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 previous inspection we rated this key question good. At this assessment, the rating remained good. 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 9 patient records during the assessment. Staff had completed a comprehensive mental health assessment of each patient in a timely manner at, or soon after, admission. Staff also assessed patients’ physical health needs in a timely manner after admission.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery oriented. Staff had developed care plans for areas identified during their assessment of the patient, including in relation to specific physical and mental health issues. For example, where patients were diagnosed with dementia, where a high falls risk and mobility issues were identified and where dietary adjustments were required.

Staff updated care plans, when necessary, as a result of routine reviews and where patients need changed, for example as a result of a deterioration of some kind.

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 and psychological therapies and activities intended to help patients acquire living skills.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration, those that needed it had specialist input to create care plans in relation to these specific needs.

The team included or had access to the full range of specialists required to meet the mental health and physical health needs of patients in the service. As well as doctors and nurses, geriatricians, occupational therapists, psychologists, social workers, pharmacists, speech and language therapists, physiotherapists, dieticians, and activity coordinators.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. There were always several qualified staff working on every shift and further support could be sought from other staff working on site or available through an on-call system. Staff told us they felt they were always able to seek support from a more experienced member of staff if they needed to.

Managers provided new staff with appropriate induction, which included a range of training and shadowing opportunities on and around the wards. This also included any bank or agency staff that worked on the wards.

Managers provided staff with supervision and appraisal. The percentage of staff that had had an appraisal in the 12 months prior to the inspection was 85%. The percentage of staff that received regular supervision was 69%. Staff told us they felt well supported by their managers.

Managers ensured staff had access to regular team meetings. We saw evidence these were well attended, covered a wide range of relevant topics and detailed notes were available for those who could not attend.

Managers identified additional learning needs of staff and provided them with opportunities to develop their skills and knowledge. Several of the qualified staff had started their careers working on the wards as support staff and had been offered the opportunity to undertake training to develop their careers.

Mental Health Act

74% of staff had received training in the Mental Health Act, however, all staff we spoke with demonstrated a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

The provider had relevant policies and procedures that reflected the previous guidance. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff worked effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they moved between different services.

Staff held regular and effective multidisciplinary meetings. Although these were well attended by a range of professionals, the meetings that we observed were not attended by patients or their representatives, but in some cases their views were represented by a verbal handover.

Staff shared information about patients at effective handover meetings within the team, between each shift. Handover documents demonstrated that essential information such as risks to self and others and increased levels of observation was available to all staff when they came on duty and would ensure that temporary staff or those that did not know patients well would have the necessary information to deliver safe care.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation, for example with those staff who were responsible for coordinating discharge or transfer between wards.

The teams had effective working relationships with teams outside the organisation, for example, local authority social services, care coordinators 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 supported patients to live healthier lives. The service had an occupational therapy team who could plan patient meals with them and held cooking sessions, in some cases helping people to maintain cooking skills to be able to live independently. Patients had access to smoking cessations schemes, an onsite fitness suite and the service facilitated regular walking sessions in the local area.

The service had input from a dietician who provided information about nutrition and exercise where it was required.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes and physical unwellness, for example, a national early warning score. The service utilised rating scales and outcome measures to monitor patients and their progress within the service. There was evidence that staff were undertaking these and reviewing as necessary.

Staff used technology to support patients effectively. Some patients and carers noted technology was used to enable them to keep in touch with their friends and family, along with attending meetings with organisations. There was also a range of technological aids used on the wards to support and monitor patients, such as hoists and sensors to detect potential falls.

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 patients to make their own decisions. Patients felt involved in decisions about their care and treatment. Patients stated that staff helped them to understand aspects of their care where it was necessary.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. Staff gave examples of how capacity was considered and the processes that were followed within the service and we saw evidence of this documented in care records.

Patients were informed of their rights under the Mental Health Act. The service could use interpreters when informing patients of their rights.