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

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.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The trust made sure people were at the centre of their care and treatment choices and decided, in partnership with them, how to respond to any relevant changes in their needs.

Patients and their carers told us they felt their care was well coordinated and staff worked well with them. They were encouraged to be involved in their care and treatment plan and knew who they could approach to request information from if needed. Staff had a very good understanding of patient’s individual likes and dislikes, and these were respected. The family and carers others we spoke with said they had specific support in the form of carer support workers, for their own needs and the care was not just about the patient but the whole family. They also said they were involved the care planning process through multi-disciplinary meetings.

Staff completed various nationally recognised tools and assessments when developing treatment plans. Patients had access to information leaflets regarding medication and treatment plans if they required them. These were available in easy read or pictorial format for patients who were more cognitively impaired.

We observed staff engaging with patients in a person-centred way and adjusting their approach according to the patient’s needs. Information was displayed around the ward informing patients of different treatment, care, and therapeutic options along with how to give feedback on care. All care and treatment plans we reviewed showed patient or carer involvement.

There were a wide range of activities taking place on each of the wards we visited. We found these to be both meaningful and touched on the strengths and interests of the patients taking part. There were options for both group and 1-1 activities dependent on patient preference and need. There were examples of celebrating special days such as carers events, the Kings birthday and works mental health day. Activity workers were in place on each ward and they attended community meetings to encourage patient and carer involvement in activities.

Patients were involved in creating and reviewing their care plans in collaboration with staff and family members (if the patient had consented to this). We saw records that showed patients had access to regular one to one time with a named nurse or key worker.

The trust understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Family and carers and patients told us they were shown round when first admitted to the wards. One relative described how they could visit the ward prior to their partner’s admission, and all relatives told us they built strong and supportive relationships with the staff caring for their loved one. Patients confirmed they were supported in relation to discharge planning and knew the steps leading to discharge.

Staff supported patients to maintain contact with their families and carers. On each ward we visited there was a carer support worker in post. This person was employed to liaise and work with carers and relatives on a day to day basis. They offered both practical and emotional support and feedback about this role was universally positive.

Patients had access to a patient information booklet and there were pathways in place with other services, for example, community mental health teams. We looked at previous discharge summaries which contained a discharge plan covering, plan of care, early warning signs of relapse or triggers for behaviours that may challenge others. We did also see examples where staff had assisted with discharge by visiting care homes with patients and continuing to visit for a short period post discharge to support the transfer.

The trust supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information governance systems were in place including an electronic records system which was password protected to maintain confidentiality of patient records.

Patients knew how to request information regarding their care and treatment. Resources including leaflets and interpreter services were available to ensure the patients understood their treatment and medication plans. Patients were able to attend ward round meetings and speak to staff at their 1 to 1 meeting where they could discuss their treatment plans and preferences in detail.

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress.

The trust had a proactive and positive culture of safety based on openness and honesty, in which concerns about safety were listened to, safety events were investigated and reported thoroughly, and lessons were learned to continually identify and embed good practices.

Patients and carers all told us they would feel comfortable in raising concerns and reported that there was lots of information on the wards about raising concerns as well as in welcome packs and on the Trust website. There was also information and posters about the trust’s patient advice and liaison service.

Patients and their loved ones could give feedback about their care and were listened to when they voiced their preferences and asked questions about their treatment or medicines. They attended weekly ward community meetings and had access to an independent advocate. Patients had regular 1-1 time with named nurses and could input their views into the discharge process.

On the wards we visited, we observed specific information about how to complain and how to contact CQC. Patients also had access to regular community meetings, and we saw a ‘you said we did’ board on most wards.

There was a variety of ways patients, and their families could provide feedback, including comment cards and on-line surveys. We looked at some recent feedback, which was very positive with 76 out of 77 positive responses. The service had received 10 complaints in the past 12 months. There were no obvious themes or trends around these complaints and issues ranged from discharge to food quality and staffing. None of the 10 complaints were fully upheld, 3 were partially upheld, 2 were not upheld and the other 5 were either unable to investigate or withdrawn after being locally managed.

The trust had a detailed incident reporting policy. Staff were aware of the trust’s incident reporting procedures and felt safe to report concerns. Safety events were usually reported promptly and in line with trust policy and were thoroughly investigated.

The trust made sure that everyone could access the care, support and treatment they needed when they needed it.

Staff ensured the needs of patients with mobility issues were met – for example, wheelchair users were placed in bedrooms at ground level or had access to lifts.

Staff made reasonable adjustments for patients – for example, people with mobility issues were provided with walking aids, shower chairs etc.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.

Staff ensured patients had access to post-discharge care – for example, S117 aftercare, community mental health services and crisis services.

Staff planned for patients’ discharge, including good liaison with care co-ordinators.

Discharge was mainly delayed due to lack of funding for placement in a care home, lack of funding for care packages at home or lack of appropriate places in the local area to manage patient needs. There were 152 delayed discharges in the 12 months leading up to our assessment. as never delayed for other than clinical reasons (or state how often it was delayed), nearly 100% of these related to external agencies, there were 8 that related to delays from internal factors, such as awaiting a bed on an adult acute ward within the trust.

The trust actively sought to listen to information about people who were most likely to experience inequality in experience or outcomes. They tailored the care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Patients could easily access the care and treatment they needed. Support for patients who spoke a different language was available. Patients told us they were supported and did not feel their needs were not being supported. Patients did not raise any concerns about their experiences on the ward in respect of equality or discrimination.

Managers gave examples of where adjustments had been made or were already in place to support patients who may have accessibility or mobility needs. Staff and managers described how patients would be supported with any spiritual or cultural needs that they may have, which included visits from religious leaders, having access to spiritual materials or being supported to attend places of worship. Staff also described how any dietary needs would be supported for any patients that had specific requirements for cultural or religious reasons.

Patients reported that they accessed advocacy services and described that they knew how to raise any concerns that they may have and that they would feel confident in being able to do this.

Staff were trained in equality, diversity, inclusion and human rights.

The trust supported people to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment and their future, for example choices about end of life care and do not attempt CPR. Care for people who are nearing the end of their life is managed and communicated in a sensitive and dignified way. We spoke to a carer of patient who had received end of life care on one of the wards. The feedback was overwhelmingly positive in terms of the way the patient and the family were cared for by the ward staff in a dignified and sensitive manner.

Staff created personalised care plans to account for the patient’s needs, wishes and feelings.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. Staff arranged discharge planning meetings, and everyone who was going to be involved with the care of a patient post discharge was invited. Staff told us there were processes in place to support patients with the transition from in-patient to home or a care home, for example, having more home leave or leave to a care home.