Pennine Care NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of the legal regulation relating to involvement of people using the service and their families (Regulation 9).

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 treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Staff attitudes and behaviours when interacting with patients showed that they were usually discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. Most of the patients we spoke with said staff were kind and respectful and most of the comments about staff received through the NHS Friends and Family Test in the 6 months preceding our inspection were positive. However, we did see some instances on the wards for people with organic mental illness, such as dementia, where care was provided in a task-focused manner, with no or minimal interaction with the individual receiving care. Some staff and patients told us that staff did not have time to sit down and chat with patients. Some of the patients we spoke with told us that staff did not always knock before entering their bedrooms or that the observations checks at night disturbed their sleep due to staff shining a bright light on to their bed.

Staff did not always support patients to understand and manage their care, treatment or condition. Some of the patients we spoke with told us that they had not been given information about their care on the wards and/or that they would not know who to ask if they had any questions. Care records contained minimal evidence of discussions taking place with patients to support them in understanding their care and treatment and to identify their views and preferences. However, records did usually include records which confirmed that patients were being reminded of their rights under the Mental Health Act, when they were detained under the Act. On the wards for people with an organic mental illness, such as dementia, patients were not always able to clearly communicate their needs verbally and, due to a lack of communication care plans for these patients, we were not able to see what arrangements were in place to support these patients to understand their care as much as possible.

Patients mostly said that staff treated them well and behaved appropriately towards them. However, some patients told us that a member of staff had spoken to them unkindly or had handled them roughly while providing care. This feedback was shared with managers at the time of the inspection and a safeguarding referral was made where the information shared by the patient raised concerns of this nature.

Staff did not always understand the individual needs of patients, including their personal, cultural, social and religious needs. Patients’ care plans did not always include information about their holistic needs and some of the patients and relatives we spoke with said that people’s personal needs were not always met on the wards, for example not having access to spiritual support of their choosing or to culturally appropriate food. During our observations of care, some temporary staff were not aware of patients’ individual support needs which led to them having to continually ask substantive staff members to share this information, which was then shared in front of other patients, which also meant that confidentiality of information about patients was not always maintained.

Staff said they were aware of the process for raising concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

The trust did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service made some adjustments for disabled patients. All the wards were fully accessible to wheelchair users and people with mobility impairments and some written information could be provided in alternative formats such as large print and Braille. Some of the wards for people living with dementia were decorated to make them more dementia friendly, for example with each bedroom door being a different bright colour to help patients find their room, and all the dementia wards had dementia friendly information, for example signs with large type and pictures as well as written words. However, patients did not always have their specific, individualised communication needs fully assessed and included in the planning and delivery of their care. Patients did not have communication care plans on their records to support staff in meeting their individualised needs, including when patients were unable to verbally communicate their needs due to their mental illness.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and other relevant information. This was clearly displayed on noticeboards on all the wards we visited and most of the patients we spoke with told us they knew how to raise concerns about their care and access advocacy support. The information was provided in a form accessible to the particular patient group and some leaflets were available in languages other than English to support patients who had a different first language which was prevalent within the areas covered by the wards. Managers usually ensured that staff and patients had easy access to interpreters and/or signers, however we were told that there could be challenges in accessing interpreters to attend ward rounds.

Patients usually had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. The patients we spoke with told us that they were usually able to access menu choices which met their individual needs. However, some patients and relatives said that patients were not always able to access culturally appropriate food.

There were systems in place for patients to access spiritual support from a diverse chaplaincy service. Information about this was displayed on noticeboards on all the wards. However, these systems were not always effective as some of the patients we spoke with told us that they had not been able to access spiritual support although they would have found this helpful. Some of the wards did not have a dedicated multi-faith area and some were using this area for another purpose, such as equipment or stock storage.

The trust did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

The provider did not always promote patients’ independence, so patients did not always know their rights and have choice and control over their own care, treatment and wellbeing. Patients did not usually have person-centred care plans on their records to support staff in maximising their independence as much as possible. Patients were not consistently empowered to have their say about things that were important to them, for example community meetings were not taking place regularly on some wards and we saw evidence in the minutes of previous meetings that issues were being continually raised by patients (for example a lack of one to one sessions with named nurses) with no evidence of action being taken to respond to this feedback. However, we did see in ward rounds that patients received accessible information about their care and had space to express their views. On some wards, patients did not have a key to their own bedroom and bedrooms were locked during the day, so they were dependent on staff support to enable them to access their rooms. This was not always provided in a timely manner while we were observing care.

Where patients were detained under the Mental Health Act, we saw evidence that they were regularly reminded of their rights as required by s132 of the Act and this was documented on their care records. However, records did not show whether informal patients were reminded of their rights, such as their right to leave the ward, and we spoke with an informal patient who was not fully aware of their rights.

Where patients needed support to maintain their independence due to physical or sensory impairments, we saw that staff usually provided this. Patients with mobility impairments had access to the equipment they needed to mobilise independently around the wards, such as wheelchairs and walking frames. However, during some of our structured observations on the wards, we saw staff failing to respond in a timely manner to direct requests for support from patients where physical frailty prevented them from meeting their own needs independently. Where patients were physically able to leave the wards (and had been granted community leave under section 17 of the Mental Health Act where required), we saw from records and patients told us that they were able to access this and use their leave to maintain their independence, for example through shopping for their own food items and seeing friends and family.

The trust did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff were aware of and dealt with any specific risk issues, such as falls or pressure ulcers, relating to each individual patient. Patients had risk assessments on admission, including specific assessments including the Malnutrition Universal Screening Tool (MUST), moving and handling assessments and Waterlow tissue viability assessments (relating to people’s risk of developing pressure ulcers). However, patients did not usually have person centred care plans on their records to support staff in meeting their individual needs and we did see some instances of staff being unfamiliar with patients’ needs and delays in patients’ expressed needs being responded to during our time on the wards. Some patients told us they had to wait for staff to support them with personal care at times and we also observed this happening during our structured observations on the wards when there were staff who were not engaged in other tasks who could have supported them more promptly. On 3 occasions our inspectors had to prompt staff to respond to patients who were requesting support.

Staff did not always identify and respond to changing risks to, or posed by, patients. We saw some care records where people’s needs had changed, for example due to deteriorating physical health, and their risk assessments and care plans had not been reviewed, and it was not possible to see from their daily notes that their care had been adapted to meet their current needs. However, most of the staff we spoke with told us that they were informed of each patient’s current needs during shift handover meetings. We observed several handovers at which information about the patients’ needs and any changes to their care was shared with the incoming staff team. Records were kept of handover meetings, although we saw that these did have gaps for some patients. Some of the patients we spoke with told us that their care needs, for example support with personal care, were not always promptly attended to by staff.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. Staff received de-escalation training as part of their prevention and management of violence and aggression training and the staff we spoke with told us that they would always attempt to verbally de-escalate an incident before resorting to physical restraint. Staff and patients told us that restraint rarely happened on the wards and the provider’s data showed that levels of physical interventions were low on all wards.

The trust did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff felt respected, supported and valued. Most of the staff we spoke with said they felt valued by the trust as an employer. The trust had a number of systems in place to support staff in feeling valued for their contribution including email bulletins relating to staff achievements and an annual staff awards ceremony.

Staff had access to support for their own physical and emotional health needs through an occupational health service. Some of the staff we spoke with told us that they had been able to access support, such as counselling, through the trust’s wellbeing service. The trust’s data showed that 25 staff from the older people’s wards had self-referred to this service in the 6 months preceding our inspection. However, some staff members told us that there was a long waiting list for the wellbeing service which had meant that some staff members who had been involved in an investigation which been challenging for them were not able to access support at the time they needed it. The trust had implemented wellbeing initiatives on the wards, which included provision of free yoga and reiki sessions for staff, staff engagement sessions and staff training modules relating to health and wellbeing.

Staff turnover was low (under 3% on average in the 6 months preceding our inspection) on all wards. In the 6 months preceding our inspection sickness absence figures were above the trust’s target of 5% on 7 out of 9 wards. Some of the staff members we spoke with told us that they were experiencing work-related stress, for example due to staffing pressures or the impact on substantive employees of a high level of temporary staff working on the wards. Some staff members told us that they had been injured at work and the trust’s data showed that 74 staff injuries occurred in the 6 months preceding our inspection, the majority of which (70%) were on the wards for people with organic mental illness. Staff on these wards were not receiving any additional support relating to the potential impact of their working environment on their health and wellbeing.

Staff appraisals included conversations about career development and how it could be supported. The staff we spoke with about career development told us that they felt well supported and were able to access training and experience to enable them to progress within the organisation, such as leadership training for managers.