Barnet Lane Clinic

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• 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

Patients were involved in planning and making shared decisions about their care and treatment, so these were centred around them and their needs. They had the option of having their own copy of their care plan. Patients told us that they were supported to work towards discharge, and some noted that they were waiting for a suitable placement to be found. Commissioners and the advocate who visited the service regularly were satisfied that patients were encouraged to work towards discharge, and to access the local community as far as possible. However, some patients told us that there was not enough to do in the evenings and at weekends and managers had not ensured there were educational, voluntary work, or employment opportunities for patients at the time of the inspection.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients said that staff supported them with their physical, mental, emotional, and social needs. They were clear that they were asked about their needs and preferences and able to contribute to their risk assessments and care plans. Some patients chose not to contribute to their care plans. Patients and their carers/relatives (when patients agreed) were involved in planning and making shared decisions about their care and treatment at ward rounds and other meetings. Patients understood their conditions, and care and treatment options (including associated risks and benefits) and any advice provided. Whilst they did not always agree with the medicines they were prescribed, their concerns were discussed and recorded, alongside the reason for the treatment, and this was reviewed regularly. Managers made reasonable adjustments where necessary to meet people’s needs such as mobility issues or language barriers.

Staff said that they were able to provide safe, effective, and person-centred care as the provider recognised and met their wellbeing needs and provided support and resources accordingly. They received regular supervision, training, and support, and could refer patients to physical health professionals outside of the hospital as needed. They provided examples of how they supported patients according to their individual preferences, including a patient who identified as of a different gender from their birth gender, patients with ongoing physical health conditions, and patients who required reassurance in particular situations. For example, it had been agreed that one patient was provided with extra support after using leave outside of the hospital, as this was a particularly high-risk time for them. We asked staff about restrictions on a patient (whilst sleeping) who was identified as at high risk of self-harm. Staff were aware of the need to review this practice regularly to ensure that this was proportionate.

We observed staff treating patients as individuals and supporting them according to their wishes. There were different activities available on the female and male wards of the hospital, with more choices available for female patients. Patients had opportunities to go on leave for activities outside of the hospital, including shopping trips, attending church services, swimming, a walking group, and trips to a local gym. Within the hospital patients could use kitchen facilities, and an art room. There were group and one to one therapy provided and large grounds which patients could access.

Patients’ care plans reflected their physical, mental, emotional, and social needs, including those related to protected characteristics under the Equality Act. Patients were involved in planning and making shared decisions about their care and treatment, so these were centred around them and their needs. They had the option of having their own copy of their care plan. Patients were given information about their conditions, care and treatment options and staff made reasonable adjustments for patients where necessary.

Although there were a range of activities available to patients at the hospital, the hospital had no links with local or recovery colleges or employment opportunities for patients. All patients we spoke with confirmed that this was the case, although not all of them were interested in pursuing educational courses or getting employment experience. Some patients told us that there was not enough to do in the evenings and at weekends. Two patients said that they missed the yoga sessions they used to have on the timetable previously. Patients told us that they were supported to work towards discharge, and 2 noted that they were waiting for a suitable placement to be found.

On the last day of our inspection visit, staff told us that one patient had been discharged in the last week, and another patient was working towards discharge shortly. They noted that in some cases, where patients had been at the hospital for several years, they needed a lot of encouragement to work towards discharge. In some cases, this had resulted in some difficult incidents when patients did not feel ready to move on. They used reflective practice and worked in partnership with the psychologist to learn from these incidents and find more constructive ways to work with patients who now considered the hospital to be their home. Staff acknowledged that there were no current links with local colleges or recovery colleges or employment opportunities for patients. This was an area identified for development with a new occupational therapist having recently been recruited for the hospital. The occupational therapist spoke of plans to introduce more support in activities of daily living, leisure and educational groups including community survival skills, and pre-vocational training. They were looking to find an appropriate apprenticeship for one patient who had a particular vocational ambition. Management advised that they had agreed links with a horticultural garden in the community group, and with a local gym. There were plans to develop community links including education sites for the autumn. They were planning to train healthcare assistants in providing more activities, particularly at weekends.

Commissioners and the advocate who visited the service regularly were satisfied that patients were encouraged to work towards discharge, and to access the local community as far as possible. They also noted the difficulties in working with some patients who did not want to be discharged, although ready, having been at the service for several years. They had no concerns that patients were being pressurised into moving on before they were ready. They were satisfied that patients were encouraged and able to self-cater, using the occupational therapy kitchen, and working towards self-administering their medicines. All patients were registered with a local GP practice.

Future plans for the hospital involved becoming a female only service, with an acute ward, a rehabilitation ward, and 4 step-down flatlets. In the interim period the flats were to be used by male patients until they found alternative placements outside of the hospital. One wheelchair user was currently accommodated on the ground floor of the hospital. Records included detailed discharge plans in place when patients were approaching discharge. Management delivering services considered the needs and preferences of different people, including those with protected characteristics under the Equality Act and those at most risk of a poorer experience of care. Activities provided included arts (with a dedicated art room) cooking sessions, music, and fitness groups. There was a walking group, swimming sessions at a local leisure centre, and trips to a local gym. At weekends, there were mostly board games and movies available. Previously patients at the hospital had been involved in growing some of their own fruit and vegetables in the hospital grounds. There were plans to restart this. However, managers had not ensured there were educational, voluntary work, or employment opportunities for patients at the time of the inspection.

Patients told us that staff gave them current information and advice in a way that they could understand. Some carers were not happy with the amount of communication from staff about their relatives’ progress. A patient, for whom English was not their first language, had information translated for them, and access to an interpreter when needed. Patients knew that they could have a copy of their care plans and could request access to their health and care records. They were able to decide which personal information could be shared with other people, including their family and care staff.

Staff said that they gave patients information and advice in a way that they could understand. They noted that they only shared information with carers with the permission of the patient. Staff were aware of the language needs, and any other accessibility needs of patients at the service in terms of understanding information. They were aware of how to request an interpreter when needed. Staff said that they offered patients a copy of their care plans. They checked with patients as to which personal information could be shared with other people.

One patient who did not speak English as a first language, had interpreters and translations when needed, and was happy with the language support provided. Information about people that was collected and shared met data protection legislation requirements. People were provided with clear and transparent information about the service. In response to concerns raised by carers of people at the service, staff had set up a carer’s forum, and undertook to improve communication about the service, including circulating a monthly newsletter.

Patients knew how to give feedback about their experiences of care and support at the hospital. They were aware of the complaints process, and how to express informal concerns to staff at the hospital. Most patients and carers felt that the hospital looked into their complaints and made changes accordingly. However, a small number of patients and carers were not happy with how responsive managers were to their concerns.

Staff were aware of the service’s complaints procedure, and said they received feedback following complaint investigations. They felt that their own concerns and suggestions about the hospital were taken seriously. Managers said that they kept people informed about how their feedback was acted on. Where improvements were required as a result, they tried to involve patients in shaping the solutions. Staff said that learning from complaints and concerns was seen as an opportunity for improvement and staff could give examples of how they incorporated learning into daily practice. For example, they had taken action to address complaints about the service’s phonelines being out of order on several occasions, with contingency plans in place to ensure that calls were not missed.

We looked at records of complaints received by the hospital within the last 12 months and found that these were generally addressed within expected timescales, and people were informed if there was any delay. Between March 2023 and February 2024, 11 complaints had been received. Of these 4 had been upheld, 4 partially upheld, 2 were inconclusive, and 1 was not upheld. The main themes were staff conduct, clinical care and discrimination. Concerns received from relatives about problems with getting through to the service by telephone, had led to managers recently upgrading the telephone system. They had also put in place a contingency for any phone outages, with a mobile phone on standby to which all calls could be diverted when needed. The contingency phone was checked every day and kept fully charged within the emergency bag. Checks of the maintenance book indicated that issues and repairs were addressed promptly, usually by the next day.

Managers ensured the service’s complaints policy and procedure were up to date and allowed 20 days for people to receive an outcome. Patients participated in restrictive practice meetings, and reviews of blanket rules. They were also involved in interviews of new staff and were being offered training in interview skills. There was no current patient representative for the hospital, although this role had been in place previously. Weekly community meetings were attended by the patients’ advocate and were an opportunity for patients to feedback on what was working well, and any concerns or requests they had. The first Friends and Family meeting was held in March 2024, with 3 people attending, it was agreed to hold these meetings at least quarterly, and that the monthly newsletter would be shared. It was agreed that carers would have a designated staff contact at the service, and the portacabin would be made available for patients to meet with family and friends once the building work was complete.

Patients told us that they received care and treatment in a way that met their accessibility needs and ensured that they were treated without fear of discrimination. They thought that they usually received treatment and support when they needed it, and that their rights were protected as far as possible. This included making the premises as accessible as possible, and reasonable adjustments for disabled people. Patients with mobility issues could access all areas of the physical premises and equipment they needed on the ground floor.

Staff spoke of improvements that had been made and were further planned to the environment to ensure that patients could access all areas they needed in a way that worked for them. Managers and staff were aware of their responsibilities to prevent discrimination and inequality and provide treatment and support in an equitable way to all patients. Staff said that the provider prioritised, and allocated resources to tackle inequalities and achieve equity of access for all. We observed that adaptations had been put in place to make the environment accessible to wheelchair users on the ground floor, and in the grounds. It was not possible to have lifts within the hospital building, so all relevant facilities were provided on the ground floor for those needing level access. The registered manager advised that further adaptations were planned in consultation with the newly appointed occupational therapist. Male patients had allocated slots to use the garden and were able to join female patients for the weekly community meeting, and some other events.

Feedback from commissioners and advocacy services indicated that staff assessed, reviewed and ,met the care needs of patients well. Commissioner's were positive about the use of pictorial aids and easy read information for patients.

Given the limitations of the hospital building, patients had access to accessible care, treatment, and support in line with best practice, quality standards and legal requirements. Reasonable adjustments were made for disabled people, addressing communication barriers, and having accessible premises. Managers said they used people’s feedback and other evidence to actively seek to improve access for people more likely to experience barriers or delays in accessing their care. As the service was undergoing change, managers had considered equity of access in the design of the new service. The provider complied with legal equality and human rights requirements, including avoiding discrimination, considering the needs of people with different protected characteristics, and making reasonable adjustments.

Patients told us that they felt able to give their views and understood their rights, including their rights to equality and their human rights. They said that if they experienced discrimination or inequality, staff listened to them, and where possible, made changes to improve their care.

Managers and staff were aware of possible discrimination and inequality that could disadvantage different groups of people using their services. Staff were aware of the need to respect patients’ pronouns, religious needs, and beliefs. Managers proactively looked at ways to address barriers to improve people’s experience, act on information about people's experiences and outcomes and allocate resources and opportunities to achieve equity. They produced a monthly diversity, equality, and inclusions summary for the hospital.

The provider complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes. They had appropriate equality, diversity and human rights policies in place, and compliance was monitored on a monthly basis.

Patients told us that they were supported to make informed choices about their care and plan their future care. Patients said that their decisions and priorities were recorded in personalised care plans that were only shared with others if they agreed to this. Patients said that staff encouraged them to achieve greater independence and supported them in their plans for moving on from the service.

Staff told us that they tried to work with patients collaboratively to make decisions about their care and treatment and prioritise what was important to them. This was not always possible, with some patients choosing not to engage in the process. Staff encouraged patients to improve their independence skills and supported them in their plans for moving on from the service. They noted that there were some patients who were ready for discharge from the service, but who had not yet found appropriate placements. After discharge, staff stayed connected with patients for the first 7 days, to ensure a smooth transition.

Patients’ future plans were recorded in personalised care plans. There were some delays in finding patients suitable placements when they were ready for discharge from the service. Staff worked with commissioners to ensure that future placements were successful. At the time of the inspection managers had instigated a cap of 19 patients for the hospital as it was due to transition to a new model of service. The hospital remained open to referrals. New patients could visit the hospital, and staff assessed them at their current placement.