Essex Partnership University NHS Foundation Trust

On this page

• 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

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 inspection, we rated this key question as requires improvement. At this inspection, the rating remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was consistent.

This service scored 58 (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 maximised the effectiveness of peoples care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them. However, not all information about people carried through all of their care and support plans.

Staff completed a comprehensive assessment of people in a timely manner at, or soon after admission. Staff regularly reviewed and updated this assessment at regular time points during their stay at the service.

We reviewed minutes from multidisciplinary meetings, these evidenced people’s care and treatment being reviewed by the multidisciplinary team, people and their carers with a person-centred approach being taken to meet people’s needs.

Records showed that staff assessed people’s communication skills and needs and provided information in a way that was tailored to those needs. For example, the speech and language therapist had completed an assessment of a person, identifying the need for easy read documents. An easy read version of the care plan had been developed and a copy given to the person.

The service had an easy read assessment tool for people with a learning disability receiving psychological therapy. We saw evidence that this has been used successfully with people to assess for anxiety, depression and self-esteem.

We reviewed a person’s ‘about me’ book, this provided comprehensive, valuable, person-centred information. This included, how to support the persons communication needs, understand their likes, dislikes and triggers, how they present when they are well, how to support them to stay well and what helps them if they become unwell. It also included information on the persons physical health needs and how they should be supported.

There was a sensory assessment, screening tool undertaken for people by speech and language therapists. Staff said they were aware of this, had access to it and found it helpful. The document had detailed information about the persons sensory needs and how to support them. When looking at a person’s records, we observed that in their positive behaviour support plan it stated they had ear defenders, however this information was not within the person’s care plans.

Staff assessed people’s physical health needs in a timely manner after admission, and this was reviewed regularly during their time at the service.

The service planned and delivered peoples care and treatment with them, including what is important and matters to them and in lines 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 National Institute of Health and Care Excellence (NICE) recommends that services supporting autistic people should have access to psychosocial interventions for support with managing the core features of autism and building upon life skills. For example, people should have a group or individualised based social learning programme and/or a group of individual activity programme. Where the person may also communicate distress through behaviour, positive behaviour support plans should be used. People had a positive behaviour support plan; there was a grab sheet and a more detailed plan. Staff met with people and carers regularly to review these plans. Staff we spoke to said they were aware of these plans, had access to them, and found them helpful.

The service provided therapeutic activities and support with life skills, facilitated by occupational therapists, psychologists and speech and language therapists. People told us there was a good choice of activities including painting, drawing and cooking. People had requested to do some cooking on the day of our visit and staff had facilitated this.

Staff assessed and met people’s needs for food and drink.

The service worked effectively across teams and services to support people, making sure they only needed to tell their story once by sharing their assessment needs when they moved between services.

Staff had regular and effective multidisciplinary meetings. There were professionals involved in the assessment and review of people’s health, care and treatment, wellbeing and communication needs. Professionals were engaged in reviews and assessments; However, it was unclear how this translated into care plans which were not comprehensive.

Staff shared information about people at effective handover meetings within the team. Nurses and healthcare assistants shared information at the end of each shift. The multidisciplinary team met regularly to review risks and incidents.

The ward team had effective working relationships with other teams within and external to the organisation. They worked closely with the community team, who visited the ward regularly.

The service did not always support people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff made sure people had access to physical health care, including specialists when required. People could access healthcare appointments that were unplanned, such as accident and emergency, because staff and leaders had devised support plans that worked for people. Plans were created with people, their carers, health professionals and social care professionals. However, these plans were not clearly documented in the persons hospital passport, there was a lack of detail to enable a person looking at it to correctly support the individual. We found a person at high risk of harm when attending hospitals had no information about the specific risks or their support needs for attending a hospital in their hospital passport. We highlighted this to leaders on the first day of our inspection, when we returned a week later for the out of hours visit, this document had been updated with more detailed information.

People had a health action plan, when we looked at this it had also not been fully completed or updated. It contained a handwritten list of medicines, but no information on what the medicines were prescribed for, any health conditions or records of health appointments. This left people at risk of unsafe care and treatment due to a lack of knowledge about their health conditions and how these impacted them. When we returned for our out of hours visit a week later, this document had been completed with the relevant information.

Staff recorded people’s vital signs on National Early Warning Scores (NEWS) charts. NEWS is a tool developed by the Royal College of Physicians, which improves the detection and response to clinical deterioration in adult patients. Charts were completed, where a person had refused physical health checks, this was documented, and we observed staff discussing this at handover.

We looked at an ‘all about me’ folder, this contained detailed information about the person’s physical health needs and how staff should support them.

Staff continuously monitored people’s health, their mental state and wellbeing.

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 discussed at the multidisciplinary meetings.

The Occupational Therapy team used the Model of Creativity (Vona du Toit) to assess people’s level of functional ability and needs. The outcome measure used is the Activity Performance Outcome Measure (APOM) which was used to compare initial level of functional ability with pre- and post-discharge functional ability. This was used to monitor the effectiveness of treatment and as evidence for the support and environment needed for people.

Nursing staff used the Health Equalities Framework (HEF) this was used to measure the effectiveness of the service delivery in terms of reducing exposure of people with a learning disability to known detriments of health inequalities.

In addition to formalised outcome measures, the service sought feedback and suggestions from people, relatives, carers and staff to support the identification of service development. For example, recently people had selected the murals to be displayed in the sensory room and day room to uplift the environment.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff assessed people’s capacity to consent to admission and treatment. Staff assessed people’s capacity for specific decisions throughout their care and treatment. Records included information about people’s capacity and how through their preferred communication, they were able to refuse or give consent for specific decisions. Staff we spoke with told us if people lacked capacity to make a specific decision, staff made decisions in their best interests, recognising the importance of the person’s wishes and involving their carers.

Staff took all practical steps to enable people to make their own decisions. People made their own choices and decisions on a day-to-day basis about what they did, what they ate and how they filled their time.

We observed staff mainly communicating with people about their choices, using simple sentences. People had easy read documents to support with communication but mainly preferred to communicate verbally.

Carers told us staff explained consent, confidentiality and how they share information.