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 as Requires Improvement. At this assessment the rating has been changed to Good. This meant people’s needs were met through good organisation and delivery.

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.

Overall patients felt involved in their care and planning their own discharge from the hospital and 25 out of 30 patients said they had been offered a copy of their care plan.

Ward managers described the measures that were in place to ensure people were supported with their protected characteristics, for example cultural needs or physical disability. Staff gave examples of how people were involved to ensure that their care meets their individual needs.

The trust used an electronic notes system consistently across all wards and the staff were aware of where particular documents and records were located. There was effective training in managing the electronic care records and the wards all had access to a ward clerk to support. Staff were aware of people’s protected characteristics and made adjustments to ensure that the most appropriate care and treatment was provided, including their cultural and spiritual preferences and gender identity. Patients were able to personalise their bedrooms.

There were processes in place to support patients to be at the centre of their care and treatment choices. meetings were held weekly and patients and their carers were invited to attend. We saw that most care plans showed evidence of patient involvement and that staff held regular one to ones with patients. Risk assessments were completed on admission and regularly reviewed including after incidents. Out of the 36 care records reviewed, 25 showed evidence of patient involvement.

There was mixed feedback from patients regarding their experience of care provision, integration and continuity. Ten patients were happy with the support they received on working towards discharge from the hospital. Two patients on Kestral ward said they were feeling stuck and were not being adequately supported to progress towards discharge.

Ward managers described the systems in place to ensure that patient flow was not delayed. Improvements had been made to the admissions and discharge processes. There were effective systems to support communication with patients' community mental health teams and the internal transfer processes from the medium-secure wards to rehabilitation wards was working well. The clinical teams were streamlined and managed continuity of care for patients well. Each consultant now had two wards to support the streamlining of patient transfers between their wards.

Advocates said that care programme approach (CPA) meetings and ward rounds were held regularly and they could attend if the patients wanted this. Staff supported patients with internal moves between wards and with graded transitions and discharges to other services.

Care delivery was planned at handovers, morning meetings and huddles. There were MDT team meetings held weekly including communication with the community teams and across wards on the forensic services.

Staff provided patients with information on their care and treatment. Patients received information about their medicines from clinicians on the ward and from the ward pharmacist teams. Patients were offered tours of the wards when they were first admitted and two patients on Evenlode were impressed as the ward representative showed them around the ward when they first came into the hospital. 12 patients said they were given written information about the ward on admission. Overall patients felt happy about the way information about their care and treatment was being shared with them.

The services were meeting the Accessible Information Standards (AIS) by ensuring information shared with the patients was in a range of different formats. This included giving printed information and leaflets and verbal information, advice and guidance. The staff were also able to arrange communication support if people needed it

Staff also told us that patients were offered copies of their care plans. Staff showed us the areas of the wards that contained boards with leaflets and posters on a variety of different topics such as medication, the Mental Health Act, the CQC and patient rights including rights to appeal and lists of local solicitors in the Oxford area.

Information was shared at the weekly MDT, daily at handover, at regular staff meetings and at the patient’s community meetings. Patients were generally provided with information and shown around the ward on admission. There was access to translation services and leaflets were available in an easy read format. Staff could request leaflets in other languages if this was required for a patient. However we attended several handovers which were brief and lacked complete information regarding changing patient risks. When we discussed this with ward managers it was felt this was because the patients had been on the ward for longer periods of time and the staff had a good understanding of the patient’s presenting risks.

We spoke with seven patients who told us they had access to independent advocacy support they were aware of the process for complaining about their care both to the trust and to the Care Quality Commission. Five patients said community meetings took place regularly on the ward and were normally chaired with the support of the patient representatives. Patients said that they generally felt involved in their care and that positive changes had been made as a result of patient feedback at the ward level. Wards had “you said – we did” boards up with dated records of information which been actioned by the ward teams to support patient’s wishes.

Staff made reasonable adjustments for patients – for example, people with mobility issues were provided with walking aids, shower chairs etc.

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.

There were measures in place to support people with their protected characteristics. Staff showed us that the wards were accessible to wheelchair users and patients had access to spiritual support on the ward. We found there was access to multi faith rooms across all the Hospital sites we visited.

All patients had access to advocacy and the advocacy service was engaged with patients within the wards. There were advocacy posters on all of the wards. Staff supported patients to access advocacy and provided a private rooms to ensure that meetings were confidential.

Care plans were person centred and reflective of patients’ specific needs.

Staff were trained in equality, diversity, inclusion and human rights with an average training level of 98% across the services.

Patients felt they were able to contribute their views at community meetings on the wards. Patients were able to access an interpreter and three patients said they were supported in relation to their protected characteristics and one patient was being supported with issues relating to their gender identity and was positive regarding the interventions and respect they had received from the staff team.

All patients had access to support from the independent mental health advocate. Ward managers and ten members of staff were able to outline the support they were offered in relation to their protected characteristics. Wards were accessible to wheelchair users. Language barriers were supported with the use of interpreters when required and information was able to be translated into other languages. There were also easy read leaflets available for patients who needed them.

An independent advocate regularly attended all of the wards and patients confirmed that they had received support from the advocacy service.

Of the 30 patients we spoke with, 12 patients were happy with the support they were receiving to work towards discharge from their wards. Five patients said they were able to take part in education and/or volunteering during their time on the wards.

Ward managers told us that improvements had been made and there were systems in place for proactive discharge planning. There were effective arrangements in place for engaging with patients' community mental health teams. There was a system for monitoring patients' length of stay and this was regularly audited and reviewed via the electronic care records system

Staff assessed patients’ capacity regarding decision making using the Mental Capacity Act when required in relation to decision specific issues We saw evidence of the use of capacity assessments in patient care records.