Sussex Partnership NHS Foundation Trust

On this page

• 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

Are services effective? This means we looked for evidence that patient’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 as good. At this assessment, the rating went down. We rated this key question as requires improvement because the effectiveness of patient’s care, treatment and support did not always achieve good outcomes.

Some patients open to the crisis teams did not have a crisis plan in place, which meant that it was not clear to them what action to take if they needed urgent support with their mental ill-health.

Due to the high demand on The Havens, the service was unable to operate in a way that was intended. In the past 12 months, there had been 652 cases of patients staying at the Havens for over 23 hours. Many patients stayed beyond the 23-hour admission period because they were waiting for a bed to become available on an inpatient acute mental health ward. This impacted on patients being able to access the right care and treatment and achieve good outcomes. Patients staying at the Havens did not always have regular access to a multidisciplinary team support such as medical doctors, occupational therapists, psychologists and pharmacists to support their care and treatment.

The service was in breach of Regulation 9: Person-centred care of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 58 (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 2. The evidence showed some shortfalls. The service did not always make sure patient’s care and treatment were effective because they did not always check and discuss patient’s health, care, wellbeing and communication needs with them.

Staff did not ensure that the needs of patients who attended the Havens were assessed, and they did not always ensure there were clear care and safety plans for patients attending the service. For example, patients who attended the Havens did not always have a care and treatment plan despite some of them needing urgent support and treatment. About 18% of the 22 patients we spoke with, reported that they did not have a care plan and were not sure what the plans for their treatment were.

Some patients open to the crisis home treatment teams did not have a crisis plan in place. For example, we reviewed 4 patients records who were being supported by the crisis team in Woodlands Centre for acute care, and two of them did not have an up-to-date crisis plan. While most patients reported that staff provided them information on how to the crisis resolution home treatment teams via the Sussex Crisis line, some patients reported that it was often difficult to get through to the teams on phone. Lack of a clear crisis or safety plan could put patients at risk and lead to increased strain on emergency services.

Patients who attended the Havens did not always have a care and treatment plan developed with them. Some patients who attended the Havens required urgent care and support with their mental health. However, because there was no legal basis for people to be held at the Havens, staff told us they could not legally keep them at the service and these patients could leave at any time. We were not assured that appropriate steps were always taken by staff to manage or minimise the patient's risk including patients who may be experiencing a mental health crisis because they did not always have a clear care and management plan in place."

Staff told us the patients could leave whenever they wanted to. This meant that patients were staying in an environment without a plan of treatment. We reviewed an incident where one patient left the Havens and attempted to harm themselves by stepping in front of a moving vehicle.

Staff completed a comprehensive mental health assessment for patients in a timely manner on admission. Physical health assessments were completed during the second home visit. For patients who had a care plan, staff ensured they were holistic, personalised and recovery oriented.

We scored the service as 1. The evidence showed significant shortfalls. The service did not plan and deliver patient’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standard.

The trust had introduced a service called The Havens in 2019, which was designed to care for patients who would normally attend the emergency department when in crisis. The Havens service model is nurse led and involved patients being supported by staff for no more than 23 hours for a period of stabilisation and support. At the time of our inspection, we found the model to be ineffective at meeting the needs of the patients in crisis.

In the last 12 months the trust reported 652 cases of where patients stayed over 24 hours. We identified that many of the patients admitted to the service required an inpatient stay in hospital. However, due to pressures on bed availability within the trust, patients were having to wait for long periods of time at The Havens whilst a bed was identified. We reviewed 3 records of patients who had been admitted to the service for 10 weeks, another patient who had been admitted for 69 days and another who had stayed for 49 days. Patients who required care from an inpatient MDT such as psychologists, occupational therapists and doctors were unable to receive this at The Havens. The lack of support from an MDT for patients that stayed for significant periods of time meant that they did not have access to care that met their needs and supported their recovery.

We observed that staff assessed and met patient’s needs for food and drink and for specialist nutrition and hydration particularly for patients at the health-based places of safety.

Managers provided new staff with appropriate induction. The induction programme was comprehensive, and staff felt it was relevant to them to do their jobs.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance.

Managers told us they ensured that staff had regular supervision. Although, some teams such as the West Sussex CRHT were below the providers target of 85% at 76% completion rate.

While we observed that appraisal rates were low across the services, the trust informed us that the months of April to June were appraisal season, and all teams needed to achieve a compliance rate of 90% by the end of June 2025.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act 1983 (MHA), the Code of Practice and the guiding principles. Staff had easy access to administrative support and legal advice on implementation of the MHA and its Code of Practice. Staff knew who their MHA administrators were.

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

Staff had easy access to local MHA policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy. However, one patient who was detained in the 136 suite had not been provided information about advocacy.

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

Staff stored copies of patients' detention papers and associated records correctly and so that they were available to all staff that needed access to them.

The trust did regular audits to ensure that the MHA was being applied correctly and there was evidence of learning from those audits.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

The teams met regularly to discuss patient’s care. Some of the crisis home treatment such as Woodlands Centres for acute care consisted of a multidisciplinary team including psychologists and occupational therapists and we saw evidence of joined up care.

The teams held daily handover meetings where they discussed patient’s care and treatment plans including current risks.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation for example, care co-ordinators and community mental health teams.

The teams had effective working relationships with teams outside the organisation such as the local authority, social services, ambulance service, the acute trust and GPs.

We scored the service as 3. The evidence showed a good standard. The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support

Staff supported patients to live healthier lives. For example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor patient’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of patients themselves.

It was not clear how the service ensured it measured the effectiveness of service delivery at the Havens to ensure that patients were getting consistently good care that met their needs. The service aimed to provide patients with support and containment when in crisis but due to many patients often requiring an inpatient hospital admission and needing to stay at the Havens beyond the 23-hour admission period, the service could not effectively deliver the model of care and monitor patient outcomes.

However, staff across the crisis resolution home treatment teams told us they used recognised rating scales to assess and record severity and outcomes for patients. For example, the teams told us HoNOS (Health of the Nation Outcome Scales). HoNOS is a tool used to measure the health and social functioning of patients with more severe mental illness.The teams also used other rating scales including surveys and Patient-Reported Outcome Measures (PROMs) which is direct feedback from the patient about their personal perspective on their health and experiences.

Staff used technology to support patients effectively such self-help tools online.

We scored the service as 3. The evidence showed a good standard. The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took practical steps to enable patients made their own decisions.

Staff recorded consent to treatment in most of the care records we reviewed. While the trust had identified through its care record audits that staff did not always clearly record consent to treatment by patients, it was taking appropriate action to address this.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.