Specification
change, and it is decided instead to use the newly updated building to house patients needing low-secure or step-down care. Before the site is even opened for this new use, it is not fit for purpose. Shortly afterwards it has to be adapted, with changed door and window locking systems; the cost of these changes now comes out of the Trust’s estates budget, rather than its capital costs.
IMPORTANCE OF CATERING FOR CHANGE Without the luxury of unlimited budgets, and in an adaptive healthcare system, I would strongly argue that it is important to make spending decisions that will cope with changes in use. Primera Life’s Twin-Tech lock system would have suited the needs of both patients with dementia and those needing secure care. Although there are Department of Health guidelines on the standards for high, medium, and low secure mental health units, there remain considerable variations in how Trusts deploy their facilities to address the needs of different service-users. Some, for example, may have all their infrastructure developed to medium secure levels, but may tailor their procedures to offer low secure services to some patients. Others have different infrastructure that effectively compels units to work in a particular way, regardless of the circumstances of the individuals in their care. In truth, patients don’t fit into neat ‘high’, ‘medium’, and ‘low’ boxes. Their mental health changes over time – sometimes day to day or hour to hour. What is needed is not a rigid system but an adaptable one – that can be altered to suit an individual on a working ward. Of course, it has to offer all the safety and security that is necessary; this is no place for a ‘make do and mend’. Rather, it is a place for smart ideas – elements such as removable door stops that prevent patients creating barricades, but still allow service-users a considerable degree of privacy.
EVERY PART OF THE PROCESS MATTERS The old adage about ‘spoiling the ship for a ha’porth of tar’ contains a lot of truth. Huge amounts of time are invested in new-build projects or major refurbishments. Clients, architects, contractors, project managers, service-users and staff, health and safety experts, and the Care Quality Commission, are all involved in bringing a project to fruition. The amounts spent on mental healthcare facilities are substantial. Things ought to be perfect, but in reality, if incorrectly managed, sometimes the smallest elements of the project can have serious consequences. If hardware, for example, is incorrectly installed it can compromise patient safety. Primera Life has seen instances where errors in fitting – clear cases of instructions not being
‘Things ought to be perfect, but in reality, if incorrectly managed, sometimes the smallest elements of the project can have serious consequences’
‘Over the last decade, there have been considerable changes to specification for the mental health sector’
the only thing that mattered – resulting in environments that were institutionalised and custodial. However the NHS now demands that mental healthcare environments are homely in appearance without compromising safety and security. It has been well proven that better surroundings and facilities can have a positive impact upon behaviour and recovery times; the NHS is responding with a specification process that now considers both function and aesthetics.
Primera’s Jerry Smith says: “Previously, function was the only thing that mattered – resulting in environments that were institutionalised and custodial. However the NHS now demands that mental healthcare environments are homely in appearance without compromising safety and security.”
followed – have meant that the essential secondary-override mechanism would not have worked in a barricade scenario. The project is thus undermined because one part of the process falls down through a lack of care, attention to detail, being rushed, or economised upon.
DANGERS OF ‘A QUICK FIX’
If a tragedy occurs within the NHS, systems, procedures, and infrastructure, come under intense scrutiny. There is a feeling that something must be done, quickly, possibly in an effort to appease loved ones, as well as to prevent a possible reoccurrence. Often the speed of the reaction causes its own issues in the fullness of time. A quick fix may be the wrong fix or even a broad-brush solution that fails to provide the specific benefits sought. There must always be a reaction to a tragedy, but responses should always be considered and appropriate.
If patient environments are ‘de-specced’ it is critical that they remain safe and eliminate the risk of self-harm. Products are specified to ensure that they are fit for purpose. Sometimes, however, contractors can benefit financially from using cheaper alternatives, and may invite quotations from several architectural ironmongers. Faced with tough competition, such companies may look for cheaper solutions in order to win the job. Consequently, the customer organisation – say an NHS Trust – doesn’t always get the right product for the application, or even the best value for money.
CHANGING SPECIFICATION PROCESS Over the last decade, there have been considerable changes to specification for the mental health sector. Previously, function was
Although this is the case in Great Britain, other countries are still evolving their processes. In Ireland, for example, it wouldn’t be uncommon to have double- occupancy rooms, or to keep
service-users contained at certain times of the day. We still have a lot to learn, and it would be foolish to think that we have made all the changes required, but we are moving in the right direction. Following on from Professor Louis Appleby’s report addressing anti-ligature measures, hardware was adapted so that handles sloped downwards. Now there are dedicated products proven to resist the attachment of ligatures – things that were unheard of only a relatively short time ago.
DRIVE FOR STYLE AND COLOUR The Disability Discrimination Act, and the later Equality Act, have also changed the specification process. Patient environments must, by law, be accessible, and not ‘intimidating, degrading, humiliating, or offensive’. There is a drive for style and colour, and more user input in the design and specification of a good therapeutic environment. As a result, projects have slowed and become more considered, and this shows in positive results.
The process of specification is changing, but
not everyone is up to speed. The issues I have highlighted are not difficult to solve. The necessary measures to prevent problems could be implemented on every single project without major complications. It just takes a little more thought, education, and understanding.
‘Now there are dedicated products proven to resist the attachment of ligatures – things that were unheard of only a relatively short time ago’
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