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The costs associated with staffing acute mental health wards is the largest expenditure in the inpatient budget. Exploring skill mix and its impact on outcomes, particularly service user outcomes should be of interest to all stakeholders involved in the commissioning, delivery and receipt of acute mental health care. This paper describes the findings of a literature and practice review of initiatives undertaken to improve staffing and skill mix, and their impact on service user outcomes. The practice review was necessary due to the paucity of published research in this area. Both research and practice initiatives do not appear to be driven by service user need. This results in a restricted and service driven range of outcome measures being used. The paper concludes by proposing recommendations for future workforce development in acute mental health settings.

The purpose of this paper, practice-based mixed methods small-scale study, is to explore the design features of a “dementia friendly” acute ward environment and, staff views on the implications of daily activity engagement for patients with dementia.

Eight staff members of the multidisciplinary team who work full time on an acute “dementia friendly” ward completed semi-structured questionnaires. Thematic analysis explored responses to the open-ended questions, and a further environmental assessment tool rated features of the “dementia friendly” ward design, on promoting aspects of well-being in patients with dementia.

Six overarching themes were found. These included: contrasting ward colours; clear ward signage; positive staff interaction; memorabilia, and activity rooms and items, had a positive influence on patient interaction, well-being and engagement in daily activities. The audit scores were rated highly for various aspects of the ward design. These included: the ward design promoting patient interaction, well-being, mobility, orientation, continence, eating and drinking and calm and security.

This practice-based small-scale study highlights the importance that a “dementia friendly” ward environment may have on patient engagement and well-being, from a daily activity perspective. Further research into the key aspects of design that enable meaningful daily activity engagement is required.

This study supports staff perceived views of the positive influence that “dementia friendly” design may have for patients with dementia. Both the physical design modifications of the ward and staff interaction were highlighted as positively influencing patient well-being, and daily activity engagement. Staff members also felt that they needed to balance the clinical ward priorities, with the contextual requirements of patients with dementia, to establish an effective “dementia friendly” ward.

The value of this research is the combined consideration of an environmental assessment tool and qualitative interviews with members of the multidisciplinary team.

This service evaluation study aimed to demonstrate the impact of implementing ward‐based multidisciplinary therapy input on an acute psychiatric ward in a London hospital for a six‐month period. The results indicated a high level of patient engagement with the project and referrals facilitated for patients following discharge. A reduction of incidents on the ward was reported over the project period compared to the previous year and there was less use of containment measures by staff by the end of the project. Recommendations are made for service improvement.

Addressing the needs of people with a dual diagnosis is a core component of acute inpatient mental healthcare. In 2006/2007, the Healthcare Commission conducted a national review of NHS acute inpatient wards in England. The review included five indicators of particular relevance to working with people with a dual diagnosis. This paper provides an overview of the review process, reports the dual diagnosis findings and considers their implications for improving the care and treatment of people with a dual diagnosis in the inpatient setting.

The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery.

A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken.

There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent.

Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

In the year 2000, the UK Government promoted the concept that hospital services be shaped around the needs of the patient to make their stay in hospital as comfortable as possible. In recognition of this, the Government advocated the introduction of a Ward Housekeeper role in at least 50 per cent of hospitals by 2004. This is a ward‐based non‐clinical role centred on cleaning, food service and maintenance to ensure that the basics of care are right for the patient. Much of the guidance for the ward housekeeper role has focussed on its development and implementation in an acute hospital setting. The aim of this research is to illustrate how the role has been adopted and implemented successfully in mental health environments and the subsequent impact for patient services.

Four case studies were undertaken in a variety of mental health settings, the principle method of data collection was qualitative semi‐structured interviews.

Common themes were identified from the case studies relating to experiences of developing and implementing the ward housekeeper role. This paper suggests models of best practice which relate to six main areas of: role, recruitment, induction, training, integration and management. It also demonstrates that the role has been successful and is highly valued by nursing staff.

The study was largely qualitative based and therefore the results do not lend themselves to be generalisable across the NHS.

The paper suggests how the ward housekeeper role should be adapted for mental health settings.

Discharging frail older people from acute hospital settings has been an issue of concern for over 40 years and recent studies suggest that enduring problems remain. This paper explores the experiences of discharge from three different units: an acute surgical ward, an acute medical ward and a specialist ward for older people. Based on extensive data from interviews with older people, their family carers and ward‐based staff, a grounded theory of the discharge experience is presented. This suggests that the quality of discharge hinges largely on whether the focus of efforts is on ‘pace’ (the desire to discharge older people as rapidly as possible) or ‘complexity’ (where due account is taken of the complex interaction of medical and wider social issues). When pace is the focus, ‘pushing’ and ‘fixing’ are the main processes driving discharge. However, when attention is given to complexity, far more subtle processes of ‘informing’ and ‘brokering’ are in evidence. These latter processes are conceived of as forms of ‘relational practice’ and it is argued that such practices lie at the heart of high quality care for older people.

In this article we explore how inpatient mental health services in England and Wales are interpreting and responding to policy derived from Mainstreaming Gender and Women's Mental Health (DH, 2003) in relation to women's safety in inpatient settings. This article will outline the background to concerns about safety in mental health settings for women and drawing on relevant literature and on interviews with service managers, practitioners and users identify some current issues in improving safety for women in inpatient settings and in creating single sex provision. Our review suggests that whilst there are improvements in provision for women in inpatient settings, some women are still not being offered a real choice of a women‐only setting on admission to hospital, and that changing the culture that permits a lack of physical and relational safety for women presents real challenges. We will discuss some of the implications for future practice.