Special Hospitals (Hansard, 23 January 1980)

§ Sir George Young

A copy of the broad guidelines adopted by Broadmoor hospital last year following consideration of a complaint to the European Commission on Human Rights is reproduced below. Each of the other special hospitals258W has notes which give similar guidance but in some cases also give in varying degrees of detail some guidance on nursing and other procedures.

Since these are rather long, they are not reproduced but I am sending copies to my hon. Friend. The hospitals are being asked to review their guidance in the light of that adopted at Broadmoor hospital.

Following are the guidelines:

SECLUSION OF PATIENTS AT BROADMOOR SPECIAL HOSPITAL

1. New working guidelines concerning the seclusion of patients at Broadmoor special hospital have now been introduced.
2. These are to apply whenever a patient is compulsorily confined to a secure room between the hours of 7 a.m. and normal bedtime. Rooms used for seclusion are to have at least 4.7 square metres floor space and to have natural lighting.
3. The nurse in charge of a ward may take the initial decision to seclude a patient whose behaviour is, or seems likely to become, so disturbed that it is desirable to isolate him for his own safety or for the safety of others. The unit (or duty) nursing officer and the responsible medical officer, or his deputy, are to be advised at once of the decision and the reason for it.
4. A programme of care for any patient secluded for more than three hours is to be drawn up by the nurse in charge in consultation with the responsible medical officer. This programme is to be reviewed daily.
5. Where for safety or security reasons normal clothing and/or furniture is withdrawn, patients are to be provided with pyjamas or other special clothing (including suitable footwear unless this is specifically banned to prevent harm to himself or others), mattresses and bedding. Disposable bedpans and urinals and toilet paper are also to be provided. Writing materials, reading matter and other items are to be provided on request at the discretion of the nurse in charge.
6. Unless the patient's conditions precludes it, he is to be allowed out of his room for toilet purposes and to take exercise (for at least 30 minutes each morning and afternoon (or evening)) and to receive visitors.
7. Patients in seclusion are to be observed at irregular intervals not exceeding 15 minutes.
8. A special record book is to be maintained on every ward in which full reports of all occasion which a patient is secluded will be made. This report, which will be cross-referenced with the daily ward report and patient's clinical records, will record, inter alia, the time the seclusion started and ended, the reason for it, details of clothing, bedding etc. supplied and observations and reviews made.
9. If the patient is secluded for more than 24 hours, the hospital management team should be informed and if the seclusion lasts for a continuous period of seven days the hospital 259 management team should make a full report to the hospital managers. Reports should thereafter be made to the hospital managers weekly for as long as seclusion continues.