Cumbria, Northumberland, Tyne and Wear 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

Effective:

This means we looked for evidence that 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 outstanding. At this assessment the rating has changed to good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

• We reviewed 68 care records during the assessment.
• Staff completed a comprehensive mental health assessment of the patient in a timely manner at the early intervention in psychosis teams and met their targets of 14 days from referral to assessment.
• There were physical health leads in the teams and systems were being developed to capture the monitoring of physical health needs and identify gaps. Spreadsheets showed monitoring for 3 monthly, 6 monthly and annual reviews. Sunderland West Community Treatment team had developed a physical health menu to assist staff with the possible required physical health screening that patients may require including lithium checks and high dose antipsychotics, links to the necessary documentation were within the physical health menu. This meant staff had easy access to the required resources. However due to staffing challenges in Gateshead, they were unable to safely staff the physical health clinics, this had been added to the risk register. This meant appointments maybe reduced and patients would not have access to physical health reviews.
• Of the 68 care records reviewed, 3 (4%) records did not have a care plan in place.
• Staff did not always update care plans when necessary. Of the 68 care records reviewed, 11 (16%) care plans were not up to date.
• Care plans were not always personalised, holistic and recovery orientated. Of the 68 care records reviewed, 16 (24%) care plans were not personalised, holistic and recovery orientated. Examples included generic cutting and pasting of information, for example in the Early Intervention in Psychosis Team - Sunderland and South Tyneside, the crisis plans included support telephone lines for people over the age of 55 and the care records were for people under 55. This meant care records were not always tailored to people’s individual needs and preferences.
• For autistic patients, care records did not always identify any reasonable adjustment that maybe required, for example in relation to communication. We saw 3 care records for autistic patients with no reasonable adjustments included.
• However at the early intervention team in psychosis Sunderland and South Tyneside we saw an example of an individual who was selecting not to use speech to communicate, staff communicated via email in advance of the session and asked questions, they responded and explored this in the session, pictures were also used and this was recorded in the care record.

• 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 medicines and psychological therapies. Regular clinics took place including depot clinics and clozapine clinics.
• Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Physical health clinics took place. We observed staff responding quickly if there were concerning blood results for patients, by doing home visits for physical health checks. Psychology staff were trained and skilled in a variety of therapies including Dialectical Behavioural Therapy (DBT) and Structured Clinical Management (SCM). Groups were facilitated by the teams in DBT, SCM, emotional regulation group and mood on track groups. One to one psychological intervention was also offered. Family therapy was provided in the early intervention in psychosis teams as required by the service standards.
• Staff participated in clinical audit, benchmarking and quality improvement initiatives. Sunderland and South Tyneside Early intervention in Psychosis had completed a pilot project to offer a peer support welcome meeting to new service users and their families and carers who were accepted as experiencing a first episode of psychosis. This was well received and a report of this was published in the Leading Minds publication.
• The team included or had access to the full range of specialists required to meet the needs of patients in the service. Including doctors, nurses, clinical psychologists, pharmacists and peer support workers.
• Staff were mostly experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group. However not all staff accessed training in Learning Disability, Autism and drug and alcohol awareness.
• Managers provided new staff with appropriate induction. There was an induction policy and checklist in place.
• 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. For managerial supervision, teams had over 70% compliance apart from North Cumbria East Community treatment team with 53%, North Cumbria Early intervention team in psychosis with 61% and Newcastle Early intervention team in psychosis with 60%. For clinical supervision, teams were over 70% compliance apart from Gateshead Early intervention team in psychosis with 60%, Newcastle Early intervention team in psychosis with 50%, North Cumbria Early intervention team in psychosis with 61%, South Northumberland Community Treatment Team with 33% and Sunderland West Community Treatment Team with 39%.
• Appraisal figures showed teams had over 75% compliance apart from North Cumbria East Community Treatment Team with 66% compliance, North Cumbria EIT with 61% and South Northumberland CTT with 41%:
• Managers ensured that staff had access to regular team meetings. Minutes showed meetings took place, however agendas and frequency of meetings varied across the teams.
• Learning and improvement webinars took place with bulletins created with links to resources for staff, these topics included trauma informed care and closed cultures. Trust bulletins were circulated to staff weekly and included service updates, training opportunities and relevant resources.
• Managers dealt with poor staff performance promptly and effectively. Records showed investigations took place, prior to determining whether disciplinary action was required.

• Staff held regular and effective multidisciplinary meetings. We observed assessment multidisciplinary meetings in community treatment teams where practitioners who had completed an assessment, presented the assessment to the meeting and a joint agreement was made about whether the person would be offered a service and actions agreed including involving third sector organisations. This meant patients would receive an outcome of their assessment in a timely way. These meetings were timely and efficient. We observed a multidisciplinary meeting within Northumberland early intervention in psychosis team where they discussed referrals, cases of concern and discharges. Teams engaged well and shared their ideas with colleagues. We observed a formulation meeting in Sunderland and South Tyneside early intervention team in psychosis where an individual who was difficult to engage was discussed and agreed actions to encourage engagement.Huddles took place at Sunderland and South Tyneside early intervention team, and we observed one of these, where staff discussed assessments, reviews and cases of concern, clear actions and risk management were agreed by the multidisciplinary team.
• The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). Records showed local authorities, and the police involved where there were safeguarding concerns. Assessment multidisciplinary team meetings showed engagement and referrals to external third sector organisations including Everyturn, SHOUT and MIND who provided mental health support and interventions. Teams worked alongside other teams within the Trust including the crisis team.
• We saw local services advertised on the notice boards within the waiting rooms of the community bases too.

• Staff supported patients to live healthier lives – for example, records showed joint working with services for people with an eating disorder. Staff gave examples of assisting patients with healthy eating advice and increasing exercise.
• Physical health monitoring took place with 3 monthly, 6 monthly and annual reviews, this was monitored to identify gaps and areas of focus. We saw team specific spreadsheets in use to monitor these.
• Clinical leads for physical health were in post, however in Gateshead East community treatment team, they were struggling to recruit to the physical health lead role. This meant there was less oversight and support for the promotion of physical health in this team.

• Staff used recognised rating scales to assess and record severity and outcomes (for example, Health of the Nation Outcome Scales). Occupational therapy staff told us they used Health of the Nation Outcome Scales. Nursing staff used side effect monitoring tools for example the Lester tool to monitor side effects of anti psychotic medicines.
• Staff used technology to support patients effectively (for example, online access to self-help tools). We saw patients being signposted to use helplines and online chat services.
• Reviews took place with patients, we observed treatment reviews taking place with Consultant Psychiatrists where treatment options were discussed with patients and these included psychological interventions as well as medicines. These appointments also reviewed and explored physical health, drug and alcohol use and diet and lifestyle. We observed reviews with the multidisciplinary team where patients treatment was reviewed, and options were discussed and information leaflets provided to patients. Support offered included family therapy and employment support. This meant patients were involved in the review of their care.

• Staff took all practical steps to enable patients to make their own decisions. Records showed that alternative communication approaches of email and pictures were used with a patient at Early Intervention in Psychosis Team - Sunderland and South Tyneside to increase their engagement with the sessions.
• For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Records showed and staff told us that capacity assessments took place.
• They did this on a decision-specific basis with regard to significant decisions. Examples included accommodation and involvement with the criminal justice system.
• When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Records showed an example where the Early Intervention in Psychosis Team - Sunderland and South Tyneside worked with the local authority regarding a patients capacity in relation to accommodation and support was provided in their best interest.