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

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.

Staff completed comprehensive mental health assessments at referral, considering presenting needs, risks and social circumstances. People detained in the health-based place of safety (HBPoS) had relevant physical health information recorded and escalated appropriately. However, across the crisis and home treatment teams, physical health assessments and ongoing monitoring were inconsistent and not always clearly recorded.

The service planned and delivered care in line with legislation and evidence-based guidance, supported by operational policies, draft protocols and partnership agreements with local agencies. Teams worked well together, with effective multidisciplinary working, positive relationships with inpatient services, community teams, police and acute hospitals. Managers held regular partnership meetings to address risks and themes.

The service monitored outcomes and respected people’s rights, using recognised outcome measures. Managers used audits and performance data to oversee quality, although there had recently been difficulties in collating accurate performance data. Staff clearly explained consent and people’s rights, particularly for those detained under the Mental Health Act. Staff across the crisis and home treatment teams ensured consent was sought and recorded upon access to the service.

This service scored 71 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s physical health with them.

Staff completed a comprehensive mental health assessment when people were referred into the service. This included the reason for referral, the person’s current presentation and identified risks. Staff also considered social circumstances, such as housing and family or caring responsibilities.

Staff in the health-based place of safety (HBPoS) recorded all relevant information related to the patient’s physical health in care records including physical health observations, recorded diet and fluid intake as well as sleep. Any concerns staff relayed to the medical staff for further assessment.

We found limited evidence that staff consistently assessed and monitored people’s physical health across the crisis and home treatment teams. Of the 10 care records we reviewed, 2 included a physical health assessment. A further 2 people had been referred by their GP or a hospital and had already had a recent physical examination. In 4 of the 10 records, staff had recorded general questions about diet, hydration and sleep. We could not locate evidence of any further physical health assessments. Staff in the Coventry team told us there used to be a weekly physical health clinic, but this had not run for some time due to staff shortages. Staff acknowledged that the team sometimes struggled to monitor and record all physical health information. There was inconsistent assessments and recording across the teams.

Staff across all teams confirmed that there were routine intermittent health checks for patients in receipt of high-risk medicines, in line with best practice and guidance.

The service planned and delivered people’s care and treatment with them. They did this in line with legislation and current evidence-based good practice and standards.

The service provided urgent support, care and treatment for people experiencing a crisis in their mental health. The 111-telephone service was regularly a first point of contact for people needing urgent help. Staff referred them to appropriate teams or signposted to agencies who may provide support.

Staff assessed people entering the service and tailored care to meet their needs, in a least restrictive way as possible, at home where possible, preventing hospital admission. Teams were able to complete medical reviews, with staff supporting patients to manage their medicines safely. Staff reviewed all patients regularly.

Where necessary, patients who required further assessment could be accommodated in the psychiatric clinical decisions unit, or in the Health Based Place of Safety. The trust provided urgent care 7 days a week, making it accessible to those in need of crisis support.

The service had a memorandum of understanding and information sharing agreement in place between other Coventry and Warwickshire agencies. These included the emergency services, county council and general hospitals. This confirmed there were partnership arrangements in place to support people experiencing mental health crisis. This was provided from the trust in draft and was to be ratified.

The trust shared the operational protocol for the Place of Safety, which was also in draft, pending ratification. This document included reference to key legislation and best practice, including Right Care Right Person. The protocol included clear actions required of staff following detention of a patient and throughout their stay.

Staff told us they worked with relevant healthcare partners and involved other professionals when people presented with physical health problems that required monitoring. People who needed specialist medicines monitoring attended relevant clinics for observations, reviews and blood tests. Psychiatrists undertook health monitoring during reviews of care. Staff shared relevant information with peoples GPs.

Staff worked with relevant teams and professionals to meet people’s needs.

We saw staff had communicated with various teams and agencies to support patient care. Examples of these included substance misuse services; the perinatal team and psychosis team.

Staff worked closely with inpatient wards and adult community mental health teams to ensure effective handovers when people were admitted to or discharged from the service.

Staff described positive working relationships within the multi-disciplinary teams across the service. During multidisciplinary meetings, staff discussed care and treatment, shared concerns and looked at how best each person could be supported.

The service had good working relationships and joint working initiatives in place, for example with the police and the general hospitals to strive for responsive, safe and appropriate care.

The service demonstrated that they supported people to live healthier lives and had considered and monitored physical health.

Staff offered advice to individuals to support them to maintain their health and wellbeing. During a home visit, we observed a discussion around sleep promotion and healthy eating.

Staff signposted people to different groups and social activities in the community, promoting wellbeing. Staff directed people to specific organisations for support tailored to their needs. For example, a person using illicit drugs was provided with details about a local organisation who offered advice around harm minimisation and additional support.

Staff discussed potential side effects of some medicines with individuals, such as weight gain. Staff routinely offered advice and information leaflets around healthy eating and exercise.

However, as indicated in the report, there were inconsistencies with physical healthcare monitoring, practice and recording across the crisis and home treatment teams.

The service routinely monitored people’s care and treatment to continuously improve it.

Outcome measures were being used by occupational therapists in the home treatment teams. DIALOG is a set of questions where patients are asked to rate their satisfaction and needs across different parts of their life and treatment. It is patient centred with a focus upon positive change. The occupational therapists used this tool as an outcome measure within group interventions.

Occupational therapists were also using The Occupational Self-Assessment (OSA), a tool based upon the Model of Human Occupation (MOHO). This measures a patient’s perception of their occupational competence and examines the value placed upon day-to-day activities. This assists people to identify and set future goals.

The trust participated in relevant national audits. For example, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCAPOP) and the National Clinical Audit of Psychosis (NCAP).

Managers regularly collected data from care records and routine clinical audits to monitor the delivery and standards of care. Results were discussed during monthly performance and quality meetings. The trust acknowledged they had experienced some recent difficulties with data collection due to the transfer over of electronic systems.

The service told people about their rights to consent and respected these when delivering care and treatment.

People who came to the health-based place of safety (HBPoS) were detained under Section 135 and 136 of the Mental Health Act. Staff in the HBPoS informed every person of their rights upon admission and throughout their stay. This was an established part of the admission process. Written information was available and given to people so they could refer back to it. Staff ensured that everyone were made aware of their rights upon expiry of the legal detention period. Most people had been discharged from the HBPoS within a 24-hour period in line with the Mental Health Act code of practice. On occasions when a 12-hour extension was required, in urgent situations, staff recorded this within care records with a rationale.

Staff gained consent from people upon entering the home treatment team services to ensure they understood and consented to support being offered. Staff talked to people about this during initial contact and recorded relevant consent within care records. We observed this during our assessment.