Leicestershire Partnership NHS Trust

On this page

• 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

At our last inspection we rated effective as good. At this inspection the rating stayed as good.

Staff assessed the physical and mental health of all people who used crisis services on assessment, and all patients on admission to the health-based place of safety (HBPoS). Staff from both the crisis services and the health-based place of safety developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for people who used services based on national guidance and best practice. The team included or had access to a range of specialists required to meet the needs of people who used services. Staff from different disciplines worked together as a team to benefit people who used services.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff carried out comprehensive assessments of people who used their services mental and physical health needs. They were aware of the impact of social issues on patients’ mental health. We reviewed 24 care records from the crisis and home treatment teams and 6 care records from the health-based places of safety (HBPoS). All records had comprehensive risk assessments in place at the time of admission. All records for the crisis and home treatment teams had a crisis care plan in place. All patients received a comprehensive physical health assessment.

Staff formulated an initial care plan with people who used services when they were admitted into the service. Care plans were personalised, holistic and recover focused. Families and carers were able to input into care plans if the person who used the service consented. Staff reviewed and updated care plans weekly or when patients' needs changed.

At the HBPoS all patients were assessed as to whether the patient had a mental disorder and whether a further assessment for admission under the Mental Health Act 1983 was required. Staff made sure that patients had a full physical health assessment and knew about any physical health problems. Staff at the place of safety completed a physical health check as part of the core assessment and performed observations.

The service 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 and current 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 people who used services. The interventions delivered were in line with guidance from the National Institute for Health and Care Excellence (NICE). For example, staff could access psychological treatments and interventions dependent on the needs of people who used services. They could also provide medical and nursing interventions. Some teams had access to occupational therapy input to help people who used services acquire living skills. Staff in the health-based places of safety (HBPoS) made sure patients’ needs for food and drink were met.

The trust had relevant policies and procedures that reflected the most recent guidance. Staff had access to local Mental Health Act policies and procedures and to the Code of Practice. Staff were required to completed mandatory Mental Health Act training in line with the responsibilities of their role. The completion rate for this training for the Crisis Resolution Home Treatment Teams (CRHTT) was at 100% and 85.7% for the Urgent Care Hub which includes staff working in the health-based place of safety.

Staff stored copies of patients' detention papers and associated records correctly so that they were available to all staff that needed access to them. Patients in the HBPoS had access to information about their rights and independent mental health advocacy.

The service had team meetings where people who used the services were discussed. We observed several meetings across the teams in the service, and reviewed meeting minutes for the service. Staff from the CRHTT teams attended daily morning planning meetings, multidisciplinary and team meetings. They attended urgent care incident review meetings, and discussed learning from incidents at their local team meetings. The Trust held learning from death meetings where learning from this was shared with staff at team meetings. Local managers and leaders attended monthly clinical governance meetings. These included quality and safety meetings. There was a clear framework of what must be discussed at a team or directorate level in meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The team manager and matron oversaw these to ensure they were being completed.

Managers ensured that staff received the necessary specialist training for their roles. The mental health crisis teams included or had access to a range of specialists required to meet the needs of people using the service. This included social workers, psychologists and occupational therapists.

The provider had relevant policies and procedures that reflected the most recent guidance. They had interagency protocols relating to Section 136 and 135 of the Mental Health Act which had been regularly reviewed.

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.

Staff from different disciplines worked together as a team to benefit people who used rapid response and home treatment team services. They supported each other to make sure people had no gaps in their care. They had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.

Staff held regular multidisciplinary meetings to discuss people and improve their care. We attended morning planning meetings with all crisis and home treatment teams. These were attended by nurses, social workers, consultant psychiatrists, other medical staff and support staff. We observed that the different disciplines were complimentary about each other’s work and their contribution to the team.

Teams had effective working relationships with other teams in the organisation. Staff carried out joint reviews of people who used their services involving other teams such as the community mental health locality teams.

Teams had good working relationships with external teams and organisations. They worked well with the local authority services and GPs. The teams shared information with the early intervention psychosis team and substance misuse services.

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.

The service supported people who used services to live healthier lives. The care records we reviewed included support for physical health, lifestyle and wellbeing needs.

The service referred people to external organisations such as substance misuse services if there was a need.

Staff told us they had helped promote a healthy lifestyle for people who used services. For example, they would meet with people for appointments at neighbourhood cafes.

The service routinely monitored people’s care and treatment to continuously improve it and to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Managers and staff monitored outcomes for people who used services through regular audits completed using an online tool. Managers used results from audits to make improvements. For example, staff took part in clinical audits of risk assessments and care plans and medicines. At the time of inspection, the crisis and home treatment teams had recently introduced quality audits on care records. Where gaps were identified these were addressed. The health-based place of safety had an audit improvement action plan. This included improving the quality of care records and decreasing the delay in finding an inpatient bed for patients who were assessed for detention under the Mental Health Act.

We saw learning and actions were identified to improve care following audits. Staff took part in quality improvement initiatives. For example, the Crisis Resolution Home Treatment Teams (CRHTT)team completed an annual local audit on people who had self-harmed. Actions from the precious audit included a staff survey to assess confidence and knowledge on how to care for these people, and ongoing staff training.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff assessed and recorded capacity to consent appropriately when it was suspected a patient’s mental capacity was impaired. Capacity to consent was considered at each assessment and recorded in the care records we reviewed. Staff gave examples of enabling people who used services to make their own decisions about their care and treatment through discussing their symptoms and risks with them and relating them to their care and safety plans

Across the crisis and home treatment teams staff assessed and recorded capacity to consent appropriately. We reviewed 24 care records of people who used crisis services and found capacity to consent was considered at each initial assessment when people were admitted to the crisis service.

We observed 2 home visits where the staff member enabled the people that used the service to make their own decisions about their care and treatment.

The trust had a Consent to Treatment Policy. The policy showed clear expectations and responsibilities for staff regarding seeking and recording consent from people who use services. This protected people from receiving treatment without their consent.

Staff were required to complete mandatory Mental Capacity Act training, and there was a clear policy on the Mental Capacity Act. The crisis service had 96% compliance rate with this training.

Patients said they were detained in the place of safety for less than 24 hours. They were unable to recall whether staff had informed them about their rights under section 136 as they said they were very unwell at the time. One patient could recall meeting with 2 doctors and a social worker who completed an assessment. We reviewed 6 care records and saw evidence in care records that staff recorded this and had provided patients with associated documentation about their rights.