St Andrew's Healthcare - Essex

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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 good. At this assessment the rating has remained 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.

During the assessment we reviewed 5 care records. Staff completed a comprehensive assessment of patients in a timely manner at, or soon after admission. All patients received a comprehensive mental state assessment by a doctor on admission. This included an assessment of the patient’s capacity to consent to admission and treatment. Staff regularly reviewed and updated this assessment at regular time points during their stay at the service.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. This included checks of patients’ temperatures, pulse, oxygen saturation and blood pressure. Staff carried out an electrocardiogram (ECG) on patients, prior to administration of antipsychotic medication.

Staff developed a care plan for each patient that met their mental and physical health needs. Care plans were personalised and recovery orientated. Plans for treatment set out the patients’ goals, as well as arrangements for occupational therapy, psychology and risk management.

Sensory passports were completed, and Positive Behaviour Support (PBS) meetings were held with patients. PBS plans supported staff and patients to manage potentially triggering situations by focussing on the underlying needs and circumstances that may contribute to them. This meant staff had a clear understanding of individual needs and preferences.

We reviewed minutes from multidisciplinary meetings, these evidenced patient’s care and treatment being reviewed by the multidisciplinary team, patients and their carers with a person-centred approach to meet patient’s needs.

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 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 and consistent with national guidance on best practice. They ensured patients had good access to physical healthcare and supported patients to live healthier lives.

We reviewed 5 care records and saw that staff delivered interventions in line with National Institute for Health and Care Excellence guidelines, this included evidence based psychological therapies and evidence based occupational therapy input, including activities of daily living (ADL) skills, vocational training and work opportunities. Additionally, the service collaborated with community partners such as Sport for Confidence and New Life Wood. The service created Positive Behaviour Support Plans (PBS) with patients, with the input from nursing and psychology to enable a person-centred approach.

Staff ensured that patients had good access to physical healthcare, staff referred patients to specialists when required. The service had access to an on-site physical healthcare team and physical health was regularly monitored.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. The service conducted numerous monthly audits which included medication, patients’ records and observations. Actions were documented and audit findings were shared and discussed at clinical audit committee meetings.

Managers used results from audits to make improvements. For example, feedback and actions from audits were shared with staff, including specific tasks for named roles to improve compliance.

We scored the service as 3. The evidence showed a good standard. 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 shared information about patients at effective handover meetings within the team, these took place twice a day, before the commencement of each shift. There was also a morning meeting which the MDT and leaders attended. There was a process to escalate any high-level concerns which staff were aware of.

Staff had regular and effective multidisciplinary team (MDT) meetings. There were professionals involved in the assessment and review of patient’s health, care and treatment, wellbeing and communication needs. Professionals were engaged in reviews and assessments.

Staff worked closely with external organisations such as local authorities and commissioners of health care services. We saw evidence in patients care plans of the service working with commissioners, community mental health teams, social workers and advocates to support patients.

We scored the service as 3. 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.

On admission, patients received a separate physical health assessment, by both a medic and a physical health nurse, this was to enable early identification of existing long-term conditions and risk factors. Patients with long-term conditions received reviews within 1 month of admission and annually thereafter, referrals to external services were made where specialist input was required.

Patients were supported to access the NHS national screening programs. On admission patients smoking status was recorded, and patients were all offered Very Brief Advice (VBA) where healthcare staff asked about smoking, advised on quitting, and offered support or referral., nicotine-replacement therapy (NRT), or vaping alternatives. The physical health nurse had trained in smoking cessation and offered ongoing support for patients that were interested in quitting.

Patients were screened for cardiometabolic risk (the chance of developing heart disease, stroke, or diabetes) using the Lester Tool on admission and then annually. The hospital had developed a local physical health huddle dashboard to monitor compliance and outcomes. The dashboard was reviewed daily in the morning meetings.

The hospital had a Quality Improvement (QI) project, to introduce a 2-stage healthy eating and lifestyle support program for long-term patients. The first stage was to promote general well-being and the second stage to provide bespoke exercise and nutrition plans, led by a sports and nutrition therapist.

Staff identified patients’ physical health needs and recorded them in their care plans. Staff conducted checks of each patient’s pulse, temperature, weight, height and blood pressure each week. Staff wrote up detailed notes for each shift covering patients’ compliance with medication, food and fluid intake, personal hygiene and sleep.

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 continuously monitored patients’ health, their mental state and well-being. At twice daily handover meetings, staff noted details of patients’ sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. For example, staff reported measures included Health of the Nation Outcome Scales (HoNOS), Clinical Global Impression (CGI), and Activity Partcipation Outcome Measure (APOM). APOM is a tool used by occupational therapists to assess and track patient progress based on the Vona du Toit Model of Creative Ability (VdTMoCA). The service also used self-reporting measures for patients, which included Clinical Outcomes in Routine Evaluation – Outcome measure (CORE-OM) and Recovering Quality of Life (ReQOL).

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 assessed patient’s capacity to consent to admission and treatment. Staff assessed patient’s capacity for specific decisions throughout their care and treatment. Capacity was monitored and recorded at multidisciplinary team meetings. Staff we spoke with told us if patients lacked capacity to make a specific decision, staff made decisions in their best interests, recognising the importance of the person’s wishes and involving their carers.

Staff took all practical steps to enable patients to make their own decisions. Patients made their own choices and decisions on a day-to-day basis about what they did, what they ate and how they filled their time. When staff felt a patient may have lacked capacity to decide, staff provided support. For example, if a patient was thought to lack capacity to consent to treatment, staff explained why the treatment was important, how they would benefit from it and described any possible side-effects.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.