Ellern Mede Barnet

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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.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 3. The evidence showed a good standard. The service made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 6 care and treatment records. Staff completed comprehensive mental and physical health assessments on admission.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised and holistic, written in the first person, and included patients’ preferences. Staff updated care plans regularly, recording details of personalised support provided including trauma work, and desensitisation work.

Patients told us about being involved in their care planning. Carers we spoke with thought their relatives’ individual needs were met well. Most carers said they were involved in their relative’s care and treatment and received regular detailed updates. In the multidisciplinary ward rounds we observed, staff discussed and addressed patient and carer feedback in detail.

We saw evidence that patients’ physical health was regularly monitored. This included monitoring sleep, daily food and fluid charts, monitoring of nutrition and hydration status, medication reviews and when needed, electrocardiograms (ECG).

We scored the service as 3. The evidence showed a good standard. The service planned and delivered patients’ 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 delivered a range of care and treatment interventions which were recommended by guidance from the National Institute for Health and Care Excellence (NICE). These included medication, dietetics, psychological therapies and family therapy. The care and treatment records demonstrated that treatment was provided in line with current guidance. For example, staff offered cognitive behavioural therapy specific to people with eating disorders, dialectical behaviour therapy, schema therapy and art psychotherapy. The service offered neuropsychological assessments and diagnostic tests, for example to support diagnosing autism, attention deficit hyperactivity disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.

The multidisciplinary team (MDT) included, or had access to, the full range of specialists required to meet the needs of patients. As well as doctors and nurses, these were therapeutic support workers, autism champions, dietitians, psychologists, psychotherapists, social workers, activity coordinators, speech and language therapists, physiotherapists, and pharmacists. The position of occupational therapist was vacant at the time of the inspection, but this was recruited to shortly after the inspection. The MDT worked with the provider’s autism lead to adapt interventions for the needs of autistic people. A sensory room was available on Ash ward, but patients told us that they preferred to use the activities room. The physiotherapist was working with individual patients on desensitisation using virtual reality headsets, and use of a music punch pad to support with managing aggression.

An Eye Movement Desensitisation and Reprocessing (EMDR) therapist visited the service to support patients with trauma needs, including the trauma caused by naso-gastric feeding under restraint.

Staff participated in clinical audit and benchmarking initiatives. The audit schedule was comprehensive and covered care planning, medicines, nasogastric feeding, supplements, dietetics, weight monitoring and outcome measures.

Staff had access to regular team meetings, reflective practice, debriefs, continued professional development and specialist training. For example, the psychology team offered training and upskilling to staff in areas including trauma-informed care, autism, dialectical behaviour therapy, and meal support training. Competency assessments for clinical staff were undertaken and signed off annually.

Staff also had training in Patient Inclusion in Least Restrictive Intervention Management Planning to support patients to be involved in decisions about their restrictions.

During the inspection some patients said there was not always enough post meal support. This was fed back to the provider for action.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support patients. They shared their assessment of patients’ needs when they moved between different services.

Staff we spoke with described working well together within the multidisciplinary team (MDT), including nursing, psychology, dietitians and family therapists. The MDT meetings we observed were well-attended by the professionals taking all disciplines into account. In addition to the core team a yoga teacher and EMDR therapist attended the service regularly.

Staff shared key information about patients at handover meetings. The teams worked well with other teams within the provider group and externally. Key system partners included NHS commissioners, local authorities, GPs and community mental health teams. Stakeholders we spoke with reported good working relationships and effective communication with the service.

Staff supervision rates were high, close to 100%, and staff said that they received the support that they needed. Training compliance was at 99%. There were regular nursing staff meetings as well as multidisciplinary meetings covering topics such as incident reporting, and lessons learned, fire safety, medicines administration, key working, and documentation.

We scored the service as 3. The evidence showed a good standard. The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

There was a range of activities on offer to help promote a healthy lifestyle for patients. These included yoga, mindfulness, walks and cooking activities. Patients could choose to spend time in the garden or go for walks. Art and music therapy were available to promote mental wellbeing.

Dietitians supported patients and staff with dietetic assessments, meal support and healthy eating advice. Fresh food was prepared daily. Healthy eating was promoted both within the hospital and at home. Carers were involved in this process through family therapy sessions and attending multidisciplinary meetings. When patients went on home leave, staff encouraged them to develop and practise good eating habits within the home environment.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored patients’ 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 patients themselves.

We reviewed 6 care and treatment records. These included evidence that staff had used recognised scales and outcome measures such as the Health of the Nation Outcome Scale, Eating Disorder examination questionnaire (EDE-Q), and depression and anxiety scales, as well as weight monitoring.

Psychology staff we spoke with shared examples of other outcome measures used within the service, which were tailored to different age groups. These included self-reporting, the Avoidant/Restrictive Food Intake Disorder screening tool, AQ-10 (autism screening tool) and others. The provider routinely collected and analysed outcome data across the hospital group.

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

Staff followed the provider’s policies on consent to treatment and 98% had completed the mandatory training in Mental Capacity Act 2005.

In the care records we reviewed, there was clear evidence that staff had obtained and documented consent from patients appropriately. Where patients were unable to consent, best interest decisions were made considering the views of relatives/carers if appropriate. Carers we spoke with said staff had explained consent, confidentiality and information sharing clearly.

We saw evidence that staff had assessed capacity on a decision-specific basis and documented the outcome appropriately. At the time of the inspection 10 patients were detained under the Mental Health Act, and 2 were detained under a court order. Mental Health Act audits were conducted every 3 months, whilst Mental Capacity Act audits were carried out 6 monthly.