Pennine Care NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good

This meant people’s needs were met through good organisation and delivery. Patients were not moved between wards except for their benefit. Patients did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Staff supported patients with activities outside the service, such as work, education and family relationships. The service met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

This service scored 82 (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 a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff within the service had based patient care around individual needs and preferences. One example was where a young person had utilised a different preferred name. This was honoured throughout their admission to the unit in key communications such as the handovers and care plans. The unit also supported a young person and parents to formally change their name via deed poll. They had supported young people’s religious beliefs and had developed wellbeing and faith care plans to support personal preferences. Pictorial and visual representations had been used to support young people in following the correct steps in line with their communication needs relating to autism. Mealtimes had been adapted around prayer times for individuals that needed it. Nutritional care plans had been created, and separate equipment, storage and protocols had been created to ensure individual cultural needs were met.

Staff provided communication support for young people where English was not their first language and that also supported communication with the refugee councils. Visual communication fans were provided to individuals to aid communication by enabling quick, clear and structured communication to meet their needs. They are a tool that are portable and a handheld visual tool designed to help children and young people and non-verbal individuals express feelings, needs or sensory issues.

They had developed individualised pictorial personal care plans to meet the needs of young people. Examples included a ‘how to wake me up’ care plan, overwhelmingness plan and these provided staff with does and don’ts in providing care to individuals. These provided techniques and supportive strategies that staff utilised. Staff empowered young people to make their own decisions about their care and treatment. We saw evidence of this in the individualised care plans. Young people had access to feedback about the service and had regular daily meetings to highlight any issues as well as time with staff to discuss any issues.

Staff had one to one engagement with young people. This gave young people the opportunity to discuss how they were feeling or to engage in activities with staff. The matron quality assurance framework captured a sample monthly to ensure checks were in place that individuals knew who their named nurse was and that they had received 1-1 time.

When individual needs changed, staff updated care plans and risk assessments and involved outside agencies and families and carers where needed.

The ward provided low‑stimulus areas, single‑sex lounges, and dedicated spaces for activities. Quiet lounges were available for young people to relax or engage with staff in. Artwork produced by young people was displayed throughout the service. Young people’s preferences and choices about their care and treatment were recorded in care plans and were well known to staff.

There was clear and accessible information displayed regarding how young people could provide feedback and how they could access interpreter services.

The evidence showed an exceptional standard. The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

When appropriate, staff ensured that patients had access to education and work opportunities. The unit had an education centre Cloughside college,that young people accessed daily. Young people had been involved in the recruitment of staff and formed part of a panel. Young people designed their own questions, and their scoring was considered and formed part of the overall scoring for candidates. Young people were paid for their time when participating as part of young person interview panels and were supported by staff throughout the process.

They encouraged parents and carers to work around the young person’s daily timetable for their visits. Staff supported patients to maintain contact with their families and carers. There was a child visiting policy for friend visiting and at the time of the inspection there were no restrictions for family and carers visiting the young people.

Young people could access their mobile phones or ward phone during admission to keep in contact with family and friends.

Families were allowed to visit their young person in their bedroom, that provided a much more relaxed environment. Young people have fed back around the positive effects of this. Family visiting rooms were available if the young person did not want the family to visit them in their room. If young people were unable to access leave off the ward, due to issues around safety or needing further assessment, family and friends could visit and use the designated family rooms and access the garden.

If a young person had access to leave from the ward, staff encouraged and supported this to help maintain their relationships with friends and family. It also supported with discharge planning and young people being able to view their transition to life outside of hospital.

Families could attend the ward at mealtimes to eat with their young person, sitting together and keeping that family connection. Family therapy was offered to families who were facing relationships difficulties.

The education unit on site (Cloughside college) organised events every month for young people and staff. Examples were a celebration of black history, attendance at careers events for young people and raising money for various charities. Young people were involved in baking cakes and producing items to raise money for various charities. Education was encouraged and staff received as part of their induction a session with Cloughside College. Staff from the education unit liaised with the young person’s current educational provider to gather information about their current education arrangements and whether there were any special educational needs support considerations or if there were any education, health care plans in place.

Staff supported patients to access chaplaincy and spiritual care. There were noticeboards that raised awareness of the service provided. The noticeboards displayed posters which included photographs an email address and telephone number.

The service understood the diverse health and care needs of young people and their local communities, and care was joined-up, flexible and supported choice and continuity. They involved partners and commissioners who were involved with the young people throughout their stay, and which delivered services specific to individual needs and protected characteristics under the Equality Act.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

On arrival at the ward we observed CQC posters and ratings were in place and visible to people entering the building. We observed information posters and booklets relating to hospital admission were displayed in the visiting areas for relatives and those visiting young people. This included information about the service, how to raise complaints, how to give feedback and support groups for relatives. Managers checked care records and completed audits to ensure staff shared appropriate information with young people and carers. This included checking that staff gave information on Mental Health Act section rights and advocacy.

The Hope unit had a dedicated website that provided information and advice for young people and their parents and carers. This was user friendly and provided information about the unit as well as support groups. They had produced a video allowing users to access what the unit and garden areas looked like.

Staff made notifications to external bodies as needed including local safeguarding and to commissioners.

Information governance systems included confidentiality of patient records. The service complied with the Accessible Information Standards. The information provided was in a form accessible to the patient group for example, in easy-read form and pictorial on wards for people with a learning disability that were tailored to meet the needs of individual young people.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on.

Staff made information leaflets available in languages spoken by patients.

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress.

The evidence showed an exceptional standard. The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result.

There were no complaints received on Hope unit in the last 12 months. However, any complaints would receive a response from the Chief Executive, which would also be sent back to the head of quality for the relevant care hub. This would then be shared with the team(s) involved, to oversee any implementation of recommendations. These were recorded on a database to enable tracking and to inform the understanding of the quality of care being provided in the care hub and support the identification of opportunities to improve services. The trust had a patient advice and liaison service (PALS) where patients, families and carers could contact to negotiate prompt solutions to problems and help bring about changes in the way that services are developed. Contact details were on their website as well as information about complaints and complements.

Patients were involved in interviewing potential staff to the unit and were involved in coproduction of the service. An example of this was to support a business case to erect a new fence to the garden area which was approved.

The unit has a Greater Manchester child and adolescent mental health service (CAMHS) lead provider collaborative participation lead. They ensured that young people, parents, and carers were actively involved in shaping the decisions that impact their care and experience on the unit. Parents and carers had been involved and had contributed to a newly designed parent/carer leaflet. They had a lived experience parent who was involved in the training for staff on the ward and who also supported the delivery of the Triangle of Care training on carers awareness trust wide.  

The family therapy team completed a monthly newsletter that shared the ideas which had come from parents.

Parents as part of their named nurse weekly contact and weekly consultant contact could contribute to the ward round document and copies of these had been included in the newsletter. Parents had their own slot to attend these meetings and were involved in the discussions about care and treatment plans.  

Parents and carers were encouraged to complete the friends and family test to share their feedback on the service. The results were very positive praising the staff and the unit for their care and treatment. They also had access to a monthly online parent, carers support group.

They provided details of free advocacy services available to those making a complaint, who provided independent support to people raising complaints.The service also provided contact details of the Parliamentary and Health Service Ombudsman at the outset of any complaint. This meant that if people did have any concerns about the Trust’s management of their complaint, they would have the contact details of an independent organisation through which they could raise those concerns.

Young people knew how to complain or raise concerns and when patients complained or raised concerns, they received feedback. Staff protected patients who raised concerns or complaints from discrimination and harassment. Staff knew how to handle complaints appropriately and information was clearly displayed throughout the unit.

Staff received feedback on the outcome of investigation of complaints and acted on the findings. The quality and safety review visits asked a question about peoples’ confidence in being able to raise complaints. Complements were shared with all the staff on the unit by newsletters and in meetings.

The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured the needs of patients with mobility issues were met and pre assessment of their individual needs were assessed. The unit was located on the first floor, and the education unit was on the ground floor with lift and stair access. Personal evacuation plans were in place for patients that needed them. The service had an accessible bathroom/ toilet and had access to lifts.

Staff made reasonable adjustments for patients for example, people with mobility issues were provided with walking aids, shower chairs and were assessed by an occupational therapist where needed. They addressed any communication barriers that young people had and assessed their preferred communication needs.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency. The hospital was within the grounds of local acute hospital with an AE department.

Staff ensured patients had access to post-discharge care, for example, S117 aftercare, community mental health services and crisis services.

Staff planned for patients’ discharge, including good liaison with care managers/co-ordinators. Delayed discharges, due to non-clinical reasons, were supported by the multi-agency leadership meeting (MALM).We observed a MALM during the assessment. The MALM provided an escalation, solutions focussed meeting. It brought together senior decision makers, to work towards a resolution, in cases where there was a barrier or obstacle preventing a young person from reaching their agreed onward destination. Information was produced for young people their families, carers and staff to inform them of what a MALM was.

In the last 12 months, Hope unit had had 42 discharges, 10 of which have been delayed due to non-clinical reasons.

The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Care plans had been produced in coproduction with young people addressing issues around cultural needs and protected characteristics. Care and education treatment reviews were in place and reviewed regularly.

Young people could attend community meetings to express their opinions, and advocacy support was available.

Staff were trained in equality, diversity, inclusion and human rights. 98% of staff had completed their training.

Line managers had access to a Neurodivergent awareness workshop to help them identify and support staff.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff supported patients to make decisions about their care and treatment and their future. They involved young people, parents and family members in these decisions.

Staff created personalised care plans to account for the patient’s needs, wishes and feelings.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs and all young people.