Incidents 44 and 52
3.28 This was substantially true of the Industrial Therapy Unit at the time both parts of the Critique were circulated, although we are not satisfied that the Charge Nurse adjusted the rates of pay with the intention of securing power over the patients. He was in charge of the Unit for 15 years until his retirement in February, 1975. There have been problems over staff and shortage of storage space, and the selection of patients to attend the Unit could have been better.
3.29 We heard no criticism of the carpentry shop, Which was started in 1967, or thereabouts: it has at all times been a first class unit.
3.30 When we visited the Industrial Therapy Unit in September and November, 1975, the quality of the staff appeared to be good, but the Unit is limited by the size of the building and the range of stimulating jobs available for the patients.
3.31 There has been very little occupational therapy carried on in the long stay wards, and too few of the long stay patients have been able to go to the Occupational Therapy Department. There has been, and still was in the Autumn of 1975, chronic Understaffing as demonstrated by the following table.
Establishment for St. Augustine's, St. Martins, Highland Court and the Day Hospital
Grade: Establishment / In post September, 1975
Head Occupational Therapist: 1 / 3
Senior Occupational Therapists 4 / 2*
(*Part time totally 37hr/week)Basic Occupational Therapists 11 / 0
Technical Instructor: 1 / 0
3.32 The prospect Of any appreciable increase in trained Occupational Therapists in post is very poor owing to the national shortage. Miss DEF, the Head Occupational Therapist has recruited the equivalent of seven-and-a—half full—time unqualified helpers. These include four helpers who commenced work in the Spring of 1975 and give each of the geriatric wards about five Sessions a week.
3.33 Miss DEF has in the past suggested to the Chief Nursing Officer that the nursing services might be, able to help her, but was told that nurses could not be spared from the wards. No consideration seemed to have been given to training interested nurses, if necessary paying them for any overtime spent in such training, so that they can put their knowledge to use during their normal working hours on the wards. It might be very partial knowledge, acquired very slowly, but it would help to cope with the present chronic shortage and, we believe add to the interest of the nurses job.
3.34 Miss DEF has also tried to recruit more untrained helpers, but there were difficulties in arranging transport for them, and the proposal got lost in the administrative corridors of the hospital.
3.35 With this very restricted staff Miss DEF said that the O.T. Department was "catering in the main for the short stay and medium stay patients". She feels that there is a great need to do more for the geriatric patients, even though the activities may have to be social rather than productive. She said “So many of the geriatrics here we have found are past being productive, they are very demented, but we must do something to lighten their days. They are in the slough of despondency, and I think we must do something for them." She disagreed with the doctor who had recently told her that all that can be done with the senile dements is let them sit. So do we.
3.36 At our request Miss DEF looked again at the whole problem between our departure in September and our return in November. She produced an imaginative plan involving the use of more paid helpers, nurses, students and voluntary workers on the Wards. This would result in considerable improvements, and we hope that it will have begun to be put into operation immediately as it had the support of the District Administrator. We shall have to consider in due course why Miss DEF was not asked to produce a scheme of this kind before.
3.37 The Physiotherapy Department is equally understaffed. In November, 1975, it had one full time senior physiotherapist, one part-time senior physiotherapist (20 hours each week) and one part-time physiotherapy aide (15 hours each week). The service provided is totally inadequate, and steps should be taken to increase the staff and find some accommodation that can be used as a geriatric gymnasium. Discussion should also take place with the nursing administration to see how nurses can be helped to increase their skills and so begin to fill this gap in the wards, particularly for geriatric patients.
3.38 We are sure that it has been recognised for some time at St. Augustines that occupational, social, recreational, remedial and, indeed, educational activities are essential adjuncts to medical and psychological therapies in a psychiatric hospital. What has not been sufficiently realised is that to be effective these activities must be well co-ordinated and organised, and their purpose and relationship clearly understood by those who run them and those who make use of them. Unless there are clear policies and reasonable facilities good staff will not be attracted, and those who are available will not be used to the best advantage.
3.39 At St. Augustine's these various activities tend to be carried on in isolation from each other. There is a Consultant responsible for keeping in touch with the Industrial Therapy Unit, but he does not do the same with the Occupational Therapy Department. Social activities are largely left to the initiative of ward staff. For example, there is no central organisation to co—ordinate the use of minibus outings. The poor posture of many patients seen walking in the corridors suggests a lack of physiotherapy and remedial activities.
3.40 We recommend the establishment of a Patients Activities Team or Committee consisting of the main people involved in these activities, with medical, nursing and administrative representatives. The purposes of the Committee will include the co-ordination of the therapeutic activities, the estimation of needs, and the control of an agreed budget for occupational, social and recreational therapy.
09 February 2025
