This booklet contains information that should be useful to you during your stay here.
If you do have any questions during your time at The Orchard, please speak to any member of staff, and they will be happy to help.
Welcome
Hello, welcome to The Orchard in Lancaster a short distance away from the Royal Lancaster Infirmary and in the city of Lancaster in the North West of England.
We are an 18-bedded acute male mental health ward for adults over the age of 18 run by Lancashire and South Cumbria Foundation Trust.
The Orchard is an inpatient service open 365 days a year, 24 hours a day.
Reception is open 8am to 8pm. The telephone number is 01524 550 500. If you want to contact the ward reception outside of the opening times, you will be directed to the nursing office.
Why am I here?
- We are a mental health hospital. Your team thinks you need help with your mental health.
- To learn new skills
- To help you stay safe in the future
- If you are under a section, you need to stay in hospital.
What happens now?
Nursing staff will meet you and walk with you onto the ward. Nursing staff will ask you some questions. This is so we can understand how to help you. They might have some paperwork for you to look at.
The nurses will check your belongings to make sure all your items are safe to bring onto the ward. Lighters and other items are not allowed here. When everything has been checked, you can take it to your bedroom.
Someone will show you around the ward.
If you have any questions, we are here to help you.
Personal needs
We will help you with your personal needs such as;
- If you need a special diet.
- If you follow a religion.
- If you speak another language, we will get someone to speak in your language for your meetings.
- We will help you to stay in contact with family and friends.
- Family and carers can come and visit you.
- We will help you see a doctor if you feel unwell.
Keeping people safe
Front door
The main door is kept locked at all times for the safety of all service users. If you are an informal service user please speak to a member of staff who will be able to let you out of the unit.
CCTV
There is 24 hour CCTV in operation at The Orchard. This is for the purpose of detecting and deterring crime. This is for the safety of service users, visitors and staff.
Observations
While you are on the ward, the ward staff will observe you. Sometimes you may not even notice them carrying out their observation checks.
Levels of observation
There are different levels of observation. Some people will be checked intermittently while for others it may be every hour. Some people have a member of staff with them at all times, depending on individual needs.
Visiting
Visiting times
There are no restrictions on visiting times within reason. To book a visiting slot, please contact the ward directly on the telephone numbers listed in this booklet.
Where can I go with visitors?
We know that visiting space is lacking on the ward, however, we do have one visiting room which can be booked if you do not have any leave or alternatively if you do have leave, you can see visitors in the café. Visitors are not allowed in the ward communal areas or the main part of the ward.
Please respect other patients' time with their visitors.
Can children visit?
No one under the age of 16 is allowed on the unit. However, space can be used to accommodate and allow children to visit, but to do this, please communicate directly with the ward to make arrangements.
How do I contact people and how do they contact me?
Mobile phones are allowed on the unit for personal use. There is also a ward mobile phone which can be borrowed by service users and a pay phone in the corridor. If someone wants to contact you, they can contact you directly if you have a mobile phone, call the ward using the numbers in this booklet, or write to you via a letter.
What do sections mean?
Section 2
If you are on a Section 2, your doctor thinks that you need to be hospital for an assessment.
How long will it last?
You can remain in hospital for up to 28 days. Your doctor may decide you need to be in hospital for longer than 28 days. You can be discharged at any time by your doctor.
Section 3
If you are on a Section 3, your doctor thinks you need treatment in hospital.
How long will it last?
You can remain in hospital for up to 6 months. If your doctor thinks you need to stay in hospital for longer than 6 months they can renew it. You can be discharged at any time by your doctor.
How can I appeal my section?
You can only appeal a Section 2 within the first 14 days by a tribunal.
For section 3, you can apply for one tribunal or more than one hospital manager's hearing.
How can I apply for a tribunal?
- Filling out the form yourself
- Asking the Mental Health Act Administrator in hospital
- Calling a Solicitor (free of charge)
- Speaking to an Independent Advocate for help (free of charge)
For section 2, the tribunal meeting should take place within 7 days of completing the form.
For section 3, the tribunal can take between 6 to 8 weeks to take place.
Informal
You are in hospital on the advice of your doctor. You have the same rights as any patient in an ordinary hospital.
If you are an informal patient (voluntary) you are not being held against your will. This right without due process and good reason is protected under the Human Rights Act (1998) and by what is known as common law. If the ward you are currently on is locked, this is because a number of patients are subject to the Mental Health Act and are not free to leave. You are free to leave at any time.
Although you are here as an informal patient, it is important for you to spend time on the ward to enable our assessment and plan your care with you. Of course, as an informal patien,t you are able to take breaks off the ward, but if you wish to leave the ward for longer periods of time, we will need to discuss with you whether inpatient stay is the most suitable way to provide your care.
Care and treatment
Your care team will talk to you about your care and treatment and this can be written into your care plan if you accept it.
This plan may involve:
- Taking medication
- Having some physical investigations/tests
- Talking to staff and answering questions
As an informal patient you can refuse treatment or interventions that are being offered to you. If this is the case the care team will review this with you, whenever possible, in terms of the impact on your mental health and try to seek alternatives. It may at this stage, have to be considered whether offering you inpatient care remains appropriate. You cannot be given any treatment or intervention against your will, except in an emergency.
If you do refuse treatment, your care team will review the impact on your mental health. If the care team are concerned about your well-being in the absence of treatment, they may ask for you to be assessed under the Mental Health Act 1983. This involves an assessment by two doctors and an approved mental health professional.
Who will be involved in my care?
Healthcare assistants
A healthcare assistant works with the nurses and other healthcare professionals, helping with treatment and looking after service users comfort and wellbeing.
Primary nurse and associate nurses
Your primary nurse is responsible for you during your stay. Your associate nurse will work with you when your named nurse is off duty. If you want to talk to someone or discuss anything important, it is best to approach these nurses first, but any member of staff can help.
Occupational therapist
Occupational therapists help people to build up the confidence and skills needed for personal, social, domestic, leisure or work activities. Occupational therapists and health and well-being workers run activities such as arts and crafts, group work, relaxation and activities in daily living.
Key worker
You will have a care coordinator to help with your care when you are in hospital and when you are discharged. You will meet them in hospital if you do not already have one. A care coordinator is a mental health practitioner who might also be an occupational therapist or social worker and has additional training.
Ward manager
On each ward, there is a ward manager, and their role is to deal with the day-to-day management of the ward and to ensure that service users are receiving the care that they require.
Matron
The modern matron's role is to ensure that the service user experience on the ward is as effective and efficient as it should be. They also ensure that the service continually develops to improve the quality of care.
Consultant psychiatrist
A consultant psychiatrist is a trained doctor who specialises in diagnosing and treating people with mental health problems. A psychiatrist will examine the different factors which may have contributed to your mental health problem and try to tailor treatment as closely as possible to your needs. Your psychiatrist has overall responsibility for your assessment, care and treatment. When you are admitted to the ward, you will be allocated a consultant psychiatrist for the duration of your stay. If you need to speak to your consultant, please speak to the ward staff and they will arrange an appointment for you.
What to expect on the ward
What happens during the day
There are set times for meals and medication and appointments with the consultants. Consultant psychiatrists are on the ward every week and your allocated consultant will usually see you once a week. You will also be given your medication at the times when it is prescribed, whether this morning, lunchtime, dinner time and/or nighttime.
Meals are offered in the dining room.
- Breakfast 8.30am to 9.30am
- Lunch 12.00pm to 12.30pm
- Dinner 5.00pm to 5.30pm
- Supper 9.00pm to 9.30pm
Tea and coffee-making facilities are available all day, cold filtered water is also available. If you need anything please ask.
You may also want to wash your clothes, bathe or shower, go out in the grounds, watch TV or listen to music, go to the occupational therapy room, go to the local shops or go for a walk. If there is something you would like to do, please ask a member of staff, and we will do our best to help make this happen.
Smoking
Smoking is not permitted within the trust buildings or the hospital grounds.
Fire safety
You will need to give your lighters to the staff. You will get your lighter back when you are discharged from the ward or go on leave from the hospital site.
All non-permitted items will be explained to you on admission.
Laundry
There is a laundry room on the ward. Staff will show you this room on admission. You are responsible for washing and drying your own clothes but staff are there to help and assist if needed.
Cleaners
There is a ward housekeeper and cleaners who come on the ward every day to clean communal areas and individual bedrooms. They are there to clean tidy spaces and therefore, you are responsible for keeping your individual space in your bedroom tidy for them to clean. The ward housekeeper will keep on top of changing your bedding.
Access to a doctor
There is a doctor available 24 hours a day, 7 days a week if you require input from a doctor. They might not always be on site; however, staff can get in touch with the doctor on your behalf if you require assistance.
Handover
Ward staff have a handover meeting when two different shifts of staff meet. This enables the day shift to update the night shift on anything that has happened during the day and vice versa. This will include an update on each service user.
Leave
If someone is on leave, it means they have been allowed time off the ward for a specific agreed period of time. Please ensure you have the ward telephone number with you when you leave the ward and that the ward has a contact number for you. Sometimes you may require staff to come with you on leave - this is called escorted leave.
Spiritual needs
Please make staff aware of any spiritual requirements you have and we will do our utmost to accommodate these. We have suitable facilities available for prayer and links with local religious and cultural groups.
Ward activities
Various different meetings happen on the ward including weekly ward reviews, CPA meetings, time with your nurse, individual activities, treatment/discharge planning, visiting the occupational therapy room, off ward activities and time with medical staff.
Occupational therapy
Activities are organised by the occupational therapy department into a timetable for you to participate and engage in whilst on the ward. You can see their timetable for the activities they offer. They are open at different times throughout the day.
Who is on the ward?
Uniform colours
Turquoise blue and white: healthcare assistant
Light blue and white: nurse
Dark blue and white: senior nurse
Dark blue and red: ward manager
Dark blue and yellow: practice development nurse
Grey and red: matron
Red and white: house keeping
Purple and white: pharmacy
Green and white: occupational therapy
Pale purple: peer support
Care planning
A care plan will be developed with you whilst on the Orchard. Usually, this will be done by your allocated named nurse. Care planning is a process of assessing, agreeing, collaborating and supporting you in all aspects of care.
The care plan will summarise the identified needs which you will have agreed with your named nurse/care team.
An effective care plan promotes supporting you through recovery-focused services that aim to empower you to be in control of your care in a structured and clear way.
Your care plan should reflect your own assessment of your situation and priorities. It should be written in a simple, personally meaningful way. It should clearly identify your preferences and strengths, be created collaboratively with you and your care team and have clearly identified actions.
Carers will be involved in care planning (due consideration to consent) and if appropriate offered a carers assessment.
Your care team will work with you to decide:
- What your mental health needs are
- What help you require – your medical, physical, psychological and social needs are all considered
- What result you would like
- What treatment would be best for you.
Care programme approach
A care programme approach (CPA) is a meeting which will take place to discuss your care, treatment and discharge plans.
The CPA will:
- Assess your needs
- Make a plan with you
- Put a plan into action
- Review the plan
People who usually attend your CPA meeting:
- Your doctor
- Your care coordinator
- Your independent advocate (if you want them to)
- Your family/friends (if you want them involved)
CPA checklist
1. You should be included in all parts of your CPA meeting.
2. Before your CPA meeting, you and your named nurse/advocate will talk through and agree a plan for the meeting.
3. Any changes to your CPA meeting should be done with you and your family wherever possible.
4. All reports to be written jargon-free so everyone understands.
5. You should be made aware of the advocacy service and have the choice for advocacy support or anyone else within the CPA.
6. Pens and paper will be available for everyone to make notes in the CPA meeting.
7. Summarising reports should be directed at you so you are aware of up-to-date information about you, also making sure you are involved in any decision making for the future.
8. All people present at your meeting will be respectful of you and each other and will behave in a respectful manner within the meeting.
9. At the end of the meeting, there should be an action plan, clearly identified people for each goal or action point, with clear timescales and the date for the next CPA should be agreed.
10. Keep me in the loop - to start planning my next CPA meeting.
Family and carers
On admission
At the Orchard, we recognise that families/carers know their family member best. On admission, family members or carers will be invited to meet with the nurse in charge to provide personal insight into the service user and present any information they feel will be of use in their treatment and care. At this time, information about the ward and about support for carers will be communicated.
If there is anyone you would like to be involved in your care, please let us know; this could even be a friend or neighbour.
On the ward
Whilst the family member is on the ward, the following information will be made available to parents or carers with the service-user’s signed consent.
- Care Plan
- Weekly update from the primary nurse
- Any significant incidents or safeguarding issues
- Minutes of CPA meetings
- Diagnosis/Formulation
- Transition and discharge planning
- Referrals to other agencies
Advocacy Focus
This is the organisation that provides independent advocacy support for service users at The Orchard.
You are entitled to a free independent advocate.
- Independent advocates are there to support you
- They are specially trained in the Mental Health Act and are sometimes called an Independent Mental Health Advocate
- They are independent and do not work for the hospital, NHS or social services
- Their support is free of charge
- You can meet with them in private; your discussion is confidential
This service is only applicable for service users who are on a section 2 or 3.
An independent advocate can help you with:
- Understanding your section
- Appealing your section
- Raising concerns about your section
- Preparing for meetings
- Attending important meetings
- Making a complaint
- Sharing your views
Advocacy Focus telephone: 0300 323 0965
Please let us know if you would like to speak with an advocate.
Additional information
Uniform colours
Turquoise blue and white: healthcare assistant
Light blue and white: nurse
Dark blue and white: senior nurse
Dark blue and red: ward manager
Dark blue and yellow: practice development nurse
Grey and red: matron
Red and white: house keeping
Purple and white: pharmacy
Green and white: occupational therapy
Pale purple: peer support
Acronyms
You may hear some acronyms whilst on the ward. Here is what some of them mean.
ADL: Activities of daily living
CPA: Care programme approach
CTO: Community treatment order
CBT: Cognitive behaviour therapy
CQC: Care Quality Commission
DoLS: Deprivation of liberty safeguard
FFT: Family and Friends Test
MDT: Multi-disciplinary team
MHA: Mental Health Act
MHRT: Mental health review tribunal
PALS: Patient Advice and Liaison Service
OT: Occupational therapist
RIO: The electronic patient record system