Archived: Schoen Clinic Chelsea

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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

At our last assessment we rated effective as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the needs of all patients on acceptance to the clinic. They developed individual treatment plans which were reviewed regularly and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. Staff from different disciplines worked together as a team to benefit patients.

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 people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients confirmed they were involved in their assessment and treatment plans.

We reviewed 6 patient care and treatment records.

Staff completed comprehensive initial assessments of patients soon after their referral to the service.

Patients were required to complete a registration form and comprehensive screening questionnaire prior to any assessments being undertaken. This was to establish their care and support needs. If patients were not assessed as being able to benefit from the service, they were signposted to other services that could potentially better meet their needs.

Patients were offered various treatment options following assessment. These included medicines, psychological therapies, occupational therapy, group therapy, family or nutritional support.

Staff assessed patients’ physical health needs where appropriate, for example eating disorder patients had blood pressure, pulse, oxygen levels, height and weight observations taken at each appointment. This helped inform treatment plans for the patient.

Staff developed treatment plans that met the needs identified during assessment. Patients and carers confirmed that treatment plans were personalised, holistic and recovery oriented.

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 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. These included medicines, a range of psychological therapies, dietitian support, group therapy, family therapy and art and creative therapy and MANTRA (Maudsley Anorexia Nervosa Treatment for Adults). Any updates with guidance and research were communicated to all clinical staff through monthly bulletins and team meetings.

Staff completed screening tools to assess whether patients had attention deficit hyperactivity disorder (ADHD) or were on the autistic spectrum disorder (ASD).

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Patients were referred to their GPs for routine physical health checks. For patients with an eating disorder treatment detailed that regular weight monitoring, BMI (body mass index), height, pulse, the sit up, squat and stand up (SUSS) test of muscle were carried out.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. The nutritionist worked with patients, carers and young people to design tailored eating plans following assessment to help individuals achieve goals such as weight management, managing medical conditions such as diabetes or eating disorders. For example, a patient treatment plan detailed nutrition advice provided to the school of a young person.

Staff participated in clinical audit. These included audits relating to health and safety audits, prescribing stationery, care and treatment records, incidents, emergency equipment, staff training and infection control. Managers used results from audits to make improvements, by implementing and monitoring action plans.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. This included consultant psychiatrists, dietician, occupational therapist, clinical psychologists, psychotherapists, speech and language therapist, family therapist and art psychotherapist.

Staff made referrals to external specialists where required. For example, a young person had been referred to inpatient Child and Adolescent Mental Health Services (CAMHS) NHS services where their needs could be met.

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

Managers gave each new member of staff a full induction to the service before they started work. Recently appointed staff told us they had been well supported and received a comprehensive induction when they joined the service.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. Staff we spoke with confirmed they had access to regular clinical and managerial supervision. Supervision completion rates were 100% at the time of our inspection.

Managers ensured that staff had access to regular team meetings. All staff were emailed a copy of the minutes.

The mandatory training was comprehensive and met the needs of patients and staff. Staff we spoke with said they felt confident carrying out their role and applied training to their practice. They were fully supported to carry out any additional required training for their continuous professional development. For example, following an appraisal, a consultant psychiatrist was given the opportunity to attend a British Association of Psychopharmacology update session to refresh and enhance their skills in managing anxiety disorders. The clinic director monitored mandatory training and alerted staff when they needed to update their training.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge, for example a clinical psychologist confirmed they were being supported with their eye movement desensitisation and reprocessing (EMDR), training. All administration staff were offered Samaritans training so that they were equipped to take patient telephone calls that were distressing or challenging. The training enabled them to support patients in a safe and compassionate way. The service held regular continuous professional development sessions for the staff team. For example, staff had attended a training session clinical application of Dialectical Behaviour Therapy (DBT).

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.

The service worked well together to support people. Staff told us there were good working relationships between all staff within the service. Patients told us the staff working with them worked well together, and all staff were kept up to date between their sessions.

Staff held regular and effective multidisciplinary meetings (MDT) to share information about patients. These included daily morning meetings for patients attending the clinic and weekly MDT meetings for adults and children and young people.

The teams had effective working relationships with teams outside the organisation, for example, local authority safeguarding teams, independent hospitals, NHS accident and emergency departments and GPs. A patient told us the service had been proactive in communicating with the emergency department so that they had the right information before they attended at the request of the consultant psychiatrist. The patient told us the service was efficient and responsive to their needs.

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 patients to live healthier lives. They offered advice and guidance as part of their treatment, for example through healthy eating advice, relapse prevention, keeping safe and harm minimisation.

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 the severity of patients’ conditions and care and treatment outcomes. Outcome measures in use included the Patient Health Questionnaire-9 (PHQ-9) which measures depression, Generalised Anxiety Disorder Questionnaire (GAD-7), the Eating Disorder Examination Questionnaire (EDE-Q) and the Depression Anxiety Stress Scale (DASS). These were undertaken at the beginning, during and end of the treatment sessions to monitor how effective treatment had been in helping the patient recover.

Staff used technology to support patients effectively, for example patients could use a quick response code (QR) to give feedback on the service and virtual appointments. Staff used social media platforms for raising awareness about mental health issues. The clinical psychologist and medical director had produced podcasts on mental health conditions and the work of the Schoen Clinic.

Clinicians used transcription tools to document consultations, which improved efficiency and accuracy and reduced the time needed to complete records. All patients gave consent before each consultation for transcription to be used.

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.

Patients were asked for consent to share information and consent to treatment during registration, screening, and assessment. Records confirmed that staff documented which other organisations patients agreed to share information with regarding their care and treatment. The registration form clearly outlined terms and conditions for treatment and cancellation.

For patients under the age of 16, staff applied Gillick competence principles to assess whether the young person had sufficient maturity and understanding to make informed decisions about their care and treatment. Where a young person was deemed Gillick competent, they could consent to treatment without parental involvement. Where these principals were applied the treating consultant psychiatrist recorded this in the patient record.

Patients told us that they were involved aspects of decision making in relation to their individual care and treatment. Patient records detailed discussions about medicines, possible side effects and sharing of information with individual GPs.