Devon 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

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

The service required improvement in how it ensured delivery of effective care across its forensic inpatient wards.

One ward lacked a clearly defined care pathway.

The quality and consistency of assessments and care planning varied, and care plans were not always person-centred or reflective of current needs. People did not consistently feel involved in planning their care.

Although a wide range of outcome measures were in use, there was limited evidence that data was systematically used to evaluate the effectiveness of interventions or drive quality improvement. The service lacked a structured audit and evaluation framework to support continuous learning and development.

However, people received timely assessments on admission, and these covered a broad range of needs. People were well supported to manage their physical health, with good access to healthcare professionals and structured health promotion initiatives. Care and treatment were generally informed by national guidance. And a range of psychological and occupational therapies were available.

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.

The quality and depth of assessments varied, and inconsistency at times impacted the effectiveness of subsequent care planning.

While risk assessments were completed on admission, they were not always updated in response to changes in presentation or following incidents. This meant that some care plans were based on outdated or incomplete information, which posed a risk to the delivery of safe and responsive care.

People who used the service had care plans, but they were not consistently person-centred or reflective of individuals’ current needs, risks, or preferences. In many cases, care plans lacked detail and did not demonstrate how the person’s assessed needs would be met. This limited their usefulness in guiding staff to deliver effective and personalised care. Although the multidisciplinary team (MDT) contributed to the development of care plans, people who used the service did not consistently feel involved in their care planning. Several people told us that their care plans did not reflect their personal goals or were not shared with them in a meaningful way. This reported lack of involvement reduced opportunities for shared decision-making and collaborative care.

Care records were generally well documented; however, inconsistencies in the use and organisation of the electronic patient record system sometimes made it difficult for staff to access the most up to date information quickly.

These findings contributed to an action plan request for person-centred care.

However, all people who used the service received initial assessments on admission, and these were generally completed in a timely manner. Assessments covered a broad range of domains, including mental health, physical health, and social needs.

There was evidence that care and treatment were informed by National Institute for Health and Care Excellence (NICE) guidelines and other national best practice standards. However, the guidance used was not always the most up to date, and there was limited oversight to ensure that staff consistently applied the latest evidence and guidance in their practice. Staff told us it was their individual responsibility to remain informed about current guidance and to apply this in the care they delivered.

On Holcombe Ward, there was no clearly defined ward purpose, admission criteria, or care pathway, which created uncertainty about the therapeutic direction and goals for people on that ward.

People using the service had access to a range of psychological therapies, including group and one-to-one interventions focused on communication, anger management, anxiety, and depression. These were delivered by the psychology team, and most people who used the service confirmed that these interventions were available to them. The occupational therapy team also provided assessments and support with activities of daily living, contributing to a holistic model of care.

All staff delivering therapeutic interventions had received appropriate training and were supported through supervision and reflective practice. This helped to maintain a baseline of competence and professional development across the team.

There were no significant gaps in treatment provision, although temporary staff sickness had led to some delays in access to therapies or education. The service had plans in place to manage this and did not anticipate it would be a long-term issue.

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.

People who used the service were well supported to manage long-term physical health conditions. Physical health needs were assessed on admission, and a small team of physical health nurses provided ongoing monitoring and treatment. Routine physical health checks were carried out and well documented. Staff were aware of how to escalate concerns about physical health, and people who used the service told us they had access to appropriate interventions and support.

The service promoted healthy lifestyles through a range of structured interventions and health promotion initiatives. All people who used the service were offered lifestyle advice by the ward medic on admission, with referrals made as needed. Interventions included smoking cessation support, physical activity programmes, community-based support, and a physical health group. Health promotion materials, including posters and leaflets, were visible across the wards and encouraged engagement with healthy eating and other wellbeing initiatives.

There was good access to physical healthcare professionals, coordinated by a dedicated physical health lead. The forensic inpatient and secure wards at Langdon Hospital had a service-level agreement (SLA) with a local GP surgery, and people using the service could also access optometry, podiatry, and dental services. While not all services had formal contracts, regular clinics were arranged to ensure access, particularly for people without community leave. For example, optician appointments were held every six months, podiatry clinics ran bi-monthly, and dental services were provided through 18 sessions per year. Diabetic people were prioritised for retinal screening and foot care.

Overall, the service demonstrated commitment to supporting people’s physical health and wellbeing, with structured interventions and access to appropriate professionals.

Overall, while the service collected a wide range of outcome data, the lack of structured audit, evaluation, and quality improvement processes meant that it could not demonstrate how this information was used to improve care.

Despite the range of outcome measures, there was limited evidence that data was consistently used to evaluate the impact or effectiveness of therapeutic interventions. While some outcome data was reviewed in clinical forums, we didn’t see evidence that there was an audit or evaluation framework in place to assess whether interventions were achieving their intended outcomes across the service. This limited the service’s ability to identify trends, benchmark performance, or drive improvements.

There was some evidence of feedback and data being used to inform service development. However, these processes were not embedded within a broader quality improvement framework. Staff and service users were not consistently involved in structured quality improvement initiatives, and there was limited evidence of changes being made in response to outcome data or feedback.

However, the service had a wide range of outcome measures capture mechanisms across disciplines, including occupational therapy, physical health, psychology, pharmacy, and social work. These included both patient-reported outcome measures (PROMs) and clinician-reported outcome measures (CROMs), such as the Hospital Anxiety and Depression Scale (HADS), Goal-Based Outcomes (GBOs), the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and Model of Human Occupation Screening Tool (MOHOST). Physical health outcomes were also monitored through structured assessments such as blood pressure, heart rate, and respiratory measures. These tools supported a recovery-focused approach and were reviewed in ward rounds and Care Programme Approach (CPA) meetings.

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.