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.

At our last inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes.

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.

Quality Statement Score: 1

The service did not maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We found that staff did not always assess patient’s physical health on, or soon after, admission. Staff used the National Early Warning Score (NEWS2) which is the standard NHS tool for detecting patient deterioration and identifying acute illness. The form stipulated that patients should have a full set of observations carried out at baseline on admission. The trust provided physical health assessment dates for all patients which confirmed that out of 124 patients, 18 patients had not received a physical health assessment within 14 days of admission, and a further 5 had not received a physical health assessment within 7 days of admission. This was most prevalent on Ward 1, the psychiatric intensive care unit at the Newsam Centre, with 8 out of 12 patients receiving a physical health assessment more than 14 days after admission. In some cases, a physical health assessment had not taken place for over a month. We were concerned that staff would be unable to arrange referrals to external services for physical health needs in a timely manner or to monitor or escalate physical health needs from the point of admission, which could potentially lead to deterioration in health status.

Care plans were up to date, holistic and recovery orientated but were not always personalised. 10 out of 16 care plans were generic in content and lacked evidence of patient involvement. Feedback from patients about involvement in their care and treatment plans was mixed, with some patients telling us they were not involved in care planning and had not been offered copies of their care plan.

Managers had taken steps to try and improve the quality and content of care plans, including a monthly audit of 50% of care plans, but improvements had not yet been fully embedded. Managers continued to share feedback from audits with staff the teams, highlighting actions and improvements and discussed care plans with staff during individual supervision. They also confirmed they had put plans in place to support staff with the care planning process.

Staff completed a comprehensive mental health assessment of each patient in a timely manner on or soon after admission. Staff obtained consent from patients to involve their families and, if given, they sent out a carer pack to them.

Speech and language therapists helped people who required extra support with communication needs.

Quality Statement Score: 3

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them and in line with legislation and current evidence-based good practice and standards.

Patients received care, treatment and support that was evidence-based and in line with good practice standards. Patients received occupational therapy, psychology, speech and language and dietetics support where appropriate.

Patients said they could seek support and advice about their care and treatment from staff. Staff supported patients to have access to an independent mental health advocate.

Pharmacists were available to help with medicines queries, and they reviewed patient prescription charts to oversee that medicines were being prescribed and administered safely. A member of the pharmacy team attended multidisciplinary team meetings where appropriate.

Staff were received training, and were able to demonstrate their knowledge of the Mental Health Act and Mental Capacity Act when they spoke with us. The trust had policies and procedures relating to the Acts which reflected the most recent guidance and staff had access to support from a mental health legislation team.

Relevant legal documents needed to comply with the Mental Health Act were in place and up to date to ensure patients were receiving their medicines in line with legislation.

Staff we spoke with told us they had the opportunity to discuss training needs with their line manager and were supported to develop their skills and knowledge. Staff described additional training, and shadowing opportunities available to them and said their managers were proactive in developing their skills to enable them to progress within the service.

Most staff received regular clinical supervision. 3 of the 6 wards within the service had clinical supervision compliance above the trust target of 85%. Wards below that target were the Becklin Centre, Ward 1 (82%), the Becklin Centre, Ward 5 (56%), and the Newsam Centre, Ward 4 (68%). Staff told us discussions in supervision sessions were used by managers to identify their training and development needs.

Most staff received an annual appraisal. 2 of the 6 wards were above the trust target of 85%. Wards below that target were the Becklin Centre, Ward 1 (81%), the Becklin Centre, Ward 4 (76%), the Becklin Centre, Ward 5 (76%), and the Newsam Centre, Ward 1 (56%).

Managers identified poor staff performance promptly and supported staff to improve either through one-to-one support or by implementing performance plans with support from the human resources team. There was a performance management policy which was up to date and subject to regular review.

Quality Statement Score: 3

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 of needs when they move between different services.

Staff told us that they had regular access to team meetings. Minutes from meetings were recorded and sent to all staff so any staff members unable to attend were kept up to date with essential information.

Staff held regular and effective multidisciplinary meetings to discuss patients and improve their care. In attendance were doctors, nurses, psychology and occupational therapy staff, dieticians and physiotherapists.

Staff and leaders told us that they had good, effective working relationships with teams both within and outside of the organisation. This included regular working with the older adult services and community teams. In preparation for discharge staff worked closely with community teams who they involved in discharge planning. This included taking patients on a period of leave and feeding back to the service about how this had gone.

Staff on ward 4 at the Newsam Centre told us crisis and home treatment teams visited the ward weekly to identify patients needing discharge support and spoke positively about this.

Throughout our assessment, we saw different healthcare professionals working in partnership together well. There appeared to be respect throughout the different disciplines for each other's point of view and clinical insight.

Ward managers ensured that tasks were delegated to staff members at the beginning of each shift. The nurse in charge was responsible for allocating duties such as medicines, attendance at meetings, leave, observations and checks.

Managers ensured that staff were able to provide support and respond to other wards if needed and each shift had an allocated first responder. Managers and staff described how they regularly supported on different wards and how staffing was often shared to ensure safer staffing levels were met.

There were standing agenda items for meetings to ensure essential information was shared and discussed.

Staff shared information about patients at handover meetings from one shift to another. We observed a handover during the inspection and saw that staff discussed patients’ presentation, risk and concerns, identifying and agreed any actions needed.

Quality Statement Score: 2

Staff supported 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.

The Becklin Centre and Newsam Centre both had gymnasiums on site which patients could use subject to a risk assessment. Some patients described activities they could access which involved exercise and access to fresh air. There were daily walking groups which we observed taking place during the inspection. During the summer months patients could take part in outdoor sports including football and badminton. There was a table tennis table and pool table within the therapy suite which patients could access.

We saw evidence in care records that staff had referred patients to external healthcare services such as podiatry and dentistry.

The trust had a smoke free policy. Managers acknowledged that this was difficult to manage and told us many patients admitted to the service smoked. All patients were reminded of the smoke free policy on arrival and throughout their admission. Smoking cessation was offered to all patients and vapes were provided to patients who smoked. However, we saw that there were cigarette butts in outdoor spaces on the wards.

Staff made sure patients had enough to eat and drink, including those with specialist nutrition and hydration needs. There was a healthy living team within the service. Managers described how they had worked with the catering team to develop more healthy food options and ensure a diverse range of food.

Quality Statement Score: 2

Staff generally monitored people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes. These included the National Early Warning Scores, Health of the Nation Outcome Scores and the Malnutrition Universal Screening tool. However, staff did not always complete National Early Warning Scores for patients to assess their physical health in a timely manner on admission.

Patients and carers told us that they received the care and support they needed. Patients said their care was regularly reviewed, and they were seen by appropriate teams and professionals to support both their mental and physical health such as psychologists, occupational therapists and GPs.

Managers told us the trust monitored the average length of stay for the service. There was an action plan in place to reduce the average length of stay based on a 3-year trajectory in line with NHS England planning guidance.

There were monthly care plan and risk assessment audits in place. Managers also completed section 132 rights audits to check that staff explained to patients their rights under the Mental Health Act on admission and revisited this regularly.

Quality Statement Score: 3

Staff told people about their rights around consent and respect these when we deliver person-centred care and treatment.

Staff explained patients' rights to them in a way they could clearly understand. Staff explained things in a way that enabled patients to make informed decisions about their care and treatment.

There were independent advocacy services that supported patients. An independent mental health advocate (IMHA) visited the wards regularly. IMHAs could also speak to patients by phone or arrange face to face meetings. Staff told us that patients were automatically referred to an IMHA on admission. We spoke with the IMHA who told us they were encouraged to raise patients' concerns about any aspect of their care and treatment both in person and by email. They confirmed that patients were told about the advocacy service and said they regularly met with patients to explain their role and how they could support them.

We saw in care records that patients were regularly reminded of their rights. There was evidence that when patients lacked capacity, staff held best interests’ meetings with the patient, their family, IMHAs, and members of the multidisciplinary team involved in the patient's care and treatment.

Staff could give examples of when they had completed capacity assessments including a recent assessment regarding a patient who was financially vulnerable and at risk of exploitation by other patients. They could explain steps they had taken to safeguard this patient.

Care records also contained evidence that staff sought patients' consent to care and treatment. Care records evidenced there were ongoing discussions with patients around consent to treatment and that capacity was assessed.