Cambridgeshire and Peterborough 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.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Mental Health Act and Mental Capacity Act ComplianceMental Health Act

The service admitted people under the Mental Health Act 1983. At the time of inspection people were detained on the ward for treatment. People’s observation levels by staff could vary from general observations, 1-1 or 2-1 staffing. The person on the ward at time of our visit was on general observations.

Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice. Staff could describe the Code of Practice guiding principles. This training was initially provided as part of the induction process and thereafter staff had regular refreshers. On the ward 100% of staff were compliant with their training in the Mental Health Act.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice.

The service had clear, accessible, relevant and up to date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. Staff explained to people their rights under the Mental Health Act in a way they could understand, repeated as necessary and recorded it in peoples notes each time. Staff discussed with people their rights including, the right to appeal against detention, information on the Mental Health Act and mental health advocacy, information was available in easy read documents for people.

Staff stored people’s detention papers and associated records correctly and staff could access them when needed.

Staff ensured people were able to take section 17 leave (permission for people to leave the ward) when this had been granted. The use of leave from the ward or hospital was discussed and agreed with the multidisciplinary team.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act. The training was initially provided as part of the induction process and thereafter staff had regular refreshers. On the ward 91.6% of staff were compliant with their training in the Mental Capacity Act.

Staff did not always update and assess capacity to consent clearly each time a person needed to make an important decision. Staff took all practical steps to enable people to make their own decisions. Staff completed an assessment on admission of each person’s capacity to consent to admission and treatment.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

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.

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

Staff completed a comprehensive assessment of people in a timely manner at, or soon after admission. Staff regularly reviewed and updated this assessment at regular time points during their stay at the service.

We reviewed minutes from multidisciplinary meetings, these evidenced people’s care and treatment being reviewed by the multidisciplinary team, people and their carers with a person-centred approach being taken to meet people’s needs.

Records showed that staff assessed people’s communication skills and needs and provided information in a way that was tailored to those needs. For example, the ward timetable had easy read versions with pictures. Psychology had created ‘grab sheets’ which was a guide to getting it right for each patient. It included the persons routine, their conditions, dos and don’ts when talking to the person, sensory issues, and likes and dislikes. This ensured that every staff member would easily be able to know how to support the patient effectively in a person-centred way.

Staff assessed people’s physical health needs in a timely manner after admission, and this was reviewed regularly during their time at the service.

The provider 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 provided a range of care and treatment interventions suitable for the patient group.

The National Institute of Health and Care Excellence (NICE) recommends that services supporting autistic people should have access to psychosocial interventions for support with managing the core features of autism and building upon life skills. For example, people should have a group or individualised based social learning programme and/or a group of individual activity programme. Where the person may also communicate distress through behaviour, positive behaviour support plans should be used. People had a positive behaviour support plan; there was a grab sheet and a more detailed plan. Staff met with people and carers regularly to review these plans. Staff we spoke to said they were aware of these plans, had access to them, and found them helpful.

The service provided therapeutic activities and support with life skills, facilitated by occupational therapists and psychologists.

People told us there was a good choice of activities which were focused on their interests. For example, a wordsearch was created containing words that related to washing machines as this was the person’s specific interest.

Staff assessed and met people’s needs for food and drink.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff had regular and effective multidisciplinary meetings. There were professionals involved in the assessment and review of people’s health, care and treatment, wellbeing and communication needs. Professionals were engaged in reviews and assessments.

Staff shared information about people at effective handover meetings within the team. Nurses and healthcare assistants shared information at the end of each shift. The multidisciplinary team met regularly to review risks and incidents.

The ward team had effective working relationships with other teams within and external to the organisation. They worked closely with the community team; this included a consultant psychiatrist which worked across both inpatient and the community. This ensured continuity of care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff made sure people had access to physical health care, including specialists when required. People could access healthcare appointments that were unplanned, such as accident and emergency, because staff and leaders had devised support plans that worked for people.

The provider 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.

Staff monitored people’s health, their mental state and wellbeing.

At daily handover meetings, staff noted details of people’s sleep, food and fluid intake, personal hygiene, compliance with medication and engagement in activities. Any changes in a person’s presentation were discussed at the multidisciplinary meetings.

In addition to formalised outcome measures, the service sought feedback and suggestions from people, relatives, carers and staff to support the identification of service development.

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

Staff assessed people’s capacity to consent to admission and treatment. Staff did not always assess people’s capacity for specific decisions throughout their care and treatment. We saw evidence that 2 people’s mental health had improved since admission, however only 1 person’s capacity assessments had been updated.

In a person’s care record, we saw evidence that if people lacked capacity to make a specific decision, staff made decisions in their best interests, recognising the importance of the person’s wishes and involving their carers.

Staff took all practical steps to enable people to make their own decisions. People made their own choices and decisions on a day-to-day basis about what they did, what they ate and how they filled their time.

We observed staff mainly communicating with people about their choices, using simple sentences. People had easy read documents to support with communication but mainly preferred to communicate verbally.

Carers told us staff explained consent, confidentiality and how they share information.