NAViGO Health and Social Care CIC

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding. Staff managed admissions and bed availability extremely well. The service maintained it’s vision to prevent the people in the local community requiring out of area placements. Patients were only moved between wards for their own benefit and in line with collaborative discharge plans. Patients did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity and carers were extremely positive about the facilities. Staff supported patients with activities outside of the ward, often going to Tee’s House to utilise the wide range of facilities within the activity floor, including cinema, beauty parlor, gym and large communal space for events. The service met the needs of all patients – including those with protected characteristics. Staff helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result. The service practiced openness, honesty and transparency.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Care record reviews of initial assessments obtained important personal preferences, life histories and detailed what was important to the person. Where patients could not make decisions about their own care due to the nature of their illness, or lack of capacity to do so, staff involved carers where possible and made efforts to ensure care would be in line with their preferences and detailed this in care plans. Staff were knowledgeable about patients’ history, and this made engagement very meaningful and person-centred.

The wards used a range of recognised assessment tools to ensure care was specific to the individual and met their needs on a holistic level. All care records reviewed were individualised, referenced personal preferences and involved carers where possible. Patients always had access to nursing staff who knew them well, as shifts were only covered by older persons nurses and support workers.

Carers told us that the services were ‘the best place for his needs’, there were ‘suitable activities such as pool, dominos, outings to supermarkets’ and that the ‘Pub’ (which had refreshments and non-alcoholic drinks available) is a good space for visiting’. All carers we spoke with told us that ‘care and treatment suits individual needs.’

We scored the service as 4. The evidence showed an exceptional standard. The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service was absolutely centred on ensuring families and patients could remain connected within their local community. Staff told us how the Janine Smith Suite had been developed and given its purpose from a patient’s carer petitioning and campaigning to keep their loved one from being placed out of area due to need. The service listened to the needs of their local community and developed the unit to support more complex needs, providing beds and ensuring care and treatment was joined up and provided continuity within their community. The service ensured joined up working with the community teams to help facilitate safe and effective discharges, integrating people back into the community where possible.

The service ensured that patients had access to places of worship within the wards or local community if indicated. The service supported patients in a holistic manner that met all religious, faith and cultural needs.

Feedback from commissioner visits noted that care plans for people demonstrated a multi-professional approach and that the units were cognisant of cultural issues for people and act accordingly to adapt procedures, foods etc to accommodate requirements. This information was communicated through social workers and 'next placement provider' at assessment visits.

Commissioners shared a compliment regarding the units – "'The words thank you really are not enough; they cover gratitude, they do not cover the impact that your team have had on myself and my issues. You all are amazing, thank you. (Older People’s Acute)"

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Navigo developed their own monthly magazine which included a vast amount of information, including the results of recent surverys, what the service is planning innovation wise, events that have happened that month, upcoming events, services available within the local area, learning and job opportunities as well as promoting successes of staff, patients and carers.

The service made notifications to external bodies as needed and in a timely and responsive manner. The wards provided information to external agencies where appropriate in order to keep care teams involved in patient care and share risk. We received positive feedback from commissioners who told us “Navigo demonstrate an open, positive, proactive and transparent approach to working with the ICB, inviting us to internal meetings. Navigo demonstrate a positive and proactive approach to working with system partners, they are an active member in the ICB-wide all-age mental health collaborative and actively collaborate with system partners”. Staff ensured carers, families and commissioners were regularly updated about the patient’s progress.

Information governance systems included confidentiality of patient records and staff training in this area was at 95% across the three wards. The service complied with the Accessible Information Standard and staff ensured that patients and carers could obtain information on treatments, local services, patients’ rights, how to complain and so on.

We scored the service as 3. The evidence showed a good standard. The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result.

The service’s Patient Experience Teamworkedwith teamson a daily basisto resolve complaintsand concernsreceived about the service areas.The teamoperatedby the name of PALs (patient advice and liaison), arecognisedterm for the public, butprovideda broader function that included formal complaints and feedback management.

We reviewed a total number of 16 complaints in last 12 months from across the older person’s service. All complaints were thoroughly reviewed by management and outcomes to these complaints were outlined with responses to the complainant. We reviewed 3 speaking up complaints, which were fully investigated and included responses such as mock inspections and staff engagement sessions.

No themes were identified through the complaints reviewed and appropriate actions were taken by the service to address and resolve these. It was evident that staff, carers and patients knew how to raise concerns, felt that these were addressed and felt listened to when speaking up. Staff and carers told us they felt they could raise concerns or complaints without fear of retribution.

There was extensive oversight of the complaints process, the patient experience teamprovideupdates to the Quality Learning Networkon a monthly basis, to provide oversight for the leaders of the service.

Information was reported on a quarterly basis through quarterly Patient Experience Reporting, which is presented at both the Quality and Clinical Governance Committee and Membership Board.The information provided in the reportcombines information from complaints,complimentsand feedback, whichgivean essence of the experience people received in the service, but also provided assurances of performanceagainst policy.

We scored the service as 3. The evidence showed a good standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it. The service and staff ensured the needs of patients with mobility issues were met, including wheelchair users being allocated bedrooms that were larger and more accessible. All units had access for people with mobility issues and access to specialist equipment to enable care needs were met.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and two of the wards were located on the same site as the acute hospital and within a short travelling distance to the local acute hospital.

Staff ensured patients had access to post-discharge care, for example, S117 aftercare (the legal duty for UK health and social services to provide free, tailored support for people discharged from hospital after being detained under specific sections), community mental health services and crisis services. Staff planned for patients’ discharges, including good liaison with care managers/co-ordinators and listening to both patient and carers wishes.

Thelong stayunits at Navigo Older People’s inpatient facilities (Jane Lewington Suite and Janine Smith Suite) provided a safe environment, staffing and skill mix which enabled staff to provideexpertcare to individuals withhighly complexneeds. This was reflected in the discharge reports for the wards, in both the number and nature of the discharges. Konar suite, as an acute unitprovided treatment for individuals who were, at the point of admission, experiencing an acute episode of mental illness which may respond to treatment. This is reflected in thedischarge data for this ward, with both higher overall discharge numbers, anda significant proportionof patients who were discharged to theirpreviousplace of residence (family home).Data showed on average, approximately 38% of service users were discharged back to their home.

Feedback from commissioners stated that the only barrier to access was that when the units are full, usually due to 'bottle neck', discharge to community placements caused delays in arranging the next placement.

We scored the service as 4. The evidence showed an excellent standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage and staff training in equality, diversity, inclusion and human rights across the service was 97%.

In the NHS People Promise Themes survey, Navigo staff ranked the provider at number 1, compared to 50 other Mental Health and Learning Disability providers.

Regular carers meetings were held to gain views and feedback around experiences and outcomes, and the senior leadership team used this feedback to discuss, action and embed strategies to produce better outcomes for patients. Carers’ feedback showed that they felt involved, listened to and supported. Quality networks within the service used information to inform policies and procedures. The wards was also involved with Culture of Care which is aboutembedding compassion, safety, and respect at the heart of all healthcare, ensuring both patients and staff feel cared for, by focusing on principles like the6 Cs(Care, Compassion, Competence, Communication, Courage, Commitment) and using tools to foster environments where everyone feels valued, involved in decisions, and supported to provide excellent care. It's a strategic initiative, especially strong in mental health, to shift from isolated decisions to collaborative, patient-centred practices that improve experiences and outcomes.

We scored the service as 4. The evidence showed an exceptional standard. People were given great support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life. Staff supported patients and carers to make decisions about their care and treatment and their future – for example DNACPRs. Care records also evidenced people’s wishes where advanced decisions were in place.

Training had been rolled out across the olderpeople’sinpatient unitsinend of lifecare. This began in partnership with the local hospices who provided training and support to staff, with nurses and support workers now trained torecogniseend of life, provide support to carers andfamiliesand provide after death care including last offices. For qualifiednurses, training also included the provision of analgesia via syringe drivers. This training equipped staff to provide comprehensive holistic care to patients in their last days, supported in familiar environments by staff they know and trust. The work wassubmittedfor a Nursing Times Award.Staff create personalised care plans to account for the patient’s needs, wishes and feelings and heavily involved carers.

One carer told us that their relative received excellent end of life care, was well cared for and the ward purchased specific furniture to ensure they were comfortable.

Care for people who are nearing the end of their life was managed and communicated in a sensitive and dignified way and the wards had the facilities for carers to stay overnight with patients who were at end of life. Staff ensured all relevant healthcare professionals and other relevant bodies are involved in planning the care and treatment of people with complex needs.