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 in 2019 we rated this key question as Good. At this assessment the rating has remained as Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 36 sets of care plans during this assessment. 12 patients told us that they were not always involved in the planning of their care but had received copies of their care plans. 13 patients said that they felt involved with their care and that it was reviewed at regular multidisciplinary team meetings. However, three patients said that they had no involvement with their care plans and two patients said that staff did not listen to them.

Staff told us that they assessed patient needs by ensuring that care plans were regularly reviewed and by holding weekly multi-disciplinary team meetings when patient care was discussed and reviewed. Ward managers described how people's needs relating to protected characteristics were assessed to ensure appropriate support was provided. We saw care plans that showed that dieticians and podiatrists were involved in supporting patients care. Four ward managers and 10 members of nursing staff said that people's physical healthcare needs were assessed on admission and regularly reviewed. We saw good evidence at Marlborough house of robust physical healthcare monitoring happening across the patient group and this was mirrored on other wards.

There was a range of processes in place to assess patient need. These included risk assessments, care plans and observation records. We reviewed 36 sets of clinical notes across the wards and reviewed risk assessments as part of this. Of those reviewed, most had been regularly reviewed and updated after incidents. We found that care plans on some of the wards contained, clear, accurate up to date information including the physical healthcare monitoring and good monitoring for patients prescribed clozapine. Diabetes blood monitoring checks were being carried out as per the care plan for six patients . We also there was low use of urgent medication when required, and post-injection monitoring was well documented as per the patient’s care plan and trust policy.

Patients told us that they received care, treatment and support that was evidence-based and in line with good practice standards. 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 and psychological therapies and, in rehabilitation wards such as Chaffron, activities, training and work opportunities were available to help patients acquire living skills. Patients across the wards said they were receiving regular occupational therapy support, regular group and one to one sessions with a psychologist. Patients said their care was reviewed and progressed at regular multidisciplinary ward rounds.

Patients had access to occupational and psychological therapies and patients’ care was regularly reviewed by a multi-disciplinary team including medical, nursing and therapy staff. There were systems in place for monitoring people's physical health during their admission and we observed good evidence of this in relation to diabetes and foot care when required. The ward teams included or had access to a range of specialists required to meet the needs of patients in the wards. As well as doctors and nurses, there were occupational therapists, clinical psychologists, pharmacists, speech and language therapists, dieticians and peer support workers. Peer support workers were active on Evenlode ward in supporting the patient who was being supported in long term segregation and they regularly visited to give them an opportunity to express any concerns.

Multi-disciplinary team meetings took place weekly and patients were invited to attend these. A range of disciplines attended including the psychiatrist, named nurse, occupational therapist and psychologist.

The services had introduced a Trauma Risk management (TRiM) band 7 member of staff to have oversight of trauma focused peer support across the forensic services and would lead on the trust wide implementation of a more trauma informed way to support staff in their day to day work.

Patients told us that when they had moved into the Oxford Health forensic wards, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care. Staff shared information about patients at effective handover meetings within the team.

Three patients told us that they were well supported in relation to their discharge including partnership working between ward staff, community mental health teams and social care providers. We reviewed 36 sets of care records and found that 23 patients had discharge plans in place from early into their admission.

The service worked in partnership with other wards, community services and the local safeguarding teams. The trust shared learning with other services through the provider collaborative and brought in learning from other organisations. The senior management was part of the quality network for forensic services which meant that they were regularly reviewed by other forensic providers from outside of the Trust.

Care plans were stored electronically and were accessible to all staff. Staff said that there was patient representation at the senior leadership meetings and that patients could make suggestions about the services at the ward community meetings which would then be taken to the senior leadership meetings.

Ward managers knew all of the patients and staff on the ward, they maintained a positive rapport with the patients and were familiar with their care plans and treatment goals. There was advocacy information available to patients on all the wards and there was a clear referral pathway for patients to be supported with mental health advocacy. Advocates met with patients monthly. Advocates could be involved in independent seclusion reviews and they said that senior staff were responsive to concerns and complaints raised by patients .

There were a variety of processes in place to support staff teams and services working together. All staff attended their ward handovers at the beginning of each shift except the allocated security worker who was receiving security handover. The security worker then completed a checklist to ensure that all risk items and areas of the ward were safe and accounted for prior to the other staff leaving. In the main staff handover information was shared on patient activities, mental state, medication issues, any leave taken, discharge planning progress. Handover discussion did not include discussion on ligature points and when we spoke to staff, they were not aways able to explain what the environmental risks were on each of the wards. There were morning community meetings which supported patient involvement, discussion of activities, ward maintenance issues and these were chaired by patient representatives. Staff meetings were being held although not always monthly as per trust policy. Staff discussed incidents, security/ligature risks, and the dates of forthcoming events. MDT meetings took place weekly and were attended by all disciplines. There was a comprehensive discussion of patient’s risks and needs and clear evidence of a recovery focused approach including steps towards discharge clearly articulated. The MDT showed good partnership working with community teams. The seclusion and long term segregation review panel meetings were attended by members of the multi-disciplinary team, the advocate to reflect the patients’ voice, the NHSE case manager and for one patient Evenlode who was being nursed in long term segregation, a member of staff from the HOPE(S) team attended. The HOPE(S) model is a human rights based approach to working with individuals in segregation developed from research and clinical practice and commissioned nationally by Mersey Care NHS.

Patients were positive that they were encouraged and supported by the staff to make healthier choices to help promote and maintain their health and wellbeing. Most patients said they had access to nutritious food which met their needs and most patients said they had 24/7 access to drinks and snacks. Seven patients said they received support and advice on healthy living from ward staff. Patient records showed that patients were given support with dietary needs, health and exercise from dieticians when required. The provider offered patients smoking cessation and mindfulness sessions held on the wards. All wards have a gym for those patients able to attend, and the staff teams had fitness instructors in their staff allocation for the wards. However two patients told us they were not able to access the gym as often as they wished as sometimes there were insufficient gym trained staff.

All patients were able to access the GP and the dentist in an emergency. Staff told us patients had access to healthy lifestyle support including smoking cessation. Staff were aware there was a variety of nutritious food available for patients.

There were processes in place to support patients to lead healthier lives. These included smoking cessation groups and products, support from a dietician in order to make healthier food choices, physical training staff and access to the on-site gyms and walking groups. Staff routinely monitored and recorded patients’ physical health. Staff provided patients with information on their care, treatment and side effects and patients could also access the recovery college to undertake a variety of courses to support their education and wellbeing The advocates supported patients to raise issues including access to healthy food, access to fresh air and access to the gym.

Patients told us that they were supported by their primary nurses and care teams to meet the outcomes in their care plans. Patients had access to activities of daily living kitchens in the occupational therapy areas and when appropriate were supported with budgeting and shopping as a way of working towards achieving independence. Patients were aware of the pathway within the services into rehabilitation or back into their communities and most patients felt that staff supported them to work towards being ready for this.

There were effective approaches to monitoring people’s care and treatment and their outcomes. Staff held regular MDT reviews and used recognised rating scales such as HoNOS (Health of the Nation Outcome Scales) and clinical risk assessments like HCR-20 (historic clinical risk management - 20) to assess patient risk. We saw historic clinical risk assessments in place; however we could not find on the electronic care records use of a recognised dynamic risk assessment. Risk was being managed effectively through the provider’s own electronic risk assessment model.

Patients told us and we saw that staff explained their rights to them. This was done and repeated regularly in line with the trust policy and in a way that patients could understand. If they were not understood then staff would make further attempts until they were assured that they had been understood as per the trust policy. We spoke with 30 members of staff and 22 were able to clearly describe the underlying principles of the Mental Health Act.

Patients said that their care and treatment was explained to them and we saw in care records that consent to treatment was gained. Patients had access to an independent mental health advocate and they could seek support with their care and treatment. Most patients said they were happy with the information given about their medication and one patient said they had spoken to a pharmacist who had supported them in understanding their prescribed medicines. We saw that consent and Mental Health Act paperwork was documented in records and audited regularly.

Staff received mandatory training in the Mental Health Act and the Mental Capacity Act. Mental Health Act was at 88% compliance and Mental Capacity Act was at 88% compliance at the time of the inspection.