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

The provider maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Young people told us they were offered copies of their care plans, and said their families were invited to ward rounds and care programme approach (CPA) meetings where appropriate.

Staff and managers described how they had modified communication techniques and documented these in care plans.

They told us how they built rapport with the young people to support and engage them, and they talked about external input from other services and discussions at the provider collaborative to improve care pathways.

They also described the support they received from their peers and managers, and meetings such as reflective practice groups.

The care records we reviewed corresponded with what staff told us about young people’s care and treatment. They were detailed and they captured risk and included safety plans and reviews. There was evidence of discharge planning and of young people’s involvement.

Staff completed a detailed assessment for young people before they were admitted.

They looked at the young people’s physical and mental health, care and support needs and aims for the admission to ensure the most effective outcomes.

On admission, staff developed care plans based on each individual’s needs. The multidisciplinary team reviewed and updated them regularly when young people’s needs changed.

The care records we reviewed supported a person-centred approach to care and treatment, and they reflected young people’s individual needs; for example, for young people with autism, staff completed communication passports.

Care and treatment were informed by input from family and carers. Managers confirmed that they had regular telephone contact with family and carers, and visits included out of hours visits.

In the care plans we reviewed we saw that staff carried out regular audits.

There was a designated carers’ liaison staff member who communicated with both carers and young people. They also facilitated a carers’ forum.

We did not speak with young people using the service about this quality statement.

Managers and staff were able to tell us about the type of service they delivered, and how this might change dependent on the needs of the young people admitted to the units, for example young people who had eating disorders.

Records showed that evidence based care was delivered.

Our review of care records showed that staff adhered to evidence based good practice and standards; for example, nasogastric feeding care plans were based on national guidance.

Staff described the support they provided to the young people, to build resources to help them recover, such as education around their difficulties and support to express them, coping skills, understanding emotions, with a focus on building trust and relationships.

Managers supported staff to develop the skills and experience they needed to meet young people’s needs. They had access to a range of training specific to the service they provided.

There was a Mental Health Act administration team who monitored compliance with the Mental Health Act and the Mental Capacity Act.

We did not speak with young people using the service about this quality statement.

Staff, including those working in occupational therapy and psychology, said they felt well integrated into the teams.

Care records we reviewed and interviews with staff provided evidence of their work with external services and providers, and involvement with the West Yorkshire provider collaborative.

Managers described appropriate delegation of tasks, including clinical tasks. For example, at shift changeovers, the nurse in charge allocated tasks based on skills and suitability using the e-roster. Tasks included environmental and relational security, feeding, observations and medications.

Every week the multidisciplinary team discussed the young people using the service. The team included staff from psychology and occupational therapy, and there was input from external services where appropriate. Families also attended and participated.

We did not identify any concerns with transitions of care, including from children’s to adult services. Care records checks confirmed that the provider worked with external services to plan and facilitate transition, and that staff shared information within the service, wider trust and external stakeholders where appropriate.

Some of the young people we spoke with told us they were supported to live more healthily; for example, they were supported to choose healthy meal options. Others could not give examples of how they were supported in this.

Staff talked to us about the personalised care plans they developed with young people. They explained how healthy living was supported and encouraged.

Care records showed that staff considered nutrition, hydration and healthy living. For example, one young person only ate food their parents brought them, and when their parents were present. The care plan described how staff supported them to consume food from the hospital.

There was a dietician who was involved in determining meals, portions, dietary supplements etc. Managers also confirmed that the chef was involved in meal planning.

Care records checks showed that staff conducted fluid monitoring where appropriate.

The service ensured young people had access to healthcare. Many were local to the area and were already registered with GPs and dentists. Staff supported them to attend appointments. Out of area patients were registered with a local GP.

A doctor at the service completed physical health assessments.

There was an activities timetable that included physical activities. The occupational therapists led sessions facilitated on the wards, including physical activity, bongo session and arts and crafts.

There was a football pitch in the secure garden.

Young people were supported to walk during ground and community leave.

We did not speak with young people using the service about this quality statement.

However, we heard how, with their parents and carers, some had been involved in developing and piloting a new questionnaire, the Re-QUEST experience measure, to measure and promote understanding of young people’s experience of mental health services.

Staff told us about the new Re-QUEST questionnaire that had been developed by the team.

They also described some ways of supporting young people to deal with their feelings; for example, using Cinemotions, a cognitive remedy to improve recognition of emotions, where they could watch cinema clips then describe how they thought the character was feeling and how they could deal with it.

The occupational therapy staff told us how they used the Model of Human Occupation Screening Tool, which addresses motivation for occupation, patterns of occupation, communication and interaction, process, motor skills, and environment. It measures progress towards occupational therapy intervention goals. They described using a child’s version of the tool, following a trial they had carried out with one group.

Staff monitored young people’s recovery and used clinical outcomes.

Care records confirmed that staff provided care with the aim of improving young people’s quality of life.

Staff were involved in audits and quality improvement. We reviewed some audit documents and found that they had identified concerns we had noted in other records.

We saw in our review of case records that the Health of the Nation Outcome Scales for Children and Adolescents was used on admission and discharge.

We saw that the service was also using ‘Have your Say’, a friends and family assessment that gathers satisfaction feedback from young people and their families, although take up had been low.

We saw copies of the Re-QUEST experience measure that was used to develop better knowledge of young people’s experiences.

The Re-QUEST experience measure had been piloted with young people, their parents and carers on discharge from the service. Admission and discharge are the two points at which information should be gathered, at the very least.

The feedback gathered was specific to the service and used to inform improvements, such as enhancements to facilities on the unit, a review and reduction of blanket restrictions, and increased awareness and enthusiasm for co-production amongst staff, young people and their parents and carers.

Longer term, it was hoped that the learning from this experience of co-production would support future co-produced service improvement and development, and for the Re-QUEST to be shared and piloted with other CYPMH inpatient units across the UK.

The young people we spoke with told us they were involved in planning their care. They said staff gave them information in ways they understood.

Staff described how they explained young people’s rights around consent and respected them when they delivered person-centred care and treatment.

Advocacy support was available for all the young people. The information was accessible for them and their families. Advocacy was offered to all young people as part of the admission process.

We saw evidence in care records of discussions that led to informed consent being obtained. There were medicines treatment certificates in place for some young people where necessary.

We saw evidence in care records that staff sought consent from young people regarding decisions about care and treatment. There were treatment certificates in place which were up to date and matched medicines on the prescription charts.