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 key question has been rated as good. 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. Young people’s outcomes were consistently good and both young people and carers feedback confirmed this. Young people’s needs were assessed in a person-centred way and there was a multidisciplinary approach to delivering care and treatment.

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.

This key question has been rated as good. 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. Young people’s outcomes were consistently good and both young people and carers feedback confirmed this. Young people’s needs were assessed in a person-centred way and there was a multidisciplinary approach to delivering care and treatment.

We saw evidence that people’s needs were met in line with current guidance and best practice. We observed multi-disciplinary team discussions that involved the young person and carer in decision making and planning future care and treatment. Care plans were in place and referenced the Mental Health Act and Mental Capacity Act where applicable. Restrictions on young people were regularly reviewed to maximise their independence, with

managers recording any restrictions on a blanket restrictions risk register. The service had comprehensive timetables which included time for daily reflections called Sunrise and Sunset meetings. There were weekly community meetings and the service ensured people had access to activities and local community groups. There was a monthly newsletter which staff and young people created together to share information, updates and good practice. Staff shared this newsletter with relatives. Relatives told us they were always included and encouraged to be involved in the young person’s care and that they felt listened to. Currently the service has 4 beds on Nova Ward, designed as a Psychiatric Intensive Care Unit (PICU) but currency not commissioned. This ward is therefore undergoing discussions around plans to re-purpose the space to extend the functions of the acute care pathway. One bedroom is utilised as the Nasogastric feeding room. This allows for young people to receive treatment away from the main ward to preserve dignity and privacy. However, this is in a separate ward and a distance for a young person to come if they are distressed or refusing Nasogastric feeds. The service is looking at alternative options.

We reviewed handover documentation, minutes of staff meetings and multidisciplinary team (MDT) minutes as well as completing observations of a young persons MDT. We found that teams integrated well to support young people on the ward. The speech and language therapy team provided referral support and attended the team meetings. There was strong liaison with Humberside Police through the Mental Health Crisis Care Concordat and the Police Mental Health Liaison Officer. Also good reporting through both non-emergency (101) and emergency (999) contacts numbers when required. The Blue Light Protocol is also known locally as a Local Area Emergency Protocol (LAEP) meeting which is used in an emergency to help the ward team and commissioners identify barriers. The occupational therapy team delivered sessions during team meetings to support staff’s understanding of sensory needs. Staff were able to reflect on incidents through learning discussions in supervision, team meetings and learning from incident meetings. The compliments and comments boxes available for staff and young people were routinely reviewed for areas of improvement. We observed a multidisciplinary meeting to discuss a young person’s discharge. This was attended by a range of professionals involved in the person’s care, including external stakeholders. The meeting included discussions about observations, nutrition, leave, activities, and physical health. The team discussed feedback from the young person and developed actions to take forward.

Young people told us that their physical health was regularly reviewed. They spoke positively about weekly community meetings to discuss activities and what they would like to do, such as quizzes, day trips out, games evenings or decorating the environment. Young people's physical health needs were assessed and documented within care plans. Care plans showed that people were encouraged and supported to make healthier choices and promoted a healthier lifestyle, including encouraging activity both on and off the ward where appropriate. Staff received training to embed and develop the skills to manage eating disorders in inpatient settings. Staff told us this had been recently introduced due an increase in young people with an eating disorder requiring admission. The team worked closely with a neighbouring Child and Adolescent Mental Health Service (CAMHS) ward to acquire these skills. There was a designated clinical lead in post with an eating disorder specialism who delivered training to staff.

The service used audits to monitor and improve outcomes. Audits were in place to review number of incidents. Managers held monthly reducing restrictive practice sessions where they reviewed seclusion data, restraint data, and blanket restrictions. They told us this gave them the opportunity to share good practice and discuss national incentives. These outcomes help identify when young people are ready for discharge as reduction in restrictive practices identified improvement in young peoples mental health. Staff were recognised and given employee of the month, which was voted for by the young people.

Young people and their carers said they felt able to raise concerns and make complaints if needed. They told us they were given information regarding their rights and that communication from the ward team was good. Young people had access to an independent mental health advocates and an independent mental capacity advocate who are a legal safeguard for people who lack the capacity to make specific important decisions: including making decisions about where they live and about serious medical treatment options. Staff told us there had been no concerns raised from advocates regarding rights of young people. Staff had a good understanding of the Mental Capacity Act and how this protected young people. Young people were supported to communicate and make decisions to enable the service to deliver person-centred care and treatment in line with people's best interests. Families were also involved in decision making and planning. Care plans reflected both the Mental Health Act and Mental Capacity Act where appropriate. Section 17 leave care plans were in place. Care plans reflected the need for Nasogastric Feeding and staff documented whether young people consented to this. Gillick Competence, refers to a young person under 16 with capacity to make any relevant decision. Young people who are 16 years old and over can be presumed to have capacity to consent to treatment. Staff received training in this area which is included the Mental Capacity Act training. Compliance was 100%.