The Sussex Beacon

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 that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. We assessed all quality statements in this key question.

Staff treated patients as individuals and involved them and their families in care and treatment decisions. Patients felt involved, listened to, and everyone involved worked well together.

The service worked well across teams and services to support people. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

However, they did not always follow legislation and current evidence-based good practice and standards

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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.

Staff treated patients as individuals and involved them and their families in care and treatment decisions. Patients felt involved, listened to, and everyone involved worked well together.

The service took a holistic approach to care, assessing physical, medical, emotional and social needs within handovers and multidisciplinary (MDT) meetings.

Staff appropriately assessed people’s individual needs at admission and discharge, and ensured the care provided met their needs.Leaders told us that assessment is continuous and multidisciplinary rather than episodic, with daily medical reviews, twice‑weekly pharmacy review, and a weekly ward round, ensuring changing needs are proactively identified and responded to.

We reviewed the electronic patient notes system and saw that individual needs were recorded such as allergies, falls risks, wound risks and whether DNACPRs were in place. DNACPR stands for “Do Not Attempt Cardiopulmonary Resuscitation.” It is a medical decision and record indicating that if a person’s heart stops or they stop breathing, CPR should not be attempted.

Staff discussed care needs, including the reason for admission, holistic care needs and any specific needs linked to substance misuse as part of the pre admission assessment. Aims and goals for the admission were discussed and documented.

The service used personalised care plans and goal setting. Staff actively encouraged people to maintain their interests and participate in activities.

The evidence showed some shortfalls. Whilst the service followed evidence based guidelines for the management of their patients, policies were not reviewed and kept up to date in line with current guidance and best practice."

The service had 114 policies, all requiring review at the time of our assessment. An independent consultant had been hired to complete this review but was still ongoing.This meant that staff could be using policies that did not reference the most up to date standards or best practice. Examples of these included the safeguarding policies for both children and adults. We saw minutes from the quality and governance committee meetings which had ‘policy status’ as a set agenda items in order to ensure they were appropriately reviewed and ratified.

The service did not benchmark data or audit findings because benchmarking information was not readily available for comparable services.

However, medical staff followed British HIV Association (BHIVA) guidelines for the management of HIV care.

Staff attended weekly multidisciplinary team meetings with the local NHS hospital HIV clinic consultants to ensure patients were receiving evidence-based care. These meetings provided an opportunity for staff (across all disciplines) to share and develop their knowledge about HIV and available treatment and support options.

The evidence showed a good standard. The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. The whole staff team worked collaboratively to make sure people's healthcare needs were met. The team included Sussex Beacon staff such as nursing staff, clinical support workers, community outreach workers and volunteers alongside consultants, pharmacists, occupational therapists and other support staff from partner organisations.

The service had systems to help care for patients who needed additional support or specialist intervention. The service worked closely with external services offering support for alcohol, drugs, housing and other social issues. Staff described clear referral pathways to other services such as tissue viability, dietetics and primary care.

Staff told us that mental health support for patients was available but needed improvement, due to the high demand. The service worked with the local NHS trust, giving access to a psychiatrist for support and advice. The service also provided in-reach to the local acute hospital for patients living with HIV who could benefit from support from the service. Registered mental health nurses were available through the service’s bank staffing system.

Inpatients benefitted from occupational therapy (OT) twice weekly, provided by the local NHS community trust.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff were experienced in supporting patients detoxing from alcohol or other substances. The aim of detox admissions was always to have the detoxed prior to discharge and to ensure access to support once discharged.

Patients had access to multiple activities, one to one and group sessions to help their physical and emotional wellbeing. All inpatients had access to activities and courses run by the day service. Examples included the positive fitness class – a physiotherapy supervised exercise group, tailored for those living with HIV and managing medication side effects or complex health needs. Other referrals included to the mindfulness programme, key worker support and smoking cessation.

The service offered a variety of holistic therapies delivered by visiting practitioners.

Staff promoted good nutrition and hydration.The on-site kitchen catered for all dietary and personal preferences, and chefs aimed to provide healthy, appealing cooked meals for both patients and staff. The inpatient unit survey showed that the majority of patients rated the standard of food as outstanding. Feedback included: “The head chef made a huge effort to accommodate the difficulties I have with my teeth and was happy to adapt dishes to meet my needs”.

The service displayed relevant information promoting healthy lifestyles and support throughout the site. We saw various posters and information leaflets on healthy living in communal areas.

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

The service used assessment and outcome tools to measure patient progress and wellbeing. These included the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)– to assess and monitor emotional wellbeing, the Patient Health Questionnaire-9 (PHQ-9)– to evaluate the severity of depression symptoms, the Generalised Anxiety Disorder-7 (GAD-7)– to measure levels of anxiety and NHS Pain Assessment Scale (0–10)– to monitor and respond to pain management needs. Staff told us that results from these scores were reviewed regularly as part of multidisciplinary care planning and quality monitoring.

The service monitored patients’ progress while at the service. As part of the inpatient unit’s patient satisfaction questionnaire, patients were asked whether they felt they had benefitted from their stay at the service. Of the 41 responses received, 92% said they had definitely benefitted, 1 responded partially and 2 chose not to comment.

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.

The service consistently explained patient’s rights regarding consent, ensuring they fully understood their rights. Staff respected these at all times when delivering person-centred care and treatment.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff told us consent and confidentiality was engrained in the service’s culture due to the history and stigma associated with HIV. Staff always sought permission before making any onwards referrals to external services due to the remaining stigma around the service being associated with HIV. We saw examples in the electronic records where staff had used the consent tab to record whether patients agreed to share their details with relevant healthcare professionals.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Patients were initially assessed for their capacity at admission.

The service provided MCA and Deprivation of Liberty Safeguards (DoLS) training, with 80% of the inpatient unit staff having completed this.

However, we reviewed the service MCA and DoLS policy and found it overdue review, raising concerns that it may not reflect the most current guidance. Additionally, the sequencing of the policy was confusing, with repeated sections and poor organisation. For example, the section on inclusiveness came after ‘process’ creating a risk that this important element may be missed.