Nottinghamshire Healthcare 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

Staff provided an effective service. Patients told us staff knew their care needs well, actively encouraged them to be involved in the care and treatment planning and respected their individual needs. Staff told us how they encouraged patients to be involved in their treatment plans and how they used nationally recognised tools to monitor treatment progress and outcomes. Staff had developed initiatives to help patients to focus on healthier lives.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 8 patients. We were told staff know them “inside and out and were amazing”. All said staff worked with them to develop their care plans and supported them with individual needs and preferences, including physical, spiritual, cultural and gender preferences.

Staff we spoke with told us how they worked with patients to identify and assess need jointly where possible. Patients were encouraged to use health diaries which helped both the patient and staff member to formulate agreed care plans according to need. We were told that one patient had contributed to a co-produced flowchart to manage her diabetes which staff were then able to refer to.

Care plans were personalised, holistic and recorded the patient voice throughout. We saw patients were involved in developing individualised plans and activity/therapy programmes.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients we spoke with told us staff were very supportive in them reaching their goals. One patient told us they were about to be discharged to a lower security facility. They said staff had gone above and beyond to support them to visit the provider on several occasions and had set up calls to establish relationships with their named nurse and others.

Staff we spoke with told us they travelled to meet potential people for admission the Rampton Hospital wherever possible. If this was not possible, they met patients over video calls. We were informed about the staged discharge approach adopted which ensured patients were only moved between services when deemed safe and appropriate.

We saw staff encouraging and supporting patients to achieve their goals and how this linked to progress towards discharge.

Teams had effective working relationships, with other relevant teams within the organisation for example, therapies and healthcare. We also saw effective working relationships with organisations for example, NHS England, Scotland and Wales.

Patients we spoke with said there was an active emphasis on living healthier lives. They gave examples of a variety initiatives available to them, including, healthy eating sessions, yoga, gym sessions, swimming, pamper sessions and horticulture. We were also told that staff encouraged them to look at mental wellbeing and the links between this and physical health. Patients told us they also used the ward community meetings to share hints, tips and advice regarding healthier lives.

Staff we spoke with told us about initiatives they had developed with patients to focus on healthier lives. We saw posters and displays focusing on “beating the winter blues”, diabetes and coeliac disease management and healthy eating. Staff on Coral ward told us they would like more opportunities to undertake specific training for example, naso gastric feeding, however they were not able to be released due to present and historical staffing shortages.

We saw the high support pathway for cervical smears which included comprehensive input from psychology to aid patient participation. We saw healthcare teams provided training for breast examination using model breasts to encourage patients to check their breast health.

Patients we spoke with said staff encouraged them to participate in care plan reviews and update risk assessments. We were told staff used language that they could understand and kept them updated as to any related and relevant topics in the media which may interest or affect them, such as large intake of caffeine and its effect on psychotic medications.

Leaders told us the team completed a physical heath spreadsheet at every ward round to ensure any identified concerns were reviewed.

Staff told us they completed audits of care plans with the patient wherever possible however staff on Coral ward said they often struggled to complete these due to the acuity of the patient’s and staffing issues. Staff used Health of the Nation Outcome Scores to assess and record severity and outcomes. The occupational therapy team used Model of Human Occupation Screening Tool Self-Assessment (MOHOST) all patients had an up to date Historical Clinical Risk Management-20 (HRC-20) assessment.

Patients we spoke with were well informed about their legal status and said that staff always acted in their best interests. They said staff supported them to access advocacy services whenever they needed to.

Staff we spoke with described how they gave patients every possible assistance to make a specific decision for themselves before they assumed that the patient lacked the mental capacity to make it. They told us for patients who might have impaired mental capacity, they assessed and recorded capacity to consent. They did this on a decision-specific basis regarding significant decisions, they also recognised the importance of the person’s wishes, feelings, culture and history.

We saw Mental Health Act consent to treatment forms stored appropriately alongside the patients’ medicines chart.

Managers undertook regular audits of Mental Health Act documentation to ensure patients had been informed of their rights in line with legal requirements.