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

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.

The service admitted people under the Mental Health Act 1983. Five patients on the ward at time of our visit were informal and 3 patients were detained under Section 3 of the Mental Health Act. All patients were on Level 1 observations.

Staff received and kept up to date with training in the Mental Health Act.

On the ward 100% of staff were compliant with their training in the Mental Health Act Level 1, and 91.67% of level 2.

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

However, it was not always clear that informal patients were made aware of their right to leave the ward at any time. Information on informal patient rights to leave the ward was not clearly displayed.

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.

Staff received and kept up to date with training in the Mental Capacity Act.

On the ward 100% of staff were compliant with their training in the Mental Capacity Act Level 1, and 72.73% of level 2.

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.

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.

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.

The dietician assessed each patient and reviewed meal plans regularly. We saw evidence that the dietician worked with carers to discuss food preferences and any foods which were a trigger for the persons eating disorder. They also assessed the level of need for post meal support and supervision.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the patient group. This included therapeutic activities.

Staff told us they worked within National Institute for Health and Care Excellence (NICE) and Medical Emergencies in Eating Disorders (MEED) best practice guidelines. Evidence based psychological interventions such as, individual eating disorder focused cognitive behavioural therapy (CBTED) and Maudsley anorexia nervosa treatment for adults (MANTRA) were available. Having a range of professionals including dieticians and psychology working together enhanced staff understanding and safe management of dietary restriction or restrictive practices, problems arising from severe and enduring illness and compensatory behaviours such as over exercising.

People told us there was a timetable of activities, that were mandatory to attend and if not attended they would be unable to access 1:1 therapy. Some activities were focused on their individual goals; for example a body image group. Most were generic skills.

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 by sharing their assessment of needs when people moved between different services.

Staff had regular and effective multidisciplinary team (MDT) meetings Professionals involved in all aspects of patient care and treatment were included.

The MDT worked together to assess and review patients. They also met regularly to review risks and incidents. Staff shared information about people at handover meetings within the team. However, 1 patient told us sometimes important information about their wellbeing was overlooked.

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 who worked across both inpatient and the community. This ensured continuity of care.

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, reduce their future needs for care and support.

They offered advice and guidance as part of their treatment. Patients had access to dietitians within the service who supported patients with dietetic assessments, meal support programmes and healthy eating advice.

All groups and therapy sessions were focussed on health and wellbeing, due to the nature of the service. For example, there was a recovery pathway which Occupational Therapy supported. Patients were supported to learn to prepare meals and then build up to eating out with their support.

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.

Staff monitored people’s health, their mental state and wellbeing. Staff followed NICE guidelines, along with MEED Guidelines.

The occupational therapist used the model of human occupation screening tool (MOHOST), The MOHOST is an occupational therapy assessment that evaluates a patient’s occupational participation by looking at 6 key areas: Motivation, Habituation (patterns), Communication/Interaction skills, Process skills, Motor skills, and the Environment, helping therapists objectify data, track progress, and guide interventions.

If a patient was on the meal preparation pathway occupational therapy would start by completing an eating and meal preparation assessment (EMPSA) to establish where the patient is with their motivation and capabilities, they then reviewed this mid-way, then again at the end of their therapy.

The psychologist used routine outcome measures (ROM) to track patients’ progress.

Two out of 4 patients we spoke with told us they had been in other eating disorder services prior to the admission on S3 ward, but that they felt they had experienced the most significant improvement while on this ward.

At daily huddle 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.

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-centred care and treatment.

At the time of our visit there was a mixture of patients on section 3 of the Mental Health Act and informal patients. Staff understood the need for engagement in therapeutic activities as part of the treatment pathway and observed patient attendance and engagement levels over time.

We observed staff mainly communicating with people about their choices, using simple sentences.