Humber Teaching NHS Foundation 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

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 the rating has remained good.

Good: Staff assessed the physical and mental health of all people on admission. They 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 based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of people on the ward. Staff from different disciplines worked together as a team to benefit people. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. 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 assessed mental and physical health needs holistically and there was a multidisciplinary approach to delivering care and treatment. We looked at 4 care records and found staff developed plans that met the needs identified during assessment. Relatives told us they were involved in providing information about their relatives and confirmed that the hospital worked with other services involved in their care and supported them with external appointments. One external partner told us, “Staff will ensure clients feel listened to, validated and able to express their feelings.” Care records were reviewed monthly or after any changes. They included observations, evidenced regular physical health reviews were taking place and evidence of contact with external partners such as GP’s, dentists, physiotherapists, advocates and social workers.

The service had plans to develop a physical health team by upskilling and empowering health care assistants to take on physical health roles and responsibilities.

The service supported staff with relevant training and provided us with information regarding an awareness session on intensive interaction, which enabled staff to learn how to use these skills effectively with the people they supported.

The care records were mainly person-centred, with clear discharge goals and ongoing review of needs and abilities. One person we spoke with told us how they were involved in creating their care plans and how they wrote parts themselves and liked to use colours and stickers of things they liked. Despite this good practice, we found some inconsistencies with the language used in some care plans which highlighted a need for proof reading or auditing to ensure consistent and clear language was used throughout.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. 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, including psychological therapies, occupational therapeutic activities, opportunities for education and tutoring intended to help people acquire living skills. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence.

The team included or had access to the full range of specialists required to meet the needs of people in the service. As well as doctors, nurses and healthcare assistants, the service had an occupational therapist and assistant, clinical psychologist, pharmacist, speech and language therapist and dietician.

Staff ensured that people had good access to physical healthcare, including access to specialists when needed, such as dentists, GPs and the acute hospital.

Staff assessed and met people’s needs for food and drink and for specialist nutrition and hydration. We spoke with the speech and language therapist during our on site inspection who told us about supporting a person with eating and the use of aromatherapy to help stimulate hunger. Communication plans were developed and the speech and language therapy team developed training for staff and audited the communication support provided on the wards.

Staff were experienced and qualified, and they were mostly receiving the training and knowledge to meet the needs of the patient group. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff had recently completed training in Playfulness, Acceptance, Curiosity and Empathy (PACE) model which helped to foster positive feelings and emotions through playful interaction, and this was being embedded into the service to improve the way care was delivered to people. The service also provided a list of specialist training to be delivered as part of the induction process which included trauma-informed care, positive behaviour support, dysphagia and signing training.

Managers told us that the wards implemented the Safewards model (the objective of the model is to reduce conflict and containment within mental health services). Staff told us they used the BUILD feedback model (a structured approach to giving feedback that encourages positive behaviour through respectful communication).

Managers provided new staff with appropriate induction, training and shadowing opportunities to ensure they were confident and competent within their role.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. We saw evidence that staff received regular supervision and over the previous 12 months the average was 91%. Staff also attended twice weekly reflective sessions as part of their supervision. The percentage of staff that had had an appraisal in the last 12 months was 100%.

Managers ensured that staff had access to regular team meetings, morning and evening handovers, morning safety huddles on both wards. There was a weekly health care assistant forum so staff were able to bring any concerns or ideas for improvements. We reviewed minutes of nurse meetings and clinical inpatient meetings and agendas which were thorough including topics such as safeguarding, lessons learnt, incident reviews, feedback and celebrating successes.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Managers told us relevant guidance from the National Institute for Health and Care Excellence was reviewed, updated and fed back to the team.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

Staff received mandatory training in the Mental Health Act however, at the time of the inspection 69% of staff had received this training which was below the trusts target and had been for the preceding 5 months. Staff we spoke with did have a good understanding of the Mental Health Act, the Code of Practice and the guiding principles and they had easy access to local Mental Health Act policies and procedures and to the Code of Practice that reflected the most recent guidance.

Staff also had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

People had easy access to information about independent mental health advocacy. We received feedback from the advocate who visited the service regularly. The advocate informed us that advocacy support is encouraged, staff listen to any concerns or views and wishes raised on behalf of people and they take these into account. We were also told that Care and Treatment Reviews (CTRs) were conducted regularly and keyworker referrals made. We did not identify any concerns regarding people being explained their rights under the Mental Health Act.

Staff ensured that people were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. However, we received feedback from staff and external partners that this can often be dependent on staffing levels and when the leave requires a vehicle, this can be dependent on whether there is a member of staff who drives, being available.

Staff requested an opinion from a second opinion appointed doctor when necessary.

The service had compliance audits in place to ensure staff provided evidence-based care and treatment, including treatment under the Mental Health Act 1983.

Quality Statement Score: 3

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 and effective multidisciplinary meetings, which included people and families as partners in their care. The service held weekly core group meetings and monthly review meetings for all people. The trust also had a Multi-AgencyDischargeEvents (MADE) which were in place to support improved patient flow across the system, recognise and unblock delays, and challenge, improve and simplify complex discharge processes. The service could escalate any concerns to support and improvepatientflowanddischarge.

Staff shared information about people at effective handover meetings within the team. We reviewed minutes from handovers and daily meetings, which included the handover of information such as immediate actions for people, planned activities, appointments, maintenance and documentation such as observation forms and diet and fluid charts.

The teams had effective working relationships with teams and organisations outside the service, for example adult safeguarding teams, intensive support team, community mental health teams, physical health services, social workers and other community services. The team had also developed good relationships with the police and senior leadership met with the police to discuss a consistent police response when required.

Care records evidenced regular contact with partners. We received feedback from external partners who told us that the multi-disciplinary team at Townend Court, “work jointly with other professionals that are involved in client’s support such as health, education, mental health housing and community teams”.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. 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.

We saw evidence in care records that staff supported people in terms of managing any physical and mental health risks, dentistry, monitoring food and fluids managing and reviewing medications. We were informed that annual health checks were to be carried out by a nurse from a local community healthcare provider. Any actions after these health checks would require a best interest meeting for any people lacking capacity to consent to any treatment.

The service had easy read posters regarding healthy eating in the service, and they informed us that meal choices aligned with individual health needs, dietary requirements, preferences and cultural considerations.

We were also informed that ward activities helped to promote a healthy lifestyle for people and that activities were individual needs led, for example walking, sports activities, including access to the gym and swimming and working with people regarding budgeting and healthy meal planning.

However, we received some feedback from staff and external partners who informed us that people’s independence was not always supported. For example, best interest decisions had been made and care plans created to support a person to live a healthier lifestyle, but we observed and were informed that this was not consistently applied.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We spoke to the team about outcomes for people and we were given some examples about meeting their needs and their goals, for example changes to a person’s medication had improved their mental health, reduced incidents and enabled them to access a day service facility 3 days a week. The 2 relatives we spoke with told us they were happy with the progress their family members were making.

The service focused on using audits to review numbers of incidents and any use of restraint. This data was used to make changes to peoples care plans and the staff’s approach to meeting needs. Records indicated that incidents overall were reducing. Staff also used rating tools to complete risk assessments and positive behaviour support plans.

The hospital ensured that staff completed mandatory training on learning disability and autism and the staff team were 96% compliant with this training.

We spoke with the occupational therapy team who told us that were no specific standardised assessments or standardised outcome measures in place. The leadership team informed us that they were reviewing and devising some patient led outcome measures for the inpatient service and the community so that they were able to assess and review the improvement and differences over time, but this was not in place at the time of our assessment.

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 we spoke with were trained and had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Training compliance at the time of our inspection was 95%.

We looked at 4 care records which demonstrated consideration of a person’s capacity to consent. Capacity assessments were carried out as appropriate and were both time and decision specific. Records demonstrated that best interest decisions were carried out, when appropriate and involved the person's family or advocate.

The service conducted regular reviews for people and had a flexible approach to any restrictions it imposed on people. Audits were in place to monitor consent and Mental Capacity Act practices to ensure they were only in place when necessary.

People had access to advocacy. The independent advocate we spoke with told us that people were supported to maintain relationships and understand their rights. Practices regarding consent and record keeping were actively monitored and reviewed to improve how people were involved in making decisions about their care and treatment. The service engaged with people who use services and their relatives and other carers, to make decisions based on a person’s best interests and ensured these were made in accordance with legislation and people’s wishes, feelings, culture and history.