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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at 6 care records during the assessment. Care plans have been an area of focused improvement for the service. The regional physical health lead and the clinical governance lead are championing the adaptation of the current care plan format, which is more suited to long stay environments, to reflect the service’s acute setting and the patient’s needs upon discharge once stabilised.

Care plans covered keeping safe, keeping healthy, a risk care plan, and a discharge plan. Care plans were completed primarily by the occupational therapy team and are updated daily and reviewed weekly after ward rounds. Care plans varied in quality and the amount of detail depended on which staff member had completed them, but all care plans had been completed soon after admission and contained a comprehensive mental health assessment of the patient. It was noted that all patients’ physical health needs were assessed in a comprehensive manner.

Care plans were personalised, holistic and recovery-oriented, with patient’s stated goals for admission, main areas identified for support and access to psychological and occupational therapy specified. Staff had updated care plans when necessary and care plan audits were part of each ward’s daily checks.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 (MHA) and the Mental Health Act Code of Practice and discharged these well.

Staff were experienced and qualified and provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication and psychological therapies, activities, and training opportunities intended to help patients acquire living skills.

Staff ensured that patients had access to physical healthcare, including access to specialists when needed. Staff assessed and met patients’ needs for food and drink. A dietitian reviews each patient and liaises with the head chef to provide a balanced menu for patients with specialist nutrition and hydration needs. Patients told us the food was excellent with up to 6 items to choose from at meals.

Staff participated in clinical audit, benchmarking and quality improvement initiatives in multidisciplinary teams that included doctors and nurses, occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists, dieticians, peer support workers.

Managers provided new staff and agency staff with appropriate induction to the service. One clinician stated induction was “best I’ve ever had”. Managers ensured that staff had access to regular team meetings which were held every morning on each ward with a comprehensive agenda and competent handover. Managers provided staff with monthly supervision, discussing case management and clinical issues on alternate months. all staff received an appraisal in the last 12 months. Staff told us supervision was excellent.

Mental Health Act

The service maintains an 'in charge' dashboard that generates a weekly MHA update to both wards. The update included the Ashton pharmacy report which may have identified Section 62 omissions, and summarised new admissions to the ward, the date of any sections expiring, consent to treatment expiring, upcoming tribunal dates including a 14-day time frame date for appeal. The MHA update was discussed at MDT morning meeting, and in the clinical governance meeting. The ‘patient rights’ section showed when these were last discussed with the patient and when due to be discussed again. Staff knew how to document when they had discussed patient rights and the patient’s preference for daily reading or any other frequency they might want.

Ninety-four per cent of staff had received training in the Mental Health Act. Staff had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were. A new position had been created to coordinate patients' detention papers and associated records (for example, Section 17 leave forms) correctly and to ensure they were available to all staff that needed access to them. Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

The provider had relevant policies and procedures that reflected the most recent guidance. Patients had access to easy-read information about their rights under the Mental Health Act and access to independent mental health advocacy. The service referred all patients to an advocacy service. Staff tried to ensure that patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted, but 5 patients told us this was frequently delayed and occasionally cancelled because staff were too busy. The service displayed a notice to tell informal patients that they could leave the ward freely.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

Staff held regular and effective multidisciplinary meetings. Staff shared information about patients at effective handover meetings within the team from shift to shift. The teams had effective working relationships with other relevant teams, for example care co-ordinators, and community mental health teams through the newly appointed family and carer’s lead who attended care coordinator and home treatment team meetings with Devon Partnership NHS Trust.

The teams had effective working relationships with local GPs, which is vital because the service cannot access the NHS e-referral system (EMIS) locally. The GP visited the service weekly. If the service needed a referral to cardiology for a patient, the visiting GP completed that referral. The case records demonstrated that the service had made referrals for ADHD assessment and worked with local community services to support successful discharges for patients requiring support for needs as diverse as Parkinsons, epilepsy and breast cancer. A dietitian visited the service every 6 weeks to support specific patients.

We scored the service as 3. The evidence showed a good standard. The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service helped patients to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. The service is a non-smoking hospital, where patients are permitted to vape in the ward gardens and their bedrooms. Smoking cessation support is provided by the service. The service is also caffeine free. Patients who wish to consume coffee and caffeinated drinks did so by purchasing this during their leave.

Patients were encouraged to follow good sleep hygiene practices. On Clyst ward, the ward TV was turned off, or the volume was turned down at midnight. Patients were given weekly protected time with their allocated nurse and discuss activities that promote a healthy lifestyle for patients like walking groups, sports activities, fruit bowls and cooking healthy meals. We observed a group activity (pool tournament) on Kenn ward facilitated by psychology staff. Both wards had an ‘activities for daily living’ (ADL) kitchen and patients had occupational therapy (OT) support to build skills and confidence prior to their discharge. Patients had therapeutic leave with their OT as well as S17 leave. The hospital MDT met each morning to discuss and understand patient support requirements.

Patients acknowledged these activities were occurring, but some male patients complained these activities were not interesting for them and that weekends were boring. The service kept a log on which activities patients attend, leave or decline, and the level of patient engagement and contributing staff. For each activity, the therapeutic aim of the session and the outcome in terms of detailed observation of fine motor skills, level of stimulation and independence when they are cooking for example, were recorded.

Patients on Clyst ward liked the horse stables, arts and craft. Patients on Kenn ward love breakfast group, where all engage. The garden was always open until 10pm.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used the recognised Health of the Nation Outcome rating scale to assess and record patient status and are trailing the clinical global impression scale (CGI) under the consultant psychiatrist’s supervision. The CGI is a valid clinical outcome measure suitable for routine use in an inpatient setting that is sensitive to change in patients, is quick to administer and useful across diagnostic groupings.

Staff used technology to support patients effectively. For example, nurses told us they could access patient blood test results using the ‘epic care’ link on the same day. This service is one of only two Elysium services that have this and nurses told us this is making a big difference to the timeliness of physical health and medication review for patients.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. Patients told us “some staff are alright, they are polite and very nice, polite and respectful, staff have been amazing with me they are polite and keep me safe”. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately on a decision-specific basis regarding significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The service has a Quality Improvement (QI) project called ‘Triangle of Care’. The project aims to triangulate care between the patient, hospital and carers. Staff told us some patients do not give consent to sharing information with carers which can be explored in 1:1 sessions but the patient's wishes are respected.