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.

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.

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

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed 12 care records during the assessment.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. This covered all aspects of their health and social needs, including risks being identified promptly, enabling the development of an individualised care and treatment plans in line with NHS England Low Secure Service Specifications and Royal College of Psychiatrists Quality Network Standards for Forensic Mental Health Services.

The assessment process was multidisciplinary, recovery-oriented, and trauma-informed, aiming to promote safety, wellbeing, and rehabilitation from the point of admission.

Staff assessed patients’ physical health needs in a timely manner after admission. The doctor carried out a physical health check on each patient which included blood testing ECG, weight and discussion about any ongoing identified physical health issues such as the management of diabetes. There were ongoing physical health checks on a weekly basis.

Staff developed care plans that met the needs identified during assessment. This included care plans for physical health issues such as asthma and diabetes.

Of the 12 care plans that we reviewed, all were personalised, holistic and recovery-oriented and contained crisis plans. In 9 out of 12 care records the patients voice was evidenced in the documentation.

We saw that staff updated care plans when necessary and there was a record of whether patients were consenting to relatives’ involvement.

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 and, activities, training and work opportunities intended to help patients acquire living skills.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. The GP visited the wards three times per week and referrals were made for specialist healthcare as and when required.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. A patient had been placed on a fluid balance chart to monitor their fluid intake to ensure that it was not too high.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Quality matron monthly assurance visits had been implemented across the trust. Quality matrons used the findings of these audits to work with ward teams to improve quality.

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 and nurses, there was a social worker, psychologists, assistant psychologists, occupational therapists and activities coordinators. However, there were reduced responsible clinicians available due to a vacancy and this was impacting on all wards. Staff told us that they were having to wait longer to receive responses regarding clinical issues and patients were waiting longer to see their responsible clinician outside of routine ward round days.

Staff were experienced, qualified, and generally had the right skills and knowledge to meet the needs of the patient group. However, some of the mandatory training levels were low and we could not be assured that all staff had been adequately trained in all of the required areas.

Managers provided new staff with an appropriate induction (using the care certificate standards as the benchmark for healthcare assistants). There was a robust induction process in place and all staff had to complete this before starting work on the wards. This covered the corporate induction, security induction and the local ward induction.

Managers provided staff with supervision to discuss case management, to reflect on and learn from practice, and for personal support and professional development and appraisal of their work performance. The trust had recently made some changes and improvements to supervision processes and had implemented a new system for supervision and it was expected that compliance rates would improve when the system was more embedded within the service. The percentage of staff that received regular supervision was 65% at Prospect Place. This was provided in line with the trust supervision policy and compliance was above the trust target. However, supervision compliance at the Tatton Unit was below the trust compliance target at 44%.

Managers ensured that staff had access to regular team meetings. There was a standing agenda and all staff received a copy of the meeting minutes.

The percentage of staff that had had an appraisal in the last 12 months was 92% on the Tatton Unit, 86% on the social inclusion ward at Prospect Place. 93% on the assessment and engagement ward at Prospect Place and 97% on the recovery and intervention ward at Prospect Place.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Learning needs were discussed at appraisal and supervision.

Managers generally ensured that staff received the necessary specialist training for their roles.

Managers dealt with poor staff performance promptly and effectively through performance management plans.

Mental Health Act

Training compliance in the Mental Health Act was at 70% across all four wards. This was below the providers target of 90%.

Staff that we spoke with had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were and how to contact them.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. This were accessed via the staff intranet.

Patients had easy access to information about independent mental health advocacy. There were posters and leaflets on each of the wards and the advocates visited the wards regularly to see patients.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We saw evidence in the patient records that this was being carried out effectively.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records including section 17 leave forms, correctly and so that they were available to all staff that needed access to them. Records were stored electronically and any paper records were scanned onto the system.

The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. The Mental Health Act staff routinely audited the use of the Mental Health Act and any actions required were escalated to ward staff

Staff held regular and effective multidisciplinary meetings. These were held monthly and attended by all disciplines, external professionals and family members where the patient had agreed this.

Staff shared information about patients at effective handover meetings within the team. There was a handover at the start of each shift and a daily staff huddle at which all information relating to patients was discussed.

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. Managers and staff had actively engaged with commissioners, local police, local authorities, social services, and Healthwatch, as well as community and other forensic teams, to support safe transitions and the improve patient experience.

Staff supported patients to live healthier lives, for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. At the Tatton Unit there was an electronic exercise board which was available to all patients who wished to complete ward based exercise.

Ward activities helped promote a healthy lifestyle for patients, for example walking groups, sports activities, cooking healthy meals and access to a dietician. Patients had access to a gym on each site.

Staff used recognised rating scales to assess and record severity and outcomes including Health of the Nation Outcome Scales (HoNOS). Thisis a method of measuring the health and social functioning of people with severe mental illness.

Staff used technology to support patients effectively including prompt access to blood test results and online access to self-help tools.

Staff took all practical steps to enable patients to make their own decisions

For patients who might have impaired mental capacity, we saw in patient records that 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. An example of this was a patient who needed a capacity assessment around money management in relation to some debts accrued. In this case he was found to have capacity and was supported to carry out his wishes in relation to the debt.