Central and North West London 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.

Staff provided a range of treatment and care for patients from evidence-based national guidance and had successfully developed a new care pathway for patients with complex emotional needs. Teams worked with others inside and outside the organisation to support ongoing patient care and discharge.

At our last comprehensive assessment, published in June 2019, we rated this key question Good. At this assessment the rating has remained Good.

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 assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion.

We looked at 28 care records and saw that staff completed a comprehensive mental health and physical health assessment of each patient either on admission or soon after. We saw staff recording and discussing individual patient need in detail and how to support different patients in different ways.

At the Campbell Centre specifically, audits had been used to identify and drive improvement in care plans. The audit scored care plans across 10 different domains including evidence of patient involvement and discharge planning.

Staff used the national early warning score (NEWS) system to detect and respond to clinical deterioration of physical health. We saw regular reviews of physical health in patient records and in staff discussions, although results were not always stored clearly and easy to find on the system. Staff discussed when a patient had refused having their physical health reviewed, although we saw this was not always recorded clearly in notes.

In a small number of records, we identified that care plans around physical health needed more detail and guidance for staff. Diabetic care plans on Crane Ward lacked detail on to how to manage deterioration of diabetes of individual patients. There was a lack of detail and guidance in care plans for staff to follow to safely manage patients who were at risk of seizures.

Staff provided a range of treatment and care for patients based on national guidance. Staff participated in clinical audit, benchmarking and quality improvement initiatives.

The trust had developed a pathway for patients with complex emotional needs. At Park Royal, having this care pathway had resulted in reducing observation levels for patients. We saw that some wards had embedded a trauma informed care approach and staff could clearly describe this. Staff at the Campbell Centre were working on a project to better manage patients with complex emotional presentations.

Staff could use an electronic, contact free, vision-based monitoring system in bedrooms to measure a person's vital signs and high-risk activity. One goal was to cause less disruption to patient sleep. The trust evaluated the use of this and gathered patient feedback. The trust educated and engaged patients in the use of Oxevision, including via posters, leaflets, community meetings, via care planning and by explaining the system directly.

Staff from different disciplines worked together to benefit patients. Ward teams had effective working relationships with other relevant teams inside and outside the organisation.

Staff held regular multidisciplinary meetings, safety huddles and team meetings to discuss patients and their care. Staff had regular ward rounds where patients could attend. We observed 8 meetings and saw these had a named facilitator and clear agenda. We did note in some meetings, staff had to leave early or join late, and this disrupted the meetings and caused distractions. We observed during handovers that staff shared information about patient presentations, dynamics on the ward, planned leave and physical health.

During an inspection of the Campbell Centre in April 2023, we asked the trust to ensure that handover meetings were effective, and that staff were aware of patient risks at the start of each shift. During this inspection, we saw the service had introduced new templates to support this, for safety huddles and audits. Some staff told us there was space to improve communication between staff even more.

Relatives told us they attended ward rounds and found them informative and helpful.

Patients had access to staff who could support them with meeting the patients social care needs and support with contacting external agencies. For example, a housing officer was involved where needed.

Wards held patient discharge meetings to involve patients and families in discharge plans. We saw deep dive discharge meetings in some patient notes with community mental health teams attending. Despite this, several patients across wards told us they would like more ongoing information about their pathway to discharge and treatment goals. Feedback from carers and relatives about the discharge process was mixed. Some said it was well planned, and they were involved. Others said there were last minute changes that were not communicated well to the family and had some negative impacts on the patient.

During an inspection of the Campbell Centre in April 2023, we asked the trust to ensure that staff received training on conditions presented by all patients. During this inspection, staff now had access to training in supporting autistic people and trauma informed approaches, including communication skills. We saw that patient notes outlined how to support autistic patients, which included information and involvement from families.

Where the trust had identified specific areas of learning needed from incidents and challenges, they had delivered face to face scenario, skills-based simulation training for specific staff groups.

Ward teams included or had access to a range of specialists to meet the needs of patients. This included nurses, healthcare assistants, doctors, psychologists, occupational therapists, activity coordinators, gym instructors, dieticians and speech and language therapists. At some sites, vacancies meant staff were working with a larger number of wards and patients than planned.

Staff supported patients to consider healthy activities and choices by supporting them to take part in programmes or giving advice. Most wards had a gym patients could use under supervision from a trained member of staff. At Riverside, we saw patients signing up to classes and doing work outside in the garden. The occupational therapist at Northwick Park offered a diabetes and healthy eating group.

Occupational therapists and activity co-ordinators delivered a range of activities, including evidence based therapeutic activities. For example, creative writing, drawing, drama therapy, outdoor games, gym sessions. Despite this, most patients and some relatives told us there could be more activities for patients to engage with during their care. Some staff said the ward would benefit from more activity coordinators. Some staff said achieving the right balance between meaningful activity and risk management and therapeutic care was something they discussed. Patients told us they were aware of activities on the ward, but some said they didn't always want to take part in them.

Staff supported patients to consider stopping smoking where needed.

Staff used recognised rating scales to assess and record severity and outcomes. The trust had a quality priority to better define and demonstrate outcomes. Each team had at least one patient reported outcome measure. The trust had a strategy in place to support services within the trust where outcome measurement was not well developed

Staff had access to technology to support patients effectively. For example, some wards had a tablet patients could use if they could not access their phone. Video calls were used to include families and carers in conversations about care, where appropriate.

Staff worked with patients to enable them to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.