St Bernard's Hospital

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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 service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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 reviewed 10 patient care and risk management plans.

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

Patients' assessments considered mental health risk history, physical health risks, and dysphagia. A range of assessment tools were used, including the Malnutrition Universal Screening Tool (MUST), Waterlow pressure ulcer risk assessment, body mapping, continence assessments, venous thromboembolism (VTE) assessments, moving and handling assessments, swallowing assessments, and multifactorial falls risk assessments. As part of the admission process, staff assessed patients for any issues with dentition, vision, and hearing to identify additional needs and support effective care planning.

Care plans were personalised, holistic and recovery orientated. They reflected the assessed needs of the patient. Staff regularly reviewed and updated care plans when patients' needs changed. Care plans mostly reflected patient views and involvement about their care and treatment.

Patients’ physical health needs were routinely identified, assessed, and clearly documented within their care plans.

Staff assessed and met patients’ nutritional and hydration needs, ensuring they had access to sufficient food and drink to support their well-being.

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 older adults 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 medication and psychological therapies and activities intended to help patients retain or improve living skills.

Staff ensured that patients had timely access to physical healthcare services, including specialist support when required. Throughout their admission, staff supported and facilitated access to appropriate physical healthcare, including referrals to specialist services where necessary, for example cardiologists and neurologists. Staff maintained positive and effective working relationships with professionals from local acute hospitals and psychiatric liaison teams promoting coordinated and holistic care for patients. We observed physiotherapists supporting patients with mobility needs at The Limes.

Where required, staff used food and fluid charts for those patients who were vulnerable to poor nutrition to effectively monitor nutritional intake and hydration levels. Individual weight monitoring was carried out. Staff had access to thickener to aid swallowing, and dietary supplements as prescribed by the dietician. We observed on all 3 wards that staff offered regular drinks and ice lollies to patients due to excessive heat temperatures. Patients received timely access to specialist support, including dietetic and speech and language therapy services, when additional assessment or intervention was needed to support nutrition, hydration, or swallowing difficulties. Staff worked collaboratively with multidisciplinary professionals to provide safe, person-centred care and promote positive health outcomes.

Ward activities promoted healthy lifestyles for patients in line with their individual needs and preferences. Patients had access to garden facilities on each ward. Staff supported both group and one-to-one activities that generally reflected patients' interests. For example, we observed patients participating in skittles and board games at The Limes, while on Meridian Ward 4 patients were engaged in an art group. At The Limes the occupational therapist ran a weekly Cognitive Stimulation Therapy (CST) Group. This was an evidence-based intervention to support patients with dementia to maintain and enhance their cognitive skills and engagement.​

On Jubilee ward we observed limited activities taking place. The activity coordinator attempted to facilitate the community meeting but was unable to continue due to the acuity levels of patients on the ward.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. Managers ensured staff carried out a range of audits to check that staff followed best practice guidance. These included audits of care plans, physical health, risk assessments, falls prevention, therapeutic observations and infection prevention and control. Managers reviewed the performance of the wards at monthly ward clinical improvement group meetings. Audit results were used to identify where improvements were needed.

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 and nurses, there were occupational therapists (OT), clinical psychologists, social workers, discharge co-ordinators, pharmacists, physiotherapists, speech and language therapists, dieticians, administrators and activity co-ordinators. Staff regularly met as a team. The care records we reviewed evidenced consistent input from the OT and psychology teams, reflecting the scope of therapeutic interventions offered. The clinical director for Jubilee ward and The Limes was an experienced Old Age Consultant Psychiatrist.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Staff had undertaken specialist training in caring for older adults and specialist training in dementia care and working with behaviour that challenges.

Each ward had registered general nurse on the staff team to provide support with patient’s physical health needs. The care records we reviewed evidenced input from the OT and psychology teams.

Managers provided all new staff with a structured and comprehensive induction programme, ensuring they were supported to understand both the Trust and ward-specific procedures and expectations. Staff reported that their induction was thorough and enabled them to develop the knowledge and skills required to undertake their roles effectively. The service supported student nurse placements and newly qualified nurses were supported through a comprehensive preceptorship programme.

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 held regular and effective multidisciplinary meetings. Staff attended monthly team meetings where they discussed topics such as incidents, safeguarding, lessons learnt and training. Meeting minutes for each ward were reviewed.

The percentage of staff that had had an appraisal in the last 12 months was above 90%.

The percentage of staff that received regular supervision was above 92%.

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.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

A Mental Health Act (MHA) monitoring visit was carried out at the same time as this assessment. A separate visit report has been issued to the service.

Over 92% of staff had received training in the Mental Health Act.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

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.

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. On all 3 wards information about the independent mental health advocacy service was clearly displayed on the noticeboards and included in the welcome pack that all patients received on admission. Patients who lacked capacity were automatically referred to the service. The advocates supported patients with tribunal hearings, ward rounds, care programme approach (CPA) meetings, community meetings and complaints.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Patient records we looked at showed staff were discussing patient rights with them on a regular basis.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. All section 17 leave was risk assessed beforehand by the multidisciplinary team.

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 so that 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. Informal patients were regularly reminded about their informal status and rights.

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 to discuss patients and improve their care. All members of the multidisciplinary team and staff worked together to understand and meet the range and complexity of patient’s needs. Patients were invited in to discuss their care and treatment and where patients had given consent family members could also attend the meeting either in person or virtually. Staff said the multidisciplinary team worked very well together and valued each other’s input.

Staff made sure they shared clear information about patients and any changes in their care, including during handover meetings. Each shift held a handover where incidents, patient care and risk were discussed.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation, such as care co-ordinators and community mental health teams.

Staff teams on each ward confirmed they had effective working relationships with teams outside the organisation. For example, acute hospitals, housing departments, local authority social services, safeguarding teams and GPs. Care records evidenced regular contact with these teams.

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, reduced their future needs for care and support.

Staff supported patients to live healthier lives. For example, through participation in smoking cessation schemes, giving healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. The service provided relevant information promoting healthy lifestyles and support. The occupational therapists worked with patients who were close to discharge to carry out functional home assessments, to ensure they had the correct mobility aids to prevent falls at home. They also completed activities of daily living skills assessments, such as washing and dressing and preparing drinks.

Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition. Staff used the malnutrition universal screening tool (MUST) to monitor patients at risk of malnutrition and obesity.

Specialist support from staff such as dietitians and speech and language therapists were available for patients who needed it. Staff supported patients to eat and drink well and were knowledgeable about guidance promoting good nutrition and hydration in later life, for example we observed some patients having a soft or pureed diet. Hot and cold drinks were offered throughout the day.

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.

At daily handover meetings, staff noted details of people’s sleep, food and fluid intake, personal hygiene, compliance with medication and engagement in activities. Any changes in a person’s presentation were recorded and discussed at the multidisciplinary meetings.

Staff used recognised rating scales to assess and record severity and outcomes, The service used the DIALOG+ outcome measure to support person-centred care planning. Staff used other evidence-based tools to monitor people’s mental and physical health, risk, and other aspects of their care as required. The psychology and occupational therapy teams used various rating scales with patients to monitor their mental health and progress over time.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. One carer told us that when their family member initially refused to consent to personal care, staff respected their decision. Staff subsequently approached the patient at a later time, and the patient then provided consent to the care. This demonstrated that staff respected patients' choices and sought consent before providing care.

Staff took all practical steps to enable patients to make their own decisions as much as possible. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. We saw that this was clearly recorded in all 10 records we viewed. 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, traditions and history. Staff assessed and recorded capacity to consent clearly each time a patient needed to make a decision. We saw capacity assessments that were time and decision specific for the patient based on their care and treatment. For one person, we saw that a best interest meeting had been undertaken where a patient required medicines covertly and involved the person's family and advocate.

Managers monitored through regular audits how well the service followed the Mental Capacity Act and made changes to practice when necessary.