Transforming Mind Solutions

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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

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

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 did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People felt involved in any assessment of their needs and felt confident staff understood their individual and cultural needs. Clinical staff undertook initial assessments to gather information about patients’ current presentation, their past medical history and family history. Staff developed care and treatment plans that were personalised and met the needs of the individual identified during the initial assessment. We observed good practice in relation to TMS treatment; however, staff did not ensure they had accurate information before prescribing oral ketamine solution. Although they discussed medical history with patients to gather this information, we could not be assured treatment was effective as the assessment did not always involve the relevant external agencies.

Staff involved patients in the completion of their assessments and treatment plans, and this was documented in care records. Clinical staff signposted people accordingly if the assessment determined treatment would be most appropriate elsewhere.

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.

The service offered a range of care and treatment interventions suitable for the patient group. The provider ensured the interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). We saw comprehensive and evidence-based treatment plans for TMS. Risk assessments were in place when deciding the most appropriate treatment.

One of the medicines that this service offers is unlicensed. Treating patients with unlicensed medicines is higher risk than treating patients with licensed medicines, because unlicensed medicines may not have been assessed for safety, quality and efficacy. Leaders told us unlicensed medicines would only be considered if there was an unmet clinical need for the patient, such as treatment resistant depression.

The provider had defined the exclusion criteria applied during the assessment of new referrals. Leaders told us this was reflective of current evidence-based good practice.

We saw evidence the provider engaged with professional forums to participate in research relating to this type of treatment. This included attendance at the Royal College of Psychiatrists International Congress and ongoing engagement with research-led organisations.

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.

We observed the team working closely together. We saw evidence of regular multidisciplinary team discussions relating to patient care and saw this occurred informally frequently throughout our onsite assessment. Team meetings were less regular. Staff told us they attended daily huddles, but these meetings were not recorded.

Staff shared information about patients, where appropriate, to ensure continuity of care. The service had effective working relationships with teams outside the organisation. Clinical staff mostly communicated well with patients’ GPs and other healthcare professionals consistently prior to and during treatment.

Patients’ records were electronic and could be accessed by all staff.

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.

Where appropriate, staff provided patients with advice to support self-care. Risk factors were identified and discussed with patients and, where necessary, shared with their usual care provider to support ongoing care. For example, staff gave advice on smoking cessation.

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.

Leaders told us people consistently reported positive outcomes, and we received positive feedback from all patients and carers we spoke with. We saw nationally recognised tools were used in individual care records to assess and record outcomes, including patient health questionnaire-9 (PHQ-9,) general anxiety disorder-7 (GAD-7,) and hospital anxiety and depression scale (HADS.) Outcomes were monitored during treatment and subsequent months following treatment.

Although we saw evidence of outcome monitoring in individual records, the provider did not provide evidence of any dashboards to demonstrate outcomes across the patient group. Leaders told us they were in the process of developing a system called the Global Neuromodulation Outcomes Registry (GNOR) to evaluate response rates, remission rates and treatment pathways. They told us this would be operational shortly following our assessment.

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff did not always understand and apply legislation relating to consent. The provider offered treatment for children aged between 14 and 16 years old. We were not assured there was a process to ensure young people had consented to their own treatment. Gillick competence is a UK legal principle determining whether children aged under 16 can consent to medical treatment without parental permission. We did not see evidence this was considered when either assessing or treating those aged under 16. Leaders told us Gillick competence principles were considered when completing the initial assessment and determining suitable treatment options, however they failed to provide evidence of this documented in care records. We were therefore not assured the provider had considered Gillick competence when ascertaining those aged under 16 had sufficient understanding of treatment risks. This was raised with the provider during this assessment; they informed us a standard template would be added to clinical records for all patients aged under 16 moving forward.

Staff did not always document consent around the use of unlicensed medicines. We did not see evidence that patients were informed of the risks associated with the use of unlicensed medicines and that staff had recorded their reasons for prescribing an unlicensed medicine. General medical council (GMC) guidance states, “You must give patients, or their parents or carers, sufficient information about the medicines you propose to prescribe, to allow them to make an informed decision.” Leaders told us consent had only been obtained verbally, and this was not documented in clinical records. Therefore, we were not assured all risks associated with the prescribing of unlicensed medicines were discussed with the patients to allow them to make an informed decision. Leaders provided us with written documentation following our assessment to demonstrate consent forms had been amended to include a statement about the risks associated with the use of unlicensed medicines.

Despite the above concerns, we did observe good practice in relation to TMS treatment in adults. We saw in care records patients were given their options for treatment and informed consent was taken in writing.