A description of staff characteristics is shown at Appendix 5.8. 22 members o f staff completed the questionnaire 11 of whom had worked on the Case 1 site prior to their transfer to the reprovided Adult Acute Day Hospital which was commissioned in October 1994, four months before the EMI day hospital. These staff were surveyed seven months after their move. The remaining staff were seven who transferred to the Adult Acute Inpatient unit and four who were relocated to the EMI Day Hospital. These staff members were surveyed three months after their move. The four staff members who transferred to the new EMI day hospital had worked in the day hospital within the institution. The average period of service was 13 years and therefore most staff had significant experience of “institutional hospital" work enabling them to make a comparison with the new facilities.
Staff who were willing to be interviewed were accepted from all grades and professions, the proviso being that they must have, in their professional duties, significant day to day contact with patients.
Am ongst those completing the questionnaires was the consultant psychiatrist to the facility to whom the author is indebted for his help in undertaking this exercise. There had been some regradings generally to the benefit of staff.
All 22 staff reported that none of their conditions of service had changed as a result of the move. 10 staff had received increases in grade / status during the period of the move and 12 staff remained in the same grade. Staff were asked when and how they first became aware that the institution was due to close, and asked more specifically when they had found out that their ward/department was to transfer and how they were formally advised. Most staff were advised about closure more than three years before, mostly in staff meetings.
W ith regard to the hospital’s service reprovision, of the 22 staff members responding, 15 were clear as to how that service reprovision was to be provided and seven were unclear. 21 o f the 22 staff felt that it had been made clear where their part of the service would be relocated. Staff were also asked whether, if during the process of implementation, their understanding o f the programme remained clear. O f the 22, 11 had remained clear and 11 had become less clear.
S taff were asked whether they had been advised in detail of the overall plan and its components together with its proposed timetable. 20 of the 22 staff felt that matters were fully explained to them whilst two did not. All staff members were also asked if changes in the plan as it was implemented were notified to them. Eight knew of changes, 12 were unaware of any and two did not know whether any changes had taken place. 20 staff responded that they had received regular updates, all through regular staff meetings. The two staff who said they had not were both enrolled nurses, grade D.
Questions were also asked to determine staff input to the planning process. It appeared that 11 of the 22 staff members had provided an input to the planning of services. Of those whose input had not been sought five replied that they felt it should have been and six that it had not been necessary. 19 staff members felt that their professional group had contributed to the planning process.
To the question whether they had known the professional representative/senior officer relevant to their work who was planning the service, 15 replied that they had and seven that they had not. Asked whether their “professional group" had contributed, 19 replied that they had, one thought they had not (nursing assistant) and two, that they did not know (nurses grade D). Staff were asked if the planning system had allowed them to make their views felt. 20 replied positively and two negatively.
Four staff members (consultant psychiatrist and 3 senior nurses) were members of the project team planning the service. O f the 18 who had not been members, three thought they should have been, (a deputy ward manager and a staff Nurse E). The four members o f the project team were all involved in drafting operational policies and did this in multi-disciplinary groups with other care professionals. All felt they had been sufficiently involved in all aspects o f the commissioning.
O f 20 staff members who had been shown the design of the facility, 19 had been able to com m ent as to whether it had met operational requirements. With regard to staff involvement in the choice of furniture and equipment, colour scheme and furnishings, ten staff members had been involved. O f the 12 who reported that they had not been involved, six thought they should have been.
Staff Training
S taff were asked questions regarding training that would assist them with their work in the new facility - see Appendix 5.9. O f 22 staff, 11 staff members indicated that training had been offered to them and 11 that it had not. O f this latter group none thought that it should have been.
O f the 11 staff offered training, ten thought that it had been necessary. The staff member who did not avail him/herself of the offer was the physiotherapist as the training was facility related rather than clinical. Of the ten staff members who had received additional training, eight thought that the training had been good and two (staff nurse “D" and staff nurse “E”) thought it adequate. Following the training process all staff were asked whether they now intended to seek any further training 19 thought no further training was necessary, but three would be seeking further training. Of the six that were not offered training only one had felt that further training was necessary to perform existing work and two wanted training for further career development.
Commissioning
Four staff had been members of the commissioning team ( consultant psychiatrist, nurse m anager “G" and two ward managers “G”). Two (deputy ward managers "F") who had not been part of the commissioning team, thought that they should have been. The four members of the commissioning team advised they had had responsibility for all aspects of commissioning. With the exception of one staff member, all of the staff felt that the commissioning had gone well.
staff Views on the quality of the new facility
Overall 90% of staff views regarding the quality of the new facility were positive as to the adequacy of size, brightness, furnishings, decorations, durability and accessibility. Notably, proportions were somewhat lower for durability (86%) and size of rooms (77%). See Table 5.5.
Table S^S Case i t ; ;: Staff Views c
A s p e c t o f new facility
^Quality bf NawF
n = 22 max acilfties (% ) positive Adequate size 17 77 Bright / light 19 86 Furnishings 22 100 Decoration 22 100 Durability 19 86 Access 20 90 W C s Quantity 22 100 Proximity 22 100 Quality 22 100 B athing Facilities Quantity 21 95 Proximity 21 95 Quality 19 86 S u p p o rt Facilities Linen 22 100 Storage 21 95 Catering 20 90 Transport 19 86In relation to the quality, quantity and convenient location of toileting facilities, an affirmative response was given by 100% of the staff. 92% o f staff thought that bathing facilities were satisfactory across the range, but 13.5% thought that the bathing quality was not adequate.
All staff thought that facilities dedicated for their use were satisfactory.
Staff were asked whether support functions were satisfactory. Only in one facility was support services seen to be 100% satisfactory. In the other two, catering and storage attracted criticism, and transport in one facility was thought by 75% of staff to be unsatisfactory.
Summary Staff Views
All 22 staff were asked, notwithstanding their degree of involvement, whether the final outcome “accepting that some physical and cost constraints will always apply" had been acceptable. All 22 staff replied that they thought it had been.
General Health Questionnaire
The General Health Questionnaire was administered to 22 staff following their move to new facilities. This aimed to measure any impact the move might have had on the physical and mental health of staff members.
Table s.®: ; tesportses to Général: Health Qüestîcmnaîre : Score
0 1 2 3 4 5 6 7 8 9 10
P hysical Health - Signs & Sym ptom s 20 1 1
T en sion / Stress 17 1 2 1 1
S e lf Esteem / J o b Satisfaction 17 5
D epression 22 1 1 1
Total Score 16 1 2
Only a few staff reported experiencing mood problems which is supported by correspondence from Chartered Clinical Psychologist ‘J.S.’ and Dr 'C.' Medical Officer, Occupational Health, responsible for staff - Appendix Letters 1 and 2.
It was anticipated that staff morale would be affected by the process of closure and subsequent redeploym ent to community facilities. GHO scores indicate low anxiety and low depression levels in staff after the move. The occupational health department confirmed that mental health effects on staff as a consequence of the reprovision programme were indeed minimal.
5.4 CASE 2
5.4.1 Brief History
Case 2 was a county asylum and was opened in 1864. The hospital was set in 94 acres of land and had cost £6963 to purchase. The cost of construction at some £20,520 was a m ajor issue as asylums were more expensive to build than workhouses. Charges of about ten shillings per head per week were being levied in an asylum whereas a pauper could be provided for, for as little as two shillings and six pence per week in a workhouse. Extensive grounds were a prerequisite, for like most other mental institutions of this era, the patients were encouraged to work for their keep in the many trades within the grounds, on a working farm or as a shoemaker etc.
Only the male wards were complete providing 240 beds when the hospital opened in 1664. The completion o f the female wards added a further 530 beds.
5.4.2 The Closure Plan
Case 2, unlike Case 1, involved the complete reprovision in the community of a fully functioning Psychiatric Institution. Appendix 5.10 shows all the facilities to be reprovided in the programme and Table 5.7. shows those examined in this study.
Case 2 closure programme took place between early 1992 when the planning commenced and April 1995 when the hospital finally closed. Interim solutions were not necessary for inpatient reprovision but were required for Day Hospital services to achieve this closure programme.
5.4.3 Built Environment - Physical Surveys
The comparison of facilities is between the original institutional wards and day hospitals and the new o r converted facilities in the community. The surveyed old ward (a 23 bedded EMI ward) had, in common with many other wards in these institutions, received some basic upgrading. The new facilities being compared are two 12 place EMI inpatient facilities which were former Local Authority Part III residential homes, managed by the Local Authority Social Services Departm ent and partly funded by the NHS, a new purpose built building also providing 12 places for EMI inpatients as part of a larger new build psychiatric facility on a new community hospital site managed and funded by the NHS.
Physical Survey Results
Two sets o f data were collected; one measuring facilities against standards set out in the Health Building Notes (HBN 37, 1973) the other concerning environmental standards.
Table s ? Case 2 Original and Réprovided facilities Compared