Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s needs were met through good organisation and delivery.

Staff worked with patients to deliver person centered care and treatment. Patients, families and appropriate professionals were involved in the development and review of treatment plans. Staff went over and above to ensure patients had access to the local community and services to help aid discharge.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients we spoke with told us they had been involved in their care and treatment plans. Patient feedback survey results we reviewed showed patients felt welcomed on the ward, staff were kind and welcoming and patients were involved in decisions about their care. Each patient had an electronic care plan in place, which consisted of clinical information including care plans, assessments, medical history and psychical health details. However, they also had a person-centred folder in place in their rooms. These consisted of a paper record of their weekly person-centred goals, details about their treatment plan including medication and side effects and details about their baby within them. Each patient had a one-to-one session with their key worker where they reviewed their goals and how they would like to be supported to meet them. These plans were then discussed in the weekly ward round where the staff teams would agree how they could support the patient.

Care plans were person centred and included information about patients’ preferences and cultural needs. One patient at the service was being supported by staff to attend the local Gurdwara as this was important to her.

Although the ward operated set visiting times, they showed flexibility when supported families. For example, a patient’s partner worked hours that did not allow him to be able to visit during visiting times and the ward had adapted these to suit the family and to allow the individual to visit the patient and his child.

Staff teams had maintained good working relationship with the community perinatal team. This team attended patient ward rounds when patients were ready for discharge to ensure the patient knew them and had the opportunity to build a relationship with them.

Staff had gone over and above to include information in patient folders about the local area patients lived in including information on local supermarkets, parks and bus routes. Staff told us they helped patients access local baby groups to help aid discharge. Staff supported patients to access their chosen place of worship within the community.

The ward health visitor held weekly meetings with local health visitor to promote continuity in care.

Teams worked together to promote continuity in care. We saw an example of when a patient had initially been referred into the service from the community team was being discharged back to the same community nurse to allow continuity in care and support.

The service did not have a wait list in place, if they were full, they would signpost patients to alternative units. The service was part of a provider collaborative with another unit. Where patients were signposted to another unit and wanted to return to their service, they would keep up to date with their treatment plan and progress to allow them to return to their service once a bed was available.

Upon admission all patients received an information pack consisting of information on the ward and the treatments available to them. Staff told us this could be made available in different languages if required. They told us they had recently used an onsite interpreter for 1 of their patients who only spoke Punjabi and for continuity in care they were able to request the use of the same interpreter for follow up appointments.

Within patient care plan folders, we saw a section which asked patients how they liked to communicate, and 1 patient had stated within this how they were visual and “liked to see things written down”. We saw information on display around how to make a complaint, access an advocate and around restrictions on the ward area. Information around restrictions was clear and stated why each restriction was in place.

Patient folders consisted of information around medicines they were taking and potential side effects.

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress, through including them in ward rounds and regular phone calls.

All patient care records we reviewed showed active involvement from patients and family members. They recorded preferences around all areas of care and patients were empowered to set weekly goals, which staff supported them to meet.

The multi-disciplinary ward round meeting we attended and the notes we reviewed demonstrated a partnership approach to treatment planning. All ward round meetings included feedback from the patient, family members, nursery nurses, activities coordinator, occupational therapist, health visitor, midwife, nursery nurses, nurses and doctors. Those who could not attend the meeting in person would submit a written update, which would then be discussed at the meeting. This demonstrated the holistic approach to treatment and treatment planning at the service.

The ward held weekly community meetings where they were able to raise any issues or concerns. Meeting minutes we reviewed showed a range of areas of discussion including bedroom access, ward restrictions, meals and activities. The ward displayed any actions they had taken following feedback from these meetings. For example, we patients had requested structured sensory activities and as a result the service had put in place a daily activity plan, that included activities such as baby massage.

The service had only received 1 complaint in the last 2 months, and this had not been upheld. However, the service had responded to the complainant within the timelines of the trusts complaints policy and supported them to access the Patient Advice and Liaison Service (PALS) and Parliamentary and Health Service Ombudsman (PHSO).

Staff ensured the needs of patients with mobility issues were met, for example, the ward was based on the ground floor making it accessible for wheelchair users and the ward had a profile bath in place if required.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital supported patients to the local acute hospital if required. During the on-site assessment staff were supporting a patient to the local emergency department, as her physical health had deteriorated, whilst the ward staff supported the patient’s baby.

Staff ensured patients had access to post-discharge care, which included community mental health services and crisis services. Patients were also able to contact the ward for advice once discharged.

Staff within the service promoted a culture in which the people using the service felt empowered to give their views. All patients had weekly one to one session with their key worker where they developed their weekly goals and discussed how the staff could support them to achieve them. Patients brought these to their weekly ward round meetings where clinicians, family members and the patient discussed these goals and how the patient was supported to achieve them.

Staff helped patients access local baby groups, shops and health services to help aid discharge.

The trust had several equality, diversity and inclusion networks which provided an opportunity for diverse groups of staff to discuss equality related issues, share good practice, and contribute to Trust policy. They also had a network of 125 EDI (Equality, Diversity and Inclusion) Ambassadors who acted as supporters, champions, and ambassadors for colleagues, helping them share their own voice.The ward had an Equality, Diversity and Inclusion ambassador as part of the staff team.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. The service health visitor held weekly calls with the community health visitor to ensure they were aware of patients progress and treatment plans.

We attended a multi-disciplinary ward round meeting for a patient who was on section 17 leave and almost ready for discharge. Their discharge care and treatment plan was personalised, detailed and included important contact details and a personalised contingency/ crisis plans. This patient had been referred into the service from the community team and the plan at discharge was for them to be discharged to the care of the same nurse to allow continuity in care and ease anxiety at discharge. However, all other patient care records we reviewed, were for patients that were not ready for discharge. We found their electronic discharge plans were not personalised and included generic statements, even though all patients had different background and living circumstances. For example, some patients were living alone, whereas others were living with family or partners. We raised this with the team during the assessment and the day after the assessment the trust confirmed these plans would now be personalised to reflect patient preferences and individual circumstances.