Bradford District Care 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.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. 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.

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

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

We looked at six care records during the assessment. We found that staff completed a comprehensive mental health assessment of each patient in a timely manner on, or soon after, admission.

Staff assessed patients’ physical health needs in a timely manner after admission and on an ongoing basis. People’s physical health needs were being met, and records evidenced this.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery oriented. Some care plans reflected the voice of the patient and patients were clearly involved in developing the plans. Other care plans were more generic but efforts to engage patients in the process were documented.

Staff updated care plans, when necessary, as a result of changes to risk, developments in patient’s progress or changes to patient’s personal circumstances.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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 NICE. These included medicines and psychological therapies and activities intended to help patients develop and acquire daily living skills. The occupational therapist developed patient’s plans in line with current good practice relating to mental health rehabilitation services.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Whilst looking at care records we saw lots of examples of patients being supported and encouraged to attend and engage in appointments relating to their physical health. We saw a physiotherapist delivering care and a psychologist visited the ward weekly.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers provided new staff with appropriate induction.

Managers provided staff with supervision and appraisal of their work performance and ensured they had access to regular team meetings. The percentage of staff that had an appraisal in the last 12 months was 78.83%, just below the trust target of 80%. The percentage of staff that received regular supervision was 85.27%.

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 and shared information about patients at effective handover meetings within the team. Handovers were carried out between each shift change and were attended by all staff. We observed one ward round meeting where staff had collected a patient on home leave so they could attend and finalise their discharge from the ward and handover to community services.

The teams had effective working relationships, including good handovers, with other relevant teams that supported their patients, including care co-ordinators, community mental health teams and safeguarding teams. We cross referenced incidents with handover documents, and these incidents were referenced.

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, reduced their future needs for care and support.

There was a doctor responsible for physical health on the ward and they attended the ward round meetings and monitored patients who had long term conditions such as diabetes. Some patients also had personal physiotherapy plans where mobility was an issue.

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.

Staff used recognised rating scales to assess and record severity and outcomes for example, the Health of the Nation Outcome Scales (HoNOS). The Model of Human Occupation Screening Tool (MOHOST) was used to determine the patient’s occupational functional ability.

An occupational therapist delivered various sessions in relation to self-care, productivity and leisure as well. Staff were able to show how patients were progressing through their treatment and there were examples of positive treatment episodes where patients had moved on to new placements.

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 patients to make their own decisions. Where there were concerns in relation to a patient’s capacity to make a specific decision we saw in records reviewed that staff had completed capacity assessments in order to support them with this. These showed the person was involved, as well as their family members where appropriate. Where people lacked capacity to consent to a specific decision, records showed that assessments were completed to ensure decisions were made in the person’s best interest.

People told us they had access to advocates who supported them with decisions where needed and helped them to understand their rights. People’s records showed they were informed of their rights in a way they could understand.