Coventry and Warwickshire Partnership NHS Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

In line with ‘Right Care, Right Support and Right Culture’ guidance, people were registered with local health services and had access to community health services. There were effective systems to support people to increase their independence and transition to be part of the community. People’s care plans fully reflected their physical, mental, emotional and social needs. People could expect information to be tailored to individual needs. People’s care, treatment and support promoted equality, removed barriers or delays and protected their rights. People were supported to make informed choices about their care and planned their future care.

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.

One person on Malvern ward told us they were fully involved in their care and treatment plans. They told us they were given choices and have now completed treatment and feel much better. One person at Janet Shaw Clinic told us, “The nurse will sit down and speak to you about it if anything needs to change and if you're happy, you sign it. Staff will explain if something is in place that you don't like and why it's there, so you get time to understand.” One person on Onyx ward said they were not involved in their care and treatment plans. 3 out of 4 carers spoken with said they were not involved in planning their relative’s care and staff did not ask them about their loved one’s preferences.

The provider advised that staff documented any reasonable adjustments required and shared these with the multi-disciplinary teams. Staff completed a communication assessment report and included any reasonable adjustments in the person’s Positive Behavioural Support Plan. The manager of Eden ward shared how staff supported a person with a terminal illness. Staff supported them in general hospital and then at the hospice. The persons family were grateful for the support. Staff really pulled together to support the person in their last days and all staff volunteered to support.

We observed staff continually engaging with people in all aspects of their care and treatment during our visit. Staff demonstrated that they knew people well and were aware of what their individual needs and preferences were.

Staff reflected people’s needs in care plans reviewed. Staff created a care plan for one person on Malvern ward which included routines that the person liked in the evening. These routines helped the person to stay calm and settled for the night.

People told us they were supported throughout their care journey and staff would work with other services to ensure their needs were met.

The provider advised that gatekeeping assessments and a Care and Treatment Review (CTR) (or equivalent process for transferred prisoners) would be undertaken before any referral could be considered by the service. Referrals and bed management were discussed in the weekly provider collaborative bed management meeting. The provider collaborative case managers sent referrals to the relevant team’s responsible clinician requesting an admission assessment. The responsible clinician would liaise with the case manager and the team currently supporting the person (either inpatient or community) to obtain further information prior to undertaking the assessment. The provider advised they have a delayed discharge group which has focused on the barriers to discharge, which included delays where a person required ongoing supervision from the Ministry of Justice and challenges finding suitable onward community placements. Senior leaders told us they work with the Transforming Care team for people with long inpatient stays and explore ways to get them back out into the community. They also told us they work with providers in the community to help them understand that people can look difficult to manage in community, but they are already part of the community. This involves myth busting and providing training to providers. Staff also worked with community teams who could support people once they were discharged.

The provider collaborative identified challenges to discharge, particularly for people on Eden ward. These challenges included a lack of medium secure learning disability provision, delays in identifying appropriate onward placements and disagreements between services on whether a person was ready for discharge. These issues were out of the provider’s control.

People’s care and treatment was delivered in a way that met their assessed needs. Staff created transition and discharge plans for people as part of their journey through the service. This was evidenced in care records we reviewed.

People told us they were provided with information they needed in relation to their care and treatment. 3 out of 4 carers spoken with told us they were not given much information about the service and the care and treatment provided to their loved ones, although they thought staff supported their relative to understand their condition and treatment needed.

The provider advised that staff requested information in relation to prospective people’s communication needs during the pre-admission assessment. Staff completed a communication assessment on admission for people with identified needs. This assessment informed how best to share information with people to meet their communication needs. Staff implemented general standards for easy-read information as per guidance from various learning disability organisations and the NHSE ‘Guide to making information accessible for people with a learning disability’. Staff would provide easy read information on Mental Health Act and medication as a standard. Where a person had communication needs due to sight, hearing or language requirements, staff would follow the trust process to book a language, British Sign Language or Braille interpreter.

We saw evidence in care records reviewed that staff assessed and planned for people’s communication needs. We also saw evidence of easy read information being provided, when needed.

Most people said that staff listened to them and involved them. People at Janet Shaw Clinic said they had a daily one to one with staff where they could raise any concerns. One person at Janet Shaw Clinic told us they raised concerns about an agency member of staff and the manager took action to resolve. Three out of 4 carers spoken to did not know how to complain or raise a concern.

The provider advised they received 7 complaints via PALS and 1 formal complaint from a person at Janet Shaw clinic between 1 September 2023 and 31 August 2024. The formal complaint was investigated and not upheld. During the same period the service received 15 compliments. We reviewed governance meeting minutes for Eden ward and saw an example of staff responding to a person complaining about not being able to have a hot drink at night, staff resolved this by providing the person with a flask to make their own hot drinks at night.

We observed staff listening to and involving people across all wards during our visit.

The provider supplied data on the number of complaints received. Following the inspection the provider shared themes from their ‘Patient and Carer Experience Group’. This group covered the Trust’s Learning Disability and Autism directorate, which also included non-secure services and community services. The provider produced monthly reports that analysed data received from people using services and carers via the ‘I want great care’ feedback route. These reports were submitted to the ‘Patient and Carer Experience Group’ to review themes from people’s positive and negative experiences. We reviewed the reports for July and August 2024. People using services and carers submitted 34 reviews of the inpatient learning disability and autism services. For both months people using services and their carers reported no negative experiences.

People experienced care, treatment and support that was timely and in line with best practice, quality standards and legal requirements. Due to the nature of the service people did not choose the service and the usual route for admission was via the criminal justice system.

The provider advised that access to service was based on clinical need with clear criteria agreed with the provider collaborative for admission and moving on criteria for people.

The provider collaborative worked closely with staff to ensure access to the service for people assessed as requiring this type of service.

The provider’s admission process clearly stated the criteria for accessing the service. Staff completed an assessment following a referral to the service from the provider collaborative. If the person was not suitable for the service, the responsible clinician would inform the provider collaborative with reasons why and signpost to other potential services.

We reviewed a document from the advocacy service outlining the approach and support they provide to people in the secure wards. This was focused on upholding peoples’ rights. We reviewed an easy read leaflet provided by the Advocacy service to people using the service that required this as well as a standard leaflet.

Senior leaders told us the service was involved in health inequalities work and a physical health matron was recruited to champion the physical health agenda. They provided a link to acute services to support when a person had a physical health need. They also focused on tissue viability for people. There was previously a lack of focus on physical health, and this has changed with more physical activities for people and supporting staff to understand how to identify physical health deterioration. Over the last 2 years staff have registered people with a local GP. Staff used Learning from Deaths reviews (LeDeR) following deaths of people with a learning disability or autism in the community, to improve equity in experience and outcomes for people on the wards. Staff completed annual physical health assessments and health action plans for people. Senior leaders told us they increased physical health input through recruitment of more physical health staff, including a dietician, an epilepsy specialist, Advanced Clinical Practitioner roles.

We reviewed ward governance meeting minutes for Eden ward and found evidence of staff escalating concerns when people were unable to access local GP services due to having long term health conditions. Senior staff approached the GP practice manager and resolved this.

One person on Malvern ward told us they were at the end of their recovery journey and staff fully involved them in discharge plans and choosing their next placement. Another person on Malvern told us they were pleased with their progress and proud of their achievements. A person on Onyx told us they were planning their discharge to a supported living placement. A person at Janet Shaw Clinic told us about the ‘Good Life Group’. They said, “We talk about past me and then how the future me is going to be. We look at short and long-term goals. I really enjoy that. I want a life outside of services.” 3 out of 4 carers said they were not involved in planning their relative’s future.

The provider told us that the service runs a ‘Leavers’ Preparation Group’ which was an eight-session preparatory, recovery focused group intervention supporting people as they approached discharge or transfer to lower levels of security. Staff on Malvern said they supported lots of people’s discharges and one person was coming back to the ward for a visit to let everyone know how they were getting on. One consultant told us that the future, discharge and transition was discussed at every care meeting even if a long way off and in line to their custodial sentence. We ask the person about their aspirations and where they want to go. This gives the person a strong understanding of what they are doing. We worked closely with community teams for a recent discharge, as there were previous failed attempts. We have links with community teams and we work together to progress transitions from the service.

Staff included people’s plans for the future in care records we reviewed across all wards. We reviewed care records for 3 people on Malvern ward. We saw examples of staff using a mapping document which provided a visual pathway for peoples’ journey through the service and beyond. We also saw that people with additional co-morbidities had treatment escalation plans and ‘Respect’ documents. This was underpinned by information in the provider’s treatment pathway document which stated “Importantly, a visual schematic permits patients to understand and recognise where they are in the process. and provides a sense of progression and potential end point to work towards. This is discussed with the patient at regular intervals as they move through their treatment pathway."