Lincolnshire Partnership 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

Responsive – this means we looked for evidence that the provider met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has remained as good as we did not assess all quality statements. Although some discharge delays were due to external factors such as housing shortages and social care delays, the trust lacked robust internal systems to drive discharge and involve people in planning their care. Care plans were often generic and did not consistently reflect individual needs, meaning coordination of care and person-centred planning for the future were not reliably effective.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We found that the service did not consistently listen to patients or involve them meaningfully in planning their care.

We spoke with 8 patients, whilst we saw patients could access their care plans on a screen in their bedroom, 5 said they had not seen a copy of their care plan.

Whilst electronic care plans contained a column where staff recorded quotes from patients about their thoughts and feelings, this information was not routinely turned into interventions for staff to follow. We found that most of the care plans were generic, as opposed to being in the patient’s voice. This meant that patients’ individual needs were not clearly addressed in their care plan, reducing the staff’s ability to provide tailored support. This also meant that care plans were more difficult for patients to engage in or use as a tool for their recovery.
 

In one case, we found a patient who had undergone an autism diagnostic assessment did not have a care plan that reflected the findings or recommendations from that report. This meant that the staff did not have guidance on how to meet the person’s individual sensory or communication needs, increasing the risk of distress and inappropriate responses in times of crisis.

We saw posters with information visible about carers champions and we heard positive feedback about this service from staff.

There were structures in place to seek and respond to patient and carer feedback, including an advocate, carer champions, weekly multidisciplinary team meetings with carer involvement (where consent was given), community meetings, and a family and friends survey provided on discharge. Staff reported that concerns raised in these forums were discussed, and complaints submitted via email were escalated appropriately. We saw there were dedicated safe spaces for carers to visit, Staff told us how they supported patients and carers to maintain connections whilst in hospital.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We found some good practice in supporting people to plan for life beyond hospital. Two patients we spoke with said that the care team had facilitated them to continue their education while in hospital, including facilitating attendance at higher education placements. This contributed positively to preparing the patient for discharge and remaining connected to their external communities. Patients who required translation support were offered choice in how they would like this support to be delivered, for example, being asked whether they wanted an interpreter to attend their ward round.

However, we also found barriers to timely and well-coordinated discharge. We found one patient who had been waiting over nine months to be discharged due to a lack of suitable housing. Staff informed us that was a lack of availability of housing and difficulties accessing social care, which were outside of the provider’s direct control but had an impact on patient flow and outcomes.

We were also informed that due to the lack of a discharge coordinator on Ward 12, staff were having to manage complex discharge tasks that were outside of the scope of their role. This meant that they were diverted from their core clinical duties and reduced time available for direct patient care, whilst also limiting the provider’s ability to prioritise safe and timely discharge planning.

Staff informed us that professionals from Community Mental Health Teams (CMHTs) did not consistently attend multidisciplinary meetings and discharge planning meetings. This meant that discharges could not always be planned collaboratively with external care teams.

Staff we spoke to said hospital avoidance plans for patients in the community were not always effective in preventing hospital admission. This meant that patients were sometimes admitted to hospital – often out of hours – despite existing community plans stating that hospital admission was not preferred or the most therapeutic option.

Although some of the barriers to discharge – such as shortages of housing and delays in social care- were beyond the providers’ control, the provider did not consistently ensure that effective systems were in place to prioritise and drive discharge planning.