Berkshire Healthcare NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

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

This service scored 79 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff used clear communication methods and accessible materials, such as easy read formats, to ensure patients understood their care and treatment options.

Systems were in place to ensure joint decision-making between staff and patients, with care plans reflecting a wide range of different needs. Staff ensured care plans were personalised and reflected the individual needs of the patients.

We observed staff responding promptly and respectfully to patients’ needs and adjusting their communication methods and approach. For example, one patient was anxious about being discharged and staff were aware this could increase their risk of incidents, so they were very cautious in ensuring the patient was in a positive mental state before speaking to them about their discharge. to ensure patients understood them. Staff we spoke with had a good knowledge of the patients they were supporting, their likes and dislikes.

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, ensuring that patients had a choice in how they spent their time.

Care plans were very personalised and reflected patients’ preferences. However, one of the easy read care plans in a patient’s folder had not been updated as frequently as the care
plans logged on the electronic records system. This meant that the patient may not have accessible versions of their most up to date care plans.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff carefully planned patients’ discharge and worked with care managers and community teams to make sure this went well. Patients who were in the process of transitioning to another care provider had clear plans in place to support their discharge. Patients were given easy read information about the place they were being discharged to. Staff from placement providers visited patients on the ward and took them out to visit their new placement, gradually building up the time they spent there. IST staff facilitated training for placement staff to support them with working with patients.

Staff supported patients to maintain contact with their families and carers. Family members were able to visit patients, take them out on leave, or contact them via the telephone. Relatives were invited to participate in meetings about their loved one’s care. We attended a care plan management meeting during our inspection which a relative participated in. However, we spoke with 2 carers who both told us they did not feel involved in the care of their relatives. They told us that staff kept them updated about how patients were on a day-to-day basis, but both carers told us they would like more involvement regarding the wider plan for their relatives.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies as needed. The service submitted notifications to the Care Quality Commission in accordance with the requirements of their registration. The service submitted safeguarding referrals to the local authority.

The service provided appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff had access to the equipment and information technology needed to do their work. Staff had access to connected care which enabled them to access records from other sectors, including acute hospitals, social care and GP services.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. This information was presented and discussed in clinical governance meetings.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. Staff provided patients with an easy read information pack on admission. They also provided carers with a carer’s information pack.

We scored the service as 4. The evidence showed an exceptional standard. The service always made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The service had not received any complaints in the 12 months prior to the inspection.

Patients and carers knew how to complain or raise concerns. We saw that information about how to make a complaint and how to raise concerns was available in an easy read format within the patient information pack.

Staff facilitated weekly community meetings to enable patients to give feedback about things such as the ward environment, activities or catering. However, we reviewed minutes from these meetings and the ‘actions from previous meetings’ section had not been completed in any of them. It was therefore not possible to see what action had been taken in response to the feedback given.

Patients were supported to be involved in quality improvement huddles on the ward, where they were supported to raise issues and identify improvements. They received feedback through this mechanism on changes made as a result of their input.

The service recorded 49 compliments in the 12 months prior to the inspection. These were received from a range of sources including patients, family members and professionals from other organisations. Staff also displayed a range of these compliments and thank you cards on a notice board on the ward.

The service participated in the Triangle of Care which is a nationally recognised framework involving patients, professionals and carers that aims to improve collaboration, safety and wellbeing. The service had completed a self assessment as part of the process, which showed that they were fully compliant with 30 of 37 standards and over 50% compliance with the remaining 7 standards.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured the needs of patients with mobility issues were met. The ward was on ground level and had wide corridors to enable wheelchair access.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.

Staff planned for patients’ discharge, including good liaison with care managers and staff from community teams. Staff from placement providers visited patients on the ward and took them out to visit their new placement, gradually building up the time they spent there. IST staff facilitated training for placement staff to support them with working with patients.

In the last 12 months, there were 5 delayed discharges from the ward. These were all due to patients awaiting a suitable onward placement. Staff used a delayed discharge tracker and the ward manager met with senior leaders weekly to review progress for each patient affected. Staff took action to escalate issues causing delays with service commissioners from the Local Authority or Integrated Care Board (ICB).

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care,supportand treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.Stafffacilitatedweekly community meetings to enable patients to give feedback about things such as the ward environment, activities or catering.Staff also invited patients to attend daily Huddle Board meetings, during which theywere supported to make meaningful contributionsregardingpotential environmental changes and other areas for improvement within the service.During these sessions, patientswere supported to discuss and review any issues or tickets they hadraised andwere provided with updates on actions taken or progress made.This enabled patients to see how their feedback had contributed to service development.

The provider had undertaken equality impact assessments ofsome oftheir policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Staffwere trained in equality, diversity,inclusionand human rights.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff began discharge planning at the point of admission with the goal of patients staying in hospital for as short a time as possible. The multidisciplinary team planned for each patient’s discharge and regularly reviewed progress towards this. Staff liaised with a wide range of health and social care professionals in the patient’s local area to ensure patients had appropriate accommodation to be discharged to. Ward staff collaborated closely with the IST who kept in touch with patients throughout their admission, to ensure a seamless transition back to the community.

Patients received comprehensive support during their transition to being discharged. This included staff from the ward or from their new placement taking them out to spend time there and gradually increasing the amount of time they spent there to help familiarise them with their new accommodation. Patients were also provided with easy read information about the place they were being discharged to. We saw that the approach to discharge planning was very person-centred. For example, one patient was anxious about being discharged and staff were aware this could increase their risk of incidents, so they were very cautious in ensuring the patient was in a positive mental state before speaking to them about their discharge.