MindOf

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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

We rated effective as Good because:

Staff completed a comprehensive, holistic and person-centred clinical, psychosocial and mental health assessment with each patient

Staff had the skills, knowledge and experience to carry out their roles.

Staff worked together, and worked well with other organisations, to deliver effective care and treatment.

Staff were consistent and proactive in empowering patients and supporting them to manage their own health and maximise their independence.

However, staff did not frequently repeat screening tools to monitor patient outcomes. The service had already identified this as an area for improvement and had plans in place to address this.

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 provider had systems to keep up to date with current evidence-based practice. We saw evidence that staff assessed needs and delivered care and treatment in line with current legislation, standards and guidance relevant to their service.

We looked at 3 patient records. We saw that staff assessed patients’ immediate and ongoing needs and delivered treatment and care in line with relevant and current evidence-based guidance and standards such as the National Institute for Health and Care Excellence (NICE) best practice guidelines.

Staff completed a comprehensive, holistic and person-centred clinical, psychosocial and mental health assessment with each patient. The service used a range of specialist assessment tools to assess a patient. This included the Mental State Examination (MSE), Strengths and difficulties Questionnaire (SDQ) to assess mental health difficulties in children and adolescents, the Revised Children’s Anxiety and Depression Scale (RCADS) and a Strengths and weaknesses tool to assess ADHD symptoms (SWAN).

Children and young people who were waiting for an ADHD assessment, were advised to complete the Adult Self Report Scale (ASRS) for ADHD. This was a self-assessment completed by the patient prior to their appointment. The service also used QbCheck and the Cognitive Assessment Screening tool (Creyos) as digital assessment tools to evaluate and measure certain aspects of ADHD such as working memory and hyperactivity.

Staff took the time to understand patient’s individual needs before offering a diagnosis and a treatment plan. Each patient and parent received a comprehensive report outlining the assessment in detail and the recommended next steps. Parents told us that the care their child received was person-centred.

Staff checked patient’s blood pressure, height and weight. Each patient was also offered an electrocardiogram (ECG), which is a non-invasive test that records the electrical activity of the heart to diagnose various heart conditions. This was a requirement before any medicines were prescribed within the service. The results were sent to a cardiologist, who provided a report on the results. Parents gave positive feedback about this, with one parent commenting that their child had an undetected health issue that was highlighted in the ECG results.

Staff had received phlebotomy training and could withdraw blood to be sent to a laboratory for testing when required. Staff used appropriate equipment to ensure that this was compliant with infection, prevention and control guidelines such as using anti-bacterial wipes to wipe down the equipment before after use, using gloves and disposing used needles in the appropriate clinical waste bins.

The service worked in partnership with patients’ GPs, the NHS and other relevant specialists to ensure patients’ full physical health was assessed and monitored when required.

Records showed that staff made clear records of their assessments and outcomes, as well as plans of care and intervention and shared this in a timely way with patients.

We saw no evidence of discrimination when making care and treatment decisions.

The service delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards. The service was involved in quality improvement activity.

Staff could demonstrate that they delivered high quality care according to best practise and national guidance. Staff were able to describe this clearly and records of assessments and treatment plans demonstrated this.

The service ensured staff were appropriately qualified. The provider had separate induction programmes for all newly appointed clinical and non-clinical staff. Inductions included referral, admissions and treatment pathways, safeguarding procedures, complaints and emergency contacts. Clinical staff were inducted on medicine and prescribing processes. All new staff were provided with copies of all policies and procedures for the service.

Manager supported staff to develop through regular, constructive clinical supervision of their work. Staff were encouraged and given opportunities to develop. For example, a clinical administrator had planned to complete their phlebotomy training. This was training to safely withdraw blood from a patient so it can be sent to a laboratory to be tested.

The Registered manager completed an annual appraisal through an independent body every year. They also attended quarterly peer review meeting with other consultant psychiatrists to reflect on their own practice. The Speech and Language therapist also attended regular peer group supervision with other clinicians in their field.

The service had systems in place for clinical audits to take place and acted on areas where areas for improvement were identified. Staff completed and monitored outcomes of audits for records, ID checks, prescribing medicines, anti-psychotic drugs, ECGs and ADHD assessments. Where audits identified any concerns, the registered manager logged the action taken to address any shortfalls in the clinical governance meetings. Staff had protected time to complete audits.

Clinical audits had a positive impact on quality of care and outcomes for patients. There was clear evidence of action to resolve concerns and improve quality. For example, staff had recently ensured that medicines were noted on the patient’s contact page in their electronic records to ensure that this was accurate for each patient and this would be used for future non-controlled drug prescribing audits.

Staff worked together, and worked well with other organisations, to deliver effective care and treatment.

Patients received coordinated and person-centred care. Staff referred to, and communicated effectively with, other services when appropriate, for example GPs, psychologists, other clinicians and therapists.

Before providing treatment, doctors at the service ensured they had adequate knowledge of the patient’s health, any relevant test results and their medicines history. The psychiatrist told us that they would not provide care and treatment if this information was not available. The patient would be signposted to more suitable sources of treatment in these circumstances to ensure safe care and treatment.

All patients were asked for consent to share details of their consultation and any medicines prescribed with their registered GP on each occasion they used the service. Where patients did not consent to their GP being contacted by the service, the consultant psychiatrist explained the potential risks associated with not sharing information and considered whether the service could offer safe care and treatment in these circumstances.

The provider had risk assessed the treatments they offered. They had identified medicines that were not suitable for prescribing if the patient did not give their consent to share information with their GP, or they were not registered with a GP. For example, medicines liable to abuse or misuse, and those for the treatment of long-term conditions such as ADHD. Where patients agreed to share their information, we saw evidence of letters sent to their registered GP in line with General Medical Council (GMC) guidance. Where patients agreed to share their information, we saw evidence of letters sent to their registered GP in line with GMC guidance.

Patient information was shared appropriately (this included when patients moved to other professional services), and the information needed to plan and deliver care and treatment was available to relevant staff in a timely and accessible way. Care and treatment for patients in vulnerable circumstances was coordinated with other services. For example, parents consented for their child’s information to be shared with their schools or their special education needs co-ordinator (SENCO).

Staff could access regular staff meetings, where relevant information about the service was shared. There were clear agendas and meeting minutes were recorded and shared with those who could not attend.

Staff were consistent and proactive in empowering patients and supporting them to manage their own health and maximise their independence.

Where appropriate, staff gave people advice so they could self-care. The initial psychiatric assessment report gave detailed information and advice for children, young people and parents such as good practice with sleep hygiene and nutritional advice.

Some patients were offered the use of a diary to record their mood between consultations.

The psychiatrist supported patients and parents to recognise individual warning signs that their mental health was deteriorating. Risk factors were identified and highlighted to patients and parents. For example, parents told us the consultant psychiatrist discussed the possible side effects of medicines with them.

Where patients' needs could not be met by the service, staff redirected them to the appropriate service for their needs, such as patients with an eating disorder.

The service monitored the progress of the patient and clinical outcomes through screening tools. Certain screening tools were used and repeated depending on what pathway the patient was on such as the Strengths and difficulties Questionnaire (SDQ) for monitoring anxiety and depression and the ADHD home or school rating scale for children and young people.

However, screening tools were not always repeated to monitor the patient’s progress and outcomes over time. The service had already recognised that this was an area that they needed to improve on and after the inspection, the service had developed a new outcome measures policy and schedule. Outcome measures were now audited and incorporated into the service’s email templates, which were now repeated and sent out at various timeframes to parents and patients.

The service obtained consent to care and treatment in line with legislation and guidance.

Staff understood the requirements of legislation and guidance when considering consent and decision making, including requirements and law around Gillick competence. Gillick competence is around assessing a young person’s functional ability to make a decision. Staff took all practical steps to enable patients to make their own decisions.

Records showed that staff supported patients and parents to make decisions and obtained parental consent to treat children. Where appropriate, they assessed and recorded a young person’s competence to make a decision.

The service recorded consent to share information clearly in individual patients’ records. Parents reported that consent was sought at each appointment.