Berkshire Healthcare NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

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

This service scored 80 (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 always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

During the inspection, we observed staff treating patients with kindness, dignity and respect. We carried out an observation using the short observational framework for inspection (SOFI) during lunchtime and observed many positive interactions between staff and patients. Staff provided patients with practical help, encouragement and emotional support. Staff supported patients to understand and manage their care and treatment by using different methods of communication considering their individual needs. All of the patients we spoke with told us that staff treated them well.

Staff supported patients to have a meaningful life by accessing services and activities important to them. This included activities such as going to the cinema, bowling and swimming, as well as visiting local shops and participating in activities on the ward. Staff developed therapeutic relationships with patients based on trust, compassion, and understanding. They demonstrated a strong awareness of individual needs, preferences, and personal histories and treated patients with dignity and respect.

Staff understood the individual needs of patients, including their personal, cultural,socialand religious needs.All staff we spoke withhad a good understanding of what was important to patients.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service made adjustments for disabled patients. For example, by ensuring disabled people’s access to premises and by meeting patients’ specific communication needs. Staff were trained in Makaton. They had a ‘sign of the week’ which we observed them practicing in their daily safety huddle.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. Patients were supported daily to choose their meals on a menu which had visual pictures to facilitate informed choice. Speech and Language Therapists provided pictures of meals and created individual place mats for patients.

Staff ensured that patients had access to appropriate spiritual support. Staff had a box of faith materials they could provide to support patients. Patients could access the multi-faith room in the hospital. Staff supported patients to access places of worship in the community and they also had access to the hospital Chaplain.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery-oriented and staff developed easy read, pictorial versions to give to patients.

Staff supported patients to understand and manage their care and treatment by using different methods of communication considering their individual needs.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients told us they felt involved in their care and treatment. They were given regular time to discuss their care with their identified key members of staff.

Patients were given a choice of food options each day. Staff supported them to select what they would like to eat using an electronic device. One patient had identified a goal of doing this independently which staff had supported them to achieve.

The occupational therapy assistant developed an individual activity choice board for each patient in collaboration with them and their relatives. They then asked patients what activities they would like to do at the start of each day.

Patients were able to personalise their bedrooms.In addition to televisions in the communal lounge areas, patients also had smart televisions in their bedrooms. This enabled them to be able to watch or listen to content of their choice in the comfort of their own bedrooms.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff responded promptly and effectively to changes in patient need, concern, or distress. Staff knew patients well so could identify changes in patient presentation or environmental dynamics and acted quickly to mitigate risk and safeguard wellbeing.

Patients felt confident approaching staff with issues or concerns, knowing they would be listened to and supported. During our inspection we observed a patient telling staff they were cold; staff responded promptly to close the windows in the room.

Patients had access to call bells in their bedrooms when they needed immediate assistance.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. Staff received specialist training in de-escalation and told us that verbal de-escalation and environmental adaptations would always be attempted prior to using restraint.

The ward had a sensory room available for patients to use. This was furnished with comfortable seating and had an interactive ceiling mounted projection system installed for patients to use. However, patients were unable to use this system at the time of our inspection due to the remote being damaged. Staff told us that patients could have music on in the room if they wished, and that access to equipment to play music would be individually risk assessed. Staff also showed us the sensory box which consisted of stress balls, fidget toys, textured materials, and calming visual aids. Staff told us that none of the patients currently on the ward had any identified sensory needs, but that sensory items would be sourced based on individual need.

We scored the service as 4. The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff, and was exceptional at supporting and enabling staff to always deliver person-centred care.

Staff we spoke with unanimously told us they felt respected, supported and valued. The most recent staff survey results showed that 91% of respondents from the ward felt valued by their team.

Staff felt positive and proud about working for the provider and their team. All staff we spoke with were exceptionally proud of the work they did to care for patients.

Staff had access to support for their own physical and emotional health needs through an occupational health service. The psychologist was in the process of setting up a wellbeing group for staff and they could also access support from the Trust wellbeing team. The psychologist also facilitated monthly reflective practice sessions for the team. One of the deputy ward managers was designated as a Professional Nurse Advocate. They provided formal and informal support to the staff team.

The provider supported staff in innovative ways. Staff had been affected by racism from patients and had been awarded with funding to develop a restorative justice video. Ward staff and the consultant nurse from the IST had set up a “no excuse for abuse” working group and submitted a bid for one off funding for a project that would strengthen staff wellbeing. Patients, staff and senior leadership colleagues will be filmed for the video talking about what racism is, the impact it has and institutional response. The video will be used for induction, incident responses and ongoing education for staff and patients.

Staff were debriefed and received support after a serious incident. Staff told us that they felt well supported following incidents. They received support from colleagues immediately following incidents and also received support from the wider organisation in the following days/weeks. When staff reported incidents the Trust wellbeing team were notified and would follow-up with staff if needed, for example, if they had been assaulted by a patient. The consultant nurse from the IST sometimes facilitated debriefs for staff at their team base to enable staff to take time away from the ward following an incident.

Staff were involved in a quality improvement project around incident debriefs. They aimed to have a documented staff debrief within 24 hours of an incident, and a patient debrief within 48 hours, using a standardised tool.

The service’s staff sickness and absence was slightly higher than the average for the provider. The average sickness rate for the ward over the last 12 months was 7%,whereas the current average for the provider was5.1%.

Staff appraisals included conversations about career development and how it could be supported. All staff had received an appraisal in the last 12 months.