Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Requires improvement: Requires improvement: Staff did not always involve patients in care planning and risk assessment or actively sought their feedback on the quality of care provided. The ward environment on Fraser ward did not enable staff to meet the individual needs of patients. Staff did not always inform and involve families and carers appropriately. Young people and their families were not always invited to be involved in multi-disciplinary team meetings where decisions about their care and treatment were taken. However, staff treated young people with compassion and kindness. They respected patients’ privacy and dignity and supported patients to understand and manage their care, treatment or condition.

The service was in breach of regulation for person-centred care.

This service scored 60 (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 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Staff attitudes and behaviours when interacting with young people showed that they were discreet, respectful and responsive, providing them with help, emotional support and advice at the time they needed it. We carried out 6 short observational framework for inspections (SOFIs) which is an observational tool used to capture the experiences of service users who may not be able to express this for themselves. We observed warm and kind interactions between staff and young people. For example, we observed staff dancing with young people, encouraging them during a baking session and talking about their interests with them.

Staff supported young people to understand and manage their care, treatment or condition. Young people told us they had had discussions about their care and treatment. However, most young people were not aware of the contents of their care plans, and some young people were unaware they had a care plan. We reviewed 12 care plans and found care plan documentation included young people’s views and there was documentation that young people had been offered a copy of their care plans. However, care plans were not presented in a way that was accessible to the young people in the service.

Staff directed young people to other services when appropriate and, if required, supported them to access those services.

Young people said staff mostly treated them well and behaved appropriately towards them. For example, young people said that staff are nice, kind and helpful and that they can talk to staff when they need to. Some young people said that staff were sometimes busy and they had to wait for them and some young people had raised individual concerns which were being investigated. Carers raised some concerns that agency staff did not always interact with young people and that this could lead to increased incidents on the wards.

Staff understood the individual needs of young people, including their personal, cultural, social and religious needs. For example, there was a chaplaincy service to meet young people’s spiritual needs and staff could order food, that met people’s spiritual and cultural needs.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards young people without fear of the consequences. Staff maintained the confidentiality of information about young people.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs. They mostly took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service made adjustments for disabled young people, for example the premises were accessible to those with a physical disability. Support for young people with communication needs varied. Some young people had communication plans in place which had been completed by speech and language therapists and some young people were using specific communication tools to help them communicate. Some staff had learnt Makaton which is a form of sign language used by some people with learning disabilities.

However, some young people who found communication difficult had not received assessments to identify the most effective ways to support them to communicate. We also received feedback from carers that communication plans were not always followed. The environment on Fraser ward did not consider the specific needs of young people on Fraser ward. The ward environment was bare and clinical and did not contain sufficient equipment and activities or any specialised equipment such as sensory equipment to support young people who had a learning disability.

Staff ensured that young people could obtain information on treatments, local services, young peoples’ rights, how to complain and so on.

The information provided was in a form accessible to the particular patient group, for example, easy-read information was available for people with a learning disability. Staff made information leaflets available in languages spoken by young people. Managers ensured that staff and young people had easy access to interpreters and/or signers.

Young people had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. For example, halal, kosher and gluten free menus were available, although some families told us that food was not always available.

Staff ensured that young people had access to appropriate spiritual support. For example, there was a multi faith room and the chaplaincy service supported young people with spiritual needs.

Quality Statement Score:1

We scored the service as 1. The evidence showed significant shortfalls. The service did not promote people’s independence, people knew their rights but did not always have choice and control over their own care, treatment and wellbeing.

Where young people were detained under the Mental Health Act, staff read them their rights and repeated these as and when required to ensure they understood their rights whilst they were detained in hospital.

Young people who were on Lotus ward were not invited to multi-disciplinary team meetings. This meant they were excluded from discussions about their own care and treatment and did not have choice or control over their own care. Young people’s families were also not routinely invited to multi-disciplinary team meetings on all wards. This meant decisions were being made without staff routinely taking into account the voices of the people who often knew the young person best. This was particularly concerning as there were a number of young people who lacked capacity to advocate for themselves and had difficulties communicating.

Blanket restrictions in place were assessed regularly to ensure they were in line with least restrictive practice. Blanket restrictions were removed, when risks were no longer present or had been mitigated.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were aware of and dealt with any specific risk issues, such as self harm, and physical health problems and care planned for these accordingly. For example, staff monitored young people’s physical health and plans were in place to address any concerns about deterioration.

Staff identified and responded to changing risks to, or posed by, young people. Staff had handovers after every shift and concerns about young people were discussed and any necessary actions were recorded.

Staff used de-escalation techniques to reduce the need for physical interventions when young peoples’ behaviours became heightened. Staff we spoke to knew young people well and understood their triggers and how to de-escalate concerns. However, carers told us that agency staff did not respond as well to support young people and this sometimes meant that de-escalation was less effective.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff mostly felt respected, supported and valued. Staff felt positive about working for the provider and their team.

Staff had access to support for their own physical and emotional health needs through an occupational health service. Staff had access to a confidential help line which was available 24/7 as part of the employee assistance programme. The service’s staff sickness and absence were similar to the average for the provider.

The provider recognised staff success within the service, for example, through staff excellence awards and through ‘shout outs’ for staff who had done something particularly well. Staff appraisals included conversations about career development and how it could be supported.