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Provider: Black Country Healthcare NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 24 January 2020

Our rating of the trust improved. We rated it as good because:

Inspection areas

Safe

Good

Updated 24 January 2020

Our rating of safe improved. We rated it as good because:

  • We rated nine out of eleven services as good and two as requires improvement in the safe key question. Our rating took into account the previous ratings of services not inspected this time.
  • In three services inspected, the clinical premises where staff saw patients were safe and clean. Staff followed best practice in infection control.
  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm
  • Staff assessed and managed risk well. Staff recognised incidents and reported them appropriately. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • In all services inspected staff followed good practice with respect to safeguarding. Staff understood how to protect patients from abuse and exploitation and worked well with other agencies to do so. Staff had training on how to recognise and report abuse and or exploitation and they knew how to apply it. There was an identified named nurse and doctor for child protection.
  • The wards had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The community teams we inspected had manageable caseloads and patients had crisis plans in place.

However,

  • We had concerns about the safety and quality in two areas. Wards at Hallam Street had blind spots, and ligature risks. There were no mirrors on the second floor for staff to observe blind spots and staff were unable to observe all parts of the ward as they were over two levels. Ligature risk assessments were complete for each ward and identified each with mitigation. The Macarthur unit had several outstanding repairs that needed to be completed.

Effective

Good

Updated 24 January 2020

Our rating of effective improved. We rated it as good because:

  • In the services we inspected staff assessed the physical and mental health of all patients. Staff developed individual care plans which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs.
  • In all services we inspected, staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also took part in clinical audit, benchmarking, and quality improvement initiatives.
  • All teams included or had access to the range of specialists needed to meet the needs of patients under their care. Managers made sure they had staff with a range of skills need to provide high quality care. They supported staff with appraisals, management supervision, opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff worked together as a team to benefit patients. They supported each other to ensure patients had no gaps in their care. The clinical team had effective working relationships with other relevant teams within the trust and with relevant services outside the organisation. They engaged with them early in the patient’s admission to plan discharge.
  • Staff in all services understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.
  • Staff in all services supported patients to make decisions about their care for themselves. They understood the trust policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

However,

  • Staff on two wards did not receive regular clinical supervision and data held by the trust did not record if staff did receive clinical supervision.
  • We observed staff using language to informal patients that suggested a restrictive approach to their leaving the ward.

Caring

Good

Updated 24 January 2020

Our rating of caring stayed the same. We rated it as good because:

Responsive

Good

Updated 24 January 2020

  • We rated eight out of eleven services as good in the responsive domain and two as outstanding. Our rating took into account the previous ratings of services not inspected this time.
  • Services were planned with local people and staff had a good understanding of the needs of patients in their community. Transitions to adult mental health services took place without any disruption to the patient’s care.
  • Admission and discharge of patients was well planned, and patients were involved in decision about their care pathway.
  • Referrals to community teams were triaged and assessments undertaken in a timely way.
  • The service met the needs of patients including those with a protected characteristic. Staff helped patients with communication, advocacy, cultural and spiritual support.
  • Patients and carers knew how to complain and raise concerns. Accessible information was available to patients and staff to better understand services available to them.

However,

  • At Hallam Street hospital patients had to share bathroom facilities because their rooms did not have en-suite facilities which might not have protected patients’ privacy and dignity.

Well-led

Good

Updated 24 January 2020

Our rating of well-led stayed the same. We rated it as good because:

  • We rated safe, effective, caring, responsive and well-led as good. Our rating for the trust took into account the previous ratings of services not inspected this time.
  • The trust operated collaboratively as a board, that meant executives and non-executive directors shared responsibility and accountability for decision-making.
  • There was a rounded understanding of performance, which appropriately covered and integrated people’s views with information on quality, operations and finances.
  • The trust board were very visible across most services of the trust. We were told of several examples of how executives visited and worked shifts in some of clinical services.
  • The trust understood the challenges to quality and sustainability, and identified the actions required to address them. This was aligned to the wider health and social care economy of the Black Country.
  • The strategy and priorities of the trust was aligned to the vision and values and reflected their part in local sustainability and transformation plans. Most staff understood the vision and values in relation to their local services.
  • Overall, the trust was a good place to work in. Staff often told us they were proud of the work they and their colleagues do every day to provide safe care and treatment.
  • Governance systems from ward to board provided good performance management information to make decisions.
  • The trust communicated well with patients, carers, staff and stakeholders. Most staff groups felt included in decisions about service re-design and development.
  • There were mostly strong arrangements in place to identify, record and manage risks. Patients mental and physical health was assessed, and care and treatment planned.
  • The trust worked to improve quality and innovation, for example, the development of the Quality First framework to improve and achieve the trusts organisational goals.
  • Recruitment of staff was an ongoing challenge to the trust but they were proactive in attempts to employ people across many of their services.
  • The trust recognised its staff in several ways, through a simple thank you to formal awards at a yearly awards ceremony.
  • There was a culture of learning and research across the trust.

However;

  • Information about staff clinical supervision was unreliable and local managers had to maintain their own data to understand if their staff was participating in clinical supervision.
  • The implementation of the new electronic patient records was underway but the timetable for rollout was going to take a long time leaving some services continuing to use a mixture of paper and electronic systems.
Checks on specific services

Community-based mental health services for adults of working age

Good

Updated 24 January 2020

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding. Though the service received a large number of referrals, the number of patients waiting for an appointment for longer than trust set-targets of 18 weeks was low.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. Care plans and sessions had been developed specifically to engage individuals. Thought had been given to patients’ interests and past experience to develop sessions and identify placements where they could use their skills. Patients told us that this reduced anxiety and made them feel like they were fully involved and, in some cases, having a positive influence at their placements.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude patients who would have benefitted from care.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Specialist eating disorders service

Good

Updated 24 January 2020

We rated it as good because:

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was sufficient for staff to give each patient the time they needed. Staff managed referrals to the service well and ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers if appropriate. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions as appropriate.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait long to start treatment. The criteria for referral to the service did not exclude people who would have benefitted from care.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Specialist community mental health services for children and young people

Good

Updated 24 January 2020

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. Clinical premises where patients were seen were now safe and clean. Previous problems with storage of medicines had been solved. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff now developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit and benchmarking to evaluate the quality of care they provided. Staff at Sandwell CAMHS participated in a multi-agency thematic inspection to audit how well local agencies worked together in an area to protect children.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Patients and carers we spoke with said they actively involved them in care decisions.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • The service was now well led and had put effective governance processes in place to ensure that procedures relating to the work of the service ran smoothly.

Acute wards for adults of working age and psychiatric intensive care units

Requires improvement

Updated 24 January 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Acute wards at Hallam Street were based over two levels, they had blind spots and ligature risks. Ligature risk assessments were complete for each ward and identified each risk with mitigation. Staff completed enhanced observations to manage risks but said the environments were challenging when trying to support acutely unwell patients.
  • Supervision rates were low for two of the wards between 20% and 50%. The trust recording systems for clinical supervision were not reliable. Managers told us there were delays with the system updating information they provided around supervision and training.
  • staff used restrictive and controlling behaviours towards informal patients wanting to go off the wards for short periods.
  • There was inconsistent leadership support for staff on two wards due to ward manager vacancies and changes within management.
  • Staff did not always record fridge and room temperatures, or act to manage temperatures that had exceeded or were not within the recommended temperature range. We found gaps in the cleaning records on two wards where staff had not recorded dates when the clinic rooms were cleaned.

However,

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

Wards for older people with mental health problems

Good

Updated 9 January 2019

  • The environments were clean and tidy. The ward layout meant staff did not find a good line of sight and there were ligature risks on all wards, staff mitigated these risks with good observation practice.
  • Risk assessments were completed and updated when risks changed.
  • Staff reported incidents using the trust’s database. Lessons learnt were used to make improvements to services.
  • Multi-disciplinary teams worked for the good of the patient. We saw the involvement of inpatient and community
  • teams as well as other local hospitals working together to provide good care.
  • Patients had access to a range of therapies provided by a range of staff employed by the trust.
  • Staff cared for patients with respect and compassion. Their interactions with patients showed their understanding of the patient group and their needs. Patients and carers gave positive feedback about the staff and the wards. They gave feedback on the service.
  • Staff involved patients in the planning of their care they involved carers and relatives if appropriate to support with care planning.
  • Staff assessed and monitored patients’ physical health throughout their admission. Patients had access to professionals specialising in aspects of physical care such as podiatrist.
  • There was a range of rooms available for patient use for activities and access to a garden at both sites. Patients also used the facilities at the Lighthouse at Edward Street Hospital.
  • Ward managers were always visible on the wards, staff said they were passionate, knowledgeable and supportive of the staff.
  • All managers promoted a positive culture throughout the service, staff felt valued and appreciated by them.

Community mental health services with learning disabilities or autism

Good

Updated 9 January 2019

Our rating of this service stayed the same. We rated it as good because:

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • The teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with services outside the organisation. Patients were able to see a psychiatrist in a timely manner and were seen urgently if required.
  • Staff ensured that patients received any necessary assessment of their physical and mental health needs and provided a range of care and treatment interventions suitable for the patient group. Staff in the promoting access to main stream health services team (PAMHS) were proactive in ensuring that patients’ physical healthcare needs were being met and supported patients to live healthier lives.
  • Staff used the Mental Capacity Act appropriately to determine if a patient had the capacity to make a specific decision. Staff gave patients every possible assistance to ensure they had the capacity to consent to treatment before they assumed that the patient lacked the mental capacity to make this decision.
  • Staff attitudes and behaviours when interacting with patients showed that they were respectful and responsive. Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Staff informed and involved families and carers appropriately and provided them with support when needed.
  • All information provided was in a form accessible to the patient group. Staff provided patients with easy-read documentation to understand their treatment. Staff knew how to access interpreters for patients who required this service.
  • Patient’s received responsive care from the service. The teams followed up with patients who did not attend appointments and supported them to attend in the future. Patients knew how to complain or raise concerns, and staff knew how to handle complaints appropriately.
  • Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed, were visible in the service and staff found them approachable. Staff knew and understood the trust’s vision and values. Staff felt respected, supported and valued. Staff spoke highly of the service manager. Staff felt positive and proud about working for the trust and their team.
  • The provider had a comprehensive schedule of meetings and reporting systems to ensure good governance of the service. Staff had access to up to date information about the work of the services they used. Staff participated in benchmarking and quality improvement initiatives and had opportunities to participate in research.

However:

  • Staffing levels could not be increased to accommodate an increase in caseload or acuity of the patient group. This meant that some staff were managing high caseloads. Staff caseloads were not formally reviewed and the service did not use a caseload management tool.
  • More than half of the records reviewed did not contain a holistic, person-centred care plan that demonstrated the patient’s goals, treatment aims or detailed involvement across the multidisciplinary team. Patients were not routinely offered a copy of their care plan.
  • Staff were not fully documenting when a best interests meeting had taken place for a patient who lacked capacity to make a decision.
  • Staff did not routinely inform people using the service how they could access independent advocacy.
  • Some patients referred to speech and language or physiotherapy were waiting longer than expected to receive an assessment.

Wards for people with a learning disability or autism

Good

Updated 9 January 2019

Our rating of this service stayed the same. We rated it as good because:

  • All wards had detailed risk assessments and used these to keep patients safe. Ligature risks were managed well by staff who used detailed plans to manage patients care. Rooms were clean and well maintained and the clinic room was fully equipped to meet the needs of patients.
  • Staff managed medication well. They had good support from the pharmacists and ensured medication was administered in a safe way to patients.
  • Staff used national guidance including that set out by the National Institute for Health and Care Excellence to provide care for patients. Staff ensured care plans had been completed with input from patients and had updated them on a regular basis as patient needs changed.
  • Staff treated patients with compassion and patients we spoke to said that staff looked after them and helped them Staff ensured patients had good access to advocacy. They made referrals or encouraged patients to refer themselves where possible.
  • Patients always had their own bed to return to following a period of leave. Managers kept beds open for patients during the transition phase to new placements to ensure this was a smooth process for patients.
  • Patients had access to an excellent range of easy read materials. We saw these were completed in both pictures and written language depending on the needs of each individual patient. Medication leaflets had a photograph of the medication box and medicines to support patients to understand what they had been prescribed and why.
  • Staff felt supported in their roles. Staff reported that managers and senior staff at a local level were supportive and approachable. Managers used a dashboard to monitor staff performance including mandatory training and supervision.

However:

  • Levels of clinical supervision for staff were low for qualified staff and healthcare assistants at Penrose House and for qualified staff at Daisy Bank due to staff sickness and there was no one available to provide this.
  • Staff stored old copies of care plans and reports in patient files at Penrose House which made the files cumbersome and difficult to navigate.
  • The activity programmes at Penrose House and Daisy Bank were limited and staff needed to ensure these were taking place.
  • The wards did not complete audits of the Mental Capacity Act and actions in the Mental Health Act audits had not been completed. Staff had completed paperwork appropriately and this had not directly impacted on patients but had the potential to do so if not improved.
  • Daisy Bank and Penrose House had delayed discharges at the time of the inspection. These were due to issues outside of their control such as suitable placements not being available for patients with complex needs. We saw that staff did what they could to keep the process moving for patients. As part of the Transforming Care Programme, overseen by NHS England, Daisy Bank closed post-inspection that meant they had no delayed discharges.
  • Daisy Bank had not had permanent leadership over a period of 18 months and this had impacted on morale of the staff and patient care however the trust made the decision to close this ward in September 2018.

Mental health crisis services and health-based places of safety

Good

Updated 9 January 2019

Our rating of this service stayed the same. We rated it as good because:

  • There were high levels of experienced staff who had undertaken a complete mandatory training programme. Regular monthly meetings ensured that staff received feedback after serious incidents and were kept up to date about improvements to the service. Care records were up to date and contained holistic and individualised information relating to care.
  • All records we checked contained comprehensive assessments including an assessment of physical health. Staff followed best practice guidance issued by national organisations such as the National Institute for Health and Care Excellence. There was a full range of mental health disciplines available to patients across the service. Staff had good knowledge of the Mental Health Act and Mental Capacity Act and how they were relevant to their service users.
  • We observed care being delivered by staff who were professional and knew their patient’s needs. They were able to tailor care delivery to the specific needs of the individuals and were aware of a wide range of impact factors such as history, culture, gender and individual ability. Where possible patients were involved in the development of their own care. Where appropriate families and carers were also involved.
  • All services we inspected were compliant with targets set by the trust in relation to referral to treatment times. The crisis and liaison services could respond quickly to urgent referrals. Information about this service and local services to support patients was available in a range of languages. Patients we spoke to were aware of how to make a complaint and felt that they would be comfortable to do so if they needed to.
  • Staff understood their roles and how they related to the trusts core values. Managers were visible and well respected. Staff felt well respected and valued by the trust. All staff we interviewed stated that they were proud of the work that they did and felt that the trust supported their development.

However

  • Some of the environments we inspected presented risks. The electronic and paper recording systems were cumbersome and difficult to navigate.
  • There had been some issues with communication with teams outside of the trust.
  • The liaison team had lost its specialist interview rooms at the local hospital where they were based. This meant that they were conducting interviews and assessments in rooms more suited to physical health care delivery.

Forensic inpatient or secure wards

Good

Updated 17 February 2017

We have rated forensic inpatient/secure ward as good overall because:

  • Following our inspection in November 2015 we rated the service as ‘good’ for Effective, Caring, Responsive and Well led. Since that inspection, we have received no information that would cause us to re-inspect these key questions or change the ratings.

However:

  • Our rating of the safe key question remains requires improvement. This was because following our inspection of this service in November 2015, we asked the trust to ensure that training was provided to increase staff awareness of the Mental Health Act code of practice. During our inspection in October 2016, we found that less than 60% of qualified and unqualified staff had received this training. This was below the NHS national training standards and the trust's training compliance target.

Community health services for children, young people and families

Good

Updated 17 February 2017

We rated the service as good overall because:

The caseloads of health visitors were being monitored and managed well. Action was taken to ensure health visitor’s caseloads were manageable, in line with national guidance. Staffing levels in health visiting had improved since our last inspection. The caseload of the Family Inclusion Team had been reduced by transferring the care of some families to other members of the health visiting team.

The equipment provided for children used at home was being maintained in line with manufacturer’s maintenance requirements.

Improvements had been made to record keeping including the use of tracer cards when notes were transferred to another service.

Staff were ensuring children were safe by notifying the safeguarding team of any concerns using the trust’s incident reporting system.

Assessment and care planning was based on evidence-based guidance

There was a clear approach to monitoring, auditing and benchmarking the quality of children’s’ services and the outcomes for people receiving care and treatment.

Staff had the skills, knowledge and experience to deliver effective care and treatment

Staff worked with other agencies in multi disciplinary teams to ensure the care children received was well co-ordinated.

Staff provided age appropriate care. They took time to interact with children and young people and their families and took account of children’s individual physical, emotional and social needs.

Staff recognised when children and families needed additional support. Staff helped families to understand the treatment provided and enabled them to make decisions around the care they received. Families were involved in planning care and treatment and could access interpreters and other support when required.

The clinical commissioning group (CCG) were developing a strategy to meet the needs of local families. Clinicians and managers from the children and family service were actively working with the CCG to develop services.

The service worked with social services and education providers to meet the needs of Children and Young People in the area, particularly children with complex needs, life-limiting conditions and disabilities.

Children waited longer than the trust’s target of 8 weeks from referral to treatment target but met the national waiting time standards for providing timely access to initial assessment, diagnosis and treatment

Health visiting services were meeting the targets for child development checks

Issues identified at the last inspection which required improvement had been addressed by managers in the trust.

There were good governance arrangements in place which meant incidents, audits, national guidelines and risks were discussed and the appropriate actions were taken.

The performance of the service was managed and action was taken to improve performance

Leaders had the capacity, capability, and experience to lead effectively

However,

The trust was not achieving targets for level 2 and 3 safeguarding training The proportion of staff who had completed the training had fallen since our last inspection from 88.2 % for level 2 and 93.3% for level 3 to 82% and 79% respectively. This meant 34 of eligible staff had not completed level 2 training and 31 staff had not completed level 3.

Children were referred to other teams within the trust but there were no shared records. Each service kept their own information about a child’s needs. Information was held in paper records. An IT system which supported information sharing was not in place and the service could not share information with GPs.

Not all services were accessible at one location for example speech therapy was not provided at the Sunflower Centre where other therapy services and the Children’s Assessment Unit was based.

The pathway for the Family Inclusion Team and the access thresholds was not clear and there was a risk that some families in need might not receive the level of service they required.

The Board did not have a designated executive lead for children. A non executive lead had been identified.

A strategy was being developed with the local Clinical Commissioning group but this was not yet in place.

Senior leaders were not visible to all staff.

The trust used a system of restorative supervision but the role of this form of supervision was not clear within the trust’s supervision policy. Restorative supervision was provided in addition to routine supervision for staff the trust believed needed additional support.

Community-based mental health services for older people

Outstanding

Updated 26 April 2016

We rated community based mental health services for older people as outstanding because:

  • Staff had good knowledge of safeguarding. They were trained to level three and identified risks and appropriate referrals were recorded.
  • Each care and treatment record contained detailed risk assessments and risk management plans. These were reviewed regularly.
  • Patients had access to advocacy services and staff knew how to support patients to make sure they had access.
  • Patient information leaflets explaining how to complain were available in all locations. Staff knew how to respond to complaints.
  • Each team followed appropriate national institute for health and care excellence guidelines; these included the use of low-dose antipsychotics in people with dementia and dementia,supporting people with dementia and their carers in health and social care.
  • In order to meet the needs of the local population, the treatment and recovery unit had developed a Punjabi cognitive stimulation group. A further cognitive stimulation group had been developed in partnership with West Bromwich Albion football club.
  • Staff told us they felt their managers were approachable and supportive.

  • There was no occupational therapy or psychotherapy input within community-based mental health services for older people. The treatment and recovery unit and the groves day centre had no psychology input.
  • Patients were not formally involved in the development of services or in staff interviews.