Derbyshire Healthcare NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last inspection we rated this key question good. At this inspection the rating has remained good.

Good: Staff treated people with compassion and kindness. They respected people’s privacy and dignity. They understood the individual needs of people who used services and supported them to understand and manage their care, treatment or condition. Staff involved people in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately.

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.

The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Staff demonstrated compassion for people who used services, and carers, and spoke about them with kindness, respect and dignity. We observed a range of multidisciplinary meetings, handovers and informal office conversations. In all instances, staff spoke about people who used services, and carers, respectfully and with compassion. All staff and managers we spoke to told us about their passion for supporting people who are in crisis or experiencing significant distress.

We spoke to 8 people who used the crisis resolution and home treatment team (CRHTT) services and 1 carer. All of them said they found staff friendly, helpful and kind. Some of them told us staff treated them without any stigma about their mental health problems, which made them feel respected.

We observed telephone calls to the mental health helpline and CRHTT duty staff. During all calls staff displayed patience and professionalism when speaking to people in distress, including carers. Staff sensitively asked callers questions to assess risk and determine the support required, without sounding intrusive or overly scripted. Staff explained next steps in a clear and accessible way and provided reassurance about what callers could expect, while ensuring they did not offer any false or unrealistic assurances. In one call, we observed staff explain to a carer that they did not have consent to share certain information with them, in a clear and supportive manner

We reviewed 25 care records and in each of them, staff used respectful language to document people’s care and treatment. People’s mental health histories, goals and interventions were documented in a sensitive and non-judgemental way.

Staff directed people to other services when appropriate and, if required, supported them to access those services. For example, there was a food bank at Chesterfield CRHTT and some staff told us they always ensured it was topped up so people had access to food.

Staff spoke about colleagues from other services and organisations, such as the police and local authority, with kindness and respect.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The mental health crisis service provided person-centred care that met people’s needs and preferences. Most staff told us how important the core assessments were at getting to understand the person’s situation, to be able to plan care and treatment that would suit them and their preferences. We reviewed 25 care records and saw core assessments covered individual preferences, such as who people wanted involved in their care and what type of contact they wanted from staff.

The service made reasonable adjustments for disabled people, including ensuring accessible premises and meeting people’s specific communication needs. Staff gave examples of using interpreters to support people to fully participate in and communicate during visits.

In care records, we saw evidence that staff considered people’s unique circumstances when planning and delivering their care. For example, staff considered if people were socially isolated, or whether their housing conditions affected their wellbeing.

Some staff told us they tried to match people with staff they had developed rapport with, particularly for neurodiverse people who benefited from consistency and familiarity. Staff also allocated visits based on individual needs and preferences. For example, where someone had a history of trauma and preferred male or female staff, an alert was added to their care record to ensure this was considered and important information was not missed.

Staff told us the gatekeeping process had been designed to be trauma‑informed and least restrictive. They said it provided a structured approach to considering the purpose of a hospital admission, alongside the person’s perspective, their risks, needs and any reasonable adjustments required.

The service audited calls to the mental health helpline and NHS 11 Option 2 to see if people were appropriately supported. They had developed a frequent caller pathway and held joint meetings with community mental health teams (CMHT) to create joint care plans that advised call operators and clinicians how best to support them if they phoned the helpline. The service did not put restrictions on people contacting the helpline and instead worked through frequent callers’ care plans with them.

Staff made sure patients detained in the health-based places of safety (HBPoS) had access to food and drink they liked. Options were available to patients to make their own meal choices and specialist diets were supported. On admission to the unit, patients were asked if they had any dietary or cultural requirements and staff could order these meals from the inpatient wards as required. We observed a patient being offered food on our inspection.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

We saw evidence in care records that staff discussed treatment options with people who used services and carers, to make decisions together. For example, staff discussed different medicines options with people so they could make informed choices.

Some staff told us, and we observed in care records, that doctors and non-medical prescribers gave people options regarding medicines during medication reviews, where appropriate. Some staff in Chesterfield CRHTT told us the patient information leaflets in the waiting room helped people make informed choices about medicines and what they think they can tolerate.

Most staff told us they worked with a focus on providing the least-restrictive care to people. For example, people receiving home treatment were supported with medicine compliance to prevent a deterioration that could lead to them being detained in hospital otherwise. This supported people to remain as independent as possible whilst receiving support for their mental health crisis.

We saw leaflets and posters that provided people with information about how to access advocacy services.

The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff identified and responded to changing risks to, or posed by, people who used services. We reviewed 25 care records and found that staff consistently adapted the support they provided in response to people’s changing needs. For example, we saw evidence staff visited someone within an hour of them calling the team and saying they were struggling with thoughts to harm themself. Staff contacted people and their next of kin as required and carried out unannounced visits where individuals did not attend planned appointments, to ensure they were safe and well.

The mental health crisis service anticipated people’s needs so it could respond quickly. In Chesterfield CRHTT, for example, we observed a multidisciplinary meeting in which staff discussed a person’s deteriorating mental health and subsequent increased risk of harm to themselves and others. A consultant doctor was allocated to attend a home visit that morning to perform a Mental Health Act assessment and, if necessary, to make the first recommendation for detention under the Mental Health Act.

We observed phone calls and reviewed 6 records of calls to the mental health helpline. Staff ensured people were safe and took time to understand their situation and reason for calling. We observed, and saw evidence in records, of call handlers appropriately escalating to clinical staff as needed. Clinical staff then contacted people promptly to provide the necessary clinical support.

We reviewed 25 care records and incident records for the 3 months prior to our inspection. Staff offered appropriate support to people who phoned the service to try to reduce their distress. For example, staff ensured people were given time to express how they were feeling before giving advice on distraction techniques and helping to identify ways of managing distress.

Staff were aware of and dealt with any specific risk issues. For example, we saw in care records and incident records and some staff told us, that people who were at immediate risk of harming themselves were prescribed limited amounts of medication to reduce the risk of overdose.

Staff used de-escalation techniques to reduce the need for physical interventions in the HBPoS when patients’ behaviours became heightened. We saw in incident records that staff consistently sought to de‑escalate situations through verbal support before considering other interventions.

Staff consistently considered people’s needs in emergencies. For example, we saw evidence in care records, and some staff told us, that staff routinely looked after or made arrangements for people’s pets to be looked after when they were admitted to hospital. Some staff told us about getting homeless people who were admitted to hospital more clothing so they could change into clean clothes in hospital.

The service had developed partnerships with local organisations to provide post‑discharge support. Staff, including peer support workers with lived experience, considered what people leaving HBPoS or CRHTTs would find most helpful. This included access to food, clothing and other essential items to ensure no one was left without basic necessities.

The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff in all teams we visited told us they felt supported by their immediate team colleagues and managers. They told us they were proud to work for their team and for the trust. Some staff told us they felt empowered by their managers to carry out their roles well, and to raise any concerns if they had any.

Most staff told us they received regular clinical and managerial supervision and annual appraisals. Supervision provided staff with the opportunity to discuss case management, to reflect on and learn from practice, and to identify any personal support and professional development needed. At the time of our inspection, appraisal compliance for all staff across CRHTTs and the mental health helpline was 87.4%, management supervision was 89.5% and clinical supervision was 93.7%. At the time of our inspection, appraisal compliance for staff in the HBPoS and inpatient ward staff who supported the HBPoS was 85.3%, management supervision was 81% and clinical supervision was 81%.

The mental health crisis service had several measures in place to support staff’s safety. All CRHTT staff told us about their teams’ “flight plan” and lone working protocols and told us they felt safe at work and on visits. Staff explained the flight plan contained all staff’s appointments and visits, which allowed managers to track their whereabouts and escalate concerns if staff did not return as expected.

We saw the lone worker risk assessment listed controls that staff also told us about, such as a lone worker application on staff’s work phones. The trust told us all staff were given booklets on personal safety on induction and staff had access to a dedicated trust intranet page regardingsafety on and off site.

Senior leaders told us they were aware of how unsettling the period of transformation could be for staff and had planned a ‘care package’ to provide additional support. The care package included support sessions on managing through periods of uncertainty and change, preparing for assessment centres​, drop-in sessions and dedicated health and wellbeing support. They had also set up an email address staff could send any queries or concerns to.

Senior leaders told us they had focused on improving team culture, cohesion, and stability, which had a positive impact on teams’ performance.

Staff success was celebrated at team and trust level. Staff could be nominated for the trust’s delivering excellence every day (DEED) awards. In Chesterfield CRHTT, we saw one of their nurses had been nominated for a DEED award the month before, and the nomination was shown on a screen in the office. We also saw a ‘star board’ on which staff wrote notes to show appreciation for each other.

Staff could access the trust’s occupational health service for support with their own physical and emotional health needs.