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 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 good. At this assessment the rating has remained good. Staff provided a range of treatment and care for patients 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 patients on the ward. Staff from different disciplines worked together as a team to benefit patients.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always assess the physical health of patients during admission. We reviewed 26 care records during the inspection and found that in the records of 4 patients, a comprehensive physical health assessment had not been completed. For example, on Amber ward, we found that the physical health assessments for 3 patients had not been completed. One patient on Falmer ward did not have their physical health check fully completed during their initial admission which posed a risk to patients’ physical health needs.

A physical health nurse was attached to all wards we visited. Patients met with the physical health doctor or nurse and received an electrocardiogram (ECG), weight check and had blood test on admission. Staff monitored patients’ ongoing physical health weekly, and all patients were able to access a local GP, dentist and optician.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.

Staff did not always involve patients in their care planning. For example, 2 patients on Maple ward and 3 patients on Amber ward said that staff completed their care plans without involving them but gave it to them to sign. We identified that staff did not always complete care plans for patients. Four patients told us they had not been involved in producing their care plans or had received a copy. One patient on Maple ward who was asthmatic did not have an asthma care plan completed, 2 patients on Amber ward did not have completed care plan and 1 patient each on Rowan and Mapel wards did not have care plans in place. Staff had not recorded the mobility difficulties of one patient who used a walking stick in their care plan on Maple ward. This was fed back to the manager during the inspection. Patients who required a PBS plan did not always have one in place. We identified that 1 patient on Amber ward, 1 patient on Falmer ward and 2 patients on Rowan wards did not have a PBS in place despite the patients requiring one. This meant that patients were at risk of restrictive interventions because there was no plan in place to guide staff on how to support a patient who may display distressed behaviour.

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. These included medication and psychological therapies, activities, and opportunities for patients to take their prescribed section 17 leave. Occupational Therapists provided activities such as karaoke, card games, board games and drawing when they could. They also provided ward based physical health activities, engaged in garden games, football, bowling, and garden related activities. However, 5 patients on Palmeira ward and Pavilion wards felt there were not many activities on the wards. One carer on Rowan ward said there were no activities on weekends. Four staff told us that HCAs engaged in activities with patients over the weekend.

Staff ensured that patients had good access to physical healthcare, including access to a dentist, optician and specialist healthcare providers.

Staff generally assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Records we reviewed showed that staff assessed the nutrition and hydration needs of the patients by using the Malnutrition Universal Screening Tool (MUST) and the Health of the Nation Outcome Scales (HoNOS) chart when patients were admitted on the wards. Staff also ensured that patients whose nutritional needs had to be monitored had food and fluid intake charts in place. For example, one patient who was on a high calorie intake diet had gained weight. This was in line with their treatment plan. Mealtimes were flexible, and second helpings were available.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

The team included the full range of specialists required to meet the needs of patients in the service. This included doctors, nurses, occupational therapists, clinical psychologists, social workers, pharmacists, support workers and activities co coordinators. However, most of the wards including Amber, Maple, Jade, Falmer and Palmeira ward did not have a permanent psychiatrist, OT and psychologist in post.Langley Green Hospital had a vacant psychiatrist post that had not been filled for over 6 months.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group, the service routinely employed agency staff who staff said were not always provided with an induction and competency training to conduct observations.

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

Managers ensured that staff had access to regular team meetings. Team meetings were held monthly on each ward and there was a standing agenda. Minutes of the meetings were circulated to all staff.

The percentage of staff that had an appraisal in the last 12 months was over 95% on all wards. Supervision was provided in line with the provider’s supervision policy. Compliance rates for management supervision were between 82-95% across the wards we visited.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff participated in appropriate mandatory training. They were also able to discuss training needs during supervision and appraisal. Staff that we spoke with told us that there was a wide variety of training courses available to them on the online learning platform.

Managers ensured that staff received the necessary specialist training for their roles. All staff we spoke with told us training provided by the trust was sufficient for their role and they also received training from the professional nurse educator (PNE).

Managers dealt with poor staff performance promptly and effectively. We saw several examples of documented poor performance whereby staff had their probationary period extended or chose to step down from the service.

Mental Health Act.

Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and the 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. These were stored on the staff intranet.

Patients had easy access to information about independent mental health advocacy. There were posters and leaflets on the wards and patients said that they were aware of the advocacy service.

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. We reviewed 3 patient records and saw that in all cases patients had been read their rights and staff told us that they revisited patients' rights until they were sure that they had been understood. We saw evidence in patients’ records that section 132 rights were read to patients within the first 7 days of their admission and weekly after that.

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.

The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent part 3 powers authorising admission to hospital for treatment. Section 117 aftercare is a legal duty under the Mental Health Act 1983 that requires local health and social services to provide free aftercare to individuals who have been detained under specific sections in hospital.

Staff completed regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. The Mental Health Act administrators sent the Responsible Clinicians and ward managers a weekly tracker with an overview of everything that they were monitoring so that they had good oversight of all areas of the Mental Health Act, including sections due to expire, patients’ rights, section renewals and mental health tribunal applications.

Staff held weekly multidisciplinary meetings (MDT). These were attended by all disciplines including nurses, psychology, occupational therapy, care coordinators and the advocate. We attended 3 MDT meetings during the assessment, and we found that the team had a thorough discussion about staffing and acuity of patients.

Staff shared information about patients at effective handover meetings within the team. We attended shift to shift handover meetings on Rowan, Jade and Amber wards and saw that all patients, incidents and risk was discussed with the incoming team. There was also a daily morning meeting on each ward where all patients were discussed. We attended a morning meeting for Jade and Palmiera wards during the assessment.

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

The teams had effective working relationships with teams outside the organisation for example the local authority, social services, GP’s and housing providers.

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. Staff took advice from the local diabetes team to more effectively manage a patient's diabetes.

Ward activities helped promote a healthy lifestyle for patients. For example, walking groups, gym sports in consultation with doctors, sports activities, cooking healthy meals, nutrition advice, and football in the garden on Amber ward. Mangers told us OT assistants covered ward activities, but some activities were led by nurses and HCA during the weekends. Amber ward had access to a tobacco dependency team that visited the ward to support patients to stop smoking.

Staff used a rating scale to assess and record severity and outcomes. This was a structured judgement tool which looked at current and historical risk on a scale of low, medium and high.

The staff used technology to support patients and their health needs effectively. Staff had prompt access to blood test results and online access to self-help tools. This was completed on admission and updated every two weeks thereafter. Staff also updated it after an incident had occurred.

Staff took all practical steps to enable patients to make their own decisions.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately, and assessments were seen in the patient records. Staff did this on a decision-specific basis regarding significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Where patients had given consent, staff spoke with relatives who knew the patient's history.