North Staffordshire Combined Healthcare NHS Trust

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• 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 assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

The service was in breach of the regulations because the lack of care plans and because staff did not always receive regular supervision or appraisal.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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.

We reviewed 4 patient care records in the mental health crisis team. Staff completed a comprehensive mental health assessment in a timely manner.

Staff had not created specific care plans, although the assessment included information about care and treatment that met the patient’s personalised and holistic needs. However, staff had not recorded patients’ goals and they were not recovery-oriented. One patient did have a care plan however this had been completed using a template that was no longer in general use. Staff had completed personalised and person-centred safety plans which were produced from the initial assessment.

Patient care note audits highlighted low compliance in completion of safety plans, recording patients’ views and hopes and goals for the future.

Staff assessed patients’ physical health reviewed and monitored their physical health needs, liaising with GPs when required. Staff had access to care records for the local acute care hospitals and GPs, so they could review physical health records including prescribed medicines.

We reviewed 6 patient care records in the health-based place of safety. Staff completed the multi-agency assessment record. An initial support plan was developed which outlined observation levels and whether any specific interventions were required in relation to risk.

The team had access to a full range of specialists required to meet the needs of patients in the service, such as nurses, support workers, a psychologist and assistant psychologist although they had been unable to recruit an occupational therapist. However, the consultant psychiatrist only worked 2 days each week for the team.

Staff provided a range of care and treatment interventions suitable for patients in crisis. 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 and practical skills-based support.

Staff assessed and monitored patients’ physical health needs and liaised closely with GPs and other healthcare specialists. Healthcare support workers had been trained in taking bloods and ECGs. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. New starters received a trust induction and relevant training.

The trust policy stated clinical staff should expect to receive supervision at least every 8 weeks and an annual appraisal. The average percentage of staff who had received regular supervision from May 2024 to April 2025 was 66%. The average percentage of staff who had received an appraisal for the same time period was 72%. Managers said supervision was low due to sickness in the leadership team and was often postponed due to high acuity in the service. The psychologist provided reflective practice that all staff could attend every 2 weeks. However, staff we spoke to said they received supervision every 6 weeks.

Staff had access to regular team meetings where they would receive information relevant to the team. They had recently been split into 2; 1 for unqualified staff and 1 for qualified.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff had access to specialist training specific for their roles. An example of courses available included crisis intervention, suicide training, 2-day Dialectical Behaviour Therapy (DBT). Staff had raised that most of the child and adolescent mental health clinicians had left the service and they did not feel suitably skilled and trained to handle young people in crisis. Managers were aware and had plans to provide a suitable training and competency package.

The crisis call line staff had a competency framework as it was a new role developed when the 2 teams merged.

Staff completed a monthly clinical audit for patient care records however it was not clear who was responsible for ensuring any required improvements were made. There were no audits for this team in the past 12 months in the clinical audit programme.

Staff from different disciplines worked together as a team and attended regular multidisciplinary team meetings and daily meetings to plan, monitor and make decisions on care and treatment. Staff shared information about patients at effective handover meetings. We observed a handover meeting and saw staff effectively communicating with each other and sharing knowledge regarding current patient presentation, risk, ongoing plans and any pending assessments. Weekly multidisciplinary meetings were chaired by the consultant psychiatrist and staff reviewed patients current presentation, treatment plans and discharge arrangements.

Staff had effective working relationships with other relevant teams in the trust, such as community mental health teams, the acute wards, and those external to the trust such as GPs, the local authority and the local acute hospital. Staff attended a weekly acute and community care meeting to discuss referrals and plans for patients who required further services post discharge.

However, the majority of referrals came from community mental health teams, up to 61%. Staff felt frustrated that a large proportion of patients known to community mental health services ended up in a crisis and required the extra support they offered. Staff said there could often be a long delay when waiting for allocation of a care coordinator from the community teams which delayed discharge and impacted on their workload.

Staff clearly documented notes in the care record following each visit or interaction with the patient or someone involved in their care, so all staff could see ongoing plans for each patient.

Staff and police liaised well when people were detained on a Section 136 or 135 and were brought to the health-based place of safety. A joint protocol was in place and every 2 months managers attended the joint agency place of safety monitoring group meetings to discuss working arrangements and any issues.

Staff supported patients to live healthier lives by offering advice and support when need was identified following assessment.Support workers within the team could provide practical support to access activities, education and attendance to groups that may aid recovery.

Staff used the Warwick-Edinburgh mental wellbeing scale to aid assessment for some patients, but not all. The service used the Threshold Assessment Grid to identify the severity of patients’ mental health problems. The trust have other rating scales that could also be used, although we did not see them within the records we reviewed.

Staff obtained consent to share information with other teams, health care professionals or with family members.

We reviewed 10 patient care records. Staff took all practical steps to enable patients to make their own decisions. However, 1 record reviewed in the health-based place of safety stated that the patient did not have capacity to consent to an informal admission, and staff had not completed a capacity assessment to support this judgement or recorded a decision made in the patient’s best interests.