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. At our last inspection we rated this key question as requires improvement. At this inspection the rating has remained requires improvement. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Staff assessed the mental and physical health needs of patients on admission which meant staff had identified key physical health needs and developed a comprehensive care plan. The service provided a full range of treatment for patients. Patients had up to date care plans in place, these were always personalised, and patients were always involved in the development of their care plans. Patient’s care met their needs and reflected and protected characteristics. For example, care plans reflected dietary conditions. Staff always supported patients to lead healthier lives. We saw outdoor activity encouraged. Staff offered activities and advice to support patients with healthy eating and to take more exercise. However, not all patients had access to a psychologist, and whilst physical health care plans were generally good, we found one patient who had an underlying health need that was not being monitored.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. Care records showed that physical health assessments were on-going from admission, with weekly checks on weight, pulse, blood pressure and other aspects of physical healthcare, with the patient’s consent. Health screening tools utilised included NEWS2, Malnutrition Universal Screening Tool (MUST), as well as assessments for diabetes, cholesterol and hypertension. However, we found one patient was not having their daily fluids monitored as prescribed in their care plan and had not been for several months. We saw other examples where the taking of blood samples or ECG’s were not recorded.The Trust system prevents administration of more than the 4g of paracetamol within 24-hours and allows dose frequency to be set. However, it does not restrict a minimum 4-hour interval between doses, which may lead to doses being administered earlier than recommended, even though the total daily limit is not exceeded. Whilst all wards had a multi-disciplinary team, not all patients had access to pyschology support, for example Chorley had a limited service which was provided from the pyschology service at Ormskirk for a small number of patients, and there were a number of activity co-ordinator vacancies.We did see staff who had been seconded to cover the activity co-ordinator vacancies in some locations. Staff developed a comprehensive care plan for each patient that met their mental and physical health needs. The electronic record system allowed for more than one care plan to be prepared, and we saw that the care plans were comprehensive and being shared with patients. Staff regularly reviewed and updated care plans when patients' needs changed. They were reviewed every week and we saw patients care being discussed daily within the morning huddle. Staff followed National Institute for Health and Care Excellence (NICE) guidance when using rapid tranquilisation. However, when we examined the trust booklets for physical health aftercare post incident we did find inconstancies in reporting physical health checks. Some booklets had not recorded physical health checks or physical observation of the patient when they had refused permission for staff to carry out checks.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff made sure patients had access to physical health care, including specialists as required. We saw that patients had accessed dentists and opticians. Staff met patients’ dietary needs and assessed those needing specialist care for nutrition and hydration. Patients told us that any religious or dietary needs were met with halal food and vegan diets supported. The service had introduced a new updated no smoking policy and did employ smoking cessation workers to work with patients. The introduction of this policy meant new patients were provided with a limited number of vapes on admission to encourage cessation. There was some confusion amongst staff we interviewed about where patients could vape. We received different answers to the actual policy which allowed vaping outdoor spaces and bedrooms. Prior to our inspection there had been several incidents whereby fires had been started by patients having access to ignition devices. While we did not see any patient with such a device, we saw evidence of cigarettes being smoked within ward confines other than those permitted by trust policy. Senior managers confirmed they were aware of concerns relating to smoking and ignition sources and were putting plans in place to reduce risks across the trust.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.