Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

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• 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.

Good: This meant people’s needs were met through good organisation and delivery. Staff managed beds well. A bed was available when a patient needed one. The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Staff supported patients with activities outside the service, such as education and family relationships. The service mostly met the needs of all patients – including those with a protected characteristic. Staff mostly helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

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 scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

All young people had an individual care plan. Care plans were individualised and showed evidence they had been written with the young person’s input. However, most young people we spoke to were not aware of the content of their care plans.

Staff we spoke with, knew young people well and could explain their needs, interests and how to support them effectively. Staff had carried out sensory and communication assessments with some but not all young people who needed them. There were plans in place to support these young people with these needs where assessments had been carried out.

Staff carried out capacity assessments when required and supported young people to make decisions. They held community meetings which supported young people to have a say in the day to day running of the ward. However, young people on Lotus ward were not invited to multi- disciplinary meetings which meant they were excluded from discussions about their own care.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff ensured that young people had access to education. Education happened during school term times and some of the young people felt there was less to do in the holidays. Carers told us that some young people also found the transition between education and holidays difficult as it disrupted their routine. Families gave really positive feedback about education, for example 1 family member said that education staff were amazing and that they were teaching family members Makaton.

Staff supported young people to maintain contact with their families and carers, family visits were supported and encouraged and the service was flexible around times. Staff worked closely with families, for example families of young people who were on the eating disorder pathway were encouraged to participate in meal support.

We scored the service as 2. The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up to date information to those involved in young people’s care. Information provided to young people and their families were in formats that were tailored to individual needs.

Staff made notifications to external bodies as needed. Information governance systems included confidentiality of young peoples’ records. The service complied with the Accessible Information Standard.

Staff ensured young people could obtain information on treatments, local services, their rights and how to complain. The information provided was in a form accessible to the particular patient group, for example, easy- read information was available for young people with a learning disability. The service had a welcome brochure for each ward, which provided young people with accessible information about their stay at the service.

Staff made information leaflets available in languages spoken by young people.

Staff did not always ensure carers, families and commissioners were regularly updated about the young peoples’ progress. Families shared mixed feedback as to how regularly they were updated. Some families told us there were delays in informing them about incidents, whereas other families felt staff kept them informed. Commissioners also told us that staff had not always shared information in a timely way although some commissioners felt this had improved.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

There were 7 formal complaints made to the service in the last 12 months. Out of these 4 complaints were partially upheld and 1 was still under investigation. No complaints were referred to the Ombudsman. Complaints were across several different wards.

We reviewed 2 complaints; both of these were investigated thoroughly and appropriate responses including apologies were sent to those making the complaints.

Most young people and their carers told us they knew how to complain or raise concerns. They told us they felt complaints would be taken seriously. When young people and their carers complained or raised concerns, they received feedback, and most people felt that their concerns had been resolved by staff. However, some young people felt that changes were not always made following them raising a concern.

Staff knew how to handle complaints appropriately and protected young people who raised concerns or complaints from discrimination and harassment.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured the needs of young people with mobility issues were met, for example wards were accessible to wheelchair users.

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. However, out of hours medical staff on Lotus ward were from another trust and therefore did not have easy access to young people’s records.

Staff ensured young people had access to post-discharge care – for example, S117 aftercare, community mental health services and crisis services. Staff planned for young peoples’ discharge, including liaison with care managers/co-ordinators. However, plans varied in quality with some plans being extremely detailed and others being more basic. Staff and stakeholders told us about failed discharges, where there were concerns the young person was not ready to leave or that that the placement would not be able to meet the needs of the young person. Stakeholders also shared concerns that there was sometimes insufficient preparation prior to discharge. However, there was also evidence that staff had planned gradual discharges to ensure the young person was ready for discharge prior to leaving and that ongoing support was provided after the young person had left.

In the last 12 months, there were 10 delayed discharges from inpatient wards. The ward with the highest number of delayed discharges was Lotus ward with 6 delayed discharges. These were mostly due to young people waiting for a placement to move to, that met their needs.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their 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. Young people could attend community meetings to share their views and the service had peer support workers who supported and advocated for young people. Young people told us they felt they could raise concerns, particularly with the peer support worker, who they said got things done.

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

We scored the service as 3. The evidence showed a good standard. People were supported 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 young people to make decisions about their care and treatment and their future. Staff created personalised discharge care plans to account for the young peoples’ needs, wishes and feelings. For example, discharge plans refer to young people preferences in relation to treatment choices, leisure activities and food preferences.

Staff mostly ensured relevant healthcare professionals and other relevant bodies are involved in planning the care and treatment of people with complex needs.