Lincolnshire Partnership 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

Effective - 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. This key question has been rated good.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard of care.

People using the service, and where appropriate their families and carers, were actively involved in assessing needs and planning care and treatment. Relatives felt listened to, valued, and included in decision-making. One relative told us, “I am involved in my son’s care and treatment; staff really do include me in decisions. I feel listened to and when I ask for anything, the staff are always very quick to get me what I need. They recently supported us in finding a dentist who could support with our son’s anxiety. The staff helped with all the forms, and it’s been great care since.”

Staff took a person-centred approach to assessment and made reasonable adjustments to ensure people were able to participate as fully as possible in discussions about their care. This included adapting communication methods and providing information in ways that met individual needs. When people were unable to communicate their views directly, staff worked closely with families, carers, and other professionals to gain a comprehensive understanding of their needs, preferences, and risks.

Staff completed comprehensive and timely assessments that considered people’s physical health, mental health, emotional wellbeing, communication needs, sensory needs, and social circumstances. Assessments were holistic, person-centred, and regularly reviewed to ensure they remained responsive to people’s changing needs. Staff assessed people alongside clinical expertise and professional judgement to develop a detailed understanding of individual needs and to inform care planning and treatment.

Where people lacked the capacity to make specific decisions, staff acted in accordance with the Mental Capacity Act 2005 and other relevant legislation, ensuring decisions were made lawfully and in the person’s best interests. Records demonstrated clear consideration of capacity, consent, and best-interest decision-making processes where required.

Services had arrangements in place to identify and support the needs of carers and families. Carer packs and central trust carer support documents were available across LDA services, with carers leads and carer champions supporting staff awareness, audits and training within the LD Hubs.

The autism diagnostic service provided carers with information packs and access to a shortened “understanding autism” course. LD Hubs had also worked with carer experts by experience to develop and improve accessible dysphagia resources, including guidance on food modification.

ESLS assessments considered mental health, physical health and behaviours of concern, supporting a holistic and person-centred approach to assessing individual needs.

We reviewed 12 care records, all of which demonstrated that full mental and physical health assessments were completed on admission, or shortly afterwards. Care plans were holistic, person-centred, and focused on meeting identified needs and achieving meaningful outcomes. Records were regularly updated to reflect changes.

We scored the service as 3. The evidence showed a good standard of care.

Staff delivered care and treatment in line with recognised evidence-based guidance, best practice and specialist approaches for people with learning disabilities and autistic people.

Positive behaviour support (PBS) approaches were embedded within practice across services. Staff completed behavioural assessments and developed personalised support plans to help understand the function of behaviours of concern and identify proactive strategies. Interventions focused on improving quality of life, reducing distress, promoting independence and supporting people to achieve meaningful personal goals. Staff also considered the importance of capable environments, recognising that adapting the environment to meet a person’s needs could reduce distress and support more effective care.

Learning disability, autism diagnostic and enhanced support liaison services used specialist assessment and formulation to inform care planning and treatment. This included cognitive assessments, executive functioning assessments, memory and dementia assessments, forensic risk assessments, complex behavioural assessments and emotional development assessments. Psychological formulation was used to develop a shared understanding of people’s needs, risks, strengths and support requirements.

Services provided adapted psychological interventions for people with learning disabilities and autistic people. These included approaches informed by cognitive behavioural therapy, acceptance and commitment therapy, cognitive analytic therapy, schema therapy, dialectical behaviour therapy and behavioural activation. Therapies were adapted to meet individual needs, including communication style, level of understanding, sensory needs and preferred ways of engaging.

The autism diagnostic service provided post-diagnostic support for autistic adults. This included psychoeducation, post-diagnostic groups and adapted psychological therapy. The service also supported wider system learning by providing training to adult mental health colleagues on how to adapt psychological therapies for autistic people.

The enhanced support liaison service provided specialist psychological assessment, formulation, occupational therapy input and training for people with complex needs, including those at risk of hospital admission or placement breakdown. The occupational therapy pathway supported the development of functional skills, independence and engagement in meaningful activity. Communication feedback tools were used to support understanding and improve the quality of interventions.

Staff recognised the importance of supporting physical health alongside mental health and emotional wellbeing. Nutritional and hydration needs were assessed, monitored and reviewed where required. Services developed accessible resources in response to identified patient need, including easy-read eating and drinking care plans and mealtime pacing resources. These supported people to better understand their care plans, make choices, and remain involved in safe, least restrictive care.

The learning disability hubs delivered targeted interventions to support physical health, communication and safety. This included physiotherapy input, augmentative and alternative communication implementation planning, abdominal massage for people at risk of constipation, and blood-taking familiarisation resources to support engagement with physical health checks. All interventions were developed in response to identified risks and aimed to improve access, understanding and health outcomes.

Staff had access to supervision, training and clinical updates to support evidence-based practice. This helped ensure that care and treatment remained informed by current guidance, professional standards and learning from practice. Services demonstrated a strong focus on adapting evidence-based care to meet individual needs, supporting independence, promoting safety and delivering person-centred outcomes for people with learning disabilities and autistic people.

We scored the service as 3. The evidence showed a good standard of care.

People using the service, together with their families and carers where appropriate, experienced coordinated and joined-up care. Staff worked collaboratively within a multidisciplinary team that included psychiatrists, nurses, psychologists, occupational therapists, occupational therapy assistants, speech and language therapists, activity coordinators, and support workers. Care and treatment reviews involved relevant professionals from both internal and external services, helping to ensure decisions were informed by a comprehensive understanding of each person’s needs and circumstances.

Staff worked effectively across teams within the service, the wider organisation, and with partner agencies to support positive outcomes for people. Regular multidisciplinary team meetings provided opportunities to discuss, review, and update care and treatment plans, ensuring care remained responsive to people’s changing needs. We observed effective communication between team members, including structured handovers that were clear, concise, and contained relevant information to support continuity of care.

Staff maintained effective working relationships with external agencies, including social care services, community providers, primary care services, and local authority teams. Information was shared appropriately and in a timely manner to support safe, coordinated care and effective risk management. Care pathways were well managed, with clear processes in place to support people moving between services and levels of care. Discharge planning was person-centred and began at the earliest opportunity, taking account of people’s individual needs, preferences, strengths, and support networks.

Staff ensured referrals to specialist and partner services were made promptly when required, and clinical responsibilities were delegated appropriately to support the delivery of safe and effective care. This collaborative approach promoted seamless care, reduced the risk of fragmented support, and helped people access the services they needed at the right time.

Quality Statement Score: 3. The evidence showed a good standard of care.

Staff supported people to manage and improve their physical health, emotional wellbeing, and overall quality of life. Care and support were focused on empowering people to make informed choices about their health, develop independence, and engage in activities that promoted healthier lifestyles.

Staff encouraged people to take part in health-promoting activities that reflected their interests, abilities, and individual needs. This included support with physical activity, walking groups, outdoor activities, wellbeing sessions, and access to exercise opportunities. Staff promoted independence by encouraging people to build confidence, develop daily living skills, and make choices that supported their long-term wellbeing.

Staff supported people to understand the importance of healthy eating and balanced lifestyle choices. People were given information and guidance in ways they could understand, while their individual preferences, cultural needs, and personal choices were respected. One person told us, “The team always suggest better food options for our son and what weight he should be.”

The service placed a focus on physical health monitoring and early identification of health concerns. Staff worked collaboratively with GPs, physical health nurses, specialist clinicians, and other healthcare professionals to ensure people received appropriate health checks, screening, and treatment. Where required, staff supported people to access specialist services, including diabetes clinics, dental services, opticians, chiropody, and other community services.

Staff made reasonable adjustments and provided support to help people understand and engage with appointments, treatment plans, and health advice.

We scored the service as 4. The evidence showed an outstanding level standard of care.

Staff routinely monitored people’s care, treatment, and progress to ensure they achieved positive outcomes and received support that remained responsive to their needs. A range of recognised assessment and outcome measures were used to inform clinical decision-making, identify risks, and evaluate the effectiveness of interventions. This included tools such as the disability distress assessment tool (DisDAT), the autism diagnostic observation schedule (ADOS) and the national early warning score (NEWS2), where appropriate. The occupational therapy team utilised the model of human occupation screening tool (MOHOST) to gain a holistic understanding of an individual’s occupational functioning and to assess how personal, environmental, and social factors influenced their participation in daily activities. These approaches supported the delivery of evidence-based care in line with national guidance.

The service had effective systems in place to monitor outcomes and drive continuous improvement. Staff regularly reviewed care plans, risk assessments, and treatment interventions to ensure they remained up to date, person-centred, and reflective of people’s changing needs and goals. Technology was used appropriately to support the monitoring and recording of outcomes, enabling staff to track progress and respond promptly when additional support was required.

A culture of continuous learning and quality improvement was evident throughout the service. Staff participated in clinical audits, service evaluations, and benchmarking activities to assess performance and identify opportunities for development. Specialist LD Hubs had worked with digital colleagues to develop a quality audit app to support records audits. The app reduced reliance on paper-based processes, streamlined audit activity, enabled teams to focus on specific areas of interest, and supported improved analysis of themes and trends. This work had since contributed to trust-wide records audit processes, and the app was being used across different care groups.

Within ESLS, service development work had continued through the occupational therapy service development plan, which captured completed projects and planned improvements for the year ahead. This included development of community and inpatient pathways and the use of adapted assessment and safety planning tools to better meet the needs of people with learning disabilities and/or autism.

Examples of improvement work included co-produced visual versions of standardised assessment tools with people with learning disabilities, resources to support adults with autism, and an easy-read safety plan to support individuals on the community pathway. These developments helped promote accessibility, inclusion and person-centred care.

The learning disability and/or autistic people (LDA) clinical reference group provided a forum for clinicians across the care group to share best practice, review evidence-based approaches and support the development of care pathways. The group supported the implementation and review of national and regional LDA priorities, The national institute for health and care excellence (NICE) guidance, service evaluations, audits, outcome measures and learning from incidents or service improvement activity.

Benchmarking had also been used to inform ongoing pathway development. This included a productive pathways benchmarking exercise completed as part of the wider review of LDA services. The findings were considered within continuing pathway development and improvement work.

The trust had continued to participate in the national learning disability and autism benchmarking programme, which assessed progress against NHS England’s learning disability improvement standards. Year-on-year participation had strengthened oversight of improvement actions. Targeted engagement had also led to increased survey returns, particularly from staff, and the work had been expanded across the organisation rather than being limited to LDA services alone.

ESLS had also developed links with colleagues in neighbouring services, including neighbouring counties intensive community teams, to support shared learning and comparison of practice. Although direct benchmarking was challenging due to ESLS having a distinct remit, the service used national principles from building the right support and transforming care to inform service development and improve outcomes for people with learning disabilities and/or autism.

Findings from audits, reviews, and peer evaluations were used to inform service development and improve outcomes for people using services. This included updating policies and procedures, implementing recommendations, and developing action plans to strengthen the quality and effectiveness of community-based support.

We scored the service as 3. The evidence showed a good standard of care.

Staff worked in partnership with people to ensure they were involved in decisions about their care, treatment, and support wherever possible. Information was provided in a way that met people’s communication needs, enabling them to understand their options and make informed choices. Staff demonstrated a commitment to promoting independence, choice, and self-determination, supporting people to make decisions for themselves wherever they had the capacity to do so.

Staff adhered to the principles of the Mental Capacity Act 2005 (MCA) and demonstrated a clear understanding of their responsibilities in relation to consent and decision-making. Mental capacity assessments were completed on a decision-specific basis where there were concerns about a person’s ability to make a particular decision, and the outcomes were clearly documented. Where people lacked capacity, staff followed best-interest decision-making processes, involving family members, carers, advocates, and relevant professionals as appropriate. Decisions took account of people’s wishes, feelings, values, beliefs, cultural background, and previous preferences to ensure a person-centred approach.

Staff understood the role of independent advocacy and made referrals where appropriate to help ensure people’s rights and views were represented. Records demonstrated that consent to care and treatment was routinely sought, reviewed, and documented, and that people were supported to understand the implications of decisions relating to their care and treatment, including medicines.

For people subject to the Mental Health Act 1983, staff demonstrated a good understanding of the legal framework and associated responsibilities. People were informed of their rights both verbally and in writing, including through accessible formats tailored to their individual communication needs. Staff ensured people understood their rights, including their right to appeal, and this information was revisited when required, such as following a change in legal status, responsible clinician, or treatment plan.

Records showed that discussions regarding rights, consent, and treatment were consistently documented. Consent to treatment arrangements, including those relating to medicines, were completed consistently. The records we reviewed demonstrated compliance with legal requirements and reflected a person-centred approach to supporting consent and decision-making.