Elizabeth House

On this page

• 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

Effective - 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 requires improvement. At this assessment the rating has changed to good.

Staff assessed the physical and mental health of all patients upon admission. Staff developed individual care plans which they reviewed regularly through multidisciplinary discussions 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 a full range of specialists required to meet the needs of patients throughout their stay. There was good multidisciplinary team working to benefit patients’ recovery.

Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Patients were aware of their rights and were supported to understand these fully and seek additional external support if needed.

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.

We reviewed 10 patient records. Staff assessed the physical and mental health needs of all patients on admission, or as soon as practically possible. Wards had a named nurse system. Named nurses developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans we reviewed reflected assessed needs of patients.

Most care plans were person centred, although we did observe many were written in the third person. Staff had indicated these had been discussed with the patient. Patient views / voice could be more widely used to reflect discussions held. Care plans were recovery orientated and looked towards goals for the future.

The physical health lead ensured patients had all relevant physical health assessments completed as directed by the medics. Patients we spoke with were happy with the physical healthcare provision they had received at the service.

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). Staff ensured that patients had good access to physical healthcare. Initial assessment included taking patient details to include weight and height.

The team included or had access to a full range of specialists required to meet the needs of patients in the service. The service did not have a substantive occupational therapist (OT) in post. However, they had been using a locum who had visited the hospital to undertake various assessments at staff requests. We saw the locum had undertaken a variety of functional assessments which included cooking, budgeting and road safety. Managers told us there had been discussions about securing a substantive OT. The service had also used a physiotherapist in the past when a patient had required this. We did not see any patients who had unmet health needs during this assessment.

Staff were skilled and appropriately trained to care for the patient group. Managers provided new staff with an appropriate induction to the service. All staff received regular supervision as a minimum two monthly. Compliance at time of assessment was 100%. Managers completed annual appraisals of staff work performance. All staff eligible at time of assessment had completed one. During appraisals, managers identified with staff any learning needs and provided them with opportunities to develop their skills and knowledge.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. At time of assessment 100% of staff had been trained and were up to date with Mental Health Act training.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice through the hospital Mental Health Act administrator. The Mental Health Act administrator had oversight of all Mental Health Act documentation and had systems in place to ensure legal requirements were met. The provider had relevant policies and procedures that reflected recent guidance.

Patients had access to information about independent mental health advocacy. This was displayed on the wards on patient notice boards. Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded when they had done this. Staff stored copies of patients' detention papers and correctly so that they were available to all staff who needed access to them.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Some patients, during the community meetings had said that staff sometimes took a while to sort out the leave paperwork, prior to leaving the hospital, which could be frustrating for them.

Staff requested an opinion from a second opinion appointed doctor when necessary. The service displayed notices to tell informal patients that they could leave the ward freely, and to speak to the nurse in charge. Care plans referred to aftercare requirements of patients with details of local teams who would be supporting them upon discharge.

The nurse in charge of each shift handed over to the incoming shift. Each patient was discussed in turn, highlighting any planned leave, activities or appointments to ensure appropriate planning.

The hospital had a daily MDT huddle meeting which we observed. Present were doctors, psychologist as well as both ward managers. Each ward manager gave a summary of the previous 24 hours on their wards, going through each patient, highlighting any incidents, concerns as well as general presentation. Staffing was reviewed and confirmed across the wards. Pending admissions and discharges were discussed. Specific tasks were allocated to individuals. For example, updating or reviewing of care plans following incidents. This meeting offered attending staff a snapshot the previous 24 hours and ensured any risk incidents or areas of concern was shared appropriately, enabling action.

Ward managers held regular staff team meetings. Managers attended the regular clinical governance meeting and shared all relevant information with staff. We saw staff regularly contacted external professionals as and when required to enhance patient care. For example, the NHS commissioning teams.

Staff supported patients to live healthier lives. We saw patients had specific care plans to address individual physical health needs, as well as staff supporting patients to make healthy choices. Menus were flexible and patients regularly fed back to the kitchen staff, so they had an element of choice around what they ate.

We saw during some community meetings; staff had taken the opportunity to have a brief discussion about hypertension and what could causes this and how people could help to reduce risks. We saw staff had been working with one patient who was overweight and was motivated to live a healthier lifestyle.

We saw many activities offered which helped promote a healthy lifestyle for patients. Patients were able to use the swimming facilities and gym facilities at a local leisure centre, with no cost to them. Some patients enjoyed going for walks with others. Some patients talked about the mobile kitchen, where patients could cook a breakfast using an air fryer, under staff supervision.

Staff used recognised rating scales / outcome measures to assess and record severity of symptoms and outcomes. The service used a well-known, standardised assessment tool for each patient upon admission and discharge to measure the health and social functioning of patients. This enabled changes in mental health to be identified and indicated if current treatment plans were effective.

Psychology staff undertook regular, weekly assessments of patients to support and monitor recovery and wellbeing. The assessment tracked numerous symptoms of psychological distress, including anxiety, depression, trauma as well as any functioning issues over the previous week. Additionally, we saw psychology staff undertook a patient outcome measure which focused on their quality of life. The findings of assessments were discussed during MDT meetings with a view to continue to support patients in their recovery.

The nature of the service meant that patients were expected to be short stay. Upon admission, staff undertook a comprehensive physical health assessment, which included routine blood tests and an electrocardiogram (ECG). The service had a local agreement with a hospital who processed blood samples in a timely way. Nursing staff completed relevant risk assessment tools, such as nutrition to identify potential concerns and inform care needed.

Staff used technology to support patients effectively. The service had an electronic notes system. Staff we spoke with knew how to navigate this to navigate to required documentation and record patient progress.

Staff we spoke with had a good awareness of people’s rights around consent to care and treatment. Staff took practical steps to support patients to make their own decisions on a day-to-day basis.

Each ward had relevant information for patients visible which included the right of informal patients being able to leave the ward (patients were asked to speak with staff). We saw information about detention under the Mental Health Act and how patients could access advocacy and / or a solicitor if they wished to discuss further or appeal against this.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. If there were doubts about a patient’s capacity in relation to a specific decision, the MDT would make decisions in the patients’ best interests, in line with the Mental Capacity Act.

Consent to admission and treatment had been discussed, assessed and recorded early in the admission process and revisited as appropriate.