Woodbourne Priory Hospital

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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 inspection 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.

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.

We reviewed 5 patient care records most of which were electronic with some paperwork still stored in paper files. Staff completed a mental health assessment of the patient on admission. Staff also assessed patients’ physical health needs in a timely manner. We saw staff had completed physical examinations on admission and tailored treatment in response to this.

Staff developed care plans that met patient needs identified during assessment. The majority were comprehensive, person-centred and holistic. Staff discussed patient care and treatment regularly and updated care records following incidents and multidisciplinary reviews.

Staff were not always updating patient care plans consistently. Staff did not record patient involvement in some care plans. In other care plans staff clearly recorded patients input using ‘I statements’ and reflecting the patient’s wishes as to how they would like their care and recovery to progress. One patient we spoke to could remember being offered a copy of their care plan. It was not recorded in their care plan if staff offered or provided a copy to the patient.

Patients were involved in ward rounds and nursing staff told us how patients could complete an MDT form prior to the meeting either on their own or with support from staff. Copies of these were in patients paper files. We were told by patients that these were fully discussed in MDT’s, but the patient’s wishes from these forms were not consistently updated on the MDT notes. For example, 1 patient’s request to leave the ward to collect their exam results was recorded on the paper form, but this had not been included in the MDT notes.

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.

Staff provided a range of care and treatment suitable for the patients in the service. The team included a full range of specialists required to meet the needs of patients. As well as doctors and nurses, there was a full complement of multi-disciplinary staff including occupational therapists, clinical psychologists, dietician and a family therapist.

Staff from different disciplines completed assessments and planned care and treatment that met patients psychological, medical and physical health needs. They used a range of assessment tools including the Eating Disorder Examination Questionnaire (EDE-Q) and generalised anxiety disorder assessment (GAD7).

There was an occupational therapy programme in place which offered a variety of recovery-based activities for patients. Patients were involved in planning activities relevant to their goals. These included activities that focused on daily living skills, healthy lifestyles, and social skills. Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice. The hospital promoted healthy eating, and staff created focused dietary plans based on patients’ personal needs. However, we saw from community meeting minutes that there were consistent concerns around the quality, temperature and frequent last-minute changes to food options. These were noted and had been fed back to the catering provider although no response was recorded. The issues around the quality of food and consistency of meals times had a higher impact on this patient group as the ward supported those with eating disorders.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. Managers used results from audits to make improvements and discussed these with staff at team meetings.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers recruited staff who were caring and compassionate and all staff working on Oak ward underwent specialist eating disorder training suitable to their role.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff told us they received specialist training which met the needs of patients. Staff were confident that if they asked for additional training managers would support them with this. We saw there were progression opportunities with some of the leaders having worked their way up through various positions in the organisation.

Managers ensured that staff had access to regular team meetings to provide feedback and discuss items related to the safe functioning of the ward.

Managers were able to give examples of how they had dealt with poor performance with staff quickly and effectively.

Mental Health Act

The provider reported 91% of staff on Oak ward received training in the Mental Health Act.

Staff were trained in and understood 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 knew who their Mental Health Act administrators were.

Formal patients had access to independent mental health advocacy however, information displayed on the ward was referring to the previous advocacy provider and needed to be updated.

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

The service displayed a notice around their locked door policy on the ward and how to ask for support to leave. This was, however, not specific to informal patients and there was nothing displayed informing them of their right to leave. This was highlighted to staff and posters with additional information were developed to be displayed during our visit.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

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 held handovers before each shift to discuss patients and anything that the staff team needed to be aware of happening on the ward. Staff discussed a range of issues in handovers including changes to clinical risk, incidents, changes in observation levels, medication and patient views.

Each patient had a multidisciplinary team meeting every 4-weeks where their care was discussed in detail, and their relatives and all professionals involved in their care were invited. People could attend virtually if they could not attend in person. We heard from a family member how the staff included them in updates and supported them to attend virtually if they could not be there in person.

Staff worked with external agencies such as community teams to ensure that patients were fully supported upon discharge. The provider had good links with external stakeholders to ensure continuity of care both pre and post admission. The ward manager established good working relationships with other Specialist Eating Disorder Units (SEDU) for patients within the West Midlands.

The manager and senior clinicians attended regular regional meetings and worked well with other hospitals under the provider.

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.

Patients’ physical health needs were assessed and documented within care plans. These were routinely monitored and reviewed.

The wider MDT took part in offering additional therapy sessions such as body image, self-care and 1 to 1 rehabilitation work. The dietician worked closely with each patient and involved family and carers in healthy life sessions to support the whole family to have a better understanding of eating disorders.

Staff also encouraged patients to access the garden and had involved them in growing vegetables that could then be incorporated into their meal planning. Patients’ physical activity was monitored whilst on the ward, so staff supported them to partake in other sedentary activities. We saw that patients used their art skills to decorate the ward and there was a dedicated art room.

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 used recognised rating scales to assess and record severity and outcomes this included the Eating Disorder Examination Questionnaire (EDE-Q) for patients on Oak Ward. Psychologists and Occupational therapists also shared that they assessed and recorded their own outcomes, revisiting and looking at improvements with patients during their time within the service.

Staff used technology to support patients effectively such as the ECG machines and equipment to help support patients with diabetes.

Regular audits of patients' files and other environmental records took place on the ward. Staff discussed audit findings in a monthly governance meeting and shared findings and learning across the service group. Managers used results from audits to make improvements and discussed these with staff at team meetings and in 1 to 1’s.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

As part of their MDT planning, patients often made requests for time away from the ward for significant events. Daily notes evidenced that patients had not been able to go off the ward on the dates requested due to risk concerns. It was not clearly recorded if the patient had been in agreement with this decision. The Mental Health Act Code of Practice states: “Informal patients must be allowed to leave if they wish, unless they are to be detained under the Act. Both the patient and, where appropriate, their carer and advocate should be made aware of this right with information being provided in a format and language the patient understands. Local policies and arrangements about movement around the hospital and its grounds must be clearly explained to the patients concerned. Failure to do so could lead to a patient mistakenly believing that they are not allowed to leave hospital, which could result in an unlawful deprivation of their liberty and a breach of their human rights.”

The recording of informal patient’s agreement for staying on the ward was not clearly documented. We saw that informal patients were not free to leave without seeking out staff support. Staff told us that patients worked with them if they had concerns about their safety when going off the ward. Care notes recorded staff rationale for why patients were unable to leave freely but lacked clear involvement and agreement from patients. Staff told us, however, that patients would often agree to remain on the ward based on safety concerns. Staff agreed this was not always clearly documented and they would take this back to the team to discuss best practice around recording of patient wishes.