St Andrew's Healthcare - Birmingham

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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.

The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We looked at 35 patient care records during the assessment, including those we reviewed to assess how the service managed patient incidents, safeguarding, seclusion and medicines.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.

Staff assessed patients’ physical health needs in a timely manner after admission. Staff made sure patients could access a variety of support services to meet their physical health needs. Staff developed care plans that met the needs identified during assessment.

Care plans were mostly personalised, holistic and recovery-oriented, even for patients who chose not to engage in the process. However, we found some out of date care plans that were no longer relevant and there were so many different care plans for each patient that it was difficult to navigate them in a timely fashion. We told the provider about this and they showed us their recent audit which also concluded that improvements were required. We spoke with the quality matrons in the service and they showed evidence of the improvement work they had recently begun for care planning.

Staff updated care plans when necessary, for example when patients’ needs changed.

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 and the Mental Health Act Code of Practice and discharged these well.

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. These will include medication and psychological therapies and, in rehabilitation wards, activities, training and work opportunities intended to help patients acquire life skills.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Patients were encouraged to become more independent with managing their physical health needs by booking and attending routine appointments.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. This was particularly important for patients who were older and living with complex physical health needs and in some cases a cognitive impairment, such as dementia. Staff made sure that patients were supported to eat and drink enough, especially if they might not remember to do it independently. Staff placed coloured and flavoured juice in prominent areas of wards as visual aids to encourage patients to drink enough.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. These included a review and refresh of the environmental audit process, with clear action plans to bring about improvements. Staff were developing co-production opportunities to involve patients in decisions about how the service was run.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, the service employed occupational therapists, clinical psychologists, social workers, a pharmacist, activity workers, an education officer, physiotherapist and a physical trainer. The service had easy access to a GP who visited the hospital every week, a podiatrist, speech and language therapist, dietician, tissue viability nurse and an optometrist.

Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction (using the care certificate standards as the benchmark for healthcare assistants).

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance.

Managers ensured that staff had access to regular team meetings and for those who were not able to attend, the minutes were easily available. Staff told us they could attend online if the meeting took place when they were not on shift.

All staff had received an appraisal in the last 12 months.

The percentage of staff that received regular supervision was 99%.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Examples included supporting staff with a nurse apprenticeship programme.

Managers ensured that staff received the necessary specialist training for their roles. Specialist training was available for staff such as trauma-informed care and personality disorder.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

95% of staff had received up to date training in the Mental Health Act.

Staff were trained in and 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 had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy. Staff displayed posters advertising the service on ward notice boards. The provider had a service level agreement with an advocacy agency. Patients valued being able to speak with an independent mental health advocate and were disappointed that changes to the agreement meant they had to book an appointment rather than see an advocate at a ward drop in session.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. In the past this had sometimes been delayed because of a lack of staff to support patients with the leave plans. Increased staffing levels meant this was less of a problem for patients.

Staff requested an opinion from a second opinion appointed doctor when necessary. One patient told us they were frustrated that they and their doctor had to wait so long to see a second opinion doctor. Records showed that staff contacted Care Quality Commission to chase this for the patient, even though the delay was beyond the hospital’s control.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly so that they were available to all staff that needed access to them. However, we have reported our findings that showed of out of date paper copies of some Mental Health Act paperwork was stored whereas the electronic records had been updated.

As patients’ discharge planning moved forward, their care plans referred to the Section 117 aftercare services that they were eligible to receive when they were discharged.

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

Staff held regular and effective multidisciplinary meetings.

Staff shared information about patients at effective handover meetings within the team (for example, shift to shift). The handover meetings we observed were well managed, contained essential risk information and a positive message for each person. Staff told us the handover meetings were key to them understanding the relational security and dynamics of the ward on each shift, as well as understanding what kind of day or night each patient had experienced.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation (for example, care co-ordinators and head office safeguarding

leads).

The teams had effective working relationships with teams outside the organisation (for example, local authority social services, mental health teams and GPs). Commissioners of the service were closely involved with staff on most levels and had a presence on site at the hospital, meeting regularly with managers and staff.

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 supported patients to live healthier lives – for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse.

Ward activities helped promote a healthy lifestyle for patients – for example walking groups, sports activities and cooking healthy meals.

Staff encourage patients to talk about their health and to make routine health appointments.

Patients told us the hospital made it easy for them to see a GP about their physical health, to see a hospital specialist if they needed tests or treatment, to get routine footcare, an eye test and dental treatment when they needed it.

Some patients told us they did not want staff to support them to live healthier lives but others told us they thought it was helpful. Patients gave examples of being supported to lose weight, get fit or stop smoking.

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 recognised rating scales to assess and record severity and outcomes (for example, Health of the Nation Outcome Scales). Occupational therapy and psychology staff used profession-specific assessment and outcome tools to monitor patients’ care and treatment.

Staff used technology to support patients effectively (for example, for prompt access to blood test results and online access to self-help tools).

Staff supported patients to learn how to use technology for example smart phones and they provided lessons in how to keep safe online.

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 about their care and treatment and about their lives in general.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately.

They did this on a decision-specific basis with regard to 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. Staff generally took a multidisciplinary approach when carrying out best interests decisions.