Northamptonshire Healthcare NHS Foundation Trust

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• 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 assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients 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 patients on the ward. Staff from different disciplines worked together as a team to benefit patients. 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 maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 6 care records which were person centred, inclusive and showed people and their families had been fully involved in care planning., Staff completed comprehensive assessments of people’s needs in a timely manner. Referrals were accepted following a Continuing Healthcare (CHC) eligibility assessment, and pre-admission assessments were undertaken before each stay, with input from families, carers and GPs. These were reviewed and updated on admission to reflect any changes in health, behaviour or support requirements.

Staff assessed people’s physical health needs promptly on arrival. This included checks such as weight, nutrition and swallowing assessments, and NEWS2 scores where appropriate. People with epilepsy had individualised seizure care plans in place, and staff confirmed they were alert to signs of dysphagia and escalated concerns to speech and language therapy teams when needed.

Care plans were personalised and holistic, addressing physical and mental health, daily living skills, communication needs, and risk reduction strategies. They were recovery-oriented, supporting people to maintain routines and preferences during respite stays. Examples included seizure management, preferred communication methods, and daily activities tailored to individuals.

Plans were reviewed within 72 hours of admission and updated promptly when needs changed. Families were fully involved, ensuring plans reflected current needs and wishes to support continuity of care. Staff confirmed care plans were accessible, regularly audited, and overseen by named nurses to maintain accuracy.

However, the service did not consistently use validated clinical rating tools, such as the Health of the Nation Outcome Scales (HoNOS), to record and measure people’s progress and outcomes. The service told us that HoNOS is not routinely used in respite settings, as it relies on monitoring over a longer period, which is not always possible during short stays. The service acknowledged this limitation and had introduced record‑keeping audits to strengthen oversight and quality assurance.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff had received training in the Mental Capacity Act and demonstrated good knowledge of their responsibilities.

Staff planned and delivered care in line with legislation, national guidance and best practice standards. People received a range of interventions that were suitable for their needs and appropriate for the respite service model. These included support with epilepsy management, dysphagia care, nutritional support, and structured activities to promote engagement and independence. In addition, Oliver McGowan training, which focuses on improving understanding and awareness of learning disabilities and autism to ensure safe, person-centred care, was available to staff. Staff accessed best practice updates through the trust intranet and competency frameworks, with new procedures accompanied by mandatory competency sign-off.

People had good access to physical healthcare. For example, we saw evidence of escalation of an elevated NEWS2 score to emergency services. Nutritional and hydration needs were supported through Speech and Language Therapy assessments, and blended diet training had been delivered to staff to meet changing patient needs.

Staff assessed and supported patients’ nutrition and hydration needs. Care plans included specialist arrangements for people with dysphagia, and meal preparation was personalised to reflect cultural preferences and health needs. Staff said they were alert to risks such as aspiration and liaised with families and speech and language therapy services to ensure safe dietary plans were in place.

The team participated in audits and reviews to support learning and improve practice, including record-keeping, hand hygiene, medicines, medication records, equipment use, and annual health checks. Findings were shared in team meetings, and changes implemented to strengthen standards. While patients did not have routine access to psychology input due to the respite nature of the service, leaders mitigated this by maintaining referral pathways to community teams.

Although the service did not have a full on-site multidisciplinary team, staff were able to access the specialists required to meet people’s needs. This included pharmacists, community occupational therapists, and speech and language therapists, who worked in partnership with ward staff and families. Plans were also in place to expand placement opportunities for therapy students, further strengthening multidisciplinary input.

Staff were experienced, qualified and demonstrated the right skills to meet the needs of the patient group. Healthcare assistants were supported to complete the Care Certificate, and one had progressed to a nurse apprenticeship. Managers provided new staff with induction, in line with Care Certificate standards, and all staff received regular supervision and appraisal. Records confirmed that supervision was expected monthly, with a minimum of 2 per quarter, and appraisals were in date for the 2025/26. Staff confirmed they attended team meetings regularly and felt supported in their professional development. Managers identified individual learning needs and provided opportunities for further training, including specialist skills such as tracheostomy care and Percutaneous Endoscopic Gastrostomy (PEG) management - a procedure where a feeding tube is placed directly into the stomach through the abdominal wall to provide nutrition when someone cannot eat normally. Performance issues were addressed promptly.

Regular supervision supported staff to reflect on clinical practice, review care delivery and embed learning, which promoted consistent, evidence-based care and treatment for people using the service.Leaders used supervision to reinforce professional standards and ensure staff understood their responsibilities in delivering safe and effective care.

Supervision data showed strong compliance in Q3 (84.2%) and Q4 (90.0%) of 2024/25, with a temporary decline in early 2025/2026.At the time of assessment, the reporting period was ongoing, and the provider subsequently confirmed that compliance had improved by the end of Q2. Leaders demonstrated oversight through active monitoring arrangements and reminders to staff to complete supervision sessions.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

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.

The trust ensured effective teamworking within the service and with external professionals to support people’s needs. Handover meetings were held at the start and end of each shift, ensuring staff shared up-to-date information about each person. These handovers were described as structured, focused on risks, and supported continuity of care. Staff also held weekly team meetings, with minutes circulated to all staff. Staff confirmed that this process worked well and reduced the likelihood of information being missed.

Families described teamwork as a strength. Staff knew patients well and worked closely with families during assessments and reviews. As a respite service, the model did not require the formal multidisciplinary team (MDT) structure typically found in inpatient wards. However, community team coordinators remained involved when needed, and external professionals were invited to attend reviews where appropriate to support continuity of care.

There were clear and effective working relationships across the provider organisation. The ward manager attended regular senior management meetings, and staff confirmed that they had good communication with service managers and other learning disability teams. Staff described these links as supportive and said they could escalate concerns when required.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

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 to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

People were also consistently supported by staff to live healthier lives, encouraging independence, choice, and confidence. Families told us they felt reassured that the service placed strong emphasis on safe nutrition and hydration. Families reported that patients became more settled, confident, and engaged since attending the service One relative told us “My relative’s confidence has improved tremendously since staying at Willows.”; “It has been life changing. I feel confident my daughter is safe”.

Activities provided within the service also helped people live healthier lives. Staff arranged opportunities for people to spend time outdoors, including supported walks and access to the garden, and encouraged participation in sensory and movement-based activities. For those able to engage in community outings, staff facilitated visits to local cafes and leisure activities to promote social interaction and wellbeing. Staff said these activities were planned flexibly around people’s needs and preferences, with the aim of supporting both physical and emotional health. Staff respected people’s individual preferences, such as ensuring that personal care was provided by female staff when requested.

This included screening for risks such as aspiration and managing long-term conditions. Staff described how they used proactive strategies to prevent health issues worsening, which reduced the likelihood of future care needs. Health promotion was evident through annual health checks, dietary support, and specialist training for example percutaneous endoscopic gastrostomy (PEG) and blended diets.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

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, and that they met both clinical expectations and the expectations of people themselves.

The provider monitored outcomes through care reviews, annual health checks, and regular audits. We saw evidence of outcome-based improvements, such as introducing competency records for the use of a specialised cot bed following our inspection. On the day of inspection, staff could not present documented evidence of completed training; however, this was later provided within the inspection timeframe, confirming staff had received training on the safe assembly and disassembly of the cot bed. Inspectors were informed that this equipment is rarely used due to the short-stay nature of the service and is only deployed when required to meet individual patient needs.

Relatives consistently reported improvements in their loved ones’ confidence, wellbeing, and engagement. One family member told us “Every single staff member treats my daughter with dignity and respect … I feel my daughter is safe.”

Staff ensured incidents and emerging risks were escalated and addressed. For example, a Datix report was completed retrospectively when a head-banging incident was identified as lacking formal documentation. Supervision was used to address individual staff learning needs.

Managers routinely monitored people’s care and treatment to ensure outcomes were positive and consistent. Care records showed that individualised care plans and risk assessments were regularly reviewed and updated to reflect people’s changing needs, particularly at each new admission. Staff said this process enabled them to identify improvements and ensure care remained safe and responsive.

Staff relied on ongoing clinical review, feedback from families and multidisciplinary input to monitor the effectiveness of care. Care plans included detailed information on risks, communication preferences and health conditions, which were revisited at each stay to confirm progress and adapt interventions.

Staff made good use of technology to support effective monitoring. The provider used both electronic and paper-based systems to capture and store records, with electronic records being the primary method. Observation records were initially completed on paper before being transferred to the electronic system to ensure accuracy and completeness. Regular audits were carried out to reconcile paper documentation with electronic notes, helping to maintain up-to-date and accurate information. This approach supported timely updates and ensured that essential records were accessible to all staff when needed. Technology was also used to communicate with families, for example via electronic feedback systems, helping the service monitor satisfaction and make improvements based on relatives’ views.

Clinical audits further supported monitoring and improvement. Examples included medicines audits, record-keeping audits and infection prevention checks. Outcomes of these reviews were shared in team meetings and used to identify learning or embed new processes, such as strengthening documentation and ensuring all annual health checks were completed.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Staff understood the Mental Capacity Act (MCA) 2005 and applied its principles. MCA assessments were decision-specific and carried out on admission, with best-interest decisions recorded in partnership with families. Records showed patients’ rights were explained in accessible ways, and relatives confirmed their involvement saying, “Communication is great – updates, emails and phone calls … always sent home with report sheet”.

All staff successfully completed MCA training during the three-month review period, achieving 100% compliance. Records confirm this high standard, and staff demonstrated clear awareness of where to access relevant policies and seek advice when needed, ensuring confidence in applying best practice. While some staff could not recall all MCA principles during interview, they were able to describe how they supported people to make decisions and recognised the importance of involving families.

Restraint was not used in the ward, and adaptations to equipment (such as cot beds) were made only, when necessary, linked to individual risk assessments and in consultation with families.

Staff respected people’s rights around consent and ensured decisions about care and treatment were made in a person-centred way. They took all practical steps to enable people to make their own decisions, including using communication aids, adapting information, and seeking input from families and carers to understand how best to support decision-making.

Where people had impaired capacity, staff carried out assessments in line with the Mental Capacity Act. Capacity was assessed and recorded appropriately on admission and reviewed annually by the community team. These assessments were decision-specific, ensuring that each significant decision was considered on its own merits rather than making assumptions about a person’s capacity overall.

Records showed that decisions were informed by the person’s wishes, feelings, culture and history, and families were involved in the process to ensure decisions reflected what mattered most to the individual.