Devon Partnership NHS 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 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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 looked at four care records during the assessment. Staff completed a comprehensive mental health assessment of each patient in a timely manner at, or soon after, admission. Risk assessments were updated every morning after the safety huddle. Legal status paperwork, including deprivation of liberty (DoLs), consent to treatment, access to leave, risk assessment, MDT and discharge plans had been correctly documented. Risk formulation was comprehensive, and included pre-disposing, presenting, and perpetuating risks, current risks risk to self and from others. Patient and carer’s voice was evident in the Positive and Proactive Support Plan (PPSP), meeting minutes and MDT records.

Physical health plans evidenced individualised physical health needs. Care plans evidenced dietary needs and preferences and PPSP were reviewed regularly. PPSP use Seligman’s (2012) evidence-based PERMA Goals framework (Positive emotions, Engagement, Relationships, Meaning Accomplishment) to support positive wellbeing. We saw that care plans included behavioural support, life skills, preventive strategies, reactive strategies, restrictive practices (including pharmacological, limited access to crockery and metal cutlery, escorted leave, vaping and finance). The service used physical intervention as a last resort. Communication passports were in place.

Discharge planning included social workers, community crisis resolution and home treatment teams and partner agencies involved with housing. Community providers attended the ward from 9am to 5pm to familiarise themselves and learn how best to work with patients.

We scored the service as 3. The evidence showed a good standard. The service 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 and current 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 unit was newly built using sensory design principles to ensure that each space within the unit had a therapeutic feel. The unit had a number of areas dedicated to supporting sensory needs. This included 2 sensory rooms and a quiet room which was also used as a therapeutic space. Similarly to the sensory room, the quiet room also had colour changing lights and other sensory functions. The service had a sensory integration gym run by OTs on the ward. The team noted that equipment in the sensory integration gym could be adapted depending on patient need. There was access to 3 communal garden spaces within the unit, divided into 'zones of regulation'. Each of the communal garden spaces contain different equipment to support patients to self-regulate based on presentation.

Staff provided a range of care and treatment interventions for the patient group recommended by guidance from the National Institute for Health and Care Excellence. We saw evidence in care plans of initiatives to reduce trauma-related tics, improved reassurance and engagement around health anxiety, medication optimization that reduced benzodiazepines. We saw pharmacy grounding decisions in evidence, occupational therapy input into safety huddles and psychology advising on motivational approaches.

Patients had access to a range of individualised activity plans and timetables for their activities. These included sensory circuits, community connection and physical activities. The service appointed a full time doctor in January to monitor the physical health of patients. Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. We saw a patient being escorted to hospital appointment for physical health related issues.

Subject to staff absence and turnover, the service had the specialist staff required to meet the needs of patients in the service. Care records evidenced contributions by occupational therapists, psychologists, doctors and dietitians. Managers ensured that staff received the necessary specialist training for their roles with continuing professional development funding evidenced within each profession, sensory integration training for physiotherapists and Vona du Toit Model of Creative Ability (VdTMoCA) training for occupational therapists.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The service held multidisciplinary (MDT) meetings weekly to review patient care and support plans were reviewed monthly for each patient. Staff noted that day to day handovers between shifts also “varied in time and quality”. Staff were not finding the time to sit down and input the required information and there was a lack of clarity around who should record that information.

Nurses told us they felt “very overwhelmed” and that HCAs “don’t feel confident to do a lot of things”, which had created a situation where “everything gets run through the nurse.” Staff told us they had noticed “things were not being handed over in handovers” which we also witnessed during the inspection.

The teams did not have effective working relationships with teams outside the organisation like GPs and social services. Local GPs had deregistered all the service’s patients on the grounds the service was not part of Langdon’s Service Level Agreement. Local GPs insisted the service’s patients remained registered with their original out of county GPs, which prevented their ability to refer patients as out of county GPs into Devon services when required. This situation had been escalated within Devon Partnership NHS and was listed on the Trust’s risk register, but in the absence of a new service level agreement being negotiated.

Following high level feedback provided at the end of the inspection the trust confirmed the Quality Improvement lead at the service will support the new interim senior nurse manager with all aspects of the action plan and culture improvement work.

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, reduce their future needs for care and support.

We saw evidence that staff supported patients to live healthier lives. One care record we looked at captured the plans to support a patient with nicotine and vaping. The support plan described how to support the patient in choosing where to vape and how to de-escalate the patient when patient was not allowed to vape in communal areas. Staff told us patients were supported to shop for ingredients and cook their own meal in the activities for daily living (ADL) kitchen.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Six patients had been discharged from the service in six months with reduced medication. Two patients had gone to supported living community placements. Staff used the Health of the Nation Outcome Scales (HONOS) rating scales to assess and record severity and outcomes, sharing the learning from each patient through supervisions and team meetings, within the teams responsible for each patient. The Responsible clinician acknowledged information needs to be shared more broadly across the whole staff team.

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. We saw that where patients had impaired mental capacity, staff assessed and recorded capacity to consent appropriately and made DOLs applications where necessary. Staff did this on a decision-specific basis with regard to significant decisions.