Essex Partnership University NHS Foundation Trust

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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 as requires improvement. At this assessment the rating has remained as requires improvement.

Leaders did not ensure that processes were in place to meet patients’ needs on admission. Patients had been admitted to the ward without an assessment being completed. Therefore, staff could not put risk mitigation in place. There was limited access to a consultant and a clinical psychologist.

However, physical health was assessed on admission. Care plans were mostly individualised and included the physical and mental health needs of the patient. There was an occupational therapy team and an activity co-ordinator available. We saw evidence some patients were involved in volunteering opportunities. There were regular walks to encourage patients to exercise and smoking cessation support was available. Essential information was shared in handover meetings. Staff used recognised rating scales to monitor health outcomes. Patients were read their rights under the Mental Health Act.

This service scored 54 (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 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Managers did not ensure processes were in place to assess patient’s needs on admission. Assessments were completed with most patients in a timely manner, but we found 2 patients had not been assessed on admission to the ward. Staff told us that pressures in the system resulted in some patients being inappropriately placed at 439 Ipswich Road. This was a concern because staff were not aware of current patient risks and appropriate mitigation could not be put in place. We requested urgent action from the trust to ensure that patients were safe and an action plan was put in place. All patient’s had a risk assessment completed and patients that were not appropriate for the service were moved to a more suitable location. Failure to assess needs puts patients at risk of avoidable harm.

Care plans were mostly individualised. In 1 care record there was a reference to a patient’s autism spectrum disorder diagnosis, but this was not reflected in their care plan. It was unclear what plans were in place to support the patient. However, most care plans were recovery orientated and included plans to develops skills such as budgeting, shopping and self-administration of medication. There was evidence of family involvement in most care plans and most care records reflected that patients were aware of advocacy support available.

Most patients told us they had a copy or had seen their care plan. Two patients told us they did not have a copy or did not have a care plan in place. Involving patients in care planning ensures that care is personalised.

Staff assessed patients’ physical health needs on admission. We found that National Early Warning Sign (NEWS 2) was completed regularly, blood tests were completed, and side effects of medication were monitored.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Leaders did not ensure there was adequate access to some members of the multidisciplinary team, to deliver evidence-based care. There was a clinical psychologist that worked at the service 1.5 days per week. Staff told us that 1 day per week was dedicated to patient appointments. We requested evidence of patients engaging with therapeutic interventions with a psychologist. The trust told us that 4 patients were engaging in one-to-one sessions with the psychologist. This was not adequate to support patients in their rehabilitation.

There were 2 consultants available for ward round for 4 hours per week. Patients had face to face appointments with the consultant every other week. However, staff told us there was not enough time with consultants on the ward. There was a process for staff to contact an on-call consultant if needed.

Managers did not ensure patients were engaging in education, employment or volunteering as part of their rehabilitation. We requested evidence of rehabilitation, including work, training and volunteering opportunities. The trust told us the occupational therapy team would assess patients and discuss their goals in relation to employment and education. We did not see any evidence that patients were engaging in these activities as part of their rehabilitation. This means that patients did not have access to opportunities that could increase their independence.

There was an occupational therapy team and an activity co-ordinator, who supported patients to develop skills. There were sessions available, such as information technology skills, sensory support, cooking groups, support with benefits and budgeting assessments to support patients with developing skills and independence.

Mental Health Act

Care records showed that patients were regularly read their section 132 rights. Mental Health Act training compliance for mental health registered staff was 71% and 100% for non- registered staff.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Managers ensured multidisciplinary meetings were taking place but we found there was limited information on purpose of admission, diagnosis and plan that had been put in place, when we reviewed meeting minutes. It was not always clear who had attended multidisciplinary meetings. There were meetings where a nurse had not attended and there was no nurse update. We found safeguarding concerns had been raised, however it was not clear what actions had been taken. For example, an action was for Prevent to be contacted. Prevent is part of the United Kingdom’s counter terror strategy. There were no updates on actions taken within meeting minutes or the safeguarding register. We raised concerns with the trust about this, and they told us appropriate referrals had been completed by a previous placement and there were no new concerns that needed to be raised. Failure to share information effectively within a multidisciplinary team can put patients at risk of avoidable harm.

Patients were individually discussed at handover meetings. We reviewed handover meeting minutes and found that staff had been engaging and supporting patients. For example, we found good descriptions of patient presentation throughout the day and information about appointments, leave and groups attended. We also found that staff had supported patients with completing forms and offering reassurance to patients when needed. This meant staff were aware of and able to support patients with their needs.

We scored the service as 2. The evidence showed some shortfalls. The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Managers did not always ensure patients were supported with living healthier lives. The trust told us that patients were supported to live healthier lives through physical health assessments, risk assessments and falls risk assessments on admission. However, risk assessments and monitoring physical health on admission were not always completed. They are also essential to ensure safety.

Patients were offered support with smoking cessation where appropriate. Long term physical health issues were managed in partnership with specialists. For example, we found that a patient had been supported by a diabetes nurse while on the ward. The trust told us that health and wellbeing was promoted in daily interactions with patients.

There were activities available to support patients to live healthier lives. This included exercise, walking groups, relaxation and cooking groups. There were also sessions such as information technology (IT) available to help develop skills.

Staff supported patients with developing independence. Patients were responsible for preparing their own meals but were supported by staff with shopping, meal preparation, portion sizes and balancing meals. The trust told us there was a dietician available if needed.

Staff at 439 Ipswich Road told us that substance misuse was a problem for some patients.The trust had a dual diagnosis policy in place, to support patients with co-occurring substance misuse and mental health needs.

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 monitored peoples care and treatment. Recognised rating scales were used to assess and monitor outcomes. For example, the Glasgow Anti-psychotic Side-effect Scale (GASS) was used to determine if patients were suffering from excessive side effects of medication. National Early Warning Score 2 (NEWS 2) was also used to assess physical health and detect physical health issues that needed escalation. This meant staff had a consistent approach to monitoring and improving people’s care.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff took steps to support patients to make decisions. Patients were read their rights under the Mental Health Act. Reading patients their rights under the Mental Health Act ensures that patients consent to and understand the care they are receiving. In 1 care record we found a mental capacity assessment was incomplete, however it had been completed in other care records that we reviewed.

We found that staff had supported patients to make their own decisions through tasks, such as shopping and cooking. Staff gave support to patients with these tasks where needed. This encouraged patients to make their own decisions and helped prepare patients for discharge.