Oxford Health NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question as Good . At this assessment the rating has remained as Good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

This service scored 70 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients said they were treated with kindness, dignity and respect by staff and the staff were working to help them leave hospital. Patients felt listened to and although they recognised there were sometimes language barriers with international staff it had not affected their care negatively. Patients felt that staff communicated with them appropriately, calmly and in a way they could understand. Most patients felt that the staff and the ward management teams knew and understood them, including their preferences, wishes, personal histories, risks, personal history and future potential. One patient said once there was a time when a staff member was rude to them and they managed to resolve it by communicating with the rest of the staff and that staff member apologised to them. Another patient said staff speak to them respectfully.

Patients believed that staff responded to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. We observed this during several incidents that happened while we were on the wards. Staff were available to support patients when they became distressed and we saw evidence of a calming and least restrictive approach being used. Patients were reassured that information about them would be treated confidentially.

There was a team of advocates across the services supplied by a local provider. There were signs for the advocacy service clearly visible on the wards with leaflets and posters available to patients. The advocacy service engaged with most of the patients and said that this was having a positive impact on patients. Advocates were routinely invited to patient review meetings and these took place regularly.

Patients were invited to their care review meetings and other meetings about their care, treatment and discharge planning. There were visiting rooms and therapy rooms that could be used on all the wards as private rooms for advocates to meet with patients and ward managers met with advocacy and were responsive to concerns raised by patients and advocates. The independent seclusion review panels were regularly taking place in line with the mental health act code of practice and advocates and members of the HOPE(S) team were invited to attend these and represent the voice of the patient.

We carried out staff and patient observations on the wards and saw that the majority of interactions were good. We did observe lots of staff across the wards on the ward floor and not in the nursing offices however sometimes the staff were described by patients as waiting for something to happen rather than interacting proactively. We completed two SOFI assessments; SOFI is an observation tool which looks at interactions between staff and patients. We observed good interactions throughout the recordings.

Patients that we spoke with were satisfied that they were treated as individuals. They stated that the staff supported their protected characteristics such as language, religious beliefs or dietary needs. Patients said they had been able to personalise their bedroom. Bedrooms we observed during the assessment had patient’s pictures and private property stored safely in them and patients felt this worked well.

On Evenlode ward we saw lots of evidence of a person centred approach to care and it was clear from our observed interactions that the staff team used a person centred active support approach and were meeting the diverse cultural and gender specific needs of the patient group.

On most wards we saw that blanket restrictions were only imposed where necessary to meet the needs of the patients and maintain the safety of patients. However on Woodlands house, there were blanket restrictions that had been imposed around the management of hot drinks that had not been added to the restrictive practice register and so were not being regularly reviewed and removed when no longer required. The restrictive practice register for all wards was held at senior management level and we saw little evidence of individual restrictions on wards being added and then fed into the reducing restrictive practice management meeting. This meant that there may have been restrictive practices happening that the senior management group were not aware of.

We saw that care plans were personalised, holistic and recovery focussed. We saw evidence of patient’s individual needs being identified such as a patients with diabetes, and patients wishing to access risk items such as knitting needles safely and with the correct risk assessments in place. Patients’ own views and wishes were reflected in the documentation.

Staff received training in equality, diversity and human rights. Compliance was at 98% at the time of the assessment. The trust had an up to date equality and diversity policy in place and this was regularly reviewed. Staff supported patients to attend places of worship in line with their faith and spiritual leaders attended the wards to see patients. There were prayer rooms available off the wards. Patients’ dietary needs were met and they could choose meals such as halal, kosher, vegan and gluten free from the menu. Staff were able to book interpreters for patients for whom English was not their first language and there were easy read leaflets and information available to those patients who needed this.

People told us that they were supported to have choice and control over their care and to make decisions about their care, treatment and wellbeing. Patients gave examples of positive involvement including the ward representatives attending Senior Leadership Team meetings and participating in recruitment processes. On some wards patients had individualised and risk assessed access to mobile phones.

We saw “you said, we did” boards across the wards where patients wishes had been identified in community meetings. These boards were dated so we could see they were recent and detailed positive steps that had been taken by wards to support the environment of the patients. One patient told us they had expressed a wish to start driving lessons and the ward was supporting this to happen.

Staff we spoke with told us that there was a variety of activities available to patients and support available in relation to people’s protected characteristics. Community meetings were held regularly and people had a choice of diet, flexible mealtimes or, on the rehabilitation wards, could progress to making their own meals.

Staff escorted patients out into the local community for those who had access to section 17 leave. Patients all reported they were supported and encouraged to maintain their relationships with friends and family. Relatives visited patients and there was access to visitors’ rooms near to the wards to facilitate this. However there were some restrictions which patients felt difficult to work with such as visits were restricted to one hour which sometimes made the patients feel a little rushed.

The wards promoted people’s independence, so they knew their rights and had choice and control over their own care, treatment and wellbeing. We saw people being supported to access activities of their choice both on and off the wards.

Patients had access to their personalised bedrooms during the day and had lockable spaces in their rooms to store valuables securely. People on all wards had keys to their own rooms. People across all wards had 24/7 access to hot and cold drinks and snacks. We observed the food service at lunchtime on two wards and there were multiple dietary preferences available including vegetarian and Halal food.

The service had a number of processes in place to ensure people had choice, independence and control. There were regular community meetings held within the service. However, we did not see sufficient evidence to demonstrate that blanket restrictions were only imposed where necessary to meet the needs of the patients and maintain the safety of patients and staff or that they were being kept under regular review when imposed.

Patients were mostly positive about staff responsiveness. 24 people spoke positively about the support they received from staff on the wards. People felt listened to and said that staff responded to them promptly and positively when they were distressed or needed help and guidance. We observed staff trying to actively help a patient who was distressed because of his new phone that was on charge. The patient returned several times in the space of 15 minutes to the office to ask the same question and was always assisted by different staff members and spoken to kindly. However four patients on Kennet ward felt like the staff had issues with their attitudes towards the patients. The patients felt that there was heavy reliance on agency staff and staff had poor attitudes towards them and were not responsive enough.

We carried out two short observational reviews during the inspection using our short observational framework for inspection (SOFI) tool. The SOFI framework is a tool used for observing and reporting the quality of care experienced by patients. Most of the interactions were positive and we observed lots of positive responses and interactions with patients.

There were enough staff who were adequately experienced and trained and were visible in communal areas. Nursing staff routinely had documented one to one sessions with patients and we saw from our observations of care records that staff engaged with patients views and tried to meet them where possible. Clinical staff were available to give advice and guidance on a range of issues, including mental and physical health, side effects and other issues such as patients’ rights and concerns about care and treatment. Staff could escalate physical or mental health concerns to the psychiatrist if required in order to support urgent patient need.

Staff were positive about workforce planning and wellbeing. Ward managers and staff said they felt safe on the ward and that they felt valued at work and were well supported by the senior leadership team. All the ward managers we spoke with felt their stress levels were manageable and felt that there were suitable processes to enable them to manage their teams effectively.

Staff were able to access specialist training in working with people with autism and challenging behaviour and it was reported that a lot of work had been completed across the services to improve staff culture and morale which had a positive impact on the patients at the Oxford Clinic.

The senior leadership team were felt to have a strong presence on the wards and staff knew who the senior leaders and clinicians were and how to access them. However there was mixed perceptions on the ward managers’ attendance on the wards since the ward managers offices had been moved from the wards. This withstanding, the staff still reported that they felt the ward managers had an open door policy and recognised the responsibilities that that the ward managers had.