Coventry and Warwickshire Partnership NHS 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 assessment we rated this key question as good. At this assessment the rating has remained the same. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

However, staff did not always assess and monitor the physical health of all patients.

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.

Patients were not always involved in the assessment of their needs. We reviewed 15 care records across all wards. Staff did not record patient involvement in the assessment of their needs in 7 records. Two records were for patients on Beechwood ward, 2 on Spencer ward, 2 on Sherbourne and 1 on Edgwick ward. However, we reviewed 2 care records on Swanswell ward that demonstrated involvement of the patient.

Assessments did not always consider the patient’s physical health needs. Doctors were not always completing the clerking in process, including a physical health assessment, when patients were admitted out of hours. We reviewed 15 care records across all wards. We found 7 care records with no evidence of doctors carrying out a physical health assessment on admission. These were completed at a later date. On Westwood ward we found 1 example of a patient admitted five days before the inspection. Doctors had not completed a physical health assessment on admission as the patient was sleeping and no further attempts to complete this were recorded. On Beechwood ward we reviewed 2 care records; doctors had not completed a full physical health assessment on admission for either patient. On Swanswell ward 1 patient’s physical health assessment was not completed until the day after their admission and another patient’s physical health assessment was not completed until 2 days after admission. On Sherbourne ward we reviewed a care record for 1 patient, the doctor had not completed a full physical health assessment on admission. On Spencer ward the doctor carried out a physical health assessment of 1 patient on admission, however this was not complete and there was limited information about the patient’s physical health. On Edgwick ward one patient told us they did not see a doctor when they were admitted. Following the inspection, the Trust reported they carried out a review of how many patients at the Caludon Centre had a doctor’s initial assessment completed on admission, including a physical health assessment. The review included all patients who were in a bed, or admitted to one, between 1 March 2025 to 30 April 25. Out of a total of 132 patients, 5 did not have an initial physical health assessment completed by a doctor on admission. This equated to 4% of patients. This did not correlate to the 7 records identified by the inspection team. However, Spencer ward manager told us they would request specialist input, for example, SaLT to assess patients’ specific needs.

The needs of carers of people using services were considered and staff signposted carers to relevant organisations for a carer’s assessment. We reviewed the carer’s information pack on Beechwood ward. This pack included details of support available to carers. The pack also included a QR code for carers to access a carer’s assessment.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff did not always monitor and take action to ensure patients’ good physical health. In 1 patient record on Beechwood ward staff recorded limited physical health monitoring. We found examples in 1 patient care records on both Sherbourne and Swanswell wards that staff had not evidenced physical health monitoring. On Hearsall ward we reviewed records of a patient who was taking clozapine. The patient had been complaining of constipation for 5 days. Staff noted for medical team to be asked to review the patient’s laxative prescription but there was no evidence that this happened. Constipation is a known adverse side effect of taking clozapine and left untreated can result in serious harm or even death. However, we reviewed another care record for a patient on Hearsall ward and saw staff had followed up physical health concerns after completing a MUST (Malnutrition Universal Screening Tool). Staff referred the patient to the dietitian for support with poor diet. Staff also supported the patient to attend a hospital appointment for a scan. Leaders told us physical health was audited as part of the care plan audit and NEWS2 was also audited.

We also saw evidence that some patients received care, treatment and support that was evidence-based and in line with good practice standards. On Swanswell ward we observed a morning huddle attended by 7 staff. Discussions included how to manage physical health concerns, smoking cessation, poor engagement, and psychological input and strategies for staff to use to support patients with specific diagnoses, such as Emotionally Unstable Personality Disorder. Staff on Swanswell ward provided a sensory items box for patients to use as a support during ward rounds. Patients had access to psychological and occupational therapies. On Sherbourne ward we spoke with the OT lead who told us about how staff were creating a sensory friendly environment and using emotional regulation techniques to support patients. Staff on Sherbourne ward said they noticed an increase in OT therapies and activities on the ward, which has had a positive impact on patients. Psychology leaders told us that the Trust increased psychology provision across mental health inpatient services. They told us therapists have increased access to training which means they can offer more services to patients, examples included EMDR (Eye Movement Desensitisation and Reprocessing), special psychometrics, CAT (Cognitive Analytic Therapy), CBT (Cognitive Behaviour Therapy, CFT (Compassion Focused Therapy), ISTDP (Intensive Short-Term Dynamic Psychotherapy) and MBT (Mentalisation Based Therapy). Each ward was covered by 2 psychologists, however, they worked as a team and if a patient was identified as requiring a specific intervention, then the psychologist trained in that intervention would provide this. Psychologists were running 3 groups, developed with staff, on the wards; ‘Managing Emotions’, ‘Managing Wellbeing’ and ‘Unusual Experiences’. Staff from different grades and disciplines were offered training in facilitating the groups with the aim for staff to lead the groups with support from psychology. There were workshops for staff on “culture of care” standards and IMROC (Implementing Recovery through Organisational Change). The NHSE culture of care standards for mental health inpatient care support all providers to realise the culture of care within inpatient settings everyone wants to experience – people who need this care and their families, and the staff who provide this care. IMROC was founded by people with lived/learned experience and aims to address the challenges faced by mental health services in embedding recovery focused practices, conversations and values into their services. We spoke with a trainee psychologist covering Quinton (Westwood) and Hearsall wards. They told us about the psychological interventions provided as described by psychology leaders. They also supported staff with reflective practice and team formulation for patients’ risks. They supported staff to develop safety plans for patients with long complex histories, helping staff to identify triggers. Staff on Spencer ward told us they used GAD-7 (a tool to screen and measure the severity of generalised anxiety disorder) and sleep scales. We spoke with 3 carers of patients at the service and asked them if they were involved in reviewing their relative’s care needs and all 3 said yes, including attendance at ward rounds.

Patients’ nutrition and hydration needs were met in line with current guidance. Patients had access to hot and cold drinks and fruit 24/7. The service met patients’ different dietary needs and included different meal options, for example, gluten free as part of the main menu.

Mental Health Act

• Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• 100% of staff received level 2 training in the Mental Health Act and 99% received level 1.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The Trust had relevant policies and procedures that reflected the most recent guidance.
• Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
• Patients had easy access to information about independent mental health advocacy. We saw details of advocacy support displayed on wards. Staff recorded requests for advocacy input in patient care records. Patients and staff knew about the advocacy service and told us advocates visited the wards weekly.
• Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We saw evidence of this in care records reviewed. Staff described how they explained rights under the MHA to patients and would revisit if patients were struggling to understand. Staff used information leaflets to help patients understand their rights. We asked 3 patients if staff explained their rights under the MHA and all 3 said they did.
• Staff did not always ensure that patients were able to take Section 17 leave (permission for detained patients to leave hospital) when this had been granted. We asked five detained patients if they were always able to access their leave as planned, 4 said they were not, and leave was sometimes cancelled or delayed due to staff not being available. Four staff told us detained patients were not always able to take their leave as planned due to staff availability.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.
• The service displayed a notice to tell informal patients that they could leave the ward freely.
• The Mental Health Act team did regular audits to ensure that the Mental Health Act was being applied correctly.

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.

Plans for transition, referral and discharge considered patient’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Staff told us that discharge planning started when patients were admitted and included patients’ family (with consent) and professionals from other services involved with the patient, for example, community teams, local authority and probation. Staff on Spencer ward tried to integrate patients into community activities before they were discharged. On Swanswell ward we saw a care coordinator from the community team visiting to speak with staff and the patient. Staff on Swanswell ward told us they supported patients to address issues that may impact on their discharge, for example, housing or lack of a care coordinator and made referrals to other services as needed.

When patients received care from a range of different staff, teams or services, it was co-ordinated effectively. All relevant staff, teams and services were involved in assessing, planning and delivering people’s care and treatment and staff worked collaboratively to understand and meet patients’ needs. Staff held regular and effective multidisciplinary meetings. On Beechwood ward we observed an MDT meeting which demonstrated positive practice in relation to internal teams working well together, for example, the discharge liaison worker and pharmacist. The MDT also evidenced good links with external teams, including 3rd sector Trusts, probation service, migrant worker team and the Home Office. On Swanswell ward we observed a morning huddle attended by 7 staff. Team cohesion was good with productive participation from everyone in the team. Therapists told us their professional opinions were valued and teams worked together well. We saw evidence in care records of staff involving community teams in patients’ discharge plans.

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.

Patients were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. Patients on Beechwood and Spencer ward told us about participating in healthy cooking sessions. A patient on Sherbourne ward told us they enjoyed doing weights in the ward gym. Staff told us patients were supported to access smoking cessation, physiotherapy and dietician support. A patient on Beechwood ward told us about the support they received from the physiotherapist. Wards were equipped with exercise and sports equipment to encourage patients to keep active. On Beechwood ward we observed a best interests meeting at which the doctor spoke at length about the patient’s physical health needs and the importance of them taking their medication. On Beechwood ward we observed an exercise session in the communal areas. Staff and patients participated in the exercises to music. The activity coordinator on Spencer ward ran health promotion groups for patients. Beechwood ward manager told us they discuss sexual safety and self-care checks with patients in community meetings. Sherbourne ward manager told us they encourage good sleep hygiene and talk to patients about how to maintain good mental health and deal with stress and anxiety. Edgwick ward manager told us they were running a Women’s Health project on the ward. Leaders told us the wards worked closely with community Trusts to support patients with specific health issues, for example, substance misuse.

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.

There were effective approaches to monitor people’s care and treatment and their outcomes. Managers described a MDT approach to reviewing patients’ progress. Teams measured patient progress through reductions in observation levels, restrictive interventions and number of incidents and an increase in patient engagement with therapies and activities. We reviewed audits completed by the Trust aligned with CQC key questions. The Trust triangulated audit findings with patient experience data from ‘I want Great Care.’ The Trust identified a reduced satisfaction in person-centred care aligned with audit findings, this led to the introduction of a Matron-led quality audit focused on care plans.

This meant that continuous improvements were made to people’s care and treatment. The Trust reported on quality improvement initiatives developed from patient experiences whilst on the wards. Examples included the AWOL (Absent Without Leave) project on the male acute wards which aimed to reduce the number of AWOLs. There was a Practice’ initiative on the PICU wards. The Trust reported a 50% reduction in the use rapid tranquillisation between 3 September 2023 and 6 October 24 and 43% reduction in restraint for the same period. There was a ‘Think Active’ initiative which aimed to increase patient physical activity across wards.

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.

Patients understood their rights around consent to the care and treatment they are offered. Patients told us that staff explained their rights to them. We saw evidence in care records reviewed that staff discussed and gained consent from patients. Staff told us that consent to treatment was gained from patients during the admission process and continually reviewed within MDT meetings and ward rounds.

There were systems and practices to ensure that patients understood the care and treatment being offered or recommended. Leaders said consent to care and treatment was regularly audited and reviewed in QIP meetings. The MHA lead also audited consent to care and treatment and supported staff with learning. Swanswell ward manager told us they use scenarios in ‘productive ward days’ to develop staff knowledge of consent, the importance of gaining consent and what to do if consent is not provided.

Where necessary, people with legal authority or responsibility could make decisions within the requirements of the Mental Capacity Act 2005.This included the duty to consult others such as carers, families and/or advocates, where appropriate. Staff told us that advocacy support was available for patients. We asked 4 patients across all wards if they were aware of the advocacy service and 3 said they were. We observed a best interests meeting on Beechwood ward attended by a staff member from the local authority. The team discussed the patient’s lack of capacity in relation to a specific decision and options as to how best support the patient and meet their mental and physical health needs. The doctor included views expressed to them by the patient’s family.

Patients’ capacity and ability to consent was taken into account, and they, or a person lawfully acting on their behalf, were involved in planning, managing and reviewing their care and treatment.