The Making Room for Dignity Programme (MRfD) team at Derbyshire Healthcare NHS Foundation Trust (DHCFT) was shortlisted for a HEFMA 2024 award in the Project of the Year category for its work on six new and refurbished healthcare facilities. The Trust is developing three units and refurbishing three others, creating single, en-suite rooms to replace the dormitory-style accommodation at its acute mental health units.
DHCFT provides mental health, learning disabilities, substance misuse and regional gambling services in Derby and across Derbyshire, as well as a wide range of children’s services.
The Trust had identified that the estate from which mental health services were provided at its two acute inpatient sites – the Hartington Unit on the Chesterfield Royal Hospital site and the Radbourne Unit on the Royal Derby Hospital site – did not comply with regulatory and legislative requirements. National policy outlined ‘must do’ improvements, comprising the provision of single-room wards, each with an en-suite bathroom where possible, single-sex accommodation on adult wards and the requirement that no-one should need to travel unnecessarily outside of their local area to receive acute mental healthcare. Derbyshire’s existing inpatient facilities contain the largest number of dormitory-style facilities in England and the county has no Psychiatric Intensive Care Unit (PICU) or Enhanced Care Unit. These issues highlighted Derbyshire as a priority for the improvement of existing services and the establishment of new PICU and enhanced care facilities to meet these national requirements.
In 2020 the Government pledged more than £400m to eradicate dormitory accommodation from mental health facilities across the country to improve the safety, privacy and dignity of people experiencing mental illness. £80m of this was allocated to mental healthcare in Derbyshire and formed the backbone of a £150m development of new and refurbished facilities at the Trust.
The Team
The small MRfD Programme team brought together people with extensive backgrounds and experiences in health, construction, estates, HR and public relations, and included a Lived Experience & Programme Support Officer and a Clinical & Operations Project Manager who is also a registered mental health nurse.
Having a person with lived experience and a registered mental health nurse embedded in the team was a new approach for the Trust. It proved to be an innovation that helped cement the relationships between the programme team and service users, carers and colleagues. These relationships have strengthened the development of facilities and service offers to those who need them, helping the Trust to provide therapy-based services in dignity-led environments.
They have also led to further innovation, such as the development of an art display cabinet made in anti-shock glass. The idea for this was put forward via the person with lived experience, acting on feedback from user and carer networks which pointed out that patients who express their artistic flair in pottery or textile work often felt second best to those who paint or draw. Now, such art can be displayed in a cabinet that is suitable for an environment in which patients may become distressed.
The Facilities
The new hospital units will be equipped with modern facilities and additional resources, including an indoor fitness room, shared therapy suite incorporating an ‘activities of daily living’ kitchen, online library resource room, arts room and access to safe outdoor space. For patients on upper floors, this will be facilitated via the creation of a safe and secure sky garden.
Sharing Best Practice
The Trust was successful in claiming 100% VAT abatement for the new build Adult Acute Unit elements of this programme. This was the result of a lengthy procedure with HMRC, which has paved the way for other Trusts facing similar issues to have their claims reconsidered and/or accepted. Given the evidence presented by the DHCFT MRfD Programme team regarding the therapeutic nature of care delivered in the adult acute units, HMRC moved on its position and agreed that these meet the threshold for the definition of residential accommodation with therapeutic care provided. This decision reduced the overall cost pressure for the programme by tens of millions of pounds.
Measure of Success
Dignity and inclusion lie at the heart of this once-in-a-lifetime investment into mental health services in Derbyshire. Whilst there is limited evidence around the impact dormitory eradication has on length of stay, these single room, en-suite settings will facilitate better quality individual patient care, improving privacy and dignity, and enabling patient preferences to be considered to a greater degree – for example, room temperature and sleep patterns.
The purpose-built facilities and single rooms will allow for better infection control and reduce the risk of incidents involving patients or staff, including via the safe cohorting of patients if there are outbreaks of infection or viruses.
The new units will be focused on therapeutic interventions, with a person-centred recovery approach. The developments will enhance the services currently available, while improving the patient experience. Following service user and staff feedback, therapy-based tools will be increased to aid recovery.
The measurement of success for this project will come with the eradication of dormitories and mixed-sex wards as well as the provision of high acuity services. The link between engaging in meaningful activity and recovery from mental ill health is well established, so the impact on the patient experience is likely to result in better outcomes for service users, improved safety, reduced aggression, increased patient satisfaction, reduced re-admissions and shorter stays.
