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 outstanding. At this assessment the rating has changed to good.

Staff assessed the physical and mental health of all young people on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for young people based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of young people on the ward. Staff from different disciplines worked together as a team to benefit young people. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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

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

We reviewed 4 care records during the inspection. Staff completed a mental health assessment of each young person either on admission or soon after. This included an assessment of the young person’s capacity to consent to admission and treatment.

Staff assessed young people’s physical health needs on admission and regularly reviewed their physical health during their time in the service. Leaders arranged additional training for staff as need arose. For example, staff had training in nasogastric (NG) tube feeding to ensure the needs of young people were met safely. Leaders were in the process of arranging tissue viability nurses to provide specialist training on wound care.

Staff developed a care plan for each young person that met their physical and mental health needs. Care plans were personalised to the individual and were holistic. Young people were involved in the development of their care plans and on an ongoing basis. Young people’s voices were evidenced throughout the records we reviewed. There was also evidence of carer involvement. Care plans were written in a way that was easy for people to understand.

We scored the service as 4. The evidence showed an exceptional standard. 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.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). Care and treatment involved therapeutic activities, prescribing medicines, individual psychology and group therapy.

Some interventions offered went beyond standard practice. For example, there was a dedicated family therapist who provided therapy sessions for young people and their families. This involved assessment, formulation and evidence-based interventions. The occupational therapist was a sensory integration practitioner, which meant they were able to assess and treat the sensory needs of young people. Young people were provided with a sensory box that was personalised to their individual sensory needs.

The service followed a least restrictive approach to young people’s care and treatment. Psychology staff met with young people, carers and staff to obtain feedback on the approach. Themes from the findings included; increased choice and control, developing responsibility for safety, reducing trauma, building trust and developing coping skills and independence. The service’s least restrictive approach prioritised long-term therapeutic outcomes through empowerment, skills development and positive risk-taking.

Staff supported young people to develop a better understanding of their condition. This included support to help young people manage their emotions. Young people were supported to access education and employment opportunities. There was a school on site which young people attended during term time. School staff supported young people to explore career pathways and options. One carer told us their loved one was supported to attend a local college once per week.

Staff ensured that young people had good access to physical healthcare, including access to specialists when needed. The service had a specialty doctor and some paediatric nurses within the multi-disciplinary team (MDT) and staff regularly monitored physical health.

Leaders ensured that staff had access to regular team meetings. Team meetings had a set agenda including safeguarding, restrictive interventions, safety alerts and training. Staff documented any actions resulting from meetings, which were completed promptly. Leaders ensured important information was communicated effectively to staff.

Staff used technology to support young people’s care. This included video calls with relatives and external professionals during meetings about their care.

Staff took part in clinical audits and quality improvement initiatives. The service conducted numerous monthly audits which included documentation, medicines management and therapeutic observations. Areas for improvement and good practice were documented and shared with staff.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Leaders provided new staff with appropriate induction. Leaders identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

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 held regular and effective multidisciplinary meetings. All young people were discussed and seen by the multidisciplinary team (MDT) in weekly ward rounds. Young people participated and shared their views about their care and treatment. Carers and external professionals were invited to attend. Representatives from young people’s schools in the community attended ward rounds if they knew the young person well.

Staff shared information about young people at effective handover meetings within the team. Handovers took place before the beginning of every shift. There was a process to escalate any concerns to leaders. Leaders discussed incidents and could organise additional support to wards if required. Staff described feeling supported by their team.

The teams had effective working relationships with other relevant teams within the organisation. For example, staff worked closely with teaching staff from the school setting within the hospital grounds. All staff within the MDT including nursing staff were complementary of one another and how they worked together to meet the needs of young people.

The teams had effective working relationships with other teams outside the organisation. For example, there were robust processes in place for safeguarding young people, and the service had developed positive working relationships with the local authority. Staff worked well with external teams involved in young people’s care, such as care coordinators and child and adolescent community mental health teams. Staff also liaised regularly with social care professionals as part of safeguarding and discharge planning.

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.

Staff supported young people to live healthier lives in a number of ways, including through healthy eating advice. The service had a dietitian who provided support to young people and guidance to staff.

Staff identified young people’s physical health needs and recorded them in their care plans. Staff conducted checks of each young person’s vital signs in accordance with their care and treatment needs. Staff wrote progress notes for every young person covering each shift.

Staff made sure young people had access to physical health care, including specialists as required. Young people were seen promptly by a doctor when they felt unwell.

Young people fed back that staff encouraged them to make healthy living choices. Young people had access to a well-equipped gym in the on-site school, which they were encouraged to use if they wanted to.

Ward activities helped promote a healthy lifestyle for young people. The timetable and individual plans promoted a healthy routine.

However, the evening food provision offered ‘cook-chill’ meals, which meant the food was prepared in advance elsewhere. They did not always provide meals that young people were familiar with. We discussed this with leaders who told us that the trust was already considering alternative arrangements.

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 continuously monitored young people’s health, their mental state and well-being. At handover meetings staff noted details of young people’s mental state, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities.

Staff used recognised rating scales to assess and record the severity of young people’s conditions and care and treatment outcomes. For example, clinicians completed Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which is a scale to measure health and social functioning of child and adolescent mental health patients. Clinicians also used Children’s Global Assessment Scaling (CGAS) to assess how far young people’s individual goals were achieved throughout the course of their admission. Where appropriate, clinicians completed the Revised Children's Anxiety and Depression Scale (RCADS) and the Eating Disorder Examination Questionnaire (EDEQ).

Occupational therapy staff used the Child Occupational Self Assessment (COSA) tool which helped young people to understand their own capabilities regarding activities of daily living and encouraged them to set their own goals. Occupational therapy staff could adapt the assessment to meet the needs of young people.

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-centered care and treatment.

Staff assessed young people’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings. Staff assessed young people’s capacity to consent to treatment under Gillick competence where appropriate.

If a young person was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported young people to understand how the Mental Health Act applied to them and supported them to understand their right to appeal.

Staff took all practical steps to enable young people to make their own decisions. When staff felt a young person may have lacked capacity to make a decision, staff did what they could to support their understanding.

Staff displayed information about how to access an Independent Mental Health Advocate (IMHA). Young people knew how to access an advocate and told us that an advocate regularly visited the ward. Young people were complementary of the support provided by the advocate.