Leeds and York Partnership 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

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.

We rated effective as good.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 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.

We looked at 12 young people’s care records during the assessment. We found that staff completed a comprehensive mental health assessment of each young person in a timely manner on, or soon after, admission.

Staff assessed physical health needs in a timely manner after admission and on an ongoing basis. Young people’s physical health needs were being met, and records evidenced this.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery oriented, although levels of personalisation varied between the two sites. Care plans reflected the voice of the young person and showed they were clearly involved in developing the plans. We saw good examples where staff used other communication techniques and translated care plans into different languages to ensure young people and carers engaged with and understood the care plans.

Staff updated care plans, when necessary, as a result of changes to risk, developments in the young person’s progress or changes to their personal circumstances. However, there were some incidences where information was recorded in the young person’s risk assessment but not in their care plan. For example, in relation to the removal of a mobile phone at night from one young person, or the use of heat pads for physical health for another.

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 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, psychological therapies, activities and education.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Care records showed that physical health assessments were on-going from admission, with weekly/daily checks on weight, pulse, blood pressure and other aspects of physical healthcare, with the young person’s consent. Health screening tools utilised included NEWS2 and the Malnutrition Universal Screening Tool (MUST).

The service had an eating disorder pathway and there was clear guidance for accepting young people onto this pathway. Dieticians worked with young people and their families to create meal plans where required. A new staff post had been created for a nasogastric feeding specialist who was available to advise and help develop care plans.

The team included or had access to the full range of specialists required to meet the needs of young people in the service. As well as doctors and nurses, the service had occupational therapists, clinical psychologists, pharmacists, speech and language therapists, dieticians and support workers. Psychology teams at both sites had created a psychological strategy, setting out how all members of the ward could work together within the psychological therapy framework to support young people.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the young people. Learning disability and autism awareness training had been completed by 94.75% of staff.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. At Mill Lodge staff had identified the need to think of different ways to engage the young people in multidisciplinary meetings about their care and treatment following acknowledgement that meeting environments could be intimidating for some. They put Quick Response (QR) codes in every young person’s bedroom so they could scan the code at any time to provide the team with information about themselves or to ask a question about their treatment. Additionally, when multidisciplinary meetings took place, they would ensure that two members of staff would go to the young person to speak with them in whatever environment the young person chose and they then reported back to the meeting.

Managers provided staff with supervision and appraisal of their work performance and ensured they had access to regular team meetings. The percentage of staff that had an appraisal in the last 12 months was 92.40%. The percentage of staff that received regular supervision was 90.66%. However, while staff at Mill Lodge told us they were receiving management supervision the minutes of these meetings were not recorded.

Additionally, managers did not ensure that all staff were provided with appropriate induction. We could not find evidence that bank staff on the ward rotas had all received a ward induction prior to working on the ward.

Mental Health Act

More than 85% of staff had received training in the Mental Health Act (MHA). Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had access to administrative support and legal advice on the implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were. The trust had relevant policies and procedures that reflected the most recent guidance. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

There was easy access to information about independent mental health advocacy. Staff usually explained the young person’s rights under the Mental Health Act to them in a way that they could understand, repeated it as required and recorded that they had done it.

Where young people were detained under the Mental Health Act, staff ensured that they were able to take Section 17 leave (permission for young people to leave hospital) when this had been granted. However, two young people at Mill Lodge who were detained had leave prescribed to attend an acute hospital for medical treatment, but the form did not provide details as to how many staff should accompany the young person to hospital.

Staff stored copies of young people’s detention papers and associated records (for example, Section 17 leave forms) correctly so that they were available to all staff that needed access to them.

The service displayed a notice to tell informal young people that they could leave the ward freely.

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. Multidisciplinary team meetings were thorough and involved a range of professionals relevant to the young persons’ care Within these meetings we saw staff from outside agencies attending and staff gave feedback on behalf of those agencies they had spoken to prior to that meeting. Carers attended personally or through virtual meeting applications and we saw they were able to question those professionals about future actions. Staff at Mill Lodge were exploring new ways of working by restructuring the young person’s involvement and offering them a QR code to input feedback or questions outside of the meeting if they wished to do so.

Staff shared information about young people at effective handover meetings within the team, handovers were thorough and were followed by a debrief to discuss incidents and any learning that had been identified from incidents.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation, for example speech and language therapist, and GPs.

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.

Staff made sure young people had access to physical health care, including specialists as required. We saw that young people had accessed dentists and opticians. Staff met young people’s dietary needs and assessed those needing specialist care for nutrition and hydration. Young people told us that any religious or dietary needs were met with options such as halal food and vegan diets supported.

Ward activities helped promote a healthy lifestyle, for example young people could access the gym and take part in other sports activities.

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 severity and outcomes for example, the National Early Warning Score (NEWS)2.

Other professionals such as psychologists, occupational therapists, family therapists and dieticians, used rating scales that were specialised to their area of expertise, such as EDE-Q (Eating Disorder Examination Questionnaire) and The Model of Human Occupation Screening Tool (MOHOST) to assess occupational functional ability. Psychology used the 5 Ps of mental health assessment (which are Presenting problem, Predisposing factors, Precipitating factors, Perpetuating factors, and Protective factors). The service also used MEED (Medical Emergencies in Eating Disorders) for those young people with an eating disorder to monitor their health.

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

Staff took all practical steps to enable young people to make their own decisions. Where there were concerns in relation to a young person’s capacity to make a specific decision, we saw in records reviewed that staff had completed capacity assessments to support them with this. These records showed the young person was involved, as well as their family members where appropriate. Where young people lacked capacity to consent to a specific decision, records showed that assessments were completed to ensure decisions were made in the person’s best interest on a decision-specific basis.

Young people told us they had access to advocates who supported them with decisions where needed and helped them to understand their rights. Records showed they were informed of their rights in a way they could understand.