Derbyshire Healthcare NHS Foundation Trust

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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

Some patients felt they were given the opportunity to be involved in the development of their care plans. However, some felt they missed 1 to 1 sessions with their nurses to discuss their care plans due to short staffing and high usage of bank and agency staff. Staff and leader told us they tried to prioritize patient interactions. Staff held regular multi-disciplinary ward round meetings to ensure patients received holistic care and treatment and had regular communication with partners to ensure provision was in place when patients were ready for discharge. However, we found that not all staff did followed the trust policy all the time when responding to complaints.

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.

At the Radbourne Unit we spoke with 14 patients; 10 said they had been involved in developing their care plan, however they said they often missed their 1:1 session with their named nurse due to staff shortages. Patients we spoke to at the Hartington Unit provided a mixed picture relating to person-centred care. Some patients felt that they were involved in their care planning; they had access to their plan and worked with staff in a recovery focused way. However, some patients felt that they were not involved in their care planning, did not have access to them or support from their named nurse. Some patients felt that on weekends they were unable to receive person centred care because the wards used a lot of bank staff who didn’t know them. One patient expressed concerns about patients with mobility issues. They highlighted that staff don’t hold doors open for patients with mobility aids.

Staff at the Radbourne Unit told us they prioritised direct patient care and One to One interactions, however, due to staff shortages this meant care plans and risk assessments were not updated as required. At the Hartington Unit we found that the patients were supported within a person-centred framework and the majority of care records were comprehensive and recovery focused. A member of staff explained that a schedule had been set up on the ward to support a patient with a visual impairment. The occupational therapist explained that in consultation with the patient we have identified things that are meaningful, such as the walking group. The patient also agreed to attend coping skills (groups adapted as this group can at times be more visual), talking groups, spending time with the therapy dog and agreed to participate in Bingo and pottery class with support from a member of staff who will make adaptations so that he is fully supported.

We observed 3 MDT/ward round meetings at the Hartington Unit where person centred discussions took place regarding patients care. During 1 meeting the patient was given support with smoking cessation and offered nicotine patches to be prescribed. There were discussions around the patients preference regarding activities on the unit and a plan was put in place to support the patient to access interest groups. We observed another meeting discussing a patients discharge plan, including accessing suitable accommodation to meet the patients accessibility needs. Suitable locations were discussed in relation to proximity of shops and amenities to enable social inclusion.

Patients were supported within a person-centred framework and the majority of care records were comprehensive and recovery focused. Ward round meetings were person centred, where discussions took place regarding patients care.

Patients we spoke with said all relevant parties were invited to their MDT meeting especially when discussing discharge back to the community. This included provision for external partners, such as social services, to join via video conferencing. However, patients at the Hartington Unit told us that low staffing levels meant that wards were often staffed with bank or agency staff. This meant that continuity of care was impacted. Patients did not have regular contact with their named nurse.

Staff at the Radbourne Unit told us that if professionals or families could not attend MDT meetings in person, there was an electronic solution to ensure their participation. Staff at the Hartington Unit told us that they work well with external partners and local communities so that care is joined up. Meetings were attended by a range of professionals providing input into patients care, including housing officers and social services. Staff informed us that due to staffing shortages they had limited time to offer 1:1 support to patients, which impacted continuity of care and that tasks were often missed on handover notes.

Social work partners partners told us staff held weekly rapid review meetings, which gave a multi-disciplinary overview on every patients’ progress. The team involved all relevant partners dependant on the patient choice. If relevant housing teams and families would be involved as patients reaching suitability for discharge.

The trust had various processes in place including weekly multi-disciplinary ward rounds and care programme approach meetings to ensure appropriate care provision was in place.

Patients we spoke to at the Radbourne Unit said there was access to a variety of leaflets in several languages. There were noticeboards with specific information, for example on a female ward we saw a noticeboard dedicated to the menopause and how to manage this. At the Hartington Unit the majority of patients informed us that they had appropriate information to meet their individual needs. However, patients complained that they did not have access to their care records. Patients with visual impairment had limited access to information in braille and therefore required the support of staff to read information. Patients also informed that activities in the hub were often missed because they didn’t know they were on. The wards had a TV displaying relevant information for patients, their families and carers.

Staff we spoke to said that patients receive information and advice that is accurate and up to date, provided in a way that they can understand, and which meets their communication needs. Patients are offered information in a range of languages. We saw staff supporting a patient whose first language was not English to gain access to an interpreter. There were numerous leaflets at the reception and in the hub providing advice for patients, families, and carers. However, on one ward at the Hartington Unit staff had removed all the information posters from the walls to stop a patient from ripping them down and recognised that this could be classed as a blanket restriction placed on other patients.

Patients had access to ward specific leaflets, that gave them information on what the ward provided and ward contact details. Each unit also had an inpatient guide, which gave an overview on patient care, patient safety and wellbeing including information on patient belongings and prohibited or restricted items, smoking, care planning and staff involved in the patients care process. The guide gave information around daily life on the ward too including information on meals, visitors, laundry, recreational services and patients’ spiritual needs.

Patients across both the Radbourne and Hartington Units knew how to feedback about their experiences of care and the service and were able to voice concerns at the weekly ward community meetings. However, some patients at the Hartington Unit felt that staff were too busy to approach and didn’t feel listened to.

At the Radbourne Unit staff told us that learning from complaints and concerns had not been routinely discussed. This had only recently been introduced as a standing agenda item at ward meetings and we did not see any evidence of this being embedded. Most staff at the Hartington Unit felt supported in their role, were able to raise complaints, share feedback and suggest ideas to managers at ward level. Staff we spoke to were aware of the complaints process and supported patients if they had concerns. Incidents were recorded using the DATIX system, however some staff said that limited learning was disseminated on a regular basis during team meetings Staff also felt reluctant to raise concerns with senior management because they didn’t feel listened to.

We attended one community meeting at the Radbourne Unit where we saw evidence of improvement whereby the hospital chef had been invited following issues with the food on offer. At the Hartington Unit we attended an area service meeting where staff and management spoke about the development of the new building being co-produced. This included running a competition to name the building. We also observed ‘you said we did posters’ on the walls in some of the wards and the patient hub.

The trusts complaints audit showed they had a total of 7 complaints over the last 3 months: 3 at the Radbourne unit and 4 at Hartington unit. All complaints were graded orange in priority and according to the Trusts Handling Patient Feedback 2022 - 2025: Comments, Concerns, Complaints, and Compliments these complaints graded orange should take no longer than 40 working days for the Trust to respond to. None of the complaints had been responded to within the timeframe expected within the trusts complaints policy.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People we spoke to at the Radbourne Unit told us that they felt involved in their care and treatment and their preferences in outcomes and planning for the future were considered and discussed at ward review and discharge meetings. We spoke with 20 patients and reviewed community meetings minutes; At the Hartington unit the majority of patients spoke positively about the support they received on the wards. However, some patients didn’t feel listened to and had raised concerns about their care with staff and during community meetings. Some patients felt that staff didn’t support people with accessibility issues well enough.

Staff we spoke to at the Radbourne Unit were able to demonstrate an understanding of discrimination and how they supported patients to access opportunities such as keeping links with local communities. At the Hartington Unit staff told us that they actively seek out and listen to information about people who are most likely to experience inequality in outcomes. During an MDT meeting we observed staff supporting a patient who had mobility issues to find suitable accommodation close to shops and amenities. We were also told how OT’s make reasonable adjustments to include patients with visual impairments in activities on the unit. However, staff did inform us that due to shortages on the ward, they were unable to dedicate 1:1 time with patients which impacted care.

The trust had processes in place to ensure all patients could raise concerns through regular ward level community meetings. All patients had access to an independent advocate. The advocates visited the wards on a regular basis.

Managers were keen to tell us about plans for the new builds and environmental upgrades will be for both male and female patients. We observed MDT/ward round meetings with a number of patients where a wide range of professionals supported patients to make informed decisions about their future. During one meeting, the medical team spoke empathetically about arrangements for a patients children post discharge. Other patients were helped to understand protective factors and staff suggested graded discharge plans for including section 17 leave. Staff used formulation to help patients understand their challenges with the hope of long-term recovery in the future.

Across both the Radbourne and Hartington Units we saw staff collaborating with external agencies to safely plan discharges. Patients told us they felt fully involved in the discharge process. We observed patients working collaboratively with staff to plan for their future, including discussing protective factors for long term recovery following discharge. However, some patients told us that they did not have access to their care plans and were not aware of their rights.

The trust had a discharge policy in place it gave an overview of the individuals who should be involved in planning discharge and guided staff to start planning discharge as soon as possible after admission. It gave guidance on a multi-disciplinary and partnership through the care programme approach. The trust had regular care programme approach meetings with partners and included relevant partners from an early stage including social workers and housing colleagues if this was appropriate according to the patient’s wishes. This allowed the patient to be involved in the discharge process from an early stage in their care. In addition to the care programme approach meetings the trust had weekly rapid review meetings. These were multi-disciplinary meetings attended by ward staff and social workers, which gave attendees an overview of each patients progress and helped them start to plan next stages including housing provision or community support if appropriate.