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

We found this service involved young people and the carers when developing personalised, person-centred care and treatment plans. We found young people and their carers were involved in ward review meetings and the development and review of their treatment plans. Where possible staff catered to individual needs and individual likes and dislikes. Staff explained treatment plans in a way that the young people and their carers understood. The service offered a range of treatment approaches including a range of therapies.

However, during this assessment staff did not always update the clinical care records when risks had been reviewed and assessed as high. We informed staff and management at the service and they addressed this immediately. They implemented the processes that were in place at the other locations and ensured staff had access to all information required.

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 young people and carers we spoke with told us once the young person was accepted onto the caseload staff assessed individual need and catered for individual choices, likes and dislikes. Carers told us treatment was tailored to both the age and clinical need of the young person, and they appreciated this.

Carers said there was a waiting list and staff maintained contact with them during their time on the list to reassess any changes to the young person.

Mangers told us they were aware of the concerns regarding the length of time young people were waiting to commence treatment. They had implemented several initiatives to improve efficiency within the service. This included job planning and caseload management for staff to review their workloads and capacity.



Staff we spoke with described how they worked with the young person to complete their care plan and covered the following areas, “about me, my pronouns are, my religion is, my dietary needs are, my language is, my learning needs are, and my strengths and skills are”.

Staff did not always update the clinical care records when risks had been reviewed and assessed as high. We saw teams held a regular risk register meeting, where young people deemed as high risk were discussed and management plans were updated. We saw staff at Lindsay Close did not record the discussions and subsequent actions in the contemporaneous clinical record. This meant staff working with the young people did not always have up to date information regarding current individual risk. We informed staff and management at the service and the addressed this immediately. They implemented the processes that were in place at the other locations and ensured staff had access to all information required.

Three carers we spoke with told us they were disappointed that medication was not deemed as a suitable option for their children with autism. However, they said staff had explained this to them in a sensitive way.

Staff told us they worked within the NICE guidelines (National Institute for Health and Care Excellence) regarding the use of medications for young people and we noted the Lindsay Close team were very low prescribers of medication. Staff told us they used evidence-based approaches to treat or support young people and their families to better manage their difficulties. These included approaches such as cognitive behaviour therapy, systemic family therapy, psychodynamic psychotherapy, dialectical behaviour therapy, EMDR (eye movement desensitization and reprocessing) amongst other therapies and interventions.

We saw staff had implemented group sessions which enabled them to see and assess multiple young people within a rolling programme of interventions including nonviolent resistance, stabilisation, attachment and trauma and drama groups.

Carers we spoke with told us they had experienced delays accessing treatments such as talking therapies when young people reached 18 years old and transitioned into adult mental health services. Staff managed the delays by keeping patients on their caseload whilst they transitioned into adult services. Carers also told us children’s paediatric services were stopped at 18 years old, which was out of the services control. However, the staff ensured a thorough handover was in place.

Staff we spoke with told us how they had built relationships both internally and externally to the trust. They gave examples whereby they had coordinated care and treatment to meet the young person’s individual needs. We saw instances where the multi-agency safeguarding team were involved in keeping young people safe from harm.

Staff based in Nottingham told us of their frustrations at not being able to secure rooms to assess young people and families, this affected the capacity to see people in a timely manner. Staff managed this risk by reviewing the waiting lists, providing support through group interventions, and offering out of hours appointments. Staff in Mansfield also told us they had recently experienced difficulties in accessing interpreting services, they had raised this with managers, who assured us a framework of provider would be implemented to prevent future delays.

We attended one complex care meeting; this was attended by several professionals involved in the young person’s care. They included the care coordinator, paediatrician, consultant psychiatrist, family therapist, occupational therapist, social worker, autism lead and representative from the young person’s school. A full clinical review was undertaken including discussions about options available. This was then relayed to the young person by a nominated person from the team.

We saw the operating procedure which stressed the importance of multi-agency working.

The young people and carers we spoke with told us of several initiatives available to them to support them to live healthier lives, these included mindfulness walks, swimming, sleep group and body image workshops.

Staff we spoke with told us they completed a holistic core assessment for every young person which considered both physical and mental aspects of the young person’s life. They supported young people to increase their knowledge of maintaining healthier lives.

Within all young people’s care and treatment records we reviewed, we saw all young people had a physical health assessment and monitoring where required.

Young people and carers told us the teams adopted a flexible approach with appointments which meant families were seen out of core times to meet their needs. Staff always asked how they were doing and monitored any changes.

Staff we spoke with told us they completed a full assessment for each young person on the electronic clinical record. However, they said this could be a very lengthy process as they were unable to access GP or other relevant records currently. Staff told us about an initiative where young people with mild to moderate depression used a digital self-help gaming application, as part of a research initiative with a local university.

Within the care and treatment records we reviewed; staff used a variety of tools to monitor outcomes. These included, the Revised Children’s Anxiety and Depression Scale (RCADS), the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS).

Both young people we spoke with told us they were always asked about consent to share their information with others.

Staff we spoke with demonstrated how they supported young people to make a specific decision for themselves before they assumed that they lacked the mental capacity to make it.

We saw posters on display in waiting areas advising patients on how to access advocacy services. All care and treatment records we reviewed demonstrated capacity had been reviewed at each care and treatment plan review.

We saw managers had undertaken audits of care and treatment records to ensure staff had assessed, considered and recorded capacity on a decision specific basis.