A REPORT ON A STUDY VISIT TO EAST LONDON NHS
FOUNDATION TRUST FROM 16/9/09 TO 14/12/09
Introduction
There has been a link since 2004, between Butabika hospital and the East London NHS
Foundation Trust in which Mental Health Professionals have either visited the UK or hosted UK
colleagues in Uganda. This linkage has tremendously facilitated the process of learning from
each other through active/passive observation and sharing information in form of meetings,
seminars and workshops. This has led to change in practice hence clinical effectiveness and
improved Hospital image.
Regarding the Nursing Dept, six (6) nurses at operational level as at April, 2009, had benefited
from this Exchange programme. It was on this premise that the Lead nurse was considered to
visit the UK so that he appreciates as well, the health services and systems in place where the
earlier nurses had rotated through. This would in turn strengthen his capacity to adequately
support and supervise all the nurses in the hospital thus improving the quality of care rendered
and placing its image into greater heights.
Objectives (overall)
1. To familiarise with the Health services and systems in the UK that promote quality health
care delivery.
Specific objectives
1. To look at the managerial roles and how they promote innovation and quality nursing care
Delivery.
2. To share information on performance management of nursing staff.
3. To identify what is workable, feasible and transferable out of ideas generated by earlier
Commonwealth fellows.
4. To compile collected data into a study visit report for presentation to the Butabika Hospital
and ELCMHT.
Methodology
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Interview of key- stakeholders
Meetings /conference
Observation
Shadowing
Review of Records
Activities participated in
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Induction course-17-18/9/09 and 5-9/10/09 at East One- purpose was to orientate
the Fellow about Mental health in the UK.
International Network for Psychiatric Nursing Research Conference held at Oxford
University – 24 – 25/9/09.
Academic sessions in Mental Health held at Barts and London University – 28/10/09
and 2/12/09.
Meeting Wendy Dyer on issues pertaining to children, adolescents and families and
how the services can be enhanced in Butabika – 22/09/09.
Meeting Chris Tacey, the Locality Manager for Newham Centre for Mental Health as
an entry point to the facility – 28/9/09.
Clinical governance meetings both in Newham centre for mental health (NCFMH)
and Mile End Hospital- aimed at ensuring clinical excellence which were held once
monthly.
Community Nurse Forum for children’s protection meeting- ensures children’s
protection against abuse -30/9/09.
All managers meeting in the Borough of Newham- a meeting that brought together
all CMHT managers in the locality to update themselves with issues pertinent to their
areas of jurisdiction and also be able to chart ways forward as a group-12/10/09.
Social inclusion meeting for the entire ELFT-looked at how best the organization can
perform better in meeting its goals with the involvement of service users, staff and
members of the local community-27/10/09.
Launch of Stratford Court Mental Health Liaison Scheme – aimed at expediting
access of mental health services to people facing charges in the Court of laws 13/10/09.
Away Day for Sapphire ward- staff went away from their workplace for a Retreat to
discuss avenues of offering better services.
CMHT- visited service users in their homes either to administer medicines or
facilitate them sign CPA (Care Program Approach) forms. This was done both in
Newham and Tower hamlets.
HTT (Home Treatment Team) - in Tower hamlets to either administer medicines to
service users in the community, monitor and assess their progress on medication or
discharge/handover to the CMHT.
Early intervention services –caters for young people with Schizophrenia. This
service prevents deterioration and therefore improves quality of life -11/11/09.
Assessment of a person psychologically traumatized- 17/11/09 at William Harvey
Institute of Psycho trauma.
Community Rehabilitation and Recovery Team – enables service users to achieve
their level of independence through medication, psychological therapies, promotion
of social networks, vocational, occupational and employment activities. The team
works with clients at their own pace – 18/11/09.
Dual Diagnosis Team – manages service users who have a mental disorder but as
well abuse alcohol and other substances. This is a specialized community service –
19/11/09.
Meetings with Jonathan Warren, the Director of Nursing – ELFT to establish the
progress of the program in terms of achievements and challenges so that an
appropriate way forward is duly put in place – 30/9/09; 30/10/09; 13/11/09; 10/12/09.
Butabika Link meetings which developed staff development bids for submission to
Funders for the year 2009-2011.
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Social events i.e. Welcome Day by the Commonwealth – 9/11/09, and Lunch/
Dinners by the Butabika Link members and well wishers.
Clinical placements both in Newham and Tower hamlets:
Newham centre for mental health
 Sapphire ward- an acute admission ward-29/9/09, 2/10/09, 2/11/095/11/09.
 Coburn unit –a complex to cater for children and adolescents who have
mental health related problems -20 -23/10/09.
 Crystal ward – a Psychiatric Intensive Care Ward-26 -30/10/09.
Tower hamlets
 Globe ward –an acute admission – 11/11/09 & 16/11/09
 Lea ward – an acute ward – 12-13/11/09
Both wards have mixed gender.
 Leaden hall ward – offers mental health care for old persons -17/11/09.
 Milharbour ward –a Psychiatric intensive care unit that caters for male
service users who have offended the law and those who are
unmanageable from other units – 30/11/09 and 1/12/09.
 Occupational Therapy Department –where service users are referred to
reinforce their Activities of Daily Living and also learn new activities – 2 –
3/12/09.
 Rosebank Ward – a Psychiatric Intensive care unit where female service
users who go against the law and those who are unmanageable from open
wards are admitted – 4/12/09.
Findings
Positives
 The Trust has a very well-planned infrastructure that caters for every aspect of Mental
Health Service delivery.
 The Trust values Equality and Diversity; Transparency and Accountability.
 Units/ wards have Service Managers who coordinate the entire business of their
localities.
 Each Service Manager, in consultation with work colleagues, develops and implements
a Financial Budget under the guidance of the Top Management.
 All services in the Trust are implemented in a Multidisciplinary manner and each
Discipline diligently plays its mandated role with full accountability.
 Service users and observance of their Rights is the first priority among others.
 Regular Committee and Departmental /Unit meetings are conducted and resolves
implemented timely.
 Time management is a priority in any activity and is always observed.
 Catering and Cleaning services are privatized to ensure quality and effectiveness.
 Resources are readily available and well managed.
 Policies are available for every activity of the Trust.
 Shortage of Nurses is ameliorated by the Bank System in place – Unit/ward Managers
have authority to hire Bank Nurses to bridge the gaps and the Trust meets their
allowances.
 Nursing care is individualized and evidence – based and all actual / potential Risks are
managed accordingly.
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Seclusions are user-friendly and safe.
Nurses undergo training in Management of Aggressive and Potentially Aggressive
(MAPA) patients.
Nurses are entitled to a 30 minute Break whenever on duty.
The Trust hires and can fire staff who do not meet the set standards.
Staff who work during antisocial hours, public holidays are given special consideration
in terms of allowances.
Ward Rounds are conducted regularly and all service users reviewed.
Wards handle adequate numbers of service users and in cubicles.
Each Ward has a well furnished Dinning space and lounge for service users.
Latest and more efficacious medicines are always stocked on the wards; Nurses and
Pharmacists ensure accountability.
Occupational Therapists play a fundamental role in the rejuvenation of service users’
Activities of Daily Living.
Most of the Mental Health Services in the Trust are Community-based.
Documentation is key to any service delivery.
Staff development is encouraged and accessed equitably – all staff must undergo
Refresher courses which are mandatory annually and those interested in advanced
study are supported.
Information sharing is encouraged as all units have modern IT equipment and all staff
are facilitated to acquire computer skills and also have access to Internet/intranet
services.
Staff have the opportunity to acquire facilities on hire purchase.
Negatives
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Nurses have too much paperwork to do while on duty resulting in limited time of
interaction with service users.
Student Nurses have minimal opportunity to practice as most times only observe and
shadow qualified Nurses.
Conclusion
Generally, the Study Visit Program was well organized as it focused on areas of interest that
were relevant to the Fellow in terms of his day to day work in Uganda. Indeed a lot of sharing
of information and experiences has been ongoing wherever the Fellow was placed. Through
this, the Fellow has been able to learn new ways of doing certain things differently in order to
be more effective. The knowledge and skills acquired will be shared with Butabika hospital
management and entire staff with a view of adding value to our performance hence improving
Clinical Effectiveness.
Recommendations
 The Trust should devise a way of reducing the current paper workload being
experienced by Nurses so that ample time is available to interact with Service users.
 Student Nurses should have ample time to practice under the supervision of qualified
Nurses. This will enable them develop Nursing skills, interest and confidence.
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Acknowledgement
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ELFT for nominating the Fellow; identifying his accommodation and formulating an
appropriate Program for him to achieve his Objectives.
All staff of Newham and Tower Hamlets Centres for Mental Health are acknowledged
for their invaluable contribution.
Commonwealth Scholarship Commission for the Funding through the British Council.
British Council – Mike Bray for transacting the Business well.
Butabika Link (London) Team- for your cohesiveness, interest and support to the Link
and Fellow.
Butabika Hospital – for availing the Fellow the opportunity to undertake the Study.
Mr & Mrs Mrewa for the comfortable accommodation and hospitality.
Cerdic Hall – for the invaluable hospitality accorded to the Fellow during the Study
period.
Compiled:…………………………
Kyaligonza Atwoki David
COMMONWEALTH FELLOW 2009
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