and Wales. • State Hospital - Scotland and Northern Ireland. The State Hospital

4. MEDIUM SECURITY PSYCHIATRIC HOSPITALS Three forensic medium secure units serve Scotland: Rowanbank in Glasgow, Rohallion in Perth and the Orchard Clinic in Edinburgh. There is also one in Northern Ireland – the Shannon Clinic. The State Hospital

5. THE STATE HOSPITAL Situated in Lanarkshire midway between Glasgow and Edinburgh, provides a national service for Scotland and Northern Ireland. The State HospitalCarstairsLanarkML11 8RP The State Hospital

6. The State Hospital (1 of 7 Special Health Boards) The State Hospital

7. The State Hospital has been part of the NHS in Scotland since 1994. It is a Special Health Board accountable to Scottish Ministers through the Scottish Government. There are 140 high-secure beds for male patients requiring maximum secure care: 12 beds specifically for patients with a learning disability. As at 31 March 2017, The State Hospital employed 642 staff within its 60 acre campus The State Hospital

8. The State Hospital

9. MAIN RECEPTION The State Hospital

10. CAMPUS The State Hospital

11. RECEPTION AREA FOR PATIENT VISITORS / CARERS The State Hospital

12. FAMILY CENTRE (for child visiting) The State Hospital

13. PATIENT ACCOMMODATION Four (36 bedded) ward hub and clusters Each hub has three wards with 12 beds The State Hospital

14. HUB ENTRANCE The State Hospital

15. PATIENT ACCOMMODATION HUB The State Hospital

16. Hub corridor, ward dining room, day room and bedroom The State Hospital

17. Patient en-suite, bedroom and disabled bathroom The State Hospital

18. WARD TREATMENTROOM The State Hospital

19. SKYE CENTRE The State Hospital

20. Skye Centre Atrium – Patients’ Bank + Shop The State Hospital

21. Gardens & Animal Assisted Therapy Centre The benefits that animals bring are unquestionably therapeutic for many patients. The State Hospital

22. Sports & Fitness The State Hospital

23. Health Centre There is a GP service and clinics in Dentistry, Podiatry, Ophthalmic, Surgical, Diabetic, ENT (ear, nose and throat), Urology, Physiotherapy and Wellbeing. The State Hospital

24. ABOUT OUR PATIENTS The most common primary diagnosis is schizophrenia. All patients are male with an average age of 42. The current average length of stay is 6.8 years, with individual lengths of stay ranging from two months to over 30 years. A large proportion of patients are overweight or obese. People with severe mental illness die much earlier than others The State Hospital

25. AGE DEMOGRAPHICS ANNUALLY AUGUST The State Hospital

26. ABOUT OUR STAFF & SERVICES • Medical cover (psychiatry) normal working hours (with on call) • GP cover 2 sessions a week • Registered Mental Health Nurses 24/7 • 1 Registered Adult Nurse (practicing) during normal working hours • Pharmacist on each hub but only have 2 deliveries of pharmacy supplies every week • Sundries once per week The State Hospital

27. WHAT IS PALLIATIVE CARE? Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual (WHO 2018) The State Hospital

28. CASE STUDY 1 • 72years old gentleman • Been in TSH 40+ years • Diagnosed with personality disorder/ low intellect • Previous medical conditions • Hepatitis B • Stoma • In November 2017 diagnosed with gastric cancer and had a gastrectomy • Follow up CT scan showed metastasised to the liver • Died October 2018 The State Hospital

29. CASE STUDY 2 • 68 year old gentleman • Been in TSH 2months • No previous psychiatric illness and generally a well educated and affluent person, just retired. • In April 2018 diagnosed with brain tumour, went for surgery and commenced on steroids. • Within 6 weeks he was admitted to the State Hospital • Died August 2018 The State Hospital

30. DIFFICULTIES • Policy and procedures • Unfamiliar for staff and patients • Increased staffing resources • Balancing security with care • Open door policy • Access for relatives The State Hospital

31. PRACTICAL ISSUES • Room layout • Sourcing Equipment • Funeral Plans / Will The State Hospital

32. CHALLENGES • Internal Resources • External Agencies • Training • NES A framework to support the learning and development needs of the health and social service workforce in Scotland The State Hospital

33. LIFE AFTER DEATH • Patients • Staff The State Hospital

34. QUESTIONS? What are your thoughts on end of life care in secure settings? What have you done to prepare for an aging population? What experience can you share with us today? kburnett@nhs.net The State Hospital