Derbyshire Healthcare 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. At our last assessment we rated this key question Good. At this assessment, the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. We found the care and treatment provided by the service was effective. It was evidence based, measurable, and monitored for outcomes. Processes and training were in place to support staff to fulfil their roles and responsibilities. Patients and where appropriate their families were encouraged to be involved in their care assessments and treatment plans which promoted and maintained a person-centred approach. Staff demonstrated a good understanding around the importance of capacity to consent. Correct processes and assessments were in place to safeguard patients and their interests. Patients were supported if they had communication needs and had access to internal and external resources to help capture their voice, which enable them to express themselves.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients and were appropriate their families participated in their care and treatment planning, and told us they felt involved, listened to, and their needs and preferences were understood and met. Dependent on diagnosis and presentation, some patients were not always able to be fully involved. On these occasions, staff supported involvement as much as possible and adhered the appropriate legal frameworks if a patient lacked the capacity to engage and make informed decisions. Where patients were unable to communicate their needs directly, staff supported their families, and carers to have input. Advocacy services could also be used to inform assessments and care planning.

Staff ensured they completed comprehensive and timely assessments of a patients’ physical, mental, emotional, and communication needs. The assessments were person-centred, and reviewed regularly with the patient, and if appropriate, their families wherever possible. Staff used clinical tools alongside professional judgment to build a comprehensive understanding of each person's individual needs. When patients lacked capacity to make decisions, staff adhered to legislation, and best practice which ensured decisions were made lawfully and, in the person’s, best interests. The patients' families and carers were also supported in their roles, with appropriate information and resources available to them.

We reviewed 9 care records during our assessment of the service. All records we reviewed as part of our assessment showed that staff completed a full mental and physical health assessment either on admission or shortly afterwards Care plans were holistic and person-centred, developed to reflect each patient’s needs and focused on meeting the expectations of the patient and achieving meaningful outcomes. Patients care records evidenced that care, and treatment plans were reviewed and updated regularly. Communication needs and preferences were clearly recorded, and where necessary, staff adjusted their communication style by utilising various forms of communication to improve the patients understanding and involvement.

The service delivered a wide range of care and treatment interventions, for example, Cognitive behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), and Compassion Focused Therapy (CFT). The psychology team formulated and promoted positive behavioural support planning (PBS) and completed behavioural assessments. Staff followed guidance from the National Institute for Health and Care Excellence (NICE) and had accessed regular clinical updates. We observed care during our assessment that was consistent with current best practice guidance.

Staff facilitated patients' specific dietary requirements, and individualised support was given. Hydration and nutrition needs were assessed by staff and monitored in line with national guidance and consistently evidenced in patients’ care records.

Staff were encouraged to explore new, research-backed approaches to improve outcomes. Staff took part in clinical audits, benchmarking, and quality improvement projects. For example, a quality improvement project to reduce restrictive practice. The project had improved the patients care journey and received positive feedback from them. A therapy dog also visited the service on a regular basis and had a positive impact on patients who were not engaging well with the service or were having difficulty in expressing themselves.

Patients and their families experienced coordinated care across teams and services. The service promoted a multidisciplinary team approach, including doctors, nurses, psychologists, occupational therapists (OTs), occupational therapy assistants (OTAs), health care assistants (HCAs) and external partners, for example, the Assertive Transitions Service (ATS) team and community-based Forensic mental health teams (FCMHT). All relevant professionals were invited to care and treatment reviews, which ensured continuity for patients, and their families.

The service prided itself on having strong collaborative working relationships within their teams, the wider organisation and with external partners. They held regular multidisciplinary team meetings (MDM) where care and treatment plans were formulated, reviewed and updated. Handovers were effective, and took place before the start of every shift, with information shared consistently throughout the teams. Staff also reported good communication with other external services, for example, the probation service. There were efficient processes in place that ensured care was well coordinated when patients moved between services. Discharge planning was robust and always considered the individual needs, preferences and circumstances of the patient. Clinical tasks were delegated effectively and referrals made, so that safe and effective care and treatment was maintained through transition by sharing accurate and up to date information in a timely manner.

The service and its numerous staff teams empowered and supported patients to manage their health and wellbeing and promoted healthier choices. There was a focus on patients being able to retain as much independence as possible. Staff encouraged health-promoting activities, for example, healthy eating advice. Physical activity was also promoted, for example, swimming, walking groups, gardening, outdoor pursuits, and sessions in the gym. Healthy meal options were available, with staff encouraging and supporting patients to make nutritional choices.

Health assessments were carried out regularly, and staff referred patients to specialist services, for example, occupational therapy (OT), and physiotherapy to meet their individual needs. The service focused on identifying any potential health risks early, this ensured timely interventions, maintained wellbeing and prevented any unnecessary deterioration.

Staff routinely monitored people’s care to achieve positive and consistent outcomes. They used recognised rating scales, such as the Malnutrition Universal Screening Tool (MUST), and physical health screenings to assess severity and track progress. For example, Waterlow score for monitoring skin integrity and pressure areas, and National Early Warning Score 2 (NEWS2). This promoted the alignment of care with clinical expectations and met the individual needs of the patients using the service.

The service had effective systems in place to ensure that care and treatment outcomes were consistent and endeavoured to ensure, they were positive. The service promoted, and its staff actively participated in monitoring and improving care, using technology where appropriate. Regular reviews of care plans ensured they remained effective and aligned with people’s changing needs. External benchmarking schemes and clinical audits were used to maintain and improve treatment pathways. The service engaged in and promoted continuous quality improvement initiatives and projects (QI), working collaboratively with other services and teams. For example, the Occupational Therapy team (OT) developed a quality improvement project aimed at improving the efficiency of the OT process and increasing the person-centredness of OT input into care plans. The results were significant. in the forensic service, increasing from 65.15% to 95.45%. The project incorporated patient feedback to enhance care plan contributions, streamlined the admission process, and freed up time for care planning and treatment. The project and its success were featured in the Health Service Journal (HSJ), with the OT team being nominated for a national award.

The service ensured patients were supported and empowered to make their own decisions about their care, treatment and support were possible. For patients with reduced mental capacity, staff assessed and recorded their capacity on a decision-specific basis, with particular emphasis placed on significant decisions in order to safeguard the patient. The process adhered to the Mental Capacity Act 2005 (MCA) guidance, ensuring that individuals were supported in making decisions for themselves where possible. If patients lacked capacity to make decisions staff followed the appropriate process, and where appropriate family members and relevant people were involved in any of the decisions made on their behalf. Patient’s wishes, feelings, cultural and religious beliefs, social background, and history were always considered when any decisions were made.

For patients who were detained under the Mental Health Act 1983, staff adhered to the legal requirements, and framework of the act. The rights of individuals were respected and ensured they were informed of their rights verbally, and also in writing, this included their right to appeal. For example, staff read patients their Section 132 rights on admission and regularly thereafter or when their mental health act status, Responsible Clinician (RC) or treatment plans changed. Staff consistently recorded reading of Section 132 rights in the patient care records. Consent to treatment regarding medicines, T2 and T3 forms were present, and in a good order. No concerns were identified within the records we reviewed.