Cumbria, Northumberland, Tyne and Wear 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 this key question good. At this assessment the rating has remained good.

Good: This meant people’s needs were met through good organisation and delivery.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

• We observed 4 home visits, 5 patient reviews and 2 assessment appointments. We saw staff discuss treatment options with patients and these included psychological interventions as well as medicines. Staff listened to patients and offered support to enable patients to find a solution to day to day difficulties that they were experiencing. Staff listened to patient preferences about type of engagement with the service and location of the appointments. Staff provided contact details to patients for support out of hours and explained how family members could contact the service on behalf of the patient in an emergency.
• We saw mood rating scales in use, where patients rated themselves and this was used to monitor progress and changes in mood.
• In the medicine review we observed, we saw staff suggest alternative treatments, explaining side effects and the implementation of the changes in medicine with patients to ensure they were giving an informed choice regarding changes in treatment. Psychological approaches were discussed and the staff member respected the patient’s decision on not wanting to access psychological interventions at that time. This meant staff were empowering patients to make their own decisions about their care and treatment.
• We saw staff praising patients on the progress they had made. Staff explored coping strategies that patients had and their social networks. Staff enabled patients to reflect on the impact of their actions and their social networks.
• For patients who were waiting for support from the teams, we observed a review taking place where the staff member signposted the patient to the variety of services and support advertised in the waiting room and encouraged the patient to make use of the resources.

• When appropriate, staff ensured that patients had access to education and work opportunities. Employment support was available to patients, either to support them to return to their place of work or to find employment and settle into a new role. Employment specialists were employed by the service and patients spoke positively of their support.
• Staff supported patients to maintain contact with their families and carers. Staff explored social networks of support within appointments with patients and family members told us they were involved in the reviews of care of their loved ones. We saw staff sought consent from patients to provide updates to family members.
• Patients spoke about accessing education opportunities at college and the progress they were making. Staff explored next steps with them and the possibility of employment support and additional support with training, leaving them with information about support available for the patient to consider.

• Staff made notifications to external bodies as needed. Reports were provided to commissioners. The early intervention teams reported on their targets, including 14 day assessment target.
• Information governance systems included confidentiality of patient records. Care records were electronic, and staff locked their computers when they were leaving their desks to ensure confidentiality of content.
• The service did not always comply with the Accessible Information Standard. We saw 3 care records for autistic patients with no reasonable adjustments included.
• Staff gave examples of how they used alternative methods of communication for some people with communication difficulties including writing and email.
• Welcome booklets that we saw in the teams were tailored to the team, however the information sent following the on site assessment, was the same across the teams and did include how to give feedback about the service. However the information was in English, and people would have to contact the patient information centre who could arrange for translation to different formats.
• Staff ensured carers, families and commissioners were regularly updated about the patient’s progress. We saw staff discussing with patients whether they consented to share information with their families and carers.

• The total number of complaints in last 12 months for the service was 205.
• The total number complaints upheld or partially upheld were 74.
• There were no complaints referred to the Ombudsman in the last 12 months.
• North Cumbria, Carlisle was the team with the highest complaints with 31. Themes were attitude of staff, clinical decisions, communication and waiting time. The service had waiting time initiatives of conducting assessments at a weekend and having agency staff focused on assessments to try to reduce the waiting time.
• Patients knew how to complain or raise concerns. We spoke with 38 patients, we asked 33 if they knew how to complain, 30 patients said they knew how to complain and 3 did not know how to complain.
• Staff knew how to handle complaints appropriately. Local level complaints were discussed directly with patients, with the aim of local resolution. Formal complaints were managed by the complaints department and allocated to managers to investigate.
• Staff sometimes received feedback on the outcome of investigation of complaints and acted on the findings. Team meeting minutes included complaints at North Cumbria Community Treatment Team and North Tyneside Community Treatment Team. All other team meeting minutes that we reviewed of the teams we visited did not have complaints in their minutes. This meant not all staff were informed of the nature of complaints in their local area and any changes in practice.

• Staff tried to ensure the needs of patients with mobility issues were met – several buildings were not accessible, with several stairs and no lifts, staff arranged to meet with people either in their own homes or other venues including clinics.
• Staff made reasonable adjustments for patients – for example, in Gateshead East Community Treatment team, records showed that a letter had been translated from English to Farsi and that an interpreter was involved in an assessment visit with consultant.
• However reasonable adjustments were not always considered or recorded for autistic patients.
• Feedback via complaints was that 33 of the complaints in the 12 months prior to the assessment were regarding discharge, patients either feeling they were discharged from the service too soon or patients did not feel they had enough support from the service following discharge from hospital. This meant patients did not feel the service planned discharge well and some people felt ill without support.

• Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Of the 33 patients we asked about giving feedback and complaining to the service, 30 patients told us they knew how to do this and felt confident doing this. They thought the team were approachable and would listen to their feedback.
• The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. The service called these equality and diversity impact assessments, and these were included in the appendices of the policies.
• Staff are trained in equality, diversity, inclusion and human rights. With compliance over 80% for the teams that we visited.

• Staff support patients to make decisions about their care and treatment and their future. Aims and aspirations were discussed with patients, staff encouraged patients to identify goals.
• Staff created some personalised care plans to account for the patient’s needs, wishes and feelings. We reviewed 68 care records during the assessment. However, of the records reviewed, 3 records did not have a care plan in place, 11 care plans were not up to date, 16 care plans were not personalised, holistic and recovery orientated. Records that were personalised showed, and patients told us of support to find or return to employment and attend college courses.
• Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. Records showed and staff told us of joint working with other agencies including safeguarding teams, eating disorder services and speech and language therapists.