Lancashire & South Cumbria 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.

This is the first assessment for this newly registered service. This key question has been rated good.

Staff assessed the physical and mental health of all patients 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 patients 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 patients on the ward. 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.

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.

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.

We reviewed 20 care records during the assessment. Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.

Staff assessed patients’ physical health needs in a timely manner after admission to the ward. A full physical examination, as well as a full set of bloods were part of the admission process by the ward doctor. We saw evidence of ongoing monitoring, in particular blood pressure and pulse were checked daily (more if required) and weight was checked weekly (again, more often if required). Physical health was also discussed during initial assessment by the community teams and on an ongoing basis, although this was understandably in a less formal manner than by the ward teams. Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery oriented. Staff updated care plans when necessary.

Quality Statement Score: 4.

We scored the service as 4. The evidence showed an exceptional standard. The service always 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. They worked to develop 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. The service offered specialist training that enhanced the care they provided to patients, this training was for all staff for whom it was relevant for their role.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication and psychological therapies and activities. The teams worked in line with the perinatal quality network guidelines.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. The National Early Warning Score (NEWS2) system was used on the ward to identify when a patient’s physical observations indicated medical intervention may be required. Patients requiring admission to an acute hospital were supported with this without undue delay. In the community, patients would generally be encouraged to seek support from their own GP for physical health issues, but anything linked to the patients care and treatment would be overseen and referrals made if required.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The teams all included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, the teams comprised of occupational therapists, psychologists, social workers, pharmacists, speech and language therapists, and peer support workers. Peer support workers were people who had previously used services and had gone on to work within the service alongside patients. This allowed patients to speak with people who had lived experience of perinatal services.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers provided new staff with appropriate induction.

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 reviewed team meeting minutes for all of the teams we visited for the 3 months leading up to our inspection. We found that managers ensured staff had access to regular team meetings and support.

The percentage of staff that had had an appraisal in the last 12 months was between 80-95% across the 4 teams.

The percentage of staff that received regular supervision was between 84-93% across the 4 teams.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers also ensured that staff received the necessary specialist training for their roles. There was a large number of training opportunities available to the specialist perinatal teams. These included, Institute of Health Visiting infant mental health training, Flourish training for managers, Perinatal Quality Network special interest training days, training around autism in perinatal women, compassion focused therapy, and dialectical behavioural therapy skills training. The Parent infant practitioners were trained in baby massage and baby bonding. Some staff were also trained in video interactive guidance; this was where staff would film the mum with the baby and use snippets of the recording to feedback positive interactions between mum and baby. Some staff had accessed specialist risk assessment training for perinatal services, and some staff had accessed the Perinatal Level 7 course at the University of Salford. The teams also had strong links with their midwifery colleagues who provided training on physical health in pregnancy.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

Over 95% of staff had received training in the Mental Health Act.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff 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.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. Patients had easy access to information about independent mental health advocacy. Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff on the ward ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.

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

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

The ward displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment (if applicable).

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

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. We observed these during our inspection and found they included the patient and if appropriate their partner or family. We found that multidisciplinary meetings were effective in planning the treatment and care of the patients, patients and their loved ones felt included in the process and were clear on the purpose of the meeting.

Staff shared information about patients at effective handover meetings within the team (for example, shift to shift or at the beginning of the day for community teams). There were daily safety huddles whereby staff discussed the risks for patients, any incidents over the last 24-48 hours and for the ward, any planned leave or appointments that day.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. For example, the crisis teams, early intervention services and community mental health teams for working age adults.

The teams had effective working relationships with teams outside the organisation. For example, the local safeguarding team, midwives, health visitors and GP Practices.

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, reduced their future needs for care and support.

Staff supported patients to live healthier lives – for example, through healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse.

Ward activities helped promote a healthy lifestyle for patients – for example walking groups, sports activities and supporting patients to cook healthy meals.

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.

Staff used recognised rating scales to assess and record severity and outcomes. On Ribblemere ward, staff used several different tools to monitor outcomes for patients. These included, the post birth questionnaire, the CORE-OM ((Clinical Outcomes in Routine Evaluation – Outcome Measure), Clustering tool and the Patient-rated Outcome and Experience Measure (POEM).

Staff used technology to support patients effectively. For example, for prompt access to blood test results and online access to self-help tools.

Quality Statement Score: 3

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 took all practical steps to enable patients to make their own decisions

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history