Rlchard Pettlnger

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its own specific needs and demands. Evidence based guidelines have to date been developed for the management of diabetic patients, and protocols are to be developed to ensure that the prescribing of newer anti-psychotic drugs is based upon good practice and known and understood outcomes.

» Learning from complaints and incidents. A complaints analysis panel has been convened which is to monitor complaints and trends, and check that actions are taken to follow up de ficiencies in the hospital’s care and procedures. Serious adverse incidents continue to be subject to extensive investigations. Recommendations arising from such inquiries are incorporated into action plans by the hospital ’s top management team.

Developing staff management

In common with the rest of the UK National Health Service, the hospital has institutionalized dif ficulties in attracting, recruiting, and retaining top quality staff. To address this the following initiatives are in place.

» The development of labor relations policies to streamline working practices and provide speedier and more effective procedures for the resolution of disputes and grievances. The hospital ’s disciplinary system has also been the subject of extensive overhaul. This part of the process has been carried out in spite of extensive opposition from the hospital’s recognized trade unions – the Prison Officers Association, the Royal College of Nursing, and UNISON (the generic public services trade union).

» Recruitment drives. The hospital has scoured the English-speaking world, as well as other parts, in order to try to provide steady sources of expert, committed, and motivated staff. A successful nursing recruitment campaign is in place in South Africa; introduced in 1999, this continues to provide a major source of effective staff. The hospital has also established some flexibility in pay and rewards, and other terms and conditions of employment. It has been able to develop an extended career structure, including the ability to appoint ‘‘nurse consultants ’’ as a career opportunity for those who work within the hospital.

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» Streamlined and standardized patterns of working hours and shift systems for nursing staff. The purpose of this has been to ensure that, as far as possible, people work regularized patterns for extended periods of time rather than having to constantly change hours of work within short periods. In other parts of the UK National Health Service it is not unusual for staff to have to work split day-night shifts; Broadmoor has sought to eliminate this as far as possible.

» Implementing a change management and investment plan to the value of $5 million which is concerned with:

» developing and enhancing facilities, expertise, and treatment avail- able for those patients in the secure unit; and

» delivering the staff, expertise, and resource levels to provide modern and appropriate mental healthcare and improve patient pathways to the treatment that they require.