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 Good. At this assessment the rating has remained Good. 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.

The service made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. Patients said that they felt involved with their care and that it was reviewed at regular meetings.

We reviewed 8 sets of care records and saw that staff completed care plans and risk assessments in a timely manner.

Clinical staff assessed patient’s physical health on admission and arranged referrals to external services for identified physical health needs. Care records showed that staff monitored ongoing physical health needs.

Staff and leaders described how people's needs relating to protected characteristics were assessed to ensure appropriate support was provided.

There were a range of processes in place to assess patient need. These included risk assessments, care plans, observation records and reviewing blanket and individual restrictions.

Care plans were personalised, holistic and recovery oriented. The plans we reviewed identified the patient’s individual needs, wishes and preferences and set out ways to manage any risks. Staff updated care plans regularly.

Patients received care, treatment and support that was evidence-based and in line with good practice standards. Patients received occupational therapy, psychology, speech and language and dietetics support where appropriate.

There were systems in place for monitoring people's physical health during their admission. The care records we reviewed showed that patients received appropriate physical health monitoring and treatment.

Pharmacists were available to help with medication queries, and they reviewed patient prescription charts to oversee that medicines were being prescribed and administered safely. A member of the pharmacy team attended multidisciplinary team meetings where appropriate.

Relevant legal documents needed to comply with the Mental Health Act were in place and up to date to ensure patients were receiving their medicines in line with legislation.

Staff we spoke with told us they had the opportunity to discuss training needs with their line manager and were supported to develop their skills and knowledge. Staff described additional training, and shadowing opportunities available to them and said their managers were proactive in developing their skills to enable them to progress within the service.

Managers identified poor staff performance promptly and supported staff to improve either through one-to-one support or by implementing performance plans with support from the human resources team. There was a performance management policy which was up to date and subject to regular review.

Staff and client interviews, care records and a review of various documents provided by the service showed that staff worked across health care disciplines and with other agencies when required to care for clients. There was evidence of good joint working partners within the provider collaborative through a range of meetings and with other teams within the trust.

There was evidence of partnership working between ward staff, community mental health teams and social care providers. Some patients had substance misuse issues and staff worked with substance misuse providers to ensure they received the support to meet their needs.

Staff held regular and effective weekly multidisciplinary meetings to discuss patients to help improve their care. Multidisciplinary teams were well attended and included managers, nurses, occupational therapy and psychology staff, in addition to care coordinators.

Staff told us that the service worked in partnership with other wards, community services and the local safeguarding teams. The Trust shared learning with other services and brought in learning from other organisations.

Care plans were stored electronically and were accessible to all staff.

Managers we spoke with knew all the patients and staff on the wards in their area of responsibility.

Staff attended their ward handovers at the beginning of each shift. Information was shared on patient activities, mental state, current risks, medication issues, any leave taken and discharge planning progress.

Patients told us they were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. There was information on display on wards about health living and a variety of physical activities available to patients.

Care records showed that patients were given support with dietary needs, health and exercise. They were offered smoking cessation and there was mindfulness sessions held on the wards. There was a gym on the hospital site for patients to attend. All patients were able to access the GP and the dentist.

Specialist support from staff such as dietitians and speech and language therapists were available for clients who needed it, and staff arranged this via the local GP.

The dietician for the service had drafted an ‘overweight and obese adults weight management for forensic inpatients’ policy which the manager said aimed to bring together the work the service was doing around healthy living into a single document

Care records showed that staff supported patients with healthy living through self- care, motivation and engagement, treating weight gain linked to medication, offering physical activity and nutritional knowledge.

Staff routinely monitored and recorded patient’s physical health. Staff provided patients with information on their care and treatment, including potential side effects to any medicines they were taking.

Patients told us that they were supported with working towards meeting the outcomes in their care plans. They had access to Activities of Daily Living kitchens and were supported with budgeting and shopping working towards achieving some independence. Patients were aware that there was a step-down service and said that staff supported them to work towards being ready for this.

There were effective approaches to monitoring people’s care and treatment and their outcomes. Staff held regular MDT reviews and used recognised rating scales such as HoNOS (Health of the Nation Outcome Scales) to assess patient risk and LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale) which is a self- assessment tool for measuring the side effects of anti-psychotic medicine.

Staff assessed and recorded capacity to consent clearly each time a person needed to make an important decision. Records showed that staff gave people a wide range of support to make specific decisions for themselves before deciding they did not have the capacity to do so. When staff assessed patients as not having capacity, they made decisions in their best interests and considered the individual’s wishes, feelings, culture and history.

Patients said that staff explained their rights to them. This was done and repeated in a way that patients could understand. Patients said that their care and treatment was explained to them, and we saw in most records that consent to treatment was gained.

Managers completed monthly nursing audits which covered key areas to ensure safety, effectiveness, and compliance. This included auditing mental capacity assessments, rights under Section 132 of the Mental Health Act, and consent to treatment documentation to ensure compliance with the Mental Health Act and Mental Capacity Act.