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06/11/08
Hyphen-21’s AGM took place on the night after Guy Fawkes, in the week of Barack Obama’s election victory (for a poem on the election result see “New Poetry” on this site)
22/04/08
Andrew Motion helped launch a new website for "Poems for..." at the Nehru Centre in London on April 22nd
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| The Code of Professional Conduct for ward rounds and similar meetings |
Most people who have been hospital patients will have experienced a hospital ward round. For many, the experience will not have been a pleasant one – a sudden onrush of people in white coats, Big Boss in the middle ; no introductions ; someone picks up your chart and reads out figures and other bits of the medical story ; then a few questions, a few answers ; and away they all go again.
If you are in hospital with a broken ankle, your ward round experience is unlikely to leave scars. The self is intact and can cope with all this. It is only the material edges that are in bits and we can all stand aside from those.
If your state is more serious, it may be a different story. I have heard from several people suffering from life-threatening illnesses who have found the detachment of that circle of white coats offensive and deeply painful. The experience can leave you feeling reduced and de-personalised, at this time of extremity and question - not just bits of you in question, but your being in question.
For psychiatric patients the ward round can be utterly traumatic. In their case, they can expect to be called into one of the ward’s meeting rooms, where a circle of professionals will be gathered (at the time of writing we still get reliable reports of ward rounds made up of as many as 12 professionals). Sometimes the patient will still be in pyjamas, creating a powerful addition to his/her sense of exposure, difference and loneliness. The professional group are likely to include several strangers. Many users of mental health services remember the ward round as merely part of the bad memory of their breakdown, an experience both terrifying and humiliating.
The code set out here is the result of listening over a period of several months to users of mental health services talking about their ward round experiences. Then, as a co-operative exercise, a list of articles was slowly put together, detailing what should have happened. The code is thus a set of guidelines that protects a vulnerable individual from the insensitive treatment that traditional ward rounds have inflicted upon them.
In 1997 a pilot version of the Code was published by the magazine “Open Mind.” In 2000 it was adopted as official policy by the CNWL Mental Health NHS Trust, operating in central London. Other Trusts have also adopted it - if not word for word, then versions very similar.
Later, a Hyphen-21 steering group member paved the way for some of the Westminster User groups to present the code to the All-Party Parliamentary Group for Mental Health at the Houses of Parliament. The presentation took place in Portcullis House, in November 2002. Soon afterwards it was presented to the biennial conference of the World Federation for Mental Health, which took place in February 2003 in Melbourne, Australia.
Both presentations were successful, with the following results.
Soon after the Portcullis House event, the UK Department of Health acknowledged the code as good practice (see Julie Nichols quote in the side bar).
In March 2004, NIMHE went a step further and committed itself to active promotion of the code at all levels (see Malcom Rae quote in the side bar).
The response to the code’s presentation at the Melbourne Congress of the World Federation for Mental Health, 2003 was also very positive (see Pirkho Lahti quote in the sidebar). Incidently the Congress was genuinely interesting in its own right and included talks by remarkable people and reports on notable initiatives. It truly felt as if here was the cutting edge of mental health work, distilled from all over the world. The code presenters took notes and the resulting report was read out to mental health staff and service users in central London later in 2003. The report is offered on the right.
In 2004 the code was featured again in OpenMind, this time as a news feature (November/December 2004). It is also displayed on the web-site of the Sainsbury Centre for Mental Health.
There are various further things still to say on this subject, just as there are various things still to do.
First -
The code does not just apply to hospital ward rounds. It applies to CPA meetings too. In principle it applies to any meeting in which mental health service users meet mental health service staff, not least meetings whose remit includes user consultation.
Second -
There is real and urgent cause to believe that the code applies beyond mental health to all aspects of health and social care.
Third -
Adopting the code as policy is one thing ; making it stick is another. Advocacy Services can monitor the success of its implementation, and Audit Departments can regularly examine how well or badly it is being followed. But in the final analysis, policing it from the outside will only supply crime figures. It won’t facilitate an improvement in practice. Although the Code needs to be a requirement from above, it also needs to be assented to actively and creatively at the level of the practitioner.
We think that worker teams should take responsibility for themselves in maintaining this code, regularly reviewing their work with it and setting their own targets for what improvements might be necessary. After all, every worker present in a ward round comes from a discipline which has its own code of good practice. Each of these codes will doubtless talk of treating patients with respect.Which means that each time a patient is treated carelessly in a ward round, all the workers present are acquiescing in the breaking of their respective codes of professional good practice. It follows that everyone involved in a ward round should support each other in ensuring that the code is closely followed.
Here, then, are some ideas for taking the code past the stage of Policy Directive and embedding it in the system as normal practice. Some of these ideas are practiced in CNWL Mental Health NHS Trust. - The code is given out to all new in-patients as part of an information pack, spelling out their rights.
- The code is displayed prominently in the ward environment
- Local advocacy services help to promote the code, and monitor its practice
- The code features in staff training and supervision
- Each psychiatric team is asked to review on a regular basis its own practice in following the code.
- Every six months there is a rotation of Senior House Officers (junior psychiatrists still in training). User group representatives have a slot on the Induction Day of each new intake and use it to present the code and explain its importance.
- Each month CNWL Mental Health NHS Trust runs an Induction course. All new staff are required to attend, whatever their status. Often as many as fifty people are present. At the initial suggestion of the writer, a video has been made for showing at each Induction course the Trust puts on. Produced to a high professional standard, the video employed a cast made up entirely of service users and seeks to convey what it’s like to be at the receiving end – what helps and what hurts. The code is featured on the video and a mock ward round is acted out. The video represents a significant investment by CNWL and a step into untried territory ; its management team are to be commended . The video is apparently unique of its kind.
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The Ward Round Code in Action
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“Thank you for your letter…to Jacqui Smith, Minister of State, about codes of conduct in mental health. I have been asked to reply…The Department of Health welcome[s] such initiatives as the Code of Professional Conduct for Ward Rounds and Similar Meetings, and is an example of good practice it would want to support…We would…want to use the strong development channels within mental health to spread these ideas…..NIMHE will also look at how it can use its network of development centres across England to share the concepts too.”
Julie Nichols, NIMHE (the National Institute for Mental Health in England)
"We discussed the above at the last meeting of the Acute In Patient National Steering Group and colleagues were impressed with the guidance and believed it will bring many benefits.
The RDC Acute In-Patient leads and others agreed to share the guidance within their respective service and practice development networks, and stimulate discussion and review of existing approaches.
Paul Rooney and I will continue to challenge existing thinking where appropriate and support the improved practice you advocate.
Well done for taking forward this issue which has been a long-standing concern for many individuals. I expect much good will occur as a result of your initiative.”
Malcolm Rae, NIMHE
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World Federation for Mental Health
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"The Board of the World Federation discussed [the code] and was very satisfied with and enthusiastic about it."
Pirkho Lahti, then the WFMH Chair
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The Code
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See the code in full by clicking the link.
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| File size: 142k |
Click here |
| An Alternative Approach |
The "Own Space" model
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| File size: 111k |
Click here |
The Melbourne Conference Report
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See the report in full by clicking the link.
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| File size: 650k (long download) |
Click here |
 to view PDFs |