Pennine Care 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 requires improvement. At this assessment the rating has remained.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The trust did not always maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 37 care records during the inspection. Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Staff did not always develop care plans that met the needs identified during assessment. 15 care plans did not reflect all the patient’s identified needs and 1 patient had no care plan at all.

Care plans were not always personalised, holistic and recovery oriented. Staff completed care plans across several different areas that were relevant to the patient’s needs including mental health, physical health and discharge. We found that care plans did not always reflect the risk identified in the risk assessments. For example, we found care plans that did not provide sufficient guidance for staff around a range of concerns, including wound care, diabetes, safeguarding and self-harm even though these had been identified as issues for patients within the risk assessments and other documentation.

Staff did not always update care plans when necessary. Care records showed that some care plans had been updated but not all care plans contained up to date information that was relevant to patients’ needs.

Staff did not always plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided 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. However, treatment interventions varied between wards. Not all wards had a psychologist, and this affected the care provided to patients on different wards. Where wards had psychologists, they carried out 1-1 work with patients and supported staff with formulations. Some wards offered groups to patients such as managing difficult emotions. Occupational therapists and activity coordinators also supported patients on the ward with functional skills, assessments and structured activities. Staff participated in clinical audit, benchmarking and quality improvement initiatives.

Staff did not always ensure that patients had good access to physical healthcare, including access to specialists when needed. Patients were referred to specialists such as physiotherapists and dieticians where required and there were physiotherapists attached to the ward. However, we identified physical health needs that were either unmet or partially met. For example, staff were not always carrying out physical health care monitoring including monitoring patient’s skin integrity, monitoring pain levels and carrying out wound assessments. Care plans did not always provide sufficient guidance to support patients with physical health conditions such as diabetes, asthma, sleep apnoea and kidney failure. Staff did not always assess and meet patients’ needs for specialist nutrition and hydration. For example, staff had not always completed fluid charts where these were required for patients.

The team mostly included or had access to the full range of specialists required to meet the needs of patients in the service. These included doctors, nurses, occupational therapists, activity coordinators and pharmacists. Some wards had an inclusion coordinator or housing officer who supported patients with practical concerns such as issues with housing and benefits, and there was a family liaison worker who supported Oak and Aspen ward. Wards had access to dieticians and physiotherapists. However, not all wards had a psychologist which meant that some wards had limited access to psychological input.

Staff were experienced and qualified but did not always have the right skills and knowledge to meet the needs of the patient group. For example, compliance for role essential skills such as the safe use of insulin was low. The service had night managers who were experienced nurses who supported night staff with any challenges during the night. Night managers moved between different locations during the night and provided support and guidance to staff.

Managers provided new staff with inductions, however there were several different templates for inductions for bank and agency staff and each contained different information which meant that not all staff had received the same information at induction. Managers told us work was being undertaken by the trust to improve inductions for staff.

Managers did not always provided staff with supervision. Staff were meant to receive clinical and management supervision separately, however there was issues with the recording and oversight of supervision which meant that senior managers were not receiving clear information as to how many staff were being supervised. There was a central system in place which aimed to record staff supervision but this was ineffective. The central supervision log did not contain the same information that managers on the wards had. The central supervision log showed that 102 staff across all wards were compliant with management supervision, 82 staff were overdue and 237 had never received a supervision. Clinical supervision compliance according to the central log showed 32 staff were compliant, 40 staff were overdue and 327 staff had never had a supervision. Staff told us they did not receive supervisions as often as they needed them. The trust had put in place objectives to improve supervision performance. 87% of staff had received an appraisal in the last 12 months.

Managers mostly ensured that staff had access to regular team meetings. Most team meetings had taken place in the last month, however there had not been a team meeting on Taylor ward since the 14th March 2025. Templates for team meeting minutes were not standardised and therefore some team meetings were more detailed than others. For example, Woodbank ward reviewed learning from incidents, quality updates and reducing restrictive practice, whereas Hollingworth ward did not cover any of these agenda items. Oak ward had a separate team meeting for night staff but there were only nighttime team meeting minutes for this ward.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. They dealt with poor staff performance promptly and effectively.

Staff did not always work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they moved between different services.

Staff did not always hold effective multidisciplinary meetings. We reviewed 6 multidisciplinary team meeting notes as part of our review of care records and found gaps in 4 of them. For example, the documentation did not always reflect whether the patient’s capacity had been assessed and we reviewed documentation that did not evidence how key risk issues for the patient were going to be addressed. This meant we could not be assured that staff were always using multidisciplinary team meetings to manage risk effectively or in an informed manner.

Staff shared information about patients at effective handover meetings within the team. We attended 2 handover meetings, staff shared key information about all patients, however staff were not always on time for handovers which meant they may not have received all the information they needed for the shift.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation for example, care co-ordinators, community mental health teams, and the crisis team.

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

Staff supported patients to live healthier lives; for example, through participation in smoking cessation schemes, healthy eating advice and sessions supporting patients dealing with issues relating to substance misuse.

Ward activities helped promote a healthy lifestyle for patients; for example, through gym sessions and exercise groups, sports activities and cooking healthy meals. One of the staff on Taylor ward was a dance instructor and offered dance sessions and some of the wards competed against each other in sports events.

The trust did not routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

Staff were mostly unable to provide us with examples of where they used recognised rating scales to assess and record severity and outcomes. For example, they were not using scales to monitor the health and social functioning of patients and were not using pain scales to monitor a patient’s pain levels where this was identified as an issue. However, staff recorded national early warning score 2 (NEWS2) to monitor patients health where there were concerns about the deteriorating health of patients. Managers carried out audits and took actions to improve care and treatment in response to these.

Staff used technology to support patients, for example staff used IPADs to support patients to communicate with their loved ones.

Staff told people about their rights around consent and respected these when they delivered person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.