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

Effective – 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.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People, their families and carers gave us mixed feedback about the needs of their relatives being met. One family member told us about the positive impact of assessment of needs had on their loved one. However, another family member told us their relative receives psychotherapy once per week but "this is not enough." Another family member expressed concerns about staff confiscating items he'd brought for his relative and had raised a complaint in response to this.

Staff told us they assessed the mental health needs of all patients. They told us that people had care plans to reflect their needs. Staff told us that all people using the service also had assessments of their health. This included any support required with communication needs, religious needs and if their families or carers were to be included in their care. Staff told us that they worked with people using the service to make decisions about the care they would receive and they link in with external organisations who can offer additional support.

People's needs were regularly reviewed via a weekly MDT meeting. Care plans showed evidence of involvement from a range of health professionals such as psychologists, occupational therapists and speech and language therapists. However, whilst some care plans were discussed with family members and evidenced family and patient involvement in care and treatment decisions, there was limited evidence of family involvement for some of those we reviewed. Care plans were holistic and included information for staff on how to support people's emotional and physical wellbeing. However, care plans did not always identify and describe how best to support people in times of crisis, particularly where the use of restraint was required. There was evidence that staff regularly carried out physical health observations. However, care plans and monitoring records did not always evidence that staff monitored physical health observations during periods of restraint which increased risks to patients. Staff created communication plans to meet patients' needs. They included strategies to support understanding and expressive language and evidenced the involvement of other healthcare professionals in creating them. It was recorded where people hadn't wanted to engage or have a copy of their care plan.

People and their family members gave us mixed feedback about their involvement in their care planning. While one person at Mitford Unit told us they did not get a copy of their care plan, another person said they hadn’t asked to see their care plan, but staff would let them see it if they asked. A patient at Rose Lodge told us they had been offered a copy of their care plan. People were able to prepare their own meals snacks were available for people throughout the day.

Staff were involved with team meetings and supervisions to keep them up to date with people's care and any changes to practice. People were spoken with regarding their detention rights and the restrictions this included. Findings from clinical audits were shared with staff via team meetings, emails and through messages from clinical managers. Mental Health Act audits were carried out monthly and during internal MDT weekly meetings. Pharmacy staff attended the wards and checked paperwork. Staff received training in the Mental Health Act and Mental Capacity Act. However, a ward manager told us this was often cancelled.

There was evidence in people's care plans of the service working in partnership with other organisations to meet people's needs. Nutritional care plans were in place and monitored. Within each ward there were daily reviews of all patients and a fortnightly clinical review for each patient. This provided an opportunity for a more in-depth regular review with the wider MDT. In addition, there were frequent discharge planning meetings for all patients, which included external agencies. The responsible Integrated Care Board (ICB) arranged regular assurance visits for each individual patient and there were regular Care and Treatment Reviews. The trust and external partners had been holding weekly Clinically Ready for Discharge Meetings (CRD) to discuss complex patients with no identified discharge plan, these meetings had since been stood down. To ensure continued adequate oversight and focus on discharge in the absence of the ICB group, the trust had implemented a weekly CRD tracker to monitor progress against plans and where escalation was required, had discussion with the ICB and commissioners. However, the service did not always deliver evidence-based care and treatment in line with guidance because of the high use of physical restrictive intervention in place, particularly on Mitford Unit. The service did not always evidence that positive behaviour support plans were used to ensure the environment and care delivered was least restrictive.

People and their family members gave us positive feedback about how the staff and teams worked together. One family member told us, “The MDT were very good” and they "loved working" with her relative. Another family member said they went to all the meetings about their relative and spoke positively about communication and told us staff keep them "informed".

Staff members expressed some concerns about the knowledge and skills of their colleagues. Staff members also told us they felt senior leadership did not always listen to concerns when they were raised. Some staff at Rose Lodge told us their role was split across different sites, and they did not feel there was sufficient time for them to perform effectively.

We observed an MDT meeting and a formulation meeting. We observed good effective MDT working on behalf of patients.

There were regular team meetings, although there were some difficulties ensuring all staff were able attend due to them either working or it being their day off. There were daily handovers between shifts to support staff's understanding of the person's day/night. Regular MDT meetings were held which patients, and their family members were invited. Discharge plans were in place, although progressing these was often difficult due to the lack of accommodation and suitable providers for care packages. Patients had access to other healthcare professionals, including occupational therapists, psychology, activity workers, physical health team, the HOPE(S) team, psychiatrists, speech, and language therapists (SALT), dietitians and physiotherapists. The wards had good links with social workers, local authorities and ICBs. Social workers often attended MDTs. A partner agency staff member said they were kept up to date with what was happening and felt included in MDT's and plans being made.

People gave us feedback regarding supporting people to live healthier lives. One family member told us their relative had lost a lot of weight since they had started going to the gym. At Rose Lodge, a family member told us her relative had dietary requirements to support dysphagia and it was all recorded in the care plan. They also told us they had no concerns about their relative’s weight. At Edenwood, one family member told us their relative looked well and noted improvements in their levels of stress and anxiety. However, at Mitford Unit, one family member told us they had concerns regarding their relative’s weight gain and the impact this was having on their joints. Another family member said their relative had put on weight since they arrived. Another family member told us, “I was concerned [Family Member] was putting on weight, there is a lack of exercise, but they’ve got a dietician involved now, to help with nutrition and he’s only had 2 takeaways.” People also gave us mixed feedback about personal hygiene. At Edenwood, one family member told us there were no issues with personal care or hygiene. They told us that, "Staff keep [Family Member] tidy and do their nails." Another told us they had no concerns around her relative’s personal care or hygiene. However, another family member told us they had complained multiple times regarding their relative’s personal hygiene and that they felt staff are “Not fully invested” in his care and expressed concern about their relative being left in an undignified state and unkempt.

Mitford Unit had access to an onsite GP. Staff told us they had built close links with the local walk-in centre who made adjustments to support people to attend appointments. For example, some patients were able to access the centre by a different door to minimise distress or anxiety. People's care plans contained information on how to support their physical and mental well-being. At Edenwood, a GP visited the ward at least once a week and was able to refer patients to other healthcare services when needed. Staff told us how they supported patients with issues around weight management and encouraged patients to take regular exercise and by changing their diet.

Care plans contained information for staff on how to support people with managing their wellbeing. People had access to appropriate health care professionals to support their mental and physical wellbeing. A range of physical health monitoring tools were in use to support physical health.

People and their families did not express any concerns regarding monitoring and improving outcomes.

Staff told us people's care and support was monitored via daily handover meetings and weekly MDT meetings where managers shared information to support the staff team with supporting people correctly. Mangers told us situation reports were completed on a daily basis to review incidents and identify lessons learned.

Quality of life outcomes were monitored and measured. Occupational therapists conducted an assessment on admission and also throughout the patient’s admission in relation to quality of life. Positive behaviour support and care plans were regularly reviewed. The trust was taking part in the Quality Network for Inpatient Learning Disability (QNLD) standards. The QNLD aims to support wards to evaluate and improve their management processes and standards of care. Membership demonstrates a commitment to providing the highest level of care to patients. Links were being made with other services in the trust who have undergone QNLD accreditation to learn from their experience. Rose Lodge had already completed a QNLD self-assessment and peer review as part of this and were due to find out in September 2024 whether they had been accredited.

People and their family members did not raise any concerns with us in relation to consent to care and treatment. One person told us they had support from an advocate. One person told us that some staff asked for consent before delivering treatment and how they wanted it to be delivered, however, also told us some staff did not.

Staff told us they assessed patients' mental capacity and took their views and wishes into account when devising care and treatment plans.

During the onsite visit, we witnessed some staff asking people for consent prior to delivering care and treatment. However, we also witnessed an episode of care where a staff member did not ask for consent prior to physically touching a patient.

Care records evidenced people had been spoken with about their detention under the Mental Health Act and this was recorded in their care plans. Advocates were available for people to speak with were they required, and asked for, that support. Advocates could attend the wards quickly when required to support patients. However, data provided by the trust demonstrated that in June 2024, only 76% of all staff had completed their mandatory training in Mental Health Act, Mental Capacity Act and DoLS.