Hertfordshire Partnership University 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 assessment we rated this key question Good. At this assessment the rating has remained Good.

Staff assessed the physical and mental health of all people who used services 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 people based on national guidance and best practice. The team included or had access to the full range of specialists required to meet the needs of people who used services. Staff from different disciplines worked together as a team to benefit people. 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 75 (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.

We reviewed 22 care records during our inspection. Staff completed a comprehensive assessment of patients mental and physical health needs in all records we reviewed.

Staff completed an initial triage form at first contact with people referred to the service that included mental health, physical health, social care needs and an initial risk assessment. This meant that people didn’t need to repeat their stories if they were signposted to another team or another care co-ordinator.

The service delivered integrated health and social care under Section 75 arrangements, ensuring Care Act 2014 duties were embedded in assessment, care planning, and review. Staff completed holistic assessments of both mental health and social needs.

Staff developed care plans that met people’s needs identified during their assessment and care plans were personalised, holistic and recovery focussed. Staff included the views of people using the service, and their families where appropriate. Care plans included safety plans for people to follow when they were experiencing a mental health crisis, including emergency telephone numbers.

The teams at Centenary House and Oxford House were piloting an enhanced physical health check programme for people using their clozapine and depo clinics. This pilot aimed to improve people’s access to health screening, facilitate earlier diagnosis of physical health conditions and work closely with GP surgeries to follow up on screening outcomes. Staff told us that feedback from people using the service had been positive. Staff had seen improved access to bowel, breast and cervical cancer screens, diabetes screening and vitamin D deficiency tests.

The provider 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 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.

Staff provided a number of therapeutic interventions alongside prescribed medicines that included cognitive behavioural therapy, cognitive behavioural therapy for psychosis (CBTp), acceptance and commitment therapy (ACT), eye movement desensitisation and reprocessing therapy (EMDR), family intervention for psychosis, drama therapy and art therapy.

However, the average waiting time for people waiting to start psychological treatment was 29 weeks. Staff told us they kept in regular contact with people who were on the waiting list.

Teams offered group sessions including a hearing voices group, dialectical behavioural therapy groups and a walking group. People using the service could also access New Leaf recovery college, which offered a variety of wellbeing and recovery focussed psychoeducational courses.

The teams included a full range of specialists required to meet the needs of patients in the service, including consultant psychiatrists, junior doctors, nurses, occupational therapists, clinical psychologists, social workers, and art and drama therapists. Adult Community Mental Heath Service teams also included personality disorder pathway teams, drug and alcohol recovery workers and employment specialist workers. The Flexible Assertive Community Teams (FACT) offered a short, intensive outreach intervention to people who needed some additional support to prevent mental health crisis or admission to an inpatient ward.

Staff participated in clinical audit, benchmarking and quality improvement initiatives at trust level, divisional and local level. Audits included national clinical audit of psychosis, POMH-UK Use of Antipsychotic Medication for Relapse Prevention in patients with a diagnosis of schizophrenia, community treatment orders, carer and family involvement and audits of the depression, emotionally unstable personality disorder and schizophrenia pathways.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff in all teams had completed workshop training in trauma informed approaches and staff told us they could access additional training such as domestic violence awareness.

The service undertook audits to monitor compliance with requirements under Section 132 of the Mental Health Act, ensuring that people subject to Community Treatment Orders (CTOs) had their rights explained to them. 92% of people subject to Community Treatment Orders had their rights explained to them within timescale.

Staff worked effectively across teams and services to support people, by sharing their assessment of needs when they move between different services.

Staff held weekly multidisciplinary meetings where they discussed people using the service who were at higher risk of harm to themselves or others, people on community treatment orders, people currently on inpatient wards and people who had not attended appointments. Staff also discussed any incidents and safeguarding concerns, and any feedback from crisis teams and partnership agencies.

Teams held a handover meeting each morning where they discussed a ‘patient priority list’ of anyone who needed support that day, people who had contacted the duty worker and any activities planned for the day.

The teams had effective working relationships, including good handovers, with other relevant teams within the trust including crisis teams, child and adolescent mental health teams, older people’s community mental health teams, and inpatient wards. Staff routinely attended review and discharge meetings on acute wards to support people during their inpatient admissions and transition planning.

The teams had effective working relationships with teams outside the trust including the local drug and alcohol teams, local councils, police and GP surgeries.

Senior Social Workers attended monthly Social Care Leads meetings, providing a consistent forum for professional leadership, oversight, and shared learning. These meetings covered key areas including safeguarding, Mental Capacity Act, Mental Health Act, Approved Mental Health Professional (AMHP) practice, and policy updates. Learning from these was shared to teams

The service supported people to manage their health and wellbeing to maximise their independence, choice and control.

Staff supported people to live healthier lives, and we saw that people’s care plans included support for sleep hygiene, diet and weight management, drug and alcohol use and smoking cessation. Staff encouraged people using the service to access the gym and other fitness and exercise facilities.

The service supported people to manage their own health, care and wellbeing needs as much as possible. One staff member coached a football group alongside Guideposts Trust, creating a space for service users to build fitness and confidence and enjoy football.

The Service worked with partner agencies such as Herts Public Health working to improve health outcomes for service users.

The provider 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 the Health of the nation outcome scales (HONOS) and patient-rated satisfaction scales to measure the outcomes and experiences of people using the service. Staff used recognised scales such as alcohol use disorders identification test (AUDIT) to assess people’s substance use.

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

We reviewed 22 care records and saw that staff assessed the mental capacity of people using the service when appropriate. Staff recorded the informed consent to treatment of people using the service and asked their opinion and views on treatment options available.

The trust had a Mental Capacity Act policy in place and 95% of staff were up to date with Mental Capacity Act and Deprivation of Liberty Safeguardstraining.

The service provided access to an independent mental health advocacy service. Posters advertising this service were displayed in reception and waiting areas for all teams. Staff supported people using the service to access independent advocacy and could help arrange appointments.