Berkshire Healthcare 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 outstanding. At this assessment the rating has changed to good.

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.

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 reviewed care records for all 4 patients admitted to the ward at the time of our inspection. Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Staff gained all relevant information from community teams, including communication needs, and existing care plans to create a comprehensive care plan.

Staff assessed patients’ physical health needs in a timely manner after admission and developed care plans to address any identified needs.

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. However, the easy read care plans in one patient's folder had not been updated for over 6 months.The team rectified this immediately to ensure that all easy read care plans were up to date.

We scored the service as 2. The evidence showed some shortfalls. The service did not always ensure that it was clear how much leave patients had to take from the hospital, or that medical reviews were carried out as often as they should be for patients in seclusion.

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 (NICE). These included medication and psychological therapies, activities, and occupational therapy intended to help patients acquire living skills. We saw that patients had varied trips into the local community and were supported to participate in activities they enjoyed, such as swimming, bowling and going to the cinema.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. A GP provided a virtual clinic for patients every week. We observed this clinic during our inspection and the GP reviewed any current health concerns and checked whether any monitoring tests were required. For example, one patient had recently been titrated on a dose of medication and the GP highlighted that a blood test was needed. Patients were invited to attend the clinic in person, or they could also send photos for the GP to review if preferred. Staff ensured that patients’ other physical health needs were also met, for example patients had been supported to attend the dentist.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Patients were assessed by a speech and language therapist and hadeating and drinking care plans in place. These were printed out and displayed on the tables during meal times to support staff in ensuring patients’ needs were met. Staff completed food and fluid charts to monitor patients’ intake of food and fluid. However, we observed that staff did not record fluid intake during mealtime on the day of our inspection.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The team had an audit programme in place which included a range of audits carried out at various frequencies throughout the year. Staff also participated in the NHS Learning Disability Speciality Services Benchmarking audit which is an annual audit allowing benchmarking of similar services across England. This allowed staff to compare their performance against key metrics with other similar services in other areas.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, patients had regular support from occupational therapists, psychologists and speech and language therapists. Psychologists provided support to patients and staff. They undertook assessments and provided group and individual sessions for patients as well as consultation and training for staff. The occupational therapy team offered a range of interventions including supporting patients with activities both within and outside the hospital. 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.

Staff were experienced and appropriately qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development). Records showed that on average 79% of staff had received monthly supervision over the last year. All staff had received an appraisal of their work performance within the last year.

Managers ensured that staff had access to regular team meetings. Staff were invited to attend a monthly team meeting which had a standard agenda.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers ensured that staff received the necessary specialist training for their roles. All staff were trained in Positive Range of Options to Avoid Crisis and use Therapy – Strategies for Crisis Intervention and Prevention (PROACT-SCIPr-UK). This is a programme that equips staff with the practical skills and knowledge to support people who may be struggling to communicate their needs. Staff told us that this training was very beneficial in helping them understand the theory behind the interventions they use, rather than just focusing on physical restraint techniques.

Mental Health Act

Ninety-three percent of staff had received training in the Mental Health Act. They had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy. Staff displayed this on a notice board.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Patients took leave from the hospital on a very regular basis. However, we found that there was some ambiguity regarding how much leave patients were allowed to take. All 4 patients on the ward during our inspection were authorised to take up to 8 hours leave once a day, however staff we spoke with were unsure whether this meant they could take shorter periods of leave multiple times a day. Managers told us that staff could seek advice from senior nurses or the patients’ responsible clinician if needed. Staff used a ‘client leave or outings’ form to record patients signing in and out of the ward. This form had space for staff to record that a risk conversation had taken place with the patient prior to them being signed out on leave but did not detail what had been considered as part of this conversation. The ‘time due back’ column was blank on most forms we reviewed.

Staff did not always ensure that seclusion reviews were carried out as often as they should be in line with the MHA Code of Practice. Seclusion had only been used 4 times in the 12 months prior to the inspection, however in one of those episodes medical reviews had not been carried out every 4 hours and there had been an11 hour gap between medical reviews. Nursing reviews had been completed every 2 hours as per the MHA Code of Practice.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. For example, an audit showed that 2 patients had been discharged from MHA section 3 whilst on trial leave at their placement. However, the required legal paperwork to formally discharge them had not been completed. This was followed up by the MHA team to ensure the paperwork was completed and learning was shared with staff on the ward.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff held regular multidisciplinary (MDT) meetings to discuss patients and improve their care. These meetings were attended by a range of staff from different disciplines and were effective in discussing a range of issues including changes to patients’ presentation, risk, incidents and medication. Staff had identified involving patients in MDT meetings as an area they would like to improve, to ensure that there is an individualised process in place for each patient to contribute in a meaningful way. They were also considering how they could involve patients in the meetings if they found it too overwhelming to attend in person. For example, supporting them to attend virtually so they would be in a room with a couple of staff members rather than in the main meeting with lots of people.

Staff shared information about patients at effective handover meetings within the team. Staff held handover meetings at the beginning of each shift.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. We saw excellent collaboration between community teams and inpatient wards. Community and ward staff attended monthly formulation meetings. They discussed one patient each month, looking at their history and lived experience and considering how this is connected to their current presentation. Staff spoke positively about how these sessions enabled them to get a greater understanding of patients, their history and where their behaviours are coming from. The results from the 2025 NHS staff survey showed that 91.3% of respondents from Campion unit felt that 'teams within the organisation work well together to achieve objectives'. This is significantly higher than the national peer group average, which was 53.7%.

Some staff told us that communication on the ward needed to be improved. They said it was a challenge to disseminate information to a large number of people working different shifts. However, they said that managers were aware of this feedback and working to improve this.

The teams had effective working relationships with teams outside the organisation. Staff worked in close partnership with a GP who provided a virtual clinic for patients every week, and they had established a working relationship with a local dentist.

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.

Staff identified patients’ physical health needs and recorded them in their care plans. Staff conducted physical health checks regularly and made sure patients had access to physical health specialists as required.

Staff supported patients to live healthier lives. Staff promoted healthy eating and exercise to patients and documented this in their care plans. Staff supported to exercise in the community, for example, swimming.

Ward activities helped promote a healthy lifestyle for patients – for example walking, sports activities and cooking healthy meals.

We scored the service as 3. The evidence showed a good standard. The service 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 recognised rating scales to assess and record severity and outcomes. Staff utilised the Health of the Nation Outcome Scale (HoNOS), Patient Health Questionnaire 9 (PHQ-9)and Generalised Anxiety Disorder-7 (GAD-7) for people with learning disabilities to collect data on outcomes. They also used the Malnutrition Universal Screening Tool (MUST) to screen for malnutrition.

Staff used technology to support patients effectively. Patient’s physical health observations were recorded electronically.

We saw many examples of positive outcomes for patients. For example, where staff had supported them to attend the dentist and helped patients to feel less anxious receiving injections, resulting in them being able to successfully receive treatments they needed.

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, including providing information for patients in easy read formats that they could understand.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

Staff used a visual based monitoring system in the seclusion room to monitor a patient’s physical health remotely. Staff informed patients of this by including it in the easy read patient information pack. If a patient objected and requested for the technology to be turned off, this would be discussed by the MDT and the patient’s wishes adhered to, if clinically safe to do so. However, there was no poster on display in the seclusion area notifying patients that the system was there and that it would be switched on while they were in seclusion. Managers told us there had been a poster, but it had been taken down. They replaced this following the inspection and also told us there was a poster in the lounge area where patients would be more likely to see it. Seclusion was rarely used on the ward. There had been 4 instances in the 12 months prior to the inspection.