Derbyshire Healthcare NHS Foundation Trust

On this page

• 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

Patients at the Hartington and Radbourne Units told us they were involved in their care and treatment by regularly attending ward rounds. Staff attended multi-disciplinary meetings where patients were involved in discussions about their care in a co-ordinated way between different services. However, patients told us they did not always have access to their care plans. We found staff completed comprehensive assessments and patients received regular physical health checks. However, staff found it difficult to navigate the electronic recording system. We found there was a lack of psychology provision across both units meaning it was difficult to get psychological provision for patients who needed it. Patients were not always aware of their right under Section 132 of the Mental Health Act (these states as soon as a patient is detained under the Act the patient must be given their rights orally and in writing, unless it is not practicable at that time. If this is the case, it must be documented in the patient's electronic care record).

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 20 patients at the Hartington Unit. The majority of patients had access to information and advice about their health and medication management and were involved in their care planning. We observed 2 MDT ward rounds where patients were involved in discussions about their care in a co-ordinated way between different services. For example, section 17 was considered with a patient as a stepping stone to being discharged. The patients case was discussed in collaboration with the early intervention in psychosis team and the early discharge team and specific mitigations were considered in relation to potential substance use whilst on leave and how this could be mitigated. Protective factors were discussed, and crisis support information was given to the patient. However, most patients did not have access to their care plans and some patients told us they were not aware of their rights. Community Meeting minutes highlighted that this was an ongoing concern for patients. Patients told us staff were generally accessible when needed however the ward was often very busy and this affected their availability. 3 patients told us they had been in a very distressed state and were unable to locate a member of staff for reassurance. 2 patients told us that staff spoke to each other in their native language and they found this anxiety provoking.

At the Radbourne Unit staff said they had very limited and insufficient training in the clinical record system, and this meant they were not confident in its use. We were told that care plans were often not updated in a timely way due to staffing shortages and the acuity of patients on the wards. We looked at 14 care plans at the Radbourne Unit with staff support to navigate the electronic system. The team found that staff were unable to effectively navigate the system, they were unable to locate a summary of a patient's presentation and progress and members of the multidisciplinary team recorded their notes in separate parts of the system. We spoke with 24 members of staff at the Hartington Unit; They reported that physical health checks were conducted as part of patients initial assessment onto the ward, although they were not always undertaken due to patients not consenting. Blood checks and ECG monitoring was also offered. We reviewed 10 care plans which corroborated this. The majority of care plans were personalised, recovery focused and contained the patients voice. Patients were advised about their medication, specifically in relation to side effects. Patients were given information about how to manage their weight and advice on healthy eating. Staff gave examples of when they had to escalate concerns to the duty Dr regarding medication side effects. Staff conducted physical health observations and used monitoring charts to record, diet, fluid in-take and weight. Staff encourage patients to take part in activities outside of the ward to help them to manage their health and wellbeing. Groups are run by the occupational therapy team and activity co-ordinators in the hub. Staff informed us that there is currently only 1 psychologist across all three wards at the unit, meaning its difficult to get psychological support for patients who need it.

At the Radbourne Unit we observed staff having difficulty navigating the electronic care record, which meant they were unable to record and update risks and changes to care plans in a timely way. We attended 2 MDT ward rounds on the Hartington Unit, where patients were people’s needs were assessed using a range of assessment tools to ensure their needs are reflected and understood. For example, section 17 was considered with a patient as a stepping stone to being discharged. The patients case was discussed in collaboration with the early intervention in psychosis team and the early discharge team and specific mitigations were considered in relation to potential substance use whilst on leave and how this could be mitigated. Protective factors were discussed, and crisis support information was given to the patient. The meeting notes were recorded, and appropriate records were updated. However, staff told us that they sometimes had issues updating the electronic care record using their handheld devices when making observations due to lack of connectivity on the unit.

Patients we spoke to at the Radbourne Unit said there was a lack of psychology across the wards however they told us that ward-based activities were frequent and well received. At the Hartington Unit the majority of patients were given information and advice about their health and care, which was co-ordinated. For example, patients were provided with information about their medication and how to manage anxiety. OT’s have discussed concept of self-love, and there is a Chaplain to give advice and support. However, not all patients felt that they were included in the development of their care plans and most we spoke to did not have access to their care plans. Some patients said they had been waiting a long time to receive access to psychological therapies.

Staff we spoke with at the Radbourne Unit said there was a lack of specific patient centred psychological therapies and the psychology team were only able to offer formulation plans for patients. Staff at the Hartington Unit told us that they provide a range of treatments and care for patients based on national guidance and best practice. Staff told us that they supported patients to live healthier lives. We saw evidence of this in the hub where staff from the activities team were supporting patients with a smoking cessation workshop and we observed the occupational therapy team conducting a session for patients on stress management. However, staff recognised that due to a shortage of psychologists on the unit, patients had to wait for access to psychological therapies. Managers informed us that a new psychologist is due to join the unit soon.

The trust had quarterly medicines management assurance subcommittee meetings in place. these were multi-disciplinary meetings attended by pharmacy and nursing staff including ward managers, where they would discuss medicines management and actions would be put in place and reviewed where required. In addition, the trust held had several specialist meetings including social worker meetings, Allied Health Professionals (Allied health professions are a group of health care professions that provide a range of diagnostic, technical, therapeutic, and support services in connection with health care) meetings and group supervisions, where professionals from those specific areas looked at treatment plans and best practice learning. This allows the staff to provide the most up to date treatment to patients.

At the Radbourne Unit we looked at 5 months of community meeting minutes and attended 1 community meeting. Patients were encouraged to participate and give feedback on their experiences on the wards. We saw that following concerns raised regarding the availability of specific dietary requirements, the hospital chef attended the meeting to discuss and resolve the issues raised. At the Hartington Unit we spoke with 20 patients, reviewed 12 community meeting minutes (all over 4-week period) and observed 1 community meeting; patients were encouraged to participate and give feedback on the wards. Most of the patients we spoke to said they felt safe enough to raise issues and the minutes from community meetings corroborated this. However, actions were not always recorded, and patients sometimes didn’t feel like they were listened to.

At the Radbourne Unit staff we spoke with gave examples of how they worked with the wider teams to benefit patients. We were told that housing and benefit advisors had been available to support patients. Staff we spoke to at the Hartington Unit said that they held regular MDT meetings on the ward, which included outside agencies who join remotely, for example social services and community teams. Staff told us that information was shared between teams during daily handover and rapid review meetings. This included handover to A&E when patients had to be admitted. Staff make sure that where possible, patients family and carers are also involved in MDT discussions or reviews. Medical staff told us they have good working links with social care, community, and home treatment teams. The unit has a housing officer and discharge co-ordinator who support with social barriers to discharge. However, some members of staff told us that sometimes information and tasks are missed during handover, which can cause difficulties for ward staff. Staff also reported that staffing issues across the unit has resulted in inconsistent mutual aid across the wards, resulting in some disagreements when staff need to redeploy to provide support. The medical team reported that they sometimes struggle to find specialist placements for patients, for example, autism services in the community. This was due to issues with the the availability of placements nationally.

We attended one multi-disciplinary meeting at the Radbourne Unit. The patient and their partner were in attendance as well as members of the patient's community team. Patient and carer views were recorded, and treatment and discharge plans were explained effectively. We observed 3 multi-disciplinary team (MDT) meetings at the Hartington Unit where patients were supported by staff to discuss their care with a large range of professionals. The discussions were holistic, recovery focused and co-ordinated. The early discharge team and social services worked well with a patient who needed specific safeguards in place. The patient was then able to go on section 17 leave before a planned discharge.

We observed 2 MDT meetings at the Radbourne Unit where patients attended the meeting and were fully involved in decision making. Ward meeting agendas had recently been updated to include learning from incidents, however we did not see evidence of this. We observed 3 MDT meetings at the Hartington Unit and a service area weekly operational meeting at the Hartington Unit. The meetings had systems and processes in place to ensure that decisions were fully discussed, recorded, and shared across the teams. However, there was evidence that some team meetings at ward level had not been recorded due to staff capacity on the ward.

The 14 patients we spoke to at the Radbourne Unit, said they were able to smoke within designated areas of the hospital grounds and vape within some inpatient areas. 4 patients told us they were unhappy that contraband items (drugs and alcohol) coming onto the wards. We were told staff supported them to use the hospital gym. The majority of patients we spoke to at the Hartington Unit said they were able to get information and advice about their health, care and support. They provided examples of the occupational therapy team working with them to cope with anxiety and Chaplain’s offering pastoral care. Many of the patients felt that the hub offered enough activities, such as karaoke and pottery classes. Patients told us that they felt staff monitored their physical health well and supported them to make healthier choices. The hub also offered healthy eating and cooking skills workshops, as well as coping skills, gardening, and a session on healthy lifestyles. However, some patients acknowledged that activities were often held in the hub and patients who didn’t want to leave the ward were left out. A patient with visual impairment said that many of the activities are visual and therefore they struggle to join groups.

Staff we spoke with at the Radbourne Unit said they were unable to carry out patient searches following leave on occasion due to staff shortages. Staff we spoke to at the Hartington Unit provided examples of how they support patients to live healthier lives, stating that physical observations are prioritised, and health checks conducted on admission. Staff support patients to attend therapeutic activities in the hub and offer advice regarding medication side effects, specifically managing weight. Staff try to reduce the need for future support by involving patients in their care planning and working to help them identify triggers and protective factors. However, staff told us that due to staff shortages they were unable to provide enough 1 to 1 support to patients.

The trust had a Tobacco Dependence Intervention and support policy in place. The policy guided staff to support patients who wanted to quit smoking and support smokers who do not want to quit, to abstain from smoking whilst in trust buildings or grounds. The policy gave clear guidance on the support given to patients and reviews that would take place, ensuring patient choice was maintained and care in this area was tailored to patient choice.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Out of the 14 patients we spoke to at the Radbourne unit, none expressed any concerns around consent to their care and treatment. At the Hartington Unit we spoke with 20 patients and reviewed 10 patient care records; the majority of patients understood their rights around consent to care and treatment and did not offer any concerns during our assessment. Patients referenced an understanding of advocacy and support, including their right to raise concerns with Healthwatch or CQC. However, there were some patients who were not aware of their rights and had not been provided with any information by staff on the ward.

Staff at both the Radbourne and Hartington Units were able to describe how they would assess patients capacity to make decisions and update their care plans accordingly.

We looked at 14 care records at the Radbourne Unit and mental capacity had been assessed appropriately in each record. However, patient section 132 rights were not consistently recorded in 8 out of 14 patient care records reviewed. We observed an MDT meeting on the Hartington Unit, where the team discussed with the patient their rights under section 132 of the Mental Health Act; including their right to appeal.

We requested information around Mental Health Act data including informing patients of their rights under Section 132. We were given information about 46 patients on Wards 33, 34 and 35 at the Radbourne Unit out of these 5 patients (11%) had not received their rights yet or had them renewed. We were given information about 42 patients on Morton, Pleasley and Tansley wards at the Hartington Unit all patients had been read their rights.