The government views adult acute inpatient care as an essential and core element of each local mental health service system. Improving inpatient care is key to the Government's drive to reform and improve mental health services." Health Minister Jacqui Smith MP, April 2002

When NIMHE was launched in June 2002, it quickly recognised the priority of improving and modernising acute inpatient delivery of care by establishing Acute Inpatient Care as one of its core programmes. This programme is aimed at generating local action promoting and sustaining service collaboration and continuous improvement in the delivery of acute inpatient care and its connection and integration with other key elements of the wider systems of health and social care.

The agenda for modernisation and servie improvement facilitated by the Acute Inpatient Care Programme is fully definied in the DH Mental Health Policy Implementation Guide - Adult Acute Inpatient Care Provision (2002), which defines the fundamental principles and key structural elements for the programme.

Specific DH Guidance on the national minimuym standards for psychiatric intensive care units (PICUs) and low secure environments was also issued in association with this guidance.

Key Objectives

The key objectives of the Acute Inpatient Programme are to help:

• Define the purpose and place of adult inpatient care in their local mental health care system.
• Establish effective means of service co-ordination of acute services in a whole system of service delivery.
• Restructure ward arrangements to better provide a safe and therapeutic inpatient experience.
• Develop effective service user centred decision-making processes and ward arrangements.
• Address the need to enhance the role, status, training, support and career development of inpatient staff.
• Direct clinical leadership and management attention and expertise on the organisation and management of inpatient services.
• Ensure adequate clinical and support inputs to inpatient wards in order to maximise the time spent by staff therapeutically engaged with service users.
• Promote ways is which future acute care provision can project a more positive and socially inclusive and less disruptive perception of mental health.

Key vehicles

The key vehicles for the delivery of the necessary service improvements are the establishment of:

• Acute Care Forums in each provider Trust with firm links across the elements of the local acute care system to develop and implement a clear service improvement plan consistent with the policy guidance.
• NIMHE development centre pratice development networks/collaboratives to link and support the work of the Acute Care Forums and to share learning across local patches.

Achievements to date

• The most recent NSF Local Implementation Team self-assessment exercise showed that the 2 Acute Inpatient indicators have shown the greatest level of improvement over the last year.
• 89% of Trusts report that they have established or are in the process of establishing their Acute Care Forum.
• One of the pioneer Acute Care Forums the 'Refocusing in Bolton' project won a NIMHE Positive Practice Award in 2003.
• The original Adult Acute Collaborative established by the Northern Centre for Mental Health was highly commended in NIMHE's Positive Practice Awards for 2003.
• The programme has developed and disseminated standards and guidance in the Capable Acute Care Forum to assist local ACFs determine the most appropriate structure and governance arrangments and clarify responsibilities and priorites.
• Each NIMHE Development Centre has now appointed an Acute Inpatient Care Programme Lead. These leads are working to establish service and practice development networks in order to bring together the acute care leads from each Trust in their region, provide the opprotunity to share experience, knowledge and learning and to promote a service improvement culture using appropriate methods and models.
• Acute inpatient Collaboratives have now been established in the South East and Eastern DCs. London Development Centre has recently initiated its own collaborative and appointed a project lead.
• Positive practice guidance has been developed and issued on the Safe and therapeutic management of Violence and Aggression in inpatient settings. This was a joint initiative with the National Patient Safety Agency (NPSA).

2004/2005 Projects in Progress

• Education, Trainng and Continuing Progessional Development for All: Guidance for acute inpatient care. Produced in collaboration with the Mental Health Care Group Work Force Team and the Sainsbury Centre for Mental Health (SCMH), this guidance will be launched in June 2004. Further details available from your local NIMHE acute care lead.
• The national benchmarking survey is a joint project with SCMH. A national survey of adult acute inpatient services was carried out in all the inpatient wards in February 2004 to provide detailed baseline information regarding beds, staffing, inputs and other resources and connections. Data is currently being analysed with draft findings expected in the Summer and a conference to launch the document in November.
• 'Health Body and Mind': A Physical Health needs resource for people using services and for staff is currently in production, due for publication at NIMHE's conference in June.
• A Service User Information template specific to mental health inpatient admission has been produced in collaboration with NHS Estates.
• Guidance re: mangementof substance misuse on acute inpatient wards. This document was postponed awaiting the reclassification of cannabis and is due to be launched later this year.
• Minimum Standards for psychiatric intensive care units (PICUs). A two year project aimed at supporting the implementation of the standards. The project is led by Dr Stephen Pereira of North East London Mental Health NHS Trust.
• PICU Safety Audit. This project is aimed at considering the effect that design, building layout and facilities have on the safety and therapeutic value of clinical delivery on PICUs and low secure units. An audit document has been developed and a pilot site identified. Following the initial audit, a schedule for rollout with all units will be agreed with SHAs.
• Management of violence and agression and project. This joint project with the NPSA was established to address major concerns and anxieties highlighted by Ministers, practitioners, service users and carers following high profile public inquiries. The project includes the development of national standards and accredited training schemes to ensure the safe and therapeutic management of violence and aggresion in acute care settings. For further information contact Gary O'Hare or Colin Dale.
• The Therapeutic engagement project aims to identify current positive practice and the attributes of successful engagement. A series of focus groups will be organised and guidance prepared later in the year. Further details forom Martin Strawbridge.
• Research and Development. The NHS Service Delivery Orgasisation (SDO)has commissioned a 3 year study on alternatives to inpatient care, ward observation and inpatient care of young people.