Governance

What Quality systems and Governance arrangements are in place?

Cornerstone House regularly reviews and develops its quality systems to enable us to ensure that we provide a high quality service which is responsive and flexible to meet the needs of our patients. The service employs a Quality Assurance Manager who has responsibility for the audit programme at Cornerstone House and for ensuring continued compliance with the Essential Standards/Fundamental Standards of Health and Safety.

Clinical Governance can be thought of as, doing the correct thing, at the correct time, by the correct staff member - the application of the best evidence to an individual's problem. As an organisation Vision Mental Health:

  • Is accountable for the actions of its staff
  • Will actively appraise and develop staff
  • Work to reduce risks and improve upon the quality of service delivery
  • To learn from our good practice and that of others, as well as learning from our mistakes and those of others
  • Duty of Candour – Cornerstone House has always championed an open and honest approach to service delivery. When something goes wrong a full investigation and written account of the incident is produced and an explanation given to people that it effects along with a frank apology. Notifications are made to external agencies where required and as an organisation we strive to learn lessons from the incident to minimise the risk of recurrence.

Our Quality Assurance Framework (QAF) Meetings compose of the senior managers/directors and clinicians of Cornerstone House.

The committee is responsible for ensuring that our stated aims and objectives are met. As part of its responsibilities it ensures that:

  • The registration requirements for the Hospital are met.
  • There is an effective clinical risk management strategy.
  • Effective workforce planning and development.
  • Poor performance is identified and addressed.
  • Clinical record keeping is conducted according to National Standards.
  • Clinical policies and procedures reflect best practice and are reviewed on an ongoing basis.
  • There is an established system of audit.
  • Establish best practice, and where possible publication of the results of it.
  • Will proactively seek feedback from our people, staff and other stakeholders (friends/families/professionals).

In addition, Cornerstone House has a Board of Directors that meetings on a monthly basis consisting of senior members of staff from Cornerstone House and external Senior Non-Executive Directors. The Board is responsible for ensuring the Quality and Safety of the service as well as acting as a direct link to staff working in NHS organisations.

How do we manage the requirements of the Mental Health Act?

A Consultant Psychiatrist is responsible for the treatment of patients detained under the Mental Health Act (1983/2007).

The administration of the Mental Health Act procedures at Cornerstone House are co-ordinated by a Mental Health Act Administrator under the supervision of a Senior Mental Health Act Administrator (with greater than 20 years’ experience). A panel of Mental Health Act Independent Hospital Managers are appointed to supervise the application of the Mental Health Act 1983/2007 at Cornerstone House. The appointment is in line with Section 23 of the MHA and Chapter 23 of the Code of Practice and they exercise this delegated responsibility on behalf of the Registered Manager. Currently Cornerstone House has six Hospital Managers with previous experience of working with the Mental Health Act.

Detailed Mental Health Act policies and procedures provide guidance to staff on the delivery of care to people detained under the Act.

If a person is admitted under a Section of the MHA, they are provided with a leaflet explaining their rights; this will be talked through by the admitting member of staff. During normal working hours, this can be done by the Mental Health Act Administrator. Out of normal working hours it will be the responsibility of the shift leader. With the consent of the person, the nearest relative will also receive a copy of the leaflet.

Any person detained under the Act can discuss the implications in further detail with the Responsible Clinician (RC) looking after them. The RC is able to review the detention and can decide to discharge someone from a section if this is believed to be appropriate.

During a period of detention, a person can request that their treatment and detention is reviewed by a Mental Health Review Tribunal. People have the right to independent, free legal counsel for this, and Cornerstone House provides people with a list of local solicitors specialising in this area.

In addition, people can request that Cornerstone House’s Mental Health Act Managers review their detention under the MHA. They have the responsibility if appropriate to:

  • Discharge patients from Section 3 and 37 MHA 1983
  • Recommend that the detention is further reviewed by a Mental Health Review Tribunal

Any person detained under any Section of the Mental Health Act will be subject to the Care Programme Approach.

Section 117 meetings will be held to plan people’ aftercare during detention and following discharge from detention.

The Conference Room at Cornerstone House is available for all hearings. A room is also provided for all interviews required.

There are a number of leaflets detailing the rights of someone detained under the MHA available at Cornerstone House.