Mersey Care 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

At our last assessment we rated this key question as good. At this assessment the rating has remained as good.

People’s outcomes were consistently good, and people’s feedback confirmed this. Staff across all locations completed referrals and obtained relevant information and arranged for interpreters if required.

Staff delivered treatment in line with national guidance. First response hubs used enhanced telephone systems to improve their service to people who needed support. Crisis resolution home treatment (CRHT) teams and health-based places of safety (HBPoS) staff ensured that consent was sought by people and patients.

The service obtained feedback from people, patients and carers to make improvements.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

During our inspection, we reviewed 33 care records of people who used Crisis Resolution Home Treatment (CRHT) teams and 16 records of patients who used the health-based places of safety (HBPoS) suites.

Staff in the (HBPoS) suites completed a referral and obtained relevant information from the police when they arrived with a patient. This included any physical health needs and extra requirements such as a translator.

CRHT staff completed a timely and comprehensive mental health assessment upon receipt of referral from Community Mental Health Teams (CMHTs), GP’s or any other professionals. In addition, a physical health assessment was completed to ensure that their needs were met if visiting CRHT’s for an appointment.

Care plans were personalised, holistic and recovery oriented. Staff reviewed care plans and risk assessment to ensure that they were patient-focused and involved views of carers if consent had been secured.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them and in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for people and patients. Interventions were recommended by and were delivered in compliance with guidance from the National Institute for Health and Care Excellence (NICE). These included medication, psychological therapies and referral to other services such as substance and alcohol rehabilitation.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Initial referral forms recorded any physical health concerns and associated treatment plans.

Staff in Crisis Resolution Home Treatment (CRHT) teams were flexible with people who used services. Appointments were changed at short notice and happened either at home or at the CRHT locations.

The health-based place of safety (HBPoS) referral form included provision for any allergies to prevent any physical health concerns.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The service used a digital telephone system for their 111 service in both first response hubs. The trust had worked alongside multiple external third party organisations to implement a new technology with the intention of providing more support to people who used the service and staff and ensuring people had access to the right clinicians.

Following the implementation of this technology, a review of data by the trust from April 2023 to December 2024 showed that there had been a 43% increase in calls handled, a 22% increase in calls answered within 60 seconds and a saving of 27,000 clinical hours.

All teams included or had access to the full range of specialists required to meet the needs of patients and people who used services. Multi-disciplinary teams included doctors, nurses, occupational therapists, clinical psychologists, social workers, pharmacists, and support time recovery workers.

Managers ensured that staff received the necessary specialist training for their roles. Staff had received comprehensive and appropriate mandatory training with an overall compliance rate of 95%. The training was appropriate for the patient group using the service.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff consistently spoke of promotion between bands. Managers emphasised the importance of ‘growing your own’ by encouraging staff development across all services. Staff also spoke of being offered development opportunities.

Managers spoke confidently about their ability to deal with poor staff performance promptly and effectively. They described different ways to do this and knew how to seek advice if required.

Managers reviewed telephone data and identified increased volume and severity of calls from people who used services at specific times of the day. Staff were given extra supervision sessions to improve their wellbeing.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

Staff knew where to seek advice on implementation of the Mental Health Act and knew who their Mental Health Act administrators were. Managers and staff made sure the service applied the Mental Health Act correctly by completing audits and discussing the findings.

During review of 12 HBPoS patient records, we found 1 patient who was detained under Section 136 of the Mental Health Act for longer than the statutory 24-hour timeframe without an extension being requested or documentation that the patient had agreed to stay there voluntarily.

The service monitored the use of the Mental Health Act, including for people from ethnic minority groups. They reported this at service board meetings and in their annual mental health report.

The service worked effectively across teams and services to support people, making sure they only needed to tell their story once by sharing their assessment of needs when they move between different services.

Staff held regular and effective multidisciplinary meetings. We reviewed the multidisciplinary minutes from the last 3 months and saw they were attended and chaired by appropriate staff and saved within clinical notes of people who used the service. Managers were aware of improvements to standardise the format and are due to introduce the same process as currently used by community mental health teams.

Staff shared information about people who used services at effective handover meetings. We attended 3 handover meetings, they were attended by members of the multi-disciplinary team, relevant clinical information was discussed such as risk, safety planning and scheduled appointments.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. We observed an emergency meeting to discuss an urgent referral from a community team to first response hubs and saw a productive discussion and agreement on appropriate actions to safeguard the safety of a person using the service.

Managers told us they continued to work with community mental health teams to enhance working relationships to proactively discuss unsuccessful referrals to Crisis Resolution Home Treatment (CRHT) Teams .

Staff across the services health-based places of safety (HBPoS) spoke of positive working relationships with police, social care and Approved Mental Health Professional (AMHP) teams. Implementation of the dedicated ‘professionals' line’ had been a significant factor in these improvements because it was a central contact point for police and AMHP teams to make and discuss referrals. Staff told us it had been a success and had avoided a lot of miscommunication with police.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients and people who used services to live healthier lives. Care plans that we reviewed included consideration of physical health and any lifestyle and wellbeing needs. Staff in the HPBoS suites signposted patients to various organisations, dependant on their needs.

Physical health was an imperative part of the treatment plan. Physical health nurses were allocated to each team and attended handover meetings to highlight concerns with any people who used services, such as mobility concerns and arranged for new equipment to be provided where appropriate. Staff spoke of healthy eating and smoking cessation initiatives and promoted these to people during appointments.

The service routinely monitored people’s care and treatment to continuously improve it and to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes through monitoring of routine outcome measures.

Staff used technology to support patients effectively by using telephone system voice analytics and call volume data to deploy extra staff at times of high demand.

Managers monitored compliance with care plan and risk assessment timescales and effectiveness through automatic interface with their computer systems.

The service told people about their rights around consent and respected these when they delivered person-centred care and treatment.

Staff took all practical steps to enable patients and people to make their own decisions. Staff spoke confidently about consent and recorded this within risk assessments and care plans. Consent of people and patients was recorded in all records that we checked for crisis home resolution (CRHT) teams with clear evidence of people’s involvement within care plans.

For patients who were brought to the health-based places of safety (HBPoS) locations, staff assessed and recorded their capacity to consent appropriately. Every record that we reviewed confirmed that patients were told their rights under Section 132 of the Mental Health Act 1983 as soon as possible. Staff recorded this within the service’s computer system and compliance was monitored by managers.

The service implemented a new health-based place of safety (HBPoS) electronic patient record form in September 2024. Since September 2024, the average length of stay in the service-wide HBPoS was just under 19 hours, within the statutory detention period of 24 hours, although this can be extended to 36 hours for assessment.

Staff received training in the Mental Capacity Act. At the time of our inspection, 99% of staff were up to date with training. Staff spoke confidently about the Mental Capacity Act and five statutory principles.

The service had a Mental Capacity Act policy. Staff told us about the policy, described how to access to it and who to contact for advice.

Our review of patient and people’s records and observation of appointments showed staff who attempted different methods to empower people who used services to make their own decisions and ensured their involved and treatment and care plans.

The service had arrangements to monitor adherence to the Mental Capacity Act.

Use of and compliance with the Mental Capacity Act was monitored, reported at service board meetings and in their annual mental health report. Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it.

Staff took all practical steps to enable patients to make their own decisions, demonstrated in care records that we reviewed.