Gloucestershire Health & 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 our judgement framework has rated this as good. However, we identified some areas of concerns at our assessment.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, well-being and communication needs with them.

We reviewed care records for each of the three people during the assessment.

While the records contained a lot of information, this sometimes made it difficult to access key details quickly.

Care plans did not always fully address identified needs. For example, in one person’s file, staff used a clinical hold despite the care plan identifying a medical condition that might make this unsafe. This indicated a gap between care planning and staff practice, potentially compromising the person’s safety.

Care plans were not consistently recovery-oriented, nor were they always updated when necessary. For instance, following a self-harm incident the care plan was not updated to include plans to prevent this occurring again.

A serious health condition was not fully considered. For example seizure records did not consistently link to person-centred care plans to ensure the person’s safety.

A Positive Behavioural Support (PBS) plan noted people liked to take items apart, but there was no exploration of items offered to dismantle and whether this would be meaningful to them.

When a person refused a planned trip out, there was no record of what happened next, what alternatives were offered, or when. In MDT meeting minutes relatives reported that people might be bored. Staff responded that activities had been offered but refused, but there was no further exploration or documented plan addressing the reasons or next steps.

Short-term goals noted in MDT minutes, such as a trip to Cotswold Water Park,often lacked documented follow-up. For example, in the June 2025 MDT minutes, it was noted a goal to visit a garden centre in March, but it was unclear from the records whether this goal was met, how successful it was, or what the next steps were.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983and the Mental Health Act Code of Practice and discharged these well Staff provided a range of care and treatment interventions suitable for the people supported, following guidance from the National Institute for Health and Care Excellence (NICE) related to learning disabilities. These included medicines and psychological therapies.

Staff ensured people had good access to physical healthcare, including referrals to specialists when needed. The multidisciplinary team (MDT) included or had access to the full range of specialists necessary to meet people’s needs. The MDT comprised representatives from the Integrated Care Board (ICB), individual support workers, clinicians, and Independent Mental Capacity Advocates (IMCA).

Managers ensured new staff received appropriate induction and provided regular supervision to support case management, reflective practice, professional development, and personal support. As of June 2025, the supervision completion rate was 95%.

Staff had access to regular team meetings, with minutes made available to those unable to attend. Learning needs were identified by managers, who provided opportunities for staff development. For example, healthcare assistants received training on autism and developed by the advanced nurse specialising in autism and learning disabilities.

Staff were trained in and demonstrated a good understanding of the Mental Health Act, its Code of Practice, and guiding principles. They had easy access to administrative support and legal advice regarding the Act’s implementation and knew who the Mental Health Act administrators were. The provider had relevant policies and procedures aligned with the most recent guidance.

People had easy access to information about independent mental health advocacy.

We scored the service as 3. The evidence showed a good standard. 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 held regular multidisciplinary meetings, where each individual’s needs and progress were discussed in detail.

Information was effectively shared during handover meetings within the team, ensuring continuity of care.

The team maintained strong working relationships with other relevant teams within the organisation. They worked closely with the Learning Disability Intensive Support Services within the Trust and the Community Learning Disability Team.

The teams fostered effective working relationships with external teams, such as commissioners and the new providers identified.

We scored the service as 2. The evidence showed some shortfalls. The service did not always support people to manage their health and well-being, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The service now had a dietitian to assist people in making healthier food choices. However, it was not always clear how these choices were reflected in people’s day-to-day lives, as the food picture cards were limited and did not include images of snacks.

Some activities supported a healthier lifestyle, such as cycling and trips to the beach. However, the frequency of these activities did not fully maximise the potential for people to live healthier lives.

However, physical health was monitored weekly with a yearly annual health check. A health check called a MUST check was completed weekly and patients were weighed weekly. Their physical health was discussed at MDT and LIFE meetings.

We scored the service as 2. The evidence showed some shortfalls. The service routinely monitored people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff used recognised rating tools, such as Health Equalities Framework (HEF)to assess and record outcomes.

They also used the National Early Warning Score (NEWS2) to monitor trends and physical health indicators, which were reviewed monthly. These included health concerns such as podiatry issues, menopause treatment, and dental health needs. The team had regular safety meetings to review outcomes., these included MDT meetings and LIFE meetings.

As stated elsewhere in the report some outcomes and actions were noted, the overall analysis lacked consistency and formal documentation. It was often unclear how conclusions had been reached, and there was limited evidence to show that all contributing factors had been fully explored and learned from.

We had mixed feedback from the patient`s relatives about the effectiveness of the service. Some relatives spoke very positively about their experience, praising the staff team for working consistently and supportively to achieve good outcomes. However, others expressed less satisfaction, describing the person’s experience as sometimes "very boring".

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff assessed each patient’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings. Records showed that these assessments covered the four elements of capacity.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.

Relatives did not raise any concerns about how consent to care and treatment was managed.