Avon and Wiltshire Mental Health 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

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 the young people in the service. 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 patients based on national guidance and best practice. The team comprised the full range of specialists required to meet the needs of the young people in the service. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Good: This meant peoples’ outcomes were consistently good, and peoples’ feedback confirmed this.

We rated this key question good because:

• Young people had care plans that staff reviewed regularly.
• We saw that staff reviewed the young peoples’ mental health during their initial assessment.
• Staff offered care and treatment based on the latest best practice guidance.
• Staff had good links to external teams.

However:

• Young people were not always involved in care planning or given a copy of their care plan.

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.

We reviewed 9 care records during the inspection and saw that all of them included a timely mental health assessment. Seven of the 9 records also had a completed physical health assessment and ongoing physical health monitoring when needed. We saw that in 2 of the 7 records staff had noted there were no identified physical health needs. The records also included physical health monitoring that was being caried out via the agreement with the local NHS hospital.

Eight of the records we checked had care plans in place that staff reviewed regularly and 1 did not have a care plan present. We discussed this with staff, and they told us it was because the young person was in hospital. However, the team was supplying regular in reach support.

The service offered a broad range of treatments to the young people. Treatments included occupational therapy, and psychological therapies including drama, music and art therapy.

The service demonstrated a focus on using evidence-based practice. Staff remained up to date with their professional development and multi-disciplinary team (MDT) meetings supported effective clinical decision-making. There was a weekly psychiatry referral meeting, twice-weekly MDT forums for case discussion and formulation, and a weekly eating disorders MDT meeting. The service also utilised specialist pathways, such asCAMHS Intensive Outreach Team (CIOT), to provide more intensive outreach support and interventions including Dialectical Behaviour Therapy (DBT). Staff also told us that parents and carers challenged professionals to keep up to date with their practice. The provider carried out internal assurance visits that included reviewing practice to ensure the teams were following best practice guidance.

Staff told us they received regular supervision and annual appraisals. Managers used appraisals to identify and agree training needs for staff for the year. At the time of the inspection the appraisal rate across the 3 teams was 82%. Staff told us that managers would approve training outside of the appraisal process, but staff needed to be up to date with their mandatory training. There was a good professional development programme in place and a session that occurred during our inspection was well attended by staff.

Mental Health Act

All staff received training in the Mental Health Act at the time of the inspection, 95% of staff were up to date with their training. Staff we spoke to had a good understanding of the Mental Health Act and the Code of Practice.

Staff we spoke to told us that the teams worked hard to avoid the need for admission to hospital under the Mental Health Act. The team worked at developing bespoke packages of care to meet the individual needs of young people rather than relying on inpatient admissions. The service maintained highly collaborative working relationships with other service providers to help reduce admissions. The staff worked hard to keep admissions rates remained low despite the high demand for the service. For example, the eating disorder team had two admissions annually.

When young people were admitted to inpatient settings, staff kept in contact with them and the ward team and worked with the inpatient staff to plan effectively for the young person’s discharge back to the community team.

The trust had relevant policies and procedures in place to support staff. Staff could get advice about the Mental Health Act when needed.

There were regular multidisciplinary team meetings (MDT) to discuss the young peoples’ care. We observed an MDT meeting and saw that they were effective in reviewing the young person’s care to ensure they received the most appropriate treatment. Staff encouraged the young people to complete a ‘My Voice’ statement so that their views were included in the meeting. However, staff had not asked the young people if they had any questions for the care team.

Staff we spoke to told us there were good working relationships between colleagues in the local team and we saw this in the MDT meeting we observed. Staff told us that they had good working relationships with colleagues in different teams and organisations. For example, the local acute hospitals and local authority safeguarding teams.

The service had a number of primary mental health specialists who work in community settings including schools, the CAMHS front door ‘Getting Advice’ or were embedded within social care teams. Staff reported this improved the outcomes for young people it worked with.

Staff promoted healthier lifestyles and could give advice about healthy eating and exercise. They had an agreement with the local children’s hospital to complete health screening and would work with young people if any follow up treatment was required.

Staff used outcome measures to monitor the effectiveness of the care and treatment provided to the young people. For example, the Revised Children's Anxiety and Depression Scale (RCADS) was used to record a baseline and then review progress against this. They also agreed goals with the young person and then reviewed this with the young person so they could identify their progress.

Staff encouraged young people to make decisions for themselves. We saw that staff had recorded that the young people had consented to treatment in 8 of the 9 records we reviewed. Staff received training in the Mental Capacity Act which included training in Gillick competence. Gillick competence is when staff assess a young person under the age of 16 as being competent to make decisions for themselves. There was a section in the electronic record for recording Gillick competence and we saw that in 5 of the 9 records we reviewed staff had considered this with the young people.