Sussex Partnership 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 young 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 Good. At this assessment the rating has remained Good. Staff assessed the physical and mental health of all young people on admission. Staff provided a range of treatment and care for young people based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of young people on the ward. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

However, they did not always develop individual care plans, and these were not always reviewed regularly through multidisciplinary discussion or updated as needed. Staff from different disciplines did not always work together as a team to benefit young people.

This service scored 63 (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 young people’s care and treatment were effective because they did not always check and discuss young people’s health, care, wellbeing and communication needs with them.

Staff completed a comprehensive mental health assessment of the young person in a timely manner at, or soon after admission. However, staff did not always develop care plans that met the needs identified during assessment, and young people we spoke with told us they did not feel involved in completing their care plans. We reviewed six care records and found care plans did not always reflect the young person’s voice or demonstrate how they had been involved in identifying their goals, preferences or support needs.

Positive Behaviour Support (PBS) plans were not updated following changes that had been discussed between psychologists and the young person.

Staff assessed young people’s physical health on admission. In all care records we found evidence of physical health monitoring taking place.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver young people’s care and treatment with them, including what was important and mattered to them.

The team included or had access to the full range of specialists required to meet the needs of young people in the service. As well as doctors and nurses, an occupational therapist, clinical psychologist and social worker worked at the service. However, there were not always enough permanent staff deployed on shift with the appropriate knowledge, skills, experience and competence to meet the needs of all the young people safely. The service had not completed assessments of staff competence, and feedback from staff, the young people and incidents, demonstrated that not all staff knew how to safely support the young people.

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, as well as supporting daily living skills. The psychological therapies offered were tailored to the individual’s needs, and young people were offered both group and 1:1 session.

Young people had access to a wide range of activities including sports activities and art. On the ward there was a gym/hall which young people could access with staff to play sports activities. A therapy dog also visited the ward regularly, which the young people told us they enjoyed.

Staff ensured that young people had good access to physical healthcare, including access to specialists when needed.

Managers provided new staff with appropriate induction and ensured that staff had access to regular team meetings.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff held regular multidisciplinary meetings. However, these were not always effective, as relevant risk information and incidents were not consistently discussed, and actions to mitigate identified risks were not always clearly agreed or documented to ensure they could be followed up and reviewed.

Staff shared information about young people during shift-to-shift handover meetings. However, these were not always effective, as important risk information, incidents and required actions were not consistently communicated or documented.

The teams had effective working relationships with external partners, including local authority social services, case managers and GP’s which supported coordinated care for the young people. Staff invited representatives from community teams and future placements to attend ward rounds. Staff also worked very closely with teachers from the onsite school the young people attended. Teaching staff gave positive feedback about their working relationship with nursing staff.

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

Staff supported young people to live healthier lives. Some of the ward activities promoted a healthy lifestyle, including access to the gym where sports activities could be played. Staff also supported young people to access fitness gyms within the community.

Young people were encouraged to establish healthy routines. Staff told us that young people were supported with healthy eating. Menus were reviewed to ensure they were nutritionally balanced. Young people were encouraged to establish good sleep health.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored young people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent.

Staff used clinical tools to support young people and monitor progress and outcomes. For example, Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) was used to track mental health and social functioning. HoNOSCA was completed in all care records that we reviewed. Children’s Global Assessment Scale (CGAS) was used to measure quality of life. This was present in all care records we reviewed.

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

Staff supported young people to make decisions on their care for themselves. They understood the service policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for young people who might have impaired mental capacity. Staff received and kept up to date with training in the Mental Capacity Act. Staff told us they regularly discussed capacity and consent during meetings about the young people’s care and treatment. They also said they would speak to the ward manager or another clinician if they had concerns around capacity.

We saw evidence of capacity and consent recorded in care plans, with capacity to consent to treatment obtained at admission and evidence of this being regularly reviewed. We also saw evidence in care plans of staff attempting to support and engage young people in decision processes before deciding that a young person did not have the capacity to do so. When staff assessed young people as not having capacity, they made decisions in the best interest of young people and considered the young person’s wishes, feelings, culture and history. Staff told us that they held a best interest meeting which would involve the young person, the nursing team, the consultant and the young person’s next of kin, where appropriate.

Staff also demonstrated a good understanding of Gillick competencies, which means they know how to assess whether a young person (under 16 years of age) has the maturity and understanding to make their own decisions about their care and treatment.