Newmarket House

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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 good. At this assessment the rating has remained good.

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 4. The evidence showed an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at all 5 care records during the assessment. There was a consistent and high-quality approach to assessing, and reviewing patient’s health, care, wellbeing and

communication needs with them. Regular reviews ensured that each patient's wellbeing was a priority and that all support was delivered in partnership with the individual.

Staff were highly proactive in assessing, managing, and anticipating risks to both patients and themselves. They demonstrated rapid responsiveness to sudden deterioration in patients’ health, supported by a service model that operated without a waiting list. Staff collaborated with patients, families, and carers to co-produce comprehensive safety plans.

Nursing staff completed a comprehensive mental health assessment of the patient on the day of admission and assessed patients’ physical health needs in a timely manner after admission. Physical health was prioritised due to the nature of the service. Patents had thorough physical heath checks completed, which included Dietetic assessment and introductory meetings with the patient, re-feed using meal plan prepared by the dietitian and twice weekly weighing to calculate BMI and blood tests if required.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery-oriented, and included Occupational & Social and Emotional & Psychological Health care plans, which were completed over the first few weeks of admissions. Care records included a traffic light system to support regulation, which was completed collaboratively between staff and patients.

Staff updated care plans when necessary and all patients had signed their care plans and were offered a copy. Patients told us they reviewed their care plans weekly with staff.

We scored the service as 4. The evidence showed an exceptional standard. The service always 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. They worked to develop evidence-based good practice and standards.

The service used the CHIME model of recovery, which focuses on five core elements essential for personal recovery, these are Connectedness, Hope, Identity, Meaning, and Empowerment. The CHIME model guides individuals to rebuild lives affected by mental illness, to improve well-being, find purpose, and regain control through supportive relationships, positive self-image, and future-oriented thinking.

Clinical staff told us they had a robust relationship with the Gastroenterology Team at the local acute hospital to treat patients through the MEED pathway. Medical Emergencies in Eating Disorders (MEED) is the definitive national clinical guideline in the UK for identifying and managing high-risk physical and psychiatric complications in patients with eating disorders.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. All patients were temporarily signed up with a local GP upon admission to the service.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, the service employed or had access to occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists, dieticians and peer support workers. Staff were experienced, qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers ensured that staff had access to regular team meetings.

The percentage of staff that received regular supervision was 97%.

Managers identified staff learning needs, providing development opportunities. Two members of the therapy team had been trained to complete ADOS-2 assessment for autism, and 2 members had been trained to complete ADI-R to take developmental history as part of the assessment for autism. This development was made in response to increased awareness and evidence of the link between autism and eating disorders. An autism pathway had been developed by the services counselling psychologist and occupational therapist which detailed the screening and assessment that took place when a patient was at an appropriate weight. In addition to this, 1 member of the therapy team had been trained to complete diagnostic interview for ADHD, in response to increased evidence of neurodivergence in patients presenting with eating disorders.

Staff had access to specialist training to support them in their roles. This included Eye Movement Desensitization and Reprocessing (EMDR) therapy which is a structured psychotherapy that helps people heal from trauma and other distressing life experiences by reprocessing upsetting memories, reducing their emotional impact, and fostering new, positive beliefs.

Since September, Newmarket House had been carrying out a multi-part Dialectical Behaviour Therapy (DBT) skills training presenting therapeutic strategies from the DBT Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness modules. The training covered the same skills that patients had been learning in their weekly DBT skills group, with a focus on how staff members can direct and encourage patients to use the skills themselves as part of developing their ability to manage challenging situations.

Group psychotherapy was delivered to encourage patients to express emotions and develop communication skills within a supportive environment. Group sessions included Cognitive Behavioural Therapy, assertiveness training to improve interpersonal communication, anxiety management using Mindfulness techniques, nutritional rehabilitation to discover the benefits of a healthy diet, Dialectical Behavioural Therapy (DBT) and Acceptance and Commitment Therapy (ACT), which uses acceptance and mindfulness strategies to assist patients in experiencing the emotionally challenging thoughts and urges.

Mental Health Act

The service did not admit patients who were detained under the Mental Health Act.

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 regular and effective multidisciplinary meetings. Staff reported feeling well-supported by both peers and leaders. Staff told us that clinical communication was maintained through consistent use of email and telephone and that the integrated record-keeping systems allowed staff to access real-time patient data, to support joint care.

Staff maintained continuity of care through effective shift-to-shift handovers and held regular multidisciplinary meetings to review individual patient needs and care plans.

The teams had effective working relationships with teams outside the organisation. For example, local authority social services, community mental health teams, GPs and local NHS eating disorder services.

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.

The service supported people to live healthier lives. They offered advice and guidance as part of their treatment. Patients had access to dietitians within the service who supported patients with dietetic assessments, meal support programmes and healthy eating advice.

All groups and therapy sessions were focussed on health and wellbeing, due to the nature of the service.

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.

The occupational therapist completed a sensory assessment with patients, which included the Multidimensional Assessment of Interoceptive Awareness Version 2 (MAIA-2). The MAIA-2 is a self-report questionnaire that measures how aware and connected a person is with their bodily sensations across eight dimensions and My Sensory Experiences Tool (MYSET), a visual card-sort for neurodivergent individuals to discuss sensory needs. This created a sensory care plan with key recommendations, such as emotional regulation strategies, eating and routine support and Interoceptive Awareness & Body Connection.

Staff used technology to support patients effectively. For example, online access to self-help tools and to order a choice of daily meals through the providers app system.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Signed agreements were obtained from all patients before the start of treatment. These forms included consent for treatment and acknowledgment of the service's cancellation and missed appointment policy. Consent for information sharing with GPs, other services, and family members was collected at the point of initial referral, and patients reported that this consent was routinely revisited by staff throughout their treatment.

Patients were involved in their medication planning and consented to their treatment pathways. Patients told us they valued their ability to make independent care choices. Staff frequently monitored ongoing consent for therapy by observing patient attendance and engagement levels over time.

Leaders told us that no formal capacity assessments had been clinically required. Staff we spoke with said any concerns regarding a patient’s decision-making capacity would result in a referral to specialist services for more intensive intervention and assessment.