Pennine Care NHS Foundation Trust

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• 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.

Staff assessed the physical and mental health of all patients 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 patients 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 patients on the ward. Staff from different disciplines worked together as a team to benefit patients. 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 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at 4 care records looked at during the assessment.

Prior to a young person being admitted to the ward the team received a copy of what is called a Tier 4 referral form from the Greater Manchester assessment and in reach centre.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Risk assessments were completed on admission as well as physical health assessments. Risk assessments were updated whenever circumstances changed. Care plans had been produced in relation to wound care, nutrition, physical health and personal care, diet and wellbeing. These were audited weekly by the named nurse for the individual patients. The assessments we looked at were comprehensive and gave a clear picture of how risks were being managed and reviewed. All young people had a formulation plan in place. Communication needs were also assessed, and they involved parents and carers. Communication cards and other ways to communicate had been assessed. However, technology was not developed to aid any communication needs.

The medical team completed a comprehensive assessment in the first 24 hours which will be completed in hours by the trusts medical team and out of hours an on-call doctor will be contacted to complete. They also completed side effect monitoring and any specialised assessments such as a waterlow assessment, venous thromboembolism assessments and any further referrals to other services such as speech and language therapists or dentists as examples, were completed. The occupational therapy team completed various assessments which included sensory profiles and needs, gym inductions, reviews of access to the building, sleep hygiene and activities of daily living. They also completed a model of human occupation screening tool.

The social worker reviewed admission information and explored what was currently in place for the young person and family, siblings and carers. They also liaised with external social care services and partners. The social worker completed parent and carer assessments. They also supported young people to apply for welfare benefits.

The psychology team completed admission questionnaires and outcome measures. They delivered formulations to the team and have input into care plans and safety plans.

The education provision completed screening on admission exploring which education the young person had been accessing prior to admission. Education staff planned support during admission such as support with examinations and discharge plans. They also liaised with external education providers and worked together to support young peoples’ ongoing education needs.

Staff developed care plans that met the needs identified during assessment. They developed these with the patients and care plans were personalised, holistic and recovery oriented. Staff updated care plans when necessary. The care plans showed clear evidence of person-centred care, with care plans presented in a visually engaging and accessible format (pictorial) that were age appropriate and easy to follow. Copies of these plans were placed on the observation boards, ensuring staff were aware of each young person’s specific needs, preferences, and goals.

Young people received 1-1 time with staff, and this was audited by the named nurses and prompted the staff to book in 1-1 sessions with patients.

Records showed that patients had their care regularly reviewed at multi-disciplinary ward round meetings led by their consultant psychiatrist and with staff attendance. Parents and young people were invited to attend for part of their meeting if they wanted.

There was evidence of discharge planning in all the records we looked at. There was evidence that patients protected characteristics had been assessed and care plans produced were specific to the needs of the individual. For example, care plans had been produced to reflect individual’s religious beliefs.

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. These included medication and psychological therapies, activities, education intended to help young people maintain daily living skills.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Clinical audits of early warning scores were completed (Paediatric Early Warning Scoring) with associated action plans to monitor implementation.

Staff on the ward implemented evidence-based guidance within their clinical practice. Some examples were, positive and proactive care, reducing the need for restrictive interventions, psychosis and schizophrenia in children and young people’ recognition and management of bipolar disorder depression in children and young people, and identification and management for eating disorders.

Assuring Transformation (AT) data was collected. This is data collection about people with a learning disability and/or autism with a mental disorder in specialist hospitals. The data is submitted by commissioners, using the NHS Digital’s Clinical Audit Platform (CAP) and the data collection is mandatory.

Staff assessed and met patients’ needs for food and drink, for specialist nutrition and hydration, and physical health checks, and audits were in place.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The matron completed a monthly matron quality assurance framework (MQA) on the unit. This was a way of checking that services were delivering safe and effective care. Alongside continually improving, highlighting risk, there were opportunities for development and escalations. They measured compliance with agreed standards, highlighted areas of good practice and shared the learning across the organisation, identifying areas of concern to be addressed by clinical services through the development of action plans.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors, psychiatrists, nurses, occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists, dieticians, activity coordinators and support workers. Family therapists and the education team were also available. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided all new staff with appropriate induction. Following the Trust induction, new starters undertook an induction checklist and local induction with their manager/team. The local CAMHS induction had been adapted and redesigned to match directly onto Quality Network for Inpatient CAMHS (QNIC Standards). In addition, a revised timetable and workbook had been designed. QNIC standards refer to the need for competency frameworks and evidence of learning. Line managers reviewed the workbooks in supervision, to ensure new starters in the service were accessing all the learning opportunities available to them.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance.

Managers ensured that staff had access to regular team meetings.

The percentage of staff that had had an appraisal in the last 12 months was 89%. This was above the trust compliance rate of 85%.

The recording and reporting of management and clinical supervision was new, and the trust expected to see performance improve as recording improved and the process was embedded. All Networks had objectives in their business plans to improve performance with targets set at 40% compliance by Q1, 60% compliance by Q2 and compliance at the trust target of 85% or above by Q3 2025/26. The trust was unable to provide an average compliance rate for staff supervision over 12 months. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers ensured that staff received the necessary specialist training for their roles. The ward manager was completing a culture of care programme. This is a programme that has been developed by NHS England that supports mental health inpatient units and is based on the Culture of Care standards. Some staff had received additional specific training to their mandatory training. Some examples of this were nasogastric tube feeding and insertion, bespoke eating disorder training, paediatric immediate life support and paediatric basic life support, skills training in suicide prevention and self-harm mitigation. The quality matron had completed the national autism trainer programme and has disseminated this to staff. The management team have also completed a three-day National Autism Trainer Programme (NAPT) Inpatient Anna Freud Autism training. Managers dealt with poor staff performance promptly and effectively.

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.

Nursing handover was held (twice daily) and again at the multidisciplinary team handover (once a day). Staff held regular and effective multidisciplinary meetings. We observed a multi-agency leader meeting (MALM) escalation solution focused meeting where the trust and partners captured all relevant information in relation to an individual young person as well as discussing discharge. The ward has a quality meeting and senior leadership team meeting.

Every morning a safety huddle was in place to review staffing for the ward. The team worked closely with the multidisciplinary team, with staff from the therapy team attending the ward to help if observations or risks escalated. Morning pathway huddles were held daily to discuss the unit, and they reviewed each patient journey. They discussed incidents, observation levels, plans for the day, any physical health concerns and any actions arising or ongoing for the team in relation to the young person’s care. Monthly team meetings were in place.

Reflective practice occurred weekly on the Hope unit with the staff team and was facilitated by the psychology team. The group aimed to enhance staff awareness of their working relationships and improve clinical practice. The group aimed to support staff in managing high levels of pressure and share lessons learned to strengthen the bonds within the team.

Staff shared information about patients at effective handover meetings within the team (for example, shift to 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).

The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs).

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 patients to live healthier lives for example, through participation in healthy eating advice. Young people fed back at weekly community meetings regarding activities they wanted as well as planning trips out. Mutual help meetings were held each evening with all patients and the staff on duty. This provided space for young people to think and plan the activities for the next day. 

Young people's physical health needs were assessed and documented within care plans and care records. Arrangements were made if young people needed to access a GP or a dentist or other healthcare. We saw the ward monitored the completion of care, education and treatment reviews (CETR). A CETR was requested by NHS England on admission. The Occupational Team (OT) completed various assessments. These included sensory profiles and needs, gym inductions, reviews of access to the building, sleep hygiene and activities of daily living. They also completed a Model of Human Occupation Screening Tool.

Ward activities helped promote a healthy lifestyle for patients, for example walking groups, sports activities and cooking healthy meals. There was a weekly timetable displayed with occupational therapy and ward activities. Young people also had supported access to gym equipment and an outside area.

Young people on the ward had made suggestions regarding more appropriate meals on the ward and this had been fed back to the catering team. There were various choices, meals that catered to all dietary and religious requirements for example Kosher, vegan, coeliac, Halal. However, one parent told us they did not provide gluten intolerant food. However, the acute trust provided a multiple allergy menu that was free from gluten but with limited choice.

Theme nights were held on the unit and young people were involved deciding what type of theme night collectively. Young people were encouraged to participate in making their own meals and had access to a kitchen area with support from staff.

Meal support care plans had been developed with young people’s input considering their needs and the support they wanted from staff. Pictorial care plans had been produced for some young people and these included how to support some young people with eating and drinking. These were written in the first person and focused on their individual needs.

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 used recognised rating scales to assess and record severity and outcomes for example, Paediatric Early Warning Scoring tools.

Hope unit had been accredited for the Quality Network for Inpatient CAMHS (QNIC) by the Royal College of Psychiatrists. The service used many audits to monitor and improve outcomes. Audits were in place to review a number of incidents. Managers held reducing restrictive practice sessions where they reviewed seclusions data, restraint data, and blanket restrictions. The care records we reviewed contained evidence of ongoing physical health monitoring. Staff completed regular audits. Assessments, care plans and risk management plans were audited to ensure they were completed and reviewed regularly. There were also environmental audits that included ligature risk audits, and audits of infection control systems, equipment and medicines. The ward manager ensured any audit findings were addressed quickly and provided feedback to the team re any outcomes of the audits.

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.

Staff took all practical steps to enable patients to make their own decisions. This was achieved by providing information on the unit and the trust provided a participation lead staff member to ensure young people were involved in their care.

Young people were involved during their assessment, and continued treatment on the unit. Advocacy was available on the unit and information was clearly displayed. Young people’s views were always listened to, and consent was always documented and recorded. We reviewed some professionals' meetings where mental capacity was assessed because of associated concerns.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding 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.

Assessment of capacity under the MHA of the patient’s capacity to consent to medication was clearly documented and patients’ rights under the MHA were audited and recorded.