Oxford Health NHS Foundation Trust

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• 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 changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of regulation 9 (person-centred care).

This service scored 62 (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: 1

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staff did not always work with young people to ensure they felt involved in their care. Half of the care plans we reviewed were generic and not personalised. Staff did not write care plans in the voice of the young person, with the exception of positive behaviour support (PBS) plans where young people had these. However, PBS plans had not been put in place for all young people who had this as an identified need.

All of the young people we spoke with told us they did not feel involved in their care. They told us that care plans were written by staff and handed to them to sign, which many young people told us they had refused to do as they did not feel the care plans accurately reflected their needs and wishes.

There were blanket restrictions in place on all 3 wards – young people could not access their own snacks, drinks or the garden without staff intervention. Access to these provisions was not individually risk assessed.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff ensured that young people had access to education opportunities. Young people on each ward had access to a school. Teachers and key workers continued with the home or school curriculum to ensure continuity in the young person's education. Every young person received a weekly timetable, although staff told us there was often low attendance at school, despite them encouraging young people to attend. On the day of our inspection only 2 young people attended school at Marlborough House.

Staff supported young people to maintain contact with their families and carers. All of the young people and relatives we spoke with told us they had been supported to maintain contact. However, 2 young people on Highfield unit and at Marlborough House told us staff had told them their visits from family would be reduced if they did not comply with their care plan.

Staff supported young people to access their chosen place of worship within the community.

Staff at Marlborough House had implemented nature-based family therapy in collaboration with a local Wildlife Trust, taking families to natural sites. A Nature Connectedness pathway had been developed with medical students, based on a five-sense, five-week programme. This tied in with Wellbeing Wednesday initiatives. Daily walks were included in the planner, and monthly nature walks took place along national trails.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies as needed. Staff submitted notifications to the Care Quality Commission.

Information governance systems included confidentiality of patient records.

Staff displayed information boards on the wards which included information about therapies, safeguarding, the Mental Health Act, advocacy, complaints and quality improvement projects.

The information provided was in a format accessible to young people. Information was simple and easy to understand.

Staff ensured carers, families and commissioners were regularly updated about the young peoples’ progress. Relatives told us that communication from the wards was good and they were given diaries to fill in when young people were given home leave.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The service received 16 complaints in the 12 months prior to the inspection. Of these, 3 were upheld, 3 were partially upheld and 10 were not upheld. None of the complaints had been referred onto the Parliamentary and Health Service Ombudsman (PHSO) for an independent review following an unsatisfactory outcome.

Young people and their relatives knew how to complain or raise concerns. However, 5 young people from across the 3 wards told us they would not raise concerns due to fear of staff treating them poorly as a result. All relatives we spoke with said they would feel comfortable to raise any complaints as needed.

Staff knew how to handle complaints appropriately.

Staff received feedback on the outcome of investigation of complaints and acted on the findings. These were discussed in team meetings.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured the needs of young people with mobility issues were met. All the wards had lifts available to enable people to access the upstairs areas. However, the lift at Marlborough House was not working during our inspection due to a water leak. The disabled toilet on Highfield unit was also out of order during our inspection.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospitals were within a reasonable travelling distance to the local acute hospital.

Staff ensured young people had access to post-discharge care – for example, S117 aftercare, community mental health services and crisis services. Care plans referred to identified Section 117 aftercare services to be provided for those who had been detained under section 3.

Staff planned for young peoples’ discharge, including good liaison with care managers/co-ordinators. There was evidence in care records that community teams and social workers were involved in discharge planning.

In the last 12 months, there were 8 delayed discharges, 7 from Highfield unit and 1 from Marlborough House. Common reasons for delayed discharge were young people awaiting placements in the community or having turned 18 and waiting for an adult bed.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff provided a variety of opportunities for young people to give feedback about the service, including patient forums, community meetings and surveys.

The provider had undertaken equality impact assessments of some of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staff were trained in equality, diversity, inclusion and human rights.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Records showed there was thorough exploration of discharge options for young people and evidence that staff supported them well through assessments for potential placements.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. For example, we saw that young people with autism had been referred to the HOPE(S) team for external input into their care.