Berkshire Healthcare NHS Foundation Trust

On this page

• 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

Responsive this means we looked for evidence that the service met people’s needs.
At our last assessment we rated responsive as good. At this assessment the rating has remained good.

Staff managed beds well. A bed was available when a patient needed one. However at times people had to stay in hospital when they were well enough to leave because of a lack of suitable provision to move onto. The design, layout, and furnishings of the ward supported people’ treatment, privacy and dignity. Staff supported people with activities. Staff helped people with communication and advocacy. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.
 

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.

Quality Statement Score: 3.
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.
At admission, a person-centred assessment gathered information about the person’s clinical presentation, interests, values, communication preferences, cultural background, religious practice and family. This was used to assess their needs. Staff adapt their communication depending on the individual: some patients benefit from being offered choices, while others become more confused and need simpler, more direct support.
When a person’s presentation changed, the care plan was updated and the treatment approach adjusted. Staff told us that they focused on a person-centred assessment and reducing medication –cognitive assessment tools were used and the importance of understanding where patients function best. The emphasis on looking at different forms of sensory input such as sound, taste and visual stimulation so to understand patient’s individual needs and preferences when considering how best to support them.
 

Quality Statement Score: 3.
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.
The service used a full multidisciplinary team to deliver integrated care. Psychiatry, nursing, dietetics, psychology and occupational therapy were available and coordinated through a weekly MDT.
Patients were allocated a named nurse. This gave the patient and their family a consistent point of contact. Families valued the named nurse arrangement.
Discharge planning was personalised and staff worked with community teams.
 

Quality Statement Score: 3.
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.
The service provided clear, timely information in a range of formats. Information was shared at referral, on admission, throughout treatment and at discharge.
Clinical information, including about diagnosis, treatment options and medicines, was explained at a level suited to the person’s understanding and capacity. They adapted their communication accordingly. Families said they received clear information throughout.
 

Quality Statement Score: 4.
We scored the service as 4. The evidence showed an exceptional standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care.
The service had an embedded culture of listening to and involving people and their families. People told us they felt heard and that their involvement in decisions about their care was genuine. This was consistent across the families we spoke with.
Goal setting was collaborative from the start. Care reviews were held with person or family present where possible. The review process was explained in advance.
Families were invited to care reviews. Children were able to visit and go to a family room located off ward.

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 held weekly community meetings and a monthly patient forum. We reviewed the minutes and found that feedback from people had led to positive changes in ward practice following the principle of you said we did. For example, on Rowan ward nursing staff arranged to feedback to the catering team regarding patient comments about limited food choices and explored how meal choices could be communicated more clearly. On Orchid Ward, most patients reported that they were unaware of their allocated key nurse. Whiteboards were subsequently used in patients' bedrooms with the names of each patient's key nurse. Staff told us this improved patient’s awareness and their accessibility to staff members.
 

Quality Statement Score: 3.
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.
Referrals were assessed on clinical need. There was no evidence that any person was disadvantaged because of a protected characteristic. There was a lift available to access wards and disabled access was also facilitated on Orchid ward. Equipment to support people with disabilities was readily available.

Staff could access interpreting services within a timely manner. Easy read information was available on the trust intranet for staff to access to meet patients’ needs. Staff could also access medication leaflets and other information in a variety of languages to meet patients' needs.
The service accepted referrals from various sources.

Quality Statement Score: 3.
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, support and treatment in response to this.
The service collected outcome data using validated measures at admission and discharge for all people. This was reviewed at clinical governance meetings monthly.
There was no evidence of differential treatment or of any patient feeling disadvantaged because of a protected characteristic.
Cultural and religious dietary requirements were accommodated with clear guidance to staff as required via written instruction on a board in the dining room. Interpreting services were available. Information was provided in different formats and at appropriate reading levels. All staff had completed equality and diversity training level 1.
 

Quality Statement Score: 3.
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, including at the end of their life.
Planning for the future started at the point of admission. We attended a ‘Red to Green’ Meeting. This meeting was to support patient flow. Discharge processes were discussed, including involvement from system partners to offer support in unblocking potential barriers.

Discharge planning was reviewed at each MDT and updated as the person’s presentation changed. Staff told us formulations were incorporated into discharge plans and shared with prospective care homes to support continuity of discharge. In addition, the ward may use Section 17 leave to test whether a proposed care placement can safely manage a patient's needs, rather than relying solely on theoretical assessments.
Staff told us that the aim was not necessarily to complete resolution of every symptom. Staff aimed to achieve a level of stability at which point the patient could be safely and appropriately managed in their new care setting or if returning home.
Occupational Therapists told us they supported with interventions to assess if a patient could safely return to home with support or to another care setting. Practical assessments were undertaken such as activities of daily living (ADL). These are assessments for essential skills and functions for example kitchen activities, washing, walking and mobility assessment, shopping and transport assessments amongst others. Staff told us that discharge was not just about the patient's improvement in mental health. It required assessing their functional ability and mental capacity to be able to manage out of hospital, the physical environment and level of support required.

The Physiotherapy team supported patients experiencing deconditioning through a range of targeted physiotherapy interventions. This enabled patients to be discharged with less restrictive care packages and supporting a more independent transition from hospital to the community.