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 as good. At this assessment the rating has remained as 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 provider 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 4 care records during our inspection. Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. Most patients received a comprehensive mental state assessment by a nurse and a doctor on admission. This included an assessment of the patient’s capacity to consent to admission and treatment.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. The hospital had a physical health lead nurse and a physical healthcare assistant. Physical health needs were well reflected in care records, with evidence of regular blood tests, ECG monitoring, bowel monitoring and referrals to dietetics, opticians, and dental services etc, as well as support with weight management. Staff completed National Early Warning Score (NEWS) 2 observations and referenced high dose antipsychotic therapy (HDAT), clozapine and lithium monitoring when appropriate. The hospital had a point-of-care (POC) device for clozapine blood monitoring which allowed staff to conduct immediate, finger-prick testing of white blood cell (WBC) counts and/or clozapine serum levels.

Staff developed a comprehensive care plan for each patient, updated where necessary, 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. They included the views of patients and family members.

We scored the service as 3. The provider 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.

Patients were typically admitted to the ward with complex mental health and personality disorders, including a history of violence or offending. Many patients had long-standing difficulties and had been in contact with community psychiatric services over many years.

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) and included prescribing medicines and offering therapeutic activities. The service offered a long-term programme, the multi-dimensional approach to trauma informed recovery (MDTIR-LT). This programme adopted a phased trauma recovery model integrating trauma-aware, informed and enhanced care principles, structured psychoeducation, dialectical behaviour therapy (DBT) skills training, and trauma-focused therapy, including eye movement desensitization and reprocessing (EMDR).

The service provided support with emotional and life skills, activities and occupational therapy. The staff team included the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, patients had regular support from occupational therapists, technical instructors, psychologists, arts psychotherapists and social workers. Psychologists provided support to patients and staff. They undertook assessments and provided group and individual sessions for patients as well as consultation and training for staff. The occupational therapy team offered a range of support including completing sensory assessments and supporting patients with activities both within and outside the hospital.

Patients had access to education. There was a classroom on the hospital site. The teacher worked with patients individually and in groups and offered a range of activities including basic maths and English skills. Within the classroom, there was a wide range of newspapers, books and DVDS that patients were able to borrow as well as computers that patients could use to access the internet.

Staff used technology to support patient care. At the time of inspection, this included video calls with relatives and external stakeholders during meetings about patient care.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. There was always a doctor on call who would manage and see any unwell patients out of hours. If any escalation was needed, patients would be taken to the local general hospital for further assessment and treatment.

Managers used results from audits to make improvements. The hospital had a programme of quality and clinical audits, for example falls in inpatient units, bowel monitoring for patients on clozapine and discharge follow up.

We scored the service as 3. The provider 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 multidisciplinary meetings to discuss patients and improve their care. At these meetings, staff reviewed the patients’ progress and the effects of medication.

Staff made sure they shared clear information about patients and any changes in their care, including during huddles and handover meetings. Manager and multidisciplinary team members met each morning to review risks and incidents.

Ward teams had effective working relationships with external teams and organisations. For example, the wards had regular contact with the independent advocacy service. Managers also worked closely with bed managers and discharge co-ordinators in NHS trust’s that placed patients at the service. Visiting professionals told us they were always made welcome at the service, staff were open and transparent and communication was good. External professionals, such as community care co-ordinators, were invited to ward rounds and multidisciplinary team meetings to discuss the progress of, and plans for, their patient.

Staff had effective working relationships with teams outside the organisation for example local authority social services, GPs and community substance misuse services.

Information relating to care, safeguarding, advocacy, activities, communication needs and feedback on care were displayed on the ward notice board for patients and family members.

We scored the service as 3. The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

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 made sure patients had access to physical health care, including specialists as required. Patients were seen promptly by a doctor when they felt unwell.

Staff participated in weekly physical health huddles to review and discuss individual patients’ physical wellbeing and healthcare needs. Staff monitored patients’ weight and encouraged weight reduction as appropriate.

Staff supported patients to live healthier lives. For example, through participation in smoking cessation schemes, healthy eating advice and dealing with issues relating to substance misuse. One of the occupational therapists was trained in auricular acupuncture for recovery from substance misuse.

Ward activities helped promote a healthy lifestyle for patients, For example, fitness sessions at the gym and walking groups. The service had introduced a programme called ‘Healthy Eating and Lifestyle Support (HEALS)’. This was a 12-week programme of health education which patients were encouraged to attend to improve their diets and fitness levels.

The service had close links with ‘Sport for Confidence’ an Essex community-based organisation who provided patients with unique sporting and physical activity opportunities in mainstream leisure facilities. The sessions provided an opportunity for people to try different physical activities in a safe and supportive environment with skilled sports coaches and occupational therapists, providing attainment of new skills, building confidence and social interaction with others.

We scored the service as 3. The provider 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 morning meetings and handovers, 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, health of the nation outcome scales (HoNOS), Clinical Group Impression Scale (CGI), Friends and Family test and the Recovering Quality of Life tool (ReQoL). To record these measurements the service had developed an outcomes framework produced together by clinicians, patients and family members. The framework covered 3 main areas: mental health, physical health and personalisation of care. Clinicians and multi-disciplinary teams used the framework to monitor patients’ progress, their quality of life and their experience of the care they received.

We scored the service as 3. The provider 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.

Staff assessed most patient’s capacity to consent to admission and treatment on admission, although we did see 1 patient where this was not recorded. Capacity was monitored and recorded at multidisciplinary team meetings. Records showed that these assessments covered the four elements of capacity.

When 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.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

Staff engaged with patients’ families to understand each patient’s history and interests.