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

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: Staff assessed the physical and mental health of all young people on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for young people 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 young people on the ward. Staff from different disciplines worked together as a team to benefit young people. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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

This service scored 63 (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 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 12 care records during the inspection. Staff completed a comprehensive mental health assessment of the young person in a timely manner at, or soon after, admission.

Staff assessed young peoples’ physical health needs in a timely manner after admission. Young people had a physical health care plan and staff carried out ongoing physical health monitoring where this had been identified as a need.

Staff developed care plans that mostly met the needs identified during assessment. Care plans were personalised, holistic and recovery-oriented. Some care plans did not fully reflect all concerns identified, for example care plans regarding room searches did always detail items that were a particular risk to young people and leave care plans did not always fully contain information as to how to support and monitor young people when out on leave, although some of this information was covered in other care plans.

Where required young people had positive behavioural support plans and sensory assessments. Some young people also had communication plans that were developed by speech and language therapy staff. However, we reviewed records for one young person who had communication difficulties and found there was no management plan in place to support the young person with their communication difficulties and no referrals had been made to supporting professionals such as speech and language therapists. Staff updated care plans regularly, including when there had been an incident.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

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, psychological therapies, activities and education. For example, a young person was involved in an anger treatment programme, and staff used a body sock to help a young person with their sensory needs. This is a sensory tool providing a hug like sensation which helps people feel safe when feeling overwhelmed by the environment. Staff completed psychological formulations with young people using the 5 Ps model, which is a structure approach to assessing people’s needs in a holistic way.

Staff mostly ensured that young people had good access to physical healthcare, including access to specialists when needed. Staff carried out weekly physical healthcare monitoring and staff carried out daily physical health monitoring where this was needed. However, we reviewed daily physical observations for 1 young person and found that 1 set of physical health observations had not been recorded on the relevant forms and 1 set of observations had been missed completely.

Some young people had a sports and fitness care plan as part of their physical healthcare plan. A GP visited the ward weekly to support young people with physical health concerns.

Staff did not always assess and meet young peoples’ needs for food and drink and for specialist nutrition and hydration. The service had an eating disorder pathway and there was clear guidance for accepting young people onto this pathway. Dieticians worked with young people and their families to create meal plan where required. However, families and carers told us food on the meal plan was not always available. This meant some young people were not always receiving the food prescribed in their meal plan and some families were bringing in food from home to ensure young people could have the food on their meal plans.

Other families whose children were not on the eating disorder pathway were concerned the food being offered was unhealthy, that portion control was not being monitored and that food was being used as a reward on a regular basis.

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

The team included or had access to the full range of specialists required to meet the needs of young people in the service. As well as doctors and nurses, the service had occupational therapists, clinical psychologists, pharmacists, speech and language therapists, dieticians and peer support workers.

Staff were experienced and qualified but did not always have the right skills and knowledge to meet the needs of the patient group. Compliance with autism training was low for all staff groups. This was particularly concerning because Fraser ward was a dedicated ward for young people with a learning disability and autistic young people. There were young autistic people on some of the other wards. We were therefore not assured that staff had all the relevant skills to support young people in the most effective way.

Managers provided new staff with an appropriate induction. They 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. Supervision compliance across the wards was 83% although supervision on Fraser ward was lower at 69%. Appraisal compliance varied significantly between wards with Lotus ward, The Riding and Stephenson ward at 90%, whereas Redburn ward was at 60% and Fraser ward was at 22%.

Managers ensured that staff had access to regular team meetings. Team meetings occurred monthly and had a standard agenda and were recorded and shared with staff members who could not attend.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. For example, the speech and language therapists and family therapists had delivered sessions, including reflective practice sessions, to help develop staff skills and knowledge.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

Staff were not all trained in the Mental Health Act, the Code of Practice and the guiding principles. 64% of staff had received training in the Mental Health Act. However, staff had a good understanding of the Mental Health Act.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice and 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.

Young people had easy access to information about independent mental health advocacy and there was evidence in young people’s records that advocates had been involved in supporting them. Staff explained to young people, 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. Staff ensured that young people were able to take Section 17 leave (permission for them to leave hospital) when this has been granted.

Staff stored copies of young people' 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. Staff requested an opinion from a second opinion appointed doctor when necessary.

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.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share an effective assessment of people’s needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings. Multidisciplinary team meetings were thorough and contained a full range of professionals. However, young people were not invited to multidisciplinary meetings on Lotus ward. Staff spoke to young people before the meetings to ask them what they wanted to raise and then fed back to them after the team meeting. This meant that young people were excluded from meetings about their own care and treatment

Staff shared information about young people at effective handover meetings within the team, handovers were thorough and were followed by a debrief to discuss incidents and any learning that had been identified from incidents.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation, for example speech and language therapist, and GPs. However, the teams did not always have effective working relationships with teams outside the organisation. Partner organisations told us communication had not always been effective and that staff had not always shared relevant information with them. Recent work had taken place to improve work with other agencies.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported young people to live healthier lives, for example, through providing advice to young people and their families around the risks of vaping, promoting healthy eating and good sleep hygiene and encouraging exercise.

Ward activities helped promote a healthy lifestyle for young people – for example young people could access the gym and take part in other sports activities such as badminton, football and swimming. Families raised concerns that young people were not always receiving healthy diets, although the trust provided us with assurances that healthy options were available at all meals.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes for example, the revised Children’s Anxiety and Depression Scale (RCADS) and the National Early Warning Score (NEWS)2.

Staff used technology to support young people effectively, for example staff used an electronic system to monitor young peoples’ movements whilst they were in their bedrooms. This supported staff to monitor young people who were at risk of harming themselves. Young people were made aware of the system and could request this be turned off, although this would not always be agreed if there were significant concerns about a young person’s safety. Staff also used body cameras which they could switch on during an incident. The body cameras captured visual and audio footage which supported investigations when incidents occurred. Technology was also used to enhance security, for example the medicines cabinet in the clinic room used fingerprint activation. There was also a piece of equipment which removed items that people were choking on, which was used to good effect during choking incidents.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable young people to make their own decisions. For those who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When young people lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.