Oxford Health 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 assessment we rated this key question good. At this assessment the rating has remained good. Staff provided a range of treatment and care for young people based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of young people on the ward. Staff from different disciplines worked together as a team to benefit young people.

This service scored 67 (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: 2

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 15 care records during our inspection, across all 3 wards. Eight of the 15 care plans we reviewed were generic and did not reflect young peoples’ wishes or goals. All 10 young people we spoke with told us they did not feel involved in their care planning.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. However, staff did not always develop care plans that met the needs identified during assessment. For example, a young person requiring restraint for nasogastric feeding did not have a care plan in place for this.

Staff assessed patients’ physical health needs in a timely manner after admission. However, staff on Meadow unit did not always ensure that physical health observations were carried out as often as they had been prescribed by the doctors.

Quality Statement Score: 2

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

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 (NICE). The wards used tailored approaches for a range of illnesses, depending on the young person’s needs, including obsessive compulsive disorder (OCD), depression, psychosis and anorexia. Staff attended conferences, engaged in extensive reading, and participated in clinical governance groups and continuing professional development (CPD) slots. They were part of the CAMHS Clinical Reference Group and matched learning activities to revalidation requirements.

Young people had access to a wide range of activities including yoga and art. On Highfield unit there was a fully equipped music studio which young people could access to record songs. A therapy dog also visited Meadow and Highfield units each week. Staff delivered a range of therapies to young people including dialectical behaviour therapy (DBT).

Staff at Marlborough house had implemented a Managing Emotions pathway for young people with difficulties in emotional regulation. The programme lasted 3 weeks, and an assessment was completed before admission. Young people completed a 3 week stay and signed a contract based on DBT skills and relational security. During the programme, they learned coping skills and linked work with their families.For those who engaged in self-harm, a chain analysis was conducted. Young people could go home for reflective leave and then return to continue the programme. The pathway had contributed to a reduction in self-harm.However, this programme had not yet been formally implemented.

Staff ensured that young people had good access to physical healthcare, including access to specialists when needed.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

The team included or had access to the full range of specialists required to meet the needs of young people. They had access to psychologists, occupational therapists, a family therapist and a speech and language therapist. A physiotherapist visited the ward weekly. Young people with eating disorders had access to a dietician.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. Supervision rates at Marlborough House had dropped to below 50% in June 2025, however, these had gradually increased and 83% of staff had received supervision in October 2025. The percentage of staff that had had an appraisal in the last 12 months was 100% on Meadow unit, 97% on Highfield unit and 93% at Marlborough House.

Managers ensured that staff had access to regular team meetings. Staff attended weekly team meetings, in addition to operational meetings, quality improvement and audit meetings and learning from incident meetings.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers ensured that staff received the necessary specialist training for their roles.

Mental Health Act

Staff were trained in and had 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.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Young people had easy access to information about independent mental health advocacy.

Staff on Highfield unit had created a video explaining patients' rights under the Mental Health Act in a way that was simple and easy to understand. However, staff did not regularly remind young people of their rights. Four young people at Marlborough House and four young people at Highfield unit had not been reminded of their rights since they were originally read to them following admission. One young person at Highfield unit had not had their rights read to them for 6 months. One young person told us they did not think they had any rights, and they did not understand why they were in hospital.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.

Staff did not always request an opinion from a second opinion appointed doctor (SOAD) when necessary. In some records there was no record that a SOAD application had been completed where it should have been.

The wards displayed a notice to tell informal young people that they could leave the ward freely. However, one informal young person told us they often encountered difficulties in staff signing them out, and that staff had threatened to detain them under the Mental Health Act.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been detained under Section 3.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings.

Staff shared information about patients at effective handover meetings between each shift.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. For example, care co-ordinators, community mental health teams, and the crisis team. Staff invited representatives from community teams to attend ward rounds.

The teams had effective working relationships with teams outside the organisation. For example, a staff member from the Integrated Care Board was present in a ward round meeting and staff worked with the HOPE(S) team to help support young people who were being nursed in long-term segregation. The HOPE(S) model is a human rights based approach to working with individuals in segregation developed from research and clinical practice. Staff on Highfield unit had worked with the police to help reduce the levels of violence and aggression from a young person. Staff also worked very closely with teachers from the schools young people attended. Teaching staff from the school connected to Meadow unit gave positive feedback about their working relationship with nursing staff and felt staff kept them up to date with regards to young peoples’ risks.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported young people to live healthier lives. Each ward ran a weekly wellbeing clinic that young people could attend to review any physical health issues. Young people could drop in, see doctors and nurses, and choose whether to attend weekly.

Ward activities helped promote a healthy lifestyle for young people. For example, young people had access to a gym and yoga sessions. Young people received an induction from a physiotherapist prior to being able to use the gym to ensure they knew how to use the equipment safely. At Marlborough House there was a basketball net in the garden and staff also ran running groups around the grounds.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent.

Staff used recognised rating scales to assess and record severity and outcomes. They used the Children’s Global Assessment Scale (CGAS) to monitor outcomes.

Staff used technology to support young people effectively. For example, where young people consented to this, they used a visual-based monitoring system in bedrooms, seclusion rooms and de-escalation rooms to monitor young peoples’ pulse and respiration rate and alert staff to any abnormalities. The monitoring system could also alert staff to any unusual activity in patient bedrooms, for example if a person was detected by the door.

Quality Statement Score: 3

We scored the service as 3. Staff told young people about their rights around consent.

Staff took all practical steps to enable young people to make their own decisions. Staff recorded whether young people under 16 were Gillick competent in their care records.

For young people 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.

When young people lacked capacity, staff made decisions in their best interests.