Nightingale Hospital

On this page

• 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

We looked for evidence on how the service provided was effective. During an inspection June 2022, we rated this key question as requires improvement. At that inspection, the service was in breach of regulation 9 (person centred care). At this inspection, the rating has changed to good. This means that the service had taken action to improve the effectiveness of its care and treatment, particularly regarding care planning and patient risk assessments. Care plans and risk assessments now contained sufficient details to meet the needs of individual patients. Care plans and risk assessments were co-produced and person-centred. Staff updated care plans when patients' needs changed. The service carried out weekly audits on care plans and risk assessments and addressed any shortfalls.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service maximised the effectiveness of people's care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 8 care and treatment records, across the wards, during our inspection.

Patients, and where appropriate families, were involved in pre-admission assessments to establish their care and support needs.

The service assessed patients before they were admitted to check they were suitable for admission. Staff completed a comprehensive mental health assessment of each patient either on admission or soon after.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the wards. Staff supported patients with their physical health needs and worked collaboratively with specialists when needed.

Ward doctors also assessed and addressed patients' physical health and liaised with the patient's individual GP and other specialists when required. Staff carried out a routine electrocardiogram on all patients, and also prior to commencement of antipsychotic medication.

Staff developed a comprehensive care plan for each patient that met their mental and physical health needs.

Care plans and risk assessments now contained sufficient details to meet the needs of individual patients. The service had improved this area of work since the last inspection and was no longer in breach of regulation.

Care plans and risk assessments were co-produced, holistic, person-centred and recovery orientated. Plans set out the patients' goals, as well as arrangements for occupational therapy, psychology and risk management. Staff updated care plans weekly as per the hospital protocol and also when patients' needs changed. The service carried out weekly audits on care plans and risk assessments and addressed any shortfalls.

The service planned and delivered people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

The service had access to a full range of specialists to meet the needs of the patients on the wards. All wards were staffed with staff nurses. They were also allocated ward doctors, psychiatrists, therapists, occupational therapist, clinical psychologist, assistant psychologist and had input from a pharmacist. Managers gave each new member of staff a full induction to the service before they started work.

Staff 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 (NICE). These included medicines, psychological therapies, activities, community access and daily life skills. Staff facilitated groups and activities every day such as yoga, meditation, group therapy, music and drama therapy. The hospital website listed the variety of groups available for patients to access.

Psychology staff provided evidence-based treatments such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), eye movement desensitisation therapy (EMDR) and family therapy. Patients could also access psychotherapy.

Managers gave each new member of staff a full induction to the service before they started work. Recently appointed staff told us they had been well supported and received a comprehensive induction before they started work on the wards. However, we heard from Allied Health Professionals who reported that the induction subjects could be improved for their professional group.

Managers supported staff through regular, constructive clinical supervision of their work. Clinical and managerial supervision compliance was over 85% across all wards at the time of inspection. Staff we spoke with confirmed they had access to regular supervision. They used supervision to discuss the current patients, to reflect and learn from practice, incidents and for personal support and professional development.

Managers made sure staff attended regular team meetings or gave information from those they could not attend. Where staff were unable to attend team meeting minutes were available.

Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. All staff on the OCD ward had undertaken training in Exposure and Response Prevention (ERP). Staff also undertook role play as part of their training to fully understand the needs of the patients on the ward.

Managers recognised poor performance, could identify the reasons and dealt with these through supervision and performance management plans.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. Managers now used results from audits to make improvements, by implementing and monitoring action plans. For example, we found improvements with patient care plans and risk assessments since our last inspection. The lead clinician for the service carried out a weekly governance review of all patients with the multidisciplinary team, this review involved checking all aspects of the patients’ medical care.

Staff held regular and effective multidisciplinary meetings to discuss patients care, treatment and improve their care. All members of the multi-disciplinary team and staff worked together to understand and meet the range and complexity of patient’s needs. Staff told us they shared clear information about patients, reviewed their care, patient progress, treatment plans and took account of any changes in risks.

Staff made sure they shared clear information about patients and any changes in their care, including during ward handover meetings. Each shift held a handover where incidents, risk history, updates from the multi-disciplinary team and patient care was discussed. Written handover information was available for all staff to refer to.

The hospital had daily situation report meeting each morning which discussed staffing, incidents, referrals, admissions, planned discharges, diary appointments and any other relevant issues. These were well attended by managers and the wider clinical team.

The ward teams had effective working relationships with teams outside the organisation such as the local authority and other NHS organisations.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice, for example healthy eating advice, managing cardiovascular risks and dealing with issues relating to substance misuse. A dietician was available to offer patients advice on healthy eating and nutrition.

The therapy team, comprising of occupational therapists, psychologists, assistant psychologist and other therapy team members offered activities targeted toward patient’s wellbeing for example, relaxation, Tai Chi, yoga and mindfulness.

The service routinely monitored people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. Staff measured patients progress and the effectiveness of their treatment at each ward round, at clinical improvement meetings and against individual recovery goals. Outcome measures in use included Health of the Nation Outcome Scales (HoNOS), PHQ-9 (Patient Health Questionnaire-9), GAD-7 (The Generalised Anxiety Disorder Assessment) and CORE -10 (Clinical Outcomes in Routine Evaluation) regularly to monitor patient’s progress, symptoms and wellbeing.

Staff used technology to support patients effectively, for example patients could use a quick response code (QR) to raise any concerns they had about the service.

The service told people about their rights around consent and respected these when they delivered person-centred care and treatment.

Staff assessed each patient’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings.

Staff gave patients all possible support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. When staff assessed patients as not having capacity, they made decisions in the best interests of patients and considered the patient’s wishes, feelings, culture and history. When a patient lacked capacity for a specific decision, staff said the multidisciplinary team, with the patient’s input, would discuss the issue and make a decision in the patient’s best interests that took into account the patient’s wishes.

Staff told us they respected patients’ choices when offering care and support. Patients confirmed this and explained they felt consulted and well informed.