Rotherham Doncaster and South Humber 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 inspection we rated this key question good. At this assessment the rating has changed to 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 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People said they were involved in their care and treatment plans and staff knew their individual needs well. Carers said their family members had made improvements since admission, and they felt included and listened to.

Staff demonstrated a strong understanding of the importance of involving people when assessing their needs. The multidisciplinary team reviewed individual needs throughout admission to identify how the service could offer support.

We reviewed 19 care records during this assessment. These showed that staff completed a comprehensive mental health assessment of each patient in a timely manner on or soon after admission. Staff also completed a needs assessment to help identify the purpose of admission and develop a plan of individualised care.

Staff produced individualised care plans with input from different disciplines using a range of tools. Staff assessed patients' physical health needs and care planned around these accordingly. Care records were up-to-date, personalised, holistic and recovery orientated.

Speech and language therapists helped people who required extra support with communication needs.

Staff obtained consent from patients to involve their families and, if given, they sent out a carer pack to them.
 

Care plan and risk assessments were reviewed regularly and updated when required such as after an incident. We saw evidence that care plans were developed in co-creation with patients and their carers.

We found concerns with the provision of activities across the service. Most staff and patients felt that there were insufficient activities for patients on the wards, particularly at Swallownest Court and the Tickhill Road site.Trust leaders acknowledged that there was a lack of activities for patients. They told us that there was an organisation wide review of activities, with change due to go into effect in October 2025 f engagement with staff and patients.

At Tickhill Road the activities timetable at Brodsworth ward was out of date. The timetable also had days where no activities were taking place, and did not specify that activities were taking place at evenings or weekends. Staff told us the activities coordinator post had been vacant for a year and that were no plans to recruit for the role. We observed a community meeting during the inspection and saw that patients raised a lack of activities during the meeting.

At Swallownest court we also found that occupational therapy provision did not meet the needs of the patient group. The care pathway provided by the lead occupational therapist stipulated that a member of the occupational therapy team should make initial contact with the patient and complete initial assessment within 72 hours of admission. This would then determine whether further functional assessments were required. We reviewed 11 records and found that none of the assessments were completed within the specified time. Only 4 had been completed; these were all late by either weeks or months after admission. We raised this with the service, who told us this was not a target they monitored. They completed a rapid audit in response which indicated less than 20% of patients had been seen by the occupational therapist within 72 hours.

The activity timetables at Swallownest Court also showed that activities were not offered every day or on evenings and weekends. We were concerned that this did not follow National Institute for Health and Care Excellence (NICE) guidelines which stipulate that activities should take place outside of daytime hours, seven days a week. We also found that there were 6 groups open to female patients, in a week but only 3 groups available to males.

Despite the lack of occupational therapy support on most wards, Kingfisher ward staff were able to provide evidence that activities took place on a daily basis, delivered by the ward team.

Patients said they could seek support and advice about their care and treatment from staff. Staff supported patients to have access to an independent advocate.
 

Managers could describe how training and guidance was adapted in response to new legislation and guidance. The trust had recently update guidance around depression, prescribing and changes to treatment. There was a National Institute for Health and Care Excellence (NICE) lead who ensured that staff were kept informed of updates and shared new guidance and legislation in governance meetings. The trust also circulated updates to guidance or legislation via email.

Staff ensured that patients had good access to physical healthcare, including access to specialists when required. These included speech and language therapists, dentists and GPs. We saw evidence in care records that staff assessed and met patients' nutritional, and hydration needs.

Staff were able to demonstrate their knowledge of the Mental Health Act and Mental Capacity Act when they spoke with us. Staff received training in the Mental Health Act and Mental Capacity Act. The provider had policies and procedures relating to the Acts which reflected the most recent guidance. Staff had access to support and advice about the use of the Acts from a mental health legislation team.

Staff had access to a learning disability specialist nurse and described how they had sought advice from them to support a patient on Kingfisher ward who had a learning disability.

We saw evidence in care records that staff requested an opinion from a second opinion appointed doctor when necessary. Care records also evidenced that staff had read and explained patients' rights to them as required.

There was information on display on patient noticeboards about access to advocacy services and informing informal patients that they had the right to leave the ward freely.

Staff told us that they had regular access to team meetings. Minutes from meetings were recorded and sent to all staff so any staff members unable to attend were kept up-to-date with essential information.

Staff and leaders told us that they had good, effective working relationships with teams both within and outside of the organisation. This included regular working with the older adult services and community teams.

Throughout our assessment, we saw different healthcare professionals working in partnership together well. There appeared to be respect throughout the different disciplines for each other's point of view and clinical insight.

Ward managers ensured that tasks were delegated to staff members at the beginning of each shift. The nurse in charge was responsible for allocating duties such as medicines, attendance at meetings, leave, observations and checks.

Managers ensured that staff were able to provide support and respond to other wards if needed and each shift had an allocated first responder. Managers and staff described how they regularly supported on different wards and how staffing was often shared to ensure safer staffing levels were met.

There were standing agenda items for meetings to ensure essential information was shared and discussed. This included lessons learned from investigating incidents, complaints and safeguarding concerns.

Staff shared information about patients at handover meetings from one shift to another. We observed a handover during the inspection and saw that staff discussed patients’ presentation, risk and concerns, identifying and agreed any actions needed.

The nurse in charge completed a checklist during each shift to ensure information about medicines, physical health, observations, seclusion, incidents, security, notifications sent to the CQC, any safeguarding referrals sent to the local authority and any care plans that had been reviewed and updated were recorded.

Managers from different services within the trust attended regular meetings together to share information and updates. For example, there was a weekly clinical leads meeting which looked at patient pathways and service pressures across the service. Managers told us this aided communication and joint working

In preparation for discharge staff worked closely with community teams who they involved in discharge planning. This included taking patients on a period of leave and feeding back to the service about how this had gone.

The service partnered with an external agency who identified whether housing or benefit needs need to be put in place to avoid delayed discharge. Managers told us how the service had arranged for a local charity to attend a carers forum to explain how they could support both them and patients. This included support with housing and grants, volunteering opportunities and building social networks with other carers.

Swallownest Court and Tickhill Road each had gymnasiums on site which had a range of state-of-the-art equipment. At Swallownest Court we saw the gym being used and there was a dedicated physical health lead who arranged visits to the gym. Patients spoke positively about the gym which they said they were encouraged to use. Some patients told us that staff encouraged them to partake in activities which involved exercise and access to fresh air. However, others felt that there were not enough activities in place to promote a healthy lifestyle.

Staff could provide examples of activities patients had attended in the community. This included boxing sessions at a local boxing gym.

We saw evidence in patient care records that staff conducted physical health screening such as electrocardiograms, blood glucose monitoring and took patients' blood pressure readings.

We saw evidence in care records that staff care planned for any physical health issues identified. We also saw evidence that staff had referred patients to external healthcare services such as podiatry and dentists.

Smoking cessation was offered to all patients who smoked. The service was currently auditing the use of electronic cigarettes to analyse the impact of these, and whether they were useful in helping patients to stop smoking.

Patients and carers told us that they received the care and support they needed. Patients said their care was regularly reviewed, and they were seen by appropriate teams and professionals to support both their mental and physical health such as psychologists, occupational therapists and GPs.

Staff used recognised rating scales to assess and record severity and outcomes. These included the National Early Warning Scores and Health of the Nation Outcome Scores. Quality improvement leads told us they were reviewing data from the Malnutrition Universal Screening tool, working closely with dieticians to ensure that staff captured appropriate data within the forms.

Managers collected data on readmission rates and length of stay which they said fed into the one of the trust’s key objectives which was to reduce the need for hospital admissions and improve the quality of community services.

Staff received training on the Mental Capacity Act and Mental Health Act.

Staff explained patients' rights to them in a way they could clearly understand. Staff explained things in a way that enabled patients to make informed decisions about their care and treatment.

There were independent advocacy services that supported patients. An advocate from the service visited the wards regularly. Advocates could also speak to patients by phone or arrange face to face meetings. Staff told us that patients were automatically referred to an advocate on admission.

We saw in care records that patients were regularly reminded of their rights. There was evidence that when patients lacked capacity, staff held best interests meetings with the patient, their family, advocates and members of the multidisciplinary team involved in the patient's care and treatment. Best interest decisions were made and recorded following these meetings.

Care records also contained evidence that staff sought patients' consent to care and treatment. For example, staff had sought consent from a patient to undertake care and treatment of a wound they had sustained. Care records evidenced there were ongoing discussions with patients around consent to treatment and that capacity was assessed.