Fir Trees Independent Hospital

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

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.

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 looked at 5 care records during the inspection.

Staff completed a comprehensive mental health assessment of each patient in a timely manner at, or soon after, admission.

Prior to admission, the service requested a full assessment of each patient’s needs to ensure the appropriate clinical history was provided, as well as any risk assessments, medical reports, social circumstances reports and other important information to ensure the referral was suitable to progress at Fir Trees. If the service had not received all the information requested, then they would not admit the patient until all of the information was provided by the referring Integrated Care Board (ICB).

On the records we looked at, we saw a detailed mental health and rehabilitation assessment and associated care plans. They had a comprehensive risk assessment completed just prior to admission and these were updated throughout their stay. Patients were involved in their risk assessments and care plans.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. All patients were registered with the local GP.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery oriented. They developed these with the patients. The care plans showed clear evidence of person-centred care. Staff updated care plans when necessary. Physical health care plans were also produced and updated where necessary.

The hospital had a learning disability qualified nurse who was the named nurse for any patient who had a learning disability. Communication and accessibility needs were assessed for each patient, and a range of assessment tools were used.

Risk assessments were updated whenever circumstances changed. The assessments we looked at were comprehensive and gave a clear picture of how risks were being managed and reviewed.

Records showed that patients had their care regularly reviewed at multi-disciplinary ward round meetings led by their consultant psychiatrist and with relevant staff in attendance. Parents and carers were invited to attend for part of their meeting if they wanted and if the individual patient agreed.

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 and discharged these well.

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). This included medication, access to psychological therapies and ward activities, and work opportunities intended to help patients acquire living skills.

Staff identified patients’ physical health needs and recorded them in their care plans. Nurses were using standardised tools to carry out an assessment of the patient to understand their physical health needs. This included the effects and side effects of medication for mental disorder using recognised tools such as the LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale) and NEWS2 (National Early Warning Score 2) tools.

A patient recovery tool was used to track progress throughout their stay, and a three-monthly report was provided with data from all the 6 hospitals in the group. These showed slight improvement across several domains, particularly mental health, identity and self‑esteem, trust, and hope.

Staff made sure patients had access to physical health care, including access to specialists as required. All patients were registered with a GP. Patients were encouraged to visit and speak to the GP about any physical health concerns. The GP carried out annual physical health checks.

Staff assessed and met patient needs for food and drink and for specialist nutrition and hydration when needed.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

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, nurses and occupational therapists, they arranged access to clinical psychologists where needed, as well as social workers, pharmacists, speech and language therapists and dieticians.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction using the care certificate standards as the benchmark for healthcare assistants.

Managers provided staff with supervision meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development, as well as appraisal of their work performance.

Managers ensured that staff had access to regular team meetings.

The percentage of staff that had had an appraisal in the 12 months prior to inspection was 95%. The percentage of staff that received regular supervision was also 95%.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers ensured that staff received the necessary specialist training for their roles. An example of this was training staff in the safe use of Naloxone. Naloxone is a life-saving medication that rapidly reverses the effects of an opioid overdose. Staff also had access to a level 3 certificate in recognising and responding to substance misuse (a nationally recognised qualification) and dialectical behaviour therapy (DBT) skills training, which is a type of talking therapy. Staff also received training on meeting the needs of people with a learning disability and autistic people, which is a national requirement.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

Most staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Training records showed that 83% of the staff had received training in the Mental Health Act.

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.

The provider had relevant policies and procedures that reflected the most recent guidance. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy.

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

Staff ensured that patients were able to take Section 17 leave, permission for patients to leave hospital, where this had been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

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

The service displayed a notice to tell informal patients that they could leave the ward freely.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

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 shared information about patients at effective handover meetings within the team, including at shift changes.

The teams had effective working relationships, including good handovers, with other relevant teams within and outside the organisation; this included care co-ordinators, community mental health teams and the crisis teams.

The teams had effective working relationships with teams outside the organisation including local authority social services, commissioners, GPs and housing services. There were external commissioners’ meetings and visits to the service to ensure plans were in place before patients were discharged.

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.

Staff supported patients to live healthier lives, such as through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse.

People's physical health needs were assessed and documented within care plans and care records.

The unit activities helped promote a healthy lifestyle for patients – for example, walking groups, sports activities and cooking healthy meals. An exercise bike was also available. Patients told us they had many visits into the community, and this included access to a fishing group, walking, and shopping for a cooking group to encourage healthy eating.

A staff member organised a social inclusion football team. This involved local community services for people with enduring mental illness helping them to get back into community activities. There was a team of patients and ex-service users that went weekly to train and get involved in tournaments and fund raisers from all over the northwest. This provided male and female patients with the opportunity to improve the lives of others and promoted wellbeing through engagement and encouragement.

All patients were registered with a local GP in the community and if a patient was prescribed Clozapine, then blood monitoring would be arranged with community teams. Health and care needs were addressed individually, and screening programmes had been discussed with the GPs so that patients had access to these.

Nurses completed physical observations of patients at Fir Trees, and a local dentist was available for patients. The occupational therapist completed functional assessments. These included activities of daily living including assessments using transport, managing finances and other assessments.

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.

The care records we reviewed contained evidence of ongoing physical health monitoring.

A patients’ recovery tool was used to track patient progress throughout their stay. A quarterly report was produced to show variances in scoring from the previous quarter. The report identified where improvements were needed, including physical health to strengthen focus on healthy eating, education, access to exercise, and meaningful physical activity. This was shared with managers and staff to enable them to focus on improvements.

Staff used technology to support patients effectively, such as online access to self-help tools.

The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Staff took all practical steps to enable patients to make their own decisions. We saw staff encouraging patients to make their own decisions.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Records we reviewed confirmed this. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

Patients signed documents to consent to their care and treatment. Assessment of capacity under the Mental Health Act (MHA) of the patient’s capacity to consent to medication was clearly documented and patient rights under the MHA were audited and recorded.