3 The Beeches

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last inspection we rated this key question as good. At this inspection the rating has remained good. This meant people’s needs were met through good organisation and delivery.

Staff managed access to the service well. The service met the needs of all patients – including those with a protected characteristic. The service treated concerns and complaints seriously and investigated them. The service asked patients for feedback about the service.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients or their relatives told us they felt that staff focused on them and treated them as partners in their care. They felt that staff listened to them throughout the process of making a diagnosis. Patients were given a lot of information about their care and treatment options and felt that they had a choice. If they did not want to take up a particular treatment, then they felt supported to do this. 

Managers and staff spoke about patients in a positive and person-centred way. Staff told us that patient care is central to their way of working, and that patients were fully involved in their treatment and support. This was recorded in the care records and plans, which were person-centred overall. 

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service was based in Wilmslow in East Cheshire. Managers told us that most patients lived within 30 miles of the service, but may come from anywhere which included internationally. Although patients were seen at the Wilmslow site, many patients had online appointments. The manager was considering satellite services in other areas, but these were not currently available at the time of our inspection. 

Staff told us that if support could not be offered within the service, patients would be signposted to services in the community. 

Most patients self-referred and were self-funded. Following a positive diagnosis, patients could choose if they wanted to receive further treatment and support from the service and were made aware of the fees for doing this. The service often provided support, if the patient was receiving medicines elsewhere.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff ensured that patients could obtain information on treatments. They had an extensive website which was part of their online information and support programme for patients.

Patients were provided with information about the price of assessment, and some additional screening and treatment, as well as being made aware that there may be future costs. The service had a schedule of fees on its website. This included separate costs for assessment and treatment of ADHD in adults, children and female-specific assessments. It stated that these were not all-inclusive costs, and additional costs were likely for further screening and medicines.  

All support programmes offered telephone support, and a tailored booklet with the information people needed, which included about emotional regulation. Staff told us the service provided printed information for patients as it gave them something ‘physical’ to refer to. 

Staff could access services to translate information into an easy-read format or into other languages but told us this was rarely needed. Staff could also access interpreters if required, but again said this did not happen often. Staff told us they would never use family members as interpreters. 

The information provided was in a form accessible to the patient group. Staff told us they tried to make reports as clear as possible for the patient. However, there was no specific information that was targeted at children or young-people. 

The provider had information governance systems that included confidentiality of patient records. Staff used the services 2 main computer-based systems that were used for care records and for monitoring and tracking information. 

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Staff knew how to handle complaints appropriately. The provider had a complaints policy that included how people could make a complaint, what the process would be, and when they should expect a response. If a complaint needed further action a manager would investigate and then respond to the complainant.

Patients knew how to complain or raise concerns. When patients complained or raised concerns, they received feedback. Staff told us that most complaints or concerns were resolved informally. There had been 5 formal complaints in the 12 months prior to the inspection. 3 had been resolved and 2 recent complaints were still in progress. All complaints were logged on the electronic database. The provider’s response to complaints showed that they had investigated the concerns raised and provided a detailed response. These took account of the person’s views, and acknowledged where the provider was at fault, or where different action could have been taken. There were no specific themes identified. 

Staff ask for patient feedback and reviewed this to pick out themes. Some patients had raised that the assessment process was too long, so the service was reviewing how to ensure that whilst remaining comprehensive the forms were easier to complete. 

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff made reasonable adjustments for patients. Staff ensured the needs of people with mobility issues were met. The service was on 3 floors and did not have a lift. However, there was flat access to the ground floor, which included a disabled toilet. Many appointments were carried out online, so patients did not need to attend the premises. 

Staff had been involved in EHCP (Education, Health and Care Plan) for some patients in a local school. Staff had also provided some free seminars in schools. 

The service was mindful of issues that may be more prevalent in some communities. Assessments for women included acknowledgement of potential hormonal factors, and specific work around the menopause. Staff were mindful that autistic people may need additional support such as longer appointments and were mindful of sensory issues. The service provided information for patients about ADHD and treatment, which people could access outside the service at their own pace. 

Staff told us they did not have a waiting list and aimed to see all patients within 4 weeks. They had trackers for monitoring this and could see if this was delayed. Delays may be caused by waiting on physical health information or other forms to be completed. There were longer times to see the medical director, but not all patients needed to see him.

Appointments were rarely cancelled. Staff told us the clinics were well planned, and there were low levels of staff sickness. In the event a clinic did need to be cancelled, administration staff would contact the person to apologise and reschedule the appointment or try and offer an appointment the same day with a different person. 

The service had a process for following up on patients who did not attend their appointments. Staff told us that it was not common for people to miss appointments, but they were aware of the process and would try and contact them. 

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Patients were asked detailed information about their backgrounds and experience as part of the assessment process, and staff took this into account when considering their plan of care and treatment. 

The provider had policies on equality, diversity and inclusion, and all staff had completed training on this.  

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The service did not provide care as part of an end of life pathway.