Blackpool Teaching Hospitals NHS Foundation Trust

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• 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 requires improvement. At this assessment the rating has changed to good.

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

Staff assessed the physical and mental health of all young people admitted to the service. They mostly 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 team did not include a full range of specialists required to meet the needs of young people at the service. Staff from different disciplines worked together as a team to benefit young people.

This service scored 67 (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 11 care records during the inspection. Staff completed a comprehensive mental health assessment of the young person, and this was mostly done in a timely manner. There were some delays in completing assessments, although this mostly appeared to be due to complications in the assessment process, for example one assessment completion was delayed due to ensuring the communication needs of the young person could be met.

Staff assessed young people’s physical health needs in a timely manner after admission. For example, staff checked young people’s weight and blood pressure and arranged for electrocardiograms (ECG) where required. Where physical health tests had been requested these could be viewed on the computer system when completed, as the system was shared with other providers including GPs.

Staff mostly developed care plans that met the needs identified during assessment, however not all young people had a care plan in place. Audits showed that 7 out of 18 records that had been audited in the last 5 months did not have a care plan. Where care plans were not in place, there was evidence of care planning and risk management in the care notes, and young people and their families told us they felt involved in their care. Care plans templates varied between different teams. Some teams had adapted care plan templates to be young person focused, holistic and recovery-oriented, whilst the care plan templates other teams used were standardised and less engaging. For example, primary mental health support team had adapted the ‘my keeping well’ care plan care to be young people friendly, engaging and relevant to young people’s specific needs. It also contained a list of helpful numbers and apps. The response and intensive support team had created a care plan for a young person using characters created by them which helped to personalise the care plan and helped the young person to engage with the process. Staff updated care plans when necessary.

We scored the service as 2. The evidence showed some shortfalls. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff received effective supervision but did not always feel supported or able to access development opportunities. The team did not have a full range of specialists to meet the required needs of young people.

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 and range of psychological therapies such as cognitive behavioural therapies, person centred counselling and eye movement and desensitisation therapy.

Staff ensured that young people had good access to physical healthcare, including access to specialists when needed.

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

The team did not include a full range of specialists required to meet the needs of young people in the service. For example, the psychologist for the team had left and at the time of our inspection psychology input was provided by a 0.2 WTE bank staff member. Staff members who had left had not been replaced and this left gaps in the team. The team had carried out a restructure to cover these gaps. Teams contained staff from a range of backgrounds including nurses, counsellors and social workers. The team referred to other professionals such as speech and language therapists where needed. There were 2 locum psychiatrists, who covered the service.

Staff told us there were difficulties accessing support for some young people such as those with avoidant/ restrictive food intake disorder (ARFID) and those who required support for gender identity dysphoria. However, the trust told us that some staff had received extra training in relation to ARFID and that information had been shared with staff about referral pathways in place to meet the needs of young people with ARFID and gender identity dysphoria.

Staff were experienced and qualified and mostly had the right skills and knowledge to meet the needs of the patient group. For example, staff were from different backgrounds and had trained in a range of interventions and therapies including psychotherapy, counselling, social work, family therapy, and Eye Movement Desensitisation and Reprocessing (EMDR).

The Trust told us that there was a commitment to ongoing professional development and told us staff had accessed courses such as EMDR masterclass, the CBT (Cognitive Behavioural Therapy) Foundation programme and the postgraduate certificate in Evidence Based Therapies for children and young people – learning disabilities and autism pathway.

Managers provided new staff with appropriate induction. Staff received a corporate induction and a local induction to their individual teams.

Managers 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. The percentage of staff that received regular supervision was 100% and the percentage of staff that had had an appraisal in the last 12 months was 98%.

Managers ensured that staff had access to regular team meetings. However, team meeting templates varied between different teams and there were no standard agenda items across all teams. This meant that some team meetings were well structured and reviewed agenda items such as learning from incidents and training whilst others were less structured.

Managers identified the learning needs of staff, for example managers carried out skills audits and mostly ensured that staff received the necessary specialist training for their roles. However, some staff told us that continuous professional development had been paused.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

Staff had received training on the Mental Health Act. The Trust had a policy which was up to date and contained guidance about how staff supported detained patients, that staff could refer to. However, it did not contain information about Community Treatment Orders (CTOs) which provide supervised treatment under the Mental Health Act, to people living in the community. The Trust told us there had been no cases of young people on a CTO in the last 5 years. They told us that if this were to occur an urgent multi-disciplinary team meeting would be convened to identify a care plan for the individual.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings. We attended a meeting and found staff carried out thorough reviews of each young person including considering safeguarding concerns, risks and referrals made to other services.

Staff shared information about young people at handover meetings and staff huddles. However, staff who worked during the evenings for the RAIS team were bank staff and they did not attend the morning handover meetings. This meant information could only be shared through documentation rather than enabling staff to discuss issues face to face.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation.

The teams had effective working relationships with teams outside the organisation, for example, local authority social services and GPs. The service had a shared computer system with other services to ensure effective information sharing could take place.

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 on healthy eating, sleep hygiene, reducing screentime, maintaining healthy relationships and where appropriate sexual health advice. For example, staff explained how diet and exercise impacted on ADHD. Staff worked in a variety of settings including schools and community settings and signposted young people and their families to other services where further advice around living healthier lives was required.

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 staff used routine outcome measurements, which was used in child and adolescent mental health services to monitor change and to help measure progress towards goals and functioning.

Staff used technology to support young people effectively. For example, staff used a Quantitative Behavioural (QB) test machine which used an infra-red camera to measure activity recordings and combined this with attention and impulse control measurements to help diagnose attention deficit hyperactive disorder (ADHD). The computer system was a shared system between local services which supported staff to share information and enabled results of tests to be accessed quickly.

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 example, staff checked young people’s understanding of the information given to them and asked young people to repeat things back to them to make sure they understood the information. Some practitioners used cue cards and picture cards to support young people to understand information given.

Staff understood the Gillick competency and used where appropriate to assess a young person’s competency to consent to treatment.

For young people 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.