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 Good. At this assessment the rating has remained Good

Good: This meant people’s needs were met through good organisation and delivery.

At our last assessment we rated responsive as good. At this assessment the rating has remained good. Staff managed beds well. A bed was available when a patient needed one. 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 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff within the service based patient care around individual needs and preferences. A patient had identified that their culture was very important to them so they worked with the ward team to develop a care plan around their culture and how they would like to be supported.

Staff encouraged patients to attend their ward rounds and meetings and to be part of that process. They provided information about treatments, medication and side effects and named nurses met with patients regularly to discuss their care and any concerns that they might have.

When appropriate, staff ensured that patients had access to education and work opportunities. Patients were supported to access the Pennine Care Health and Wellbeing College and local sessions were organised by the engagement lead to aid patients attending onsite or via Microsoft Teams. Five patients on Tatton Unit had accessed courses that have been facilitated by the Health and Well-Being College.

Staff supported patients to maintain contact with their families and carers. Patients could use the ward phone if they did not have access to their own mobile.

Staff supported patients to access their chosen place of worship within the community if patients had the approved leave and would escort them there if appropriate.

Staff made notifications to external bodies as needed including the Care Quality Commission, commissioners and the local authority.

Information governance systems included confidentiality of patient records. All patient records were stored on an electronic system.

The service complied with the Accessible Information Standard.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights and how to complain. We saw a variety of information on the patients notice boards on each of the wards.

The information provided was in a form accessible to the particular patient group. Staff provided easy read versions of information for patients who would benefit from this.

Staff made information leaflets available in languages spoken by patients. They accessed google translate services via the internet.

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress. Staff contacted carers regularly, invited them to patient meetings and updated them following incidents or changes in care and treatment. Commissioners were kept updated on any incidents or changes to note and they routinely attended the wards to conduct quality visits.

The total number of complaints in last 12 months for this service was 2.

Those complaints were still under investigation and had not yet concluded and as such there were no referrals to the Parliamentary and Health Service Ombudsman (PHSO) in the last 12 months.

Both of the complaints related to patients at Prospect Place and there were no complaints for the Tatton Unit.

A number of themes were identified within the two complaints, including lack of communication about changes in medication, concerns about leave, lack of access to psychological therapy and lack of reasonable adjustments.

Patients knew how to complain or raise concerns to staff on the ward.

When patients complained or raised concerns, they received feedback once the complaint had reached its conclusion.

Staff protected patients who raised concerns or complaints from discrimination and harassment.

Staff knew how to handle complaints appropriately. They understood the process and supported patients to document and escalate concerns through the correct channels.

Complaints outcomes were fed back through the relevant care hub so that ward staff could receive any themes or lessons learned and act on the findings.

Staff ensured the needs of patients with mobility issues were met, for example, wheelchair users were placed in bedrooms at ground level or had access to lifts. Patients with mobility issues had a personal emergency evacuation plan (PEEP) in place. For patients who had electrical scooters, the service worked with the fire safety lead and estates to find solutions to charging the equipment safely.

Staff made reasonable adjustments for patients for example, people with mobility issues were provided with walking aids, wheelchairs and shower chairs.

The service did not have adequate medical cover day and night as the trust had unsuccessfully tried to recruit to fill a vacant responsible clinician post across the low secure pathway. The service had tried to mitigate against this by providing some cover from other services to try to limit the impact on patients and staff. We could not be sure that a doctor could attend the ward quickly in an emergency. The hospital was within a reasonable travelling distance to the local acute hospital.

Staff ensured patients had access to post-discharge care for example, section117 aftercare, community mental health services and crisis services.

Staff planned for patients’ discharge, including good liaison with care managers/co-ordinators. The low secure wards produced quarterly exception reports which captured various elements of the service, including discharge, number of days delayed and further rationale as to why discharges may have been delayed.

In the last 12 months, there were 11 delayed discharges from this service. The wards with the highest number of delayed discharges were at Prospect Place, with 9 and the remaining 2 were at the Tatton Unit.

There were varying reasons for the delayed discharges including lack of suitable accommodation, awaiting transfer to prison, awaiting finalisation for funding and transitional leave and amendments to support plans.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. There was an engagement lead who was responsible for leading on Patient and Carer Engagement across the care hub and ensuring the experiences of service users’ and carers informed the delivery of services. There were weekly community meetings on each ward. The trust used a patient feedback calendar program. This program featured six themed questionnaires which were offered to patients on a bimonthly basis to feedback on their experience. Areas for improvement were identified from the results of the feedback.

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. Staff were encouraged to undertake an Equality Impact Assessment (EIA) as soon as possible at the start of a project, policy or new programme of work. Guidance and templates were available to staff via the EIA hub on the Pennine Care Intranet including a one-minute guide; template and action plan.

Staff were trained in equality, diversity, inclusion and human rights and compliance rates were at 98% at the time of the assessment.

Staff supported patients to make decisions about their care and treatment and their future. However, there were no patients on DNACPR within the wards at the time of the assessment.

Care for people who were nearing the end of their life was managed and communicated in a sensitive and dignified way. Staff highlighted an example of a patient who had sadly passed away and gave examples of how they had supported the patient and their relative.

Staff ensured that all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. This included referrals to offender management services, occupational therapy, psychology and substance misuse services along with the involvement of specialist physical health professionals.