Northamptonshire Healthcare 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

At our last assessment we did not inspect this key question. At this assessment the rating is outstanding. This meant people’s outcomes were consistently better than expected compared to similar services.

The service ensured people’s care and treatment was highly effective by delivering comprehensive assessments, personalised care and evidence-based interventions that reflected people’s individual needs, preferences and goals. Staff completed thorough mental and physical health assessments, regularly reviewed care plans and adapted support to meet changing needs. Care was person-centred, with staff demonstrating a strong understanding of people’s communication, sensory and emotional needs. Multidisciplinary teams worked collaboratively with internal and external services to provide coordinated care and support positive outcomes. Staff promoted healthier lives through proactive physical healthcare monitoring, health promotion initiatives and a wide range of therapeutic activities. They routinely monitored outcomes using recognised assessment tools and technology to support effective care delivery. Staff understood their responsibilities under the Mental Health Act and Mental Capacity Act and ensured people were involved in decisions about their care wherever possible. Patients told us staff listened to them, explained treatment options clearly and supported them to make informed choices.

This service scored 92 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

The service ensured people's care and treatment was exceptionally effective by carrying out comprehensive assessments and developing highly personalised care plans that reflected people's individual needs, preferences, strengths and goals. Staff consistently used assessment information to deliver person-centred care and demonstrated innovation in identifying and responding to people's physical and mental health needs.

We reviewed 14 care records and found staff completed comprehensive mental and physical health assessments on admission, or shortly afterwards. Staff used this information to develop holistic, recovery-oriented care plans which they regularly reviewed with people. Care records demonstrated that staff assessed, monitored and responded to changing needs throughout a person's admission. The physical healthcare team visited all wards daily to provide specialist support, review observations, monitor physical health conditions and advise on treatment and interventions.

Staff demonstrated innovation by working with a local sexual health service to develop and implement a screening and management pathway for sexually transmitted infections. Staff incorporated a brief screening questionnaire into routine admission assessments and offered all people screening, education and treatment where appropriate. Leaders told us this initiative was being considered for wider implementation across other inpatient services due to the positive impact it had on identifying and addressing unmet healthcare needs.

Care plans were consistently person-centred and reflected people's views, wishes and goals. People told us they met regularly with their named nurse and had protected time to discuss their progress, risks, wellbeing and future plans. Most patients said staff listened to them and involved them in decisions about their care.

We saw several examples of exceptionally personalised care planning. Staff demonstrated a detailed understanding of people's communication, sensory and emotional needs and adapted support accordingly. For example, staff worked closely with autistic people to develop highly individualised care plans which detailed preferred communication methods, sensory preferences, environmental adjustments and strategies to reduce distress. This supported a consistent approach across the multidisciplinary team and enabled people to engage more effectively in their care and treatment.

Staff also showed a proactive and person-centred approach when planning care for people whose needs extended beyond the service. We reviewed a highly detailed temporary care plan developed to support a person attending a local general hospital for treatment. Staff had worked extensively with hospital colleagues to understand the person's needs and identify potential anxieties. The plan included arrangements to minimise waiting times, the use of preferred treatment environments, the availability of appropriately trained staff and specialist equipment required to support safe and effective care. This reduced potential distress and ensured the patient could access treatment in the least restrictive and most supportive way, with staff who knew them well.

The service always 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. They worked to develop evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

The service ensured people's care and treatment was exceptionally effective by delivering a wide range of evidence-based interventions and continuously developing staff knowledge and skills to meet people's changing and complex needs. Staff worked collaboratively with patients and staff across disciplines to ensure patients received timely, holistic and person-centred care in line with current national guidance and best practice.

Staff provided a broad range of psychological, therapeutic and clinical interventions appropriate to the needs of the patient group. Care and treatment were delivered in line with National Institute for Health and Care Excellence (NICE) guidance and recognised best practice. This included interventions to support people experiencing severe mental illness, co-existing mental health and substance misuse needs, eating disorders, self-harm and management of violence and aggression. Staff demonstrated a strong commitment to delivering trauma-informed care and had embedded approaches consistent with NHS England guidance.

Staff worked proactively with external health professionals to ensure people had prompt access to specialist physical healthcare. We saw evidence of effective liaison with local GP practices and acute hospital services to coordinate investigations, treatment and ongoing healthcare support. Staff ensured people's physical health needs were monitored closely and responded to changes in presentation without delay. As part of the service's implementation of Martha's Rule, staff promoted a culture of listening to concerns about physical health deterioration and ensured people, carers and families could request an additional clinical review where they felt a person's condition was worsening or not being fully recognised. This supported the early identification and escalation of physical health concerns.

Managers recognised emerging patient needs and invested in workforce development to ensure people could receive effective care within the service. For example, staff had completed additional specialist training to safely support people with disordered eating who required nutrition through enteral tube feeding. This meant a number of patients could remain and be supported at the hospital, without having to transfer and disrupt care. Where people were at risk of malnutrition or dehydration, staff closely monitored food and fluid intake and reviewed this daily to ensure prompt intervention when required.

The multidisciplinary team included a comprehensive range of professionals with the skills and expertise required to meet people's diverse needs. The team consisted of doctors, nurses, support workers, psychologists, occupational therapists, physiotherapists, pharmacists and peer support workers. Staff told us they felt supported by colleagues from different disciplines and worked together to ensure care remained as coordinated and responsive as possible.

Staff were experienced, qualified and competent in meeting people's needs. All staff completed a comprehensive induction and had regular opportunities to reflect on and develop their practice. Managers ensured all staff received clinical supervision, compliance at time of assessment was 99%. Staff received annual appraisals to review professional development and performance, compliance was 97% across the service. Staff told us supervision was meaningful and supported them to deliver the best care they could. Appraisals offered the opportunity to discuss further development and explore opportunities available in areas of interest.

Leaders promoted a culture of learning and continuous improvement through a comprehensive programme of national and local clinical audits. Audits included reviews of care plans, risk assessments, therapeutic observations, physical healthcare, infection prevention and control, the Mental Health Act and the Mental Capacity Act. Staff used audit findings to monitor standards of care and drive improvements.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. At time of assessment, compliance with this training was 94%. Staff had easy access to the trusts Mental Health Legislation team, who offered support and advice. Staff undertook routine and robust audits relating to those detained under the Act to ensure legal requirements were met.

Staff safety stored all documentation which was accessible to staff who might need to see access, including Section 17 leave (permission for patients to leave hospital). Staff ensured that patients were able to take Section 17 leave when this has been granted. Staff ensured they completed relevant risk assessments prior to the patients leaving the ward, in line with hospital policy. The trust had relevant Mental Health Act policies and procedures that reflected recent guidance which staff could access, including the Code of Practice.

Patients had access to information about independent mental health advocacy. Wards had posters displayed with contact details so patients could arrange a call or a meeting. Staff explained to patients their rights in a way that they could understand, repeated these as required and recorded when they had done this. The wards displayed notices to tell informal patients that they could leave the ward freely.

Medics requested an opinion from a second opinion appointed doctor as and when necessary.

Care plans referred to relevant aftercare services for patients who had been subject to detention under the Mental Health Act to maximise successful discharge and stability.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service worked well across teams and services to support people. Staff shared information effectively and worked collaboratively with internal and external professionals to ensure people received coordinated care throughout their treatment.

The nurse in charge of each shift provided a structured handover to incoming staff. Staff discussed each patient in turn, including their current presentation, risks, recent incidents and any planned leave, activities or appointments. This helped ensure staff had up-to-date information and could plan care appropriately.

Staff held regular multidisciplinary team meetings and daily team huddles to review people's progress, discuss risks and coordinate care. Staff told us these meetings were effective and supported joint decision-making.

Teams had effective working relationships with other services within the organisation, including care co-ordinators, crisis and home treatment teams, community mental health teams and physical healthcare services. Relevant healthcare professionals were invited to attend patients' review meetings to ensure people involved in their care remained informed and could contribute to treatment planning and discharge arrangements.

Staff worked positively with services outside the organisation. For example, they liaised regularly with a local general hospital to support a patient who required frequent hospital appointments. Staff from both services developed a clear care plan and shared relevant information to promote continuity of care and reduce the need for the patient to repeatedly explain their circumstances.

When patients moved between wards within the hospital, staff could access care records electronically. This supported information sharing between teams and helped ensure continuity of care during transfers.

The service always supported people to manage their physical and mental health and wellbeing in ways that maximised their independence, choice and control. Staff took a proactive and person-centred approach to helping people develop the knowledge, skills and confidence to manage their health both during admission and after discharge. As a result, people were better able to understand their health needs, make informed choices and sustain healthier lifestyles.

Staff recognised the close relationship between physical and mental health and worked with people to identify health risks early and prevent avoidable deterioration. They completed comprehensive physical health assessments for every patient on admission using a recognised assessment tool aligned with national guidance. Assessments provided a clear baseline of each person’s physical health and lifestyle needs, including weight, body mass index, blood glucose levels, cardiovascular risk factors, smoking, alcohol use, exercise and substance misuse. This enabled staff to tailor support and interventions to each person’s individual circumstances and long-term health goals.

People received timely physical health reviews, including blood tests and electrocardiograms (ECGs), which helped staff identify and respond to underlying health conditions at an early stage. The physical healthcare team visited wards daily and provided specialist advice, education and support, enabling people to become active partners in managing their own health. Patients told us they developed the skills and confidence to manage long-term health conditions independently. One patient with diabetes described learning to monitor their own blood glucose levels as “super helpful” because they now felt able to continue managing their condition after discharge. They had also received information about diabetes and healthy eating to support longer-term self-management.

The service supported people to make healthier lifestyle choices in ways that respected their preferences and promoted sustainable change. Patients told us staff helped them make informed decisions about food and nutrition without feeling restricted or judged. Catering staff provided a varied range of nutritious meals each day, including options tailored to individual dietary needs and health goals. Patients described how staff helped them make healthier choices while still enjoying foods they liked, which encouraged positive and lasting changes to their eating habits.

Staff were committed to reducing health inequalities and supporting people to improve their physical health. Two wards participated in a smoking reduction project. People who wished to reduce or stop smoking were offered nicotine replacement therapy, personalised advice and ongoing encouragement. Patients told us staff helped them understand the benefits of reducing smoking and supported them to set achievable goals. Some people had successfully reduced their smoking during admission, and one patient said they were motivated to “keep it up” after discharge.

People had regular opportunities to participate in physical and therapeutic activities that promoted wellbeing, confidence and social inclusion. Occupational therapists, physiotherapists, sports technicians and ward staff worked together to provide a broad programme of activities, including walking groups, Tai Chi, exercise classes, sports sessions, swimming and access to the on-site gym. Patients described positive outcomes from taking part, including improved mood, reduced frustration, increased confidence and a desire to continue exercising after discharge. An external football coach also visited twice each month, providing additional opportunities for structured physical activity and community engagement.

The service demonstrated innovation and a strong commitment to improving longer-term health outcomes. For example, it had been nominated for an award for its sexually transmitted infection research project. This promoted education, screening and treatment, and increased access to sexual health support both on the wards and through local community services. Staff told us patients who had previously declined sexual health screening had engaged with the project and accessed testing for the first time.

The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service routinely monitored people's care and treatment to help improve outcomes and ensure care remained effective and responsive to their needs. Staff used recognised outcome measures and a range of technological systems to support the delivery and monitoring of care.

Staff used recognised rating scales to assess and record people's needs, progress and outcomes. Nursing and medical staff completed the Health of the Nation Outcome Scales (HoNOS) on admission. This enabled staff to assess a person's health and social functioning and provided a framework to monitor progress during their admission. One patient told us “The staff are very good at monitoring my physical health – I have had lots of tests. They keep an eye on my weight to and help me choose healthier foods. I have lost quite a few pounds”.

Occupational therapists used the Creative Participation Assessment (CPA) to assess how people were functioning and to monitor changes over time. The assessment considered areas such as motivation, confidence, behaviour, communication, ability to complete tasks, emotional responses and levels of support required. This helped staff identify individual needs, plan appropriate interventions and review progress towards recovery goals.

The occupational therapy team also used the Activity Participation Outcome Measure (APOM) to monitor changes in people's daily functioning and occupational performance. The measure helped staff assess engagement in therapeutic activities, independence with everyday tasks, interaction with the environment and social communication. Staff used this information to inform care planning and support discussions about progress and discharge planning.

Staff used technology effectively to support the delivery of care. Electronic patient information boards enabled staff to access key information quickly and supported effective communication within teams. The trust also used an electronic prescribing system across all wards. This system included clinical safety alerts, such as allergy warnings, and reminders to support the timely administration of medicines. Staff reported this had reduced medicines related errors.

Staff recorded physical health observations using an electronic observations system (eObs). Staff told us this supported accurate record-keeping and enabled them to monitor and review physical health observations more efficiently. We saw patients who had elevated blood pressure had been reviewed more frequently which had led to a change in treatment and an overall reduction in blood pressure over time.

The service demonstrated an innovative approach to monitoring and improving physical health outcomes through its work on sexual health. The service had recently been nominated for an award for its sexually transmitted infection (STI) research project. This promoted screening, treatment and education about sexual health. Following the project's implementation, the approach had become embedded within routine clinical practice and had been sustained for approximately 9 months.

On admission, staff used screening questionnaires to identify symptoms and lifestyle factors that may increase the risk of infections. Based on the information gathered, staff offered additional blood tests, including screening for HIV and Hepatitis C, before extending testing to other sexually transmitted infections where appropriate. This enabled staff to identify potential health concerns at an early stage and provide timely interventions. Where results were positive, patients received treatment on the ward or were supported to access specialist care through the local sexual health clinic. At the time of our assessment, the trust was undertaking a formal post-implementation evaluation to assess the impact of the initiative on patient outcomes and inform future service development.

The bed management team used an electronic communication system to coordinate referrals, admissions and discharges. This supported oversight of patient flow and helped staff identify delays and monitor out of area placements daily. There was ongoing quality improvement work around patient’s length of stay. The NHSE benchmark for inpatient adult inpatient services is 60 days. Data from May 2026 demonstrated the average length of stay on all wards across the service remained below this benchmark.

The service had also introduced point-of-care testing to support physical healthcare monitoring. This enabled staff to carry out blood glucose and cholesterol checks without the need for venous blood sampling. As a result, staff could monitor people's physical health more easily and identify potential health concerns at an early stage.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service worked with people to support them to make informed decisions about their care and treatment. Staff understood their responsibilities in relation to consent and the Mental Capacity Act and took appropriate steps to ensure people were involved in decisions wherever possible.

Staff we spoke with demonstrated a good understanding of patients’ rights in relation to consent to care and treatment. They supported people to make decisions on a day-to-day basis and provided explanations when patients required additional information to understand their care and treatment options. Patients told us they were involved in decisions about their care and that staff took time to explain things in a way they could understand, enabling them to make informed choices.

Information about patients’ rights was readily available on the wards. This included information for informal patients about their right to leave the ward, information about detention under the Mental Health Act, and details of how to access advocacy services or legal advice if patients wished to challenge or discuss their detention. Information was available in a number of different formats and languages.

Staff discussed, assessed and recorded consent to admission and treatment at the earliest opportunity and reviewed this throughout a patient’s admission. Records showed staff explained patients’ rights regularly. Where a patient did not fully understand the information provided, staff recorded this and revisited the discussion later to ensure patients were given further opportunities to understand their rights and treatment options.

Where there were concerns about a patient’s mental capacity, staff completed decision-specific capacity assessments and recorded these appropriately. Records demonstrated that staff considered whether patients could understand, retain and weigh relevant information, and communicate their decisions. Where patients lacked capacity to make a specific decision, multidisciplinary teams made decisions in the person’s best interests in line with the principles of the Mental Capacity Act.

For example, in one care record we reviewed, a patient had declined to attend a local general hospital for further assessment recommended by the doctor. Staff completed a capacity assessment, discussed the risks and potential consequences with the patient, and recorded that the patient had capacity to make this decision. Staff respected the patient’s choice after satisfying themselves that the decision had been made with an appropriate understanding of the risks involved.

We reviewed records which included capacity assessments and best interests’ decisions relating to significant aspects of care and treatment. These included decisions regarding electroconvulsive therapy (ECT), accommodation and support needs, and the management of enteral feeding through PEG and nasogastric tubes. This demonstrated staff had considered all relevant information and had followed legal frameworks when they needed to make decisions on behalf of patients who lacked capacity.