Potters Bar Clinic

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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 did not assess this key question. At this assessment the rating is good.

Staff completed regular physical health monitoring of patients. There were regular multi-disciplinary meetings, where patient needs were discussed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward teams had access to a range of specialists required to meet the needs of patients. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

However, risk assessments were not always completed in a timely manner on admission to the service. Risk assessments did not always have a plan in place to meet patients’ specific needs. Therefore, there was not always risk mitigation in place.

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 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Staff did not always ensure that risk was assessed immediately on admission. We reviewed 6 care records and found 3 care records had risk assessments on the day of or soon after admission. Identified risks did not always have a risk management plan in place. For example, where there was an identified risk of impulsive behaviour, there was no management plan in place. This meant that staff were not always aware of and able to mitigate risk to patients. We discussed this with leaders during our inspection and all risk assessments were reviewed.

Staff assessed physical health on admission. In all care records we found evidence of regular physical health monitoring taking place.

We scored the service as 3. The evidence showed a good standard. 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 ensured patients received evidenced based care. There was a psychology team that delivered interventions recommended by National Institute of Health and Care Excellence (NICE). There was a weekly dialectical behavioural therapy (DBT) group session to support patients to stabilise and develop coping strategies. There were art therapy groups and exercise groups available.

Staff told us that patients could be referred for individual therapy sessions. This included sessions such as cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR) and anger management. We found evidence of patients engaging with evidence-based care in patient care plans.

Staff were able to identify needs of patients and develop care accordingly. For example, staff had developed an autism spectrum disorder (ASD) pathway in response to increasing need.

There was an activity timetable in place, which included activities such as psychesoma (an exercise programme for mental health patients), pet therapy, ward cooking arts and crafts and self-care. Some patients told us there could be more activities available.

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 had regular multi-disciplinary meetings. We reviewed the last 3 multi-disciplinary team meetings and found staff had shared information effectively. For example, there were discussions on observation levels, physical health, incidents, staffing, admission and discharges. There were clear actions, with a named staff member and due date. This meant that information about risk was effectively being shared.

We reviewed handover meeting minutes and found essential information about each patient was shared. For example, observation level, changes in presentation, current risks and physical health needs were recorded. This meant that staff were effectively sharing information between shifts.

Staff worked alongside external agencies where appropriate to effectively deliver care. For example, staff liaised with services such as the police and the local authority when needed. Staff also worked alongside community care coordinators to support patients.

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.

Staff supported patients to live healthier lives. For example, in 1 care record we found a patient had been supported with a tooth extraction. This included a plan to support the patient following the procedure, such as a soft food diet and staff education about oral care.

Staff used assessment tools, such as clinical institute of withdrawal from alcohol assessment (CIWA-AR) to assess patients for alcohol withdrawal. This meant that staff were using tools to identify risks and to identify additional needs. Bank and permanent staff had completed training in managing opiate dependence with an overall compliance rate of 96%.

Staff ensured there was an activity timetable in place to promote a healthy lifestyle. For example, there were exercise and ward cooking sessions available to patients. However, some patients told us there were not enough activities available.

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 clinical tools to support patients. For example, Health of the Nation Outcome scales (HoNOS) was used. This is a scale to measure health and social functioning of mental health patients. This meant that staff were monitoring patients’ progress.

Staff used tools to review mental health. The Clinical Outcomes in Routine Evaluation-10 (CORE-10) is a self-report questionnaire used in psychotherapy to measure a person’s psychological distress over the past week. This meant staff were monitoring patients’ mental health and were able to identify any changes in risk.

Most staff had completed training in national early warning sign (NEWS 2), with 91% compliance.

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.

Staff supported patients with making decisions. In all care records that we reviewed, we found evidence of a capacity assessment to consent to treatment. Patients were read their rights under the Mental Health Act. Reading patients their rights under the Mental Health Act ensures that patients consent to and understand the care they are receiving.

There was information available on how to access an Independent Mental Health Advocate (IMHA). Most patients we spoke with knew how to access an advocate and told us that independent mental health advocates regularly came onto the wards.