St Mary's Hospital

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 had up to date and comprehensive assessments in place. These were reviewed regularly. Patients’ physical health was assessed and monitored. There was ongoing physical health care where required including engagement with a GP.

The teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. Care was delivered in line with national guidance and best practice. Staff worked well together as a multidisciplinary team. Staff worked collaboratively with stakeholders to deliver joined-up care to patients.

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.

Patients we spoke with told us they had been involved in the assessment process on admission. They told us that staff completed mental health and physical health assessments with them. Patients we spoke with generally felt that staff understood their needs and were confident their treatment reflected this. None of the patients we spoke with had communication needs. Patients told us assessments were reviewed in 1:1 Sessions and in multidisciplinary reviews.

Staff we spoke with were able to describe the assessment process and their involvement in it. They were able to describe how they were informed of the outcomes of assessments and how associated care and risk management plans were shared with them. Staff we spoke with described how updated information on each patient was shared at handovers between shifts. Staff described how patient observation levels were assessed and reviewed daily.

Staff were aware of how they could access specialist assessments, for example occupational therapy, speech and language therapy or psychology.

Staff we spoke with demonstrated a good knowledge of individual patients and were able to describe their needs and treatment plan.

Staff completed a full assessment of patients on admission. Physical health screening was completed within 24 hours of admission, either by the hospital physical health team or the nurse on duty. Physical health assessments included baseline bloods and an electrocardiogram. Assessment documentation was comprehensive and covered all relevant areas.

Assessment and patient need was reviewed regularly in 1:1 nurse sessions and weekly multidisciplinary ward rounds.

We reviewed 9 care records and found each had a comprehensive assessment in place which captured all relevant information and evidenced involvement from the patient and relevant stakeholders such as family members, loved ones and other services involved in the patients care.

Patients we spoke with told us they could get information and advice about their health, care and support. They felt there was a good range of treatment options available to them. We spoke with patients who had engaged with occupational therapy and with psychology. They were positive about the input they had received. Patients told us that there was a range of activities offered, including activities that supported them to live as they want to, for example activities such as access to the local community, shopping, exercise and cooking/baking.

None of the patients we spoke with reported concerns about their physical health treatment and some of the patients we spoke with told us they had access to a GP.

Staff delivered care and treatment in line with best practice. Staff we spoke with were able to describe the range of professional input, treatment and care options available to patients in line with national guidance. This included support around physical healthcare and access to an 8-week psychology programme covering areas such as sleep hygiene and hearing voices. Senior managers were able to explain the process at provider level for reviewing new guidance and disseminating it to services.

Provider policies were written in line with national guidance. There were governance structures at provider level to review and disseminate new guidance. Wards completed clinical audits to ensure compliance with relevant standards and guidance.

Patients we spoke with told us that their care was delivered by a multidisciplinary team. We spoke to individuals who had engaged with occupational therapy, psychology and pharmacy. Patients told us they were able to get information and advice about their health, care and support including from named nurses, consultants and the GP. Some of the patients we spoke with attended their ward round patient review with the multidisciplinary team. They were part of discussions within the meeting to coordinate and personalise their care.

Staff we spoke with described a supportive multi-disciplinary team within the ward and told us that they worked well together. They were able to describe links with other wards, services and organisations and explain how they worked together.

Staff had access to the information they required to appropriately assess, plan and deliver people’s care and treatment. They were able to detail the pathways and referral processes between wards and other services and describe how they supported patients through those transitions whilst maintaining continuity of care. Staff were able to describe the processes and guidelines for sharing information within the multidisciplinary team and with external wards and services. They were able to discuss examples where they had worked collaboratively with relevant staff, teams and services to deliver care and treatment and support patient’s pathways.

Staff attended handovers between shifts. We did not observe a handover during our assessment but reviewed handover sheets and documentation. These included updates on patient presentations, changes in risk or circumstances and any required actions. Staff we spoke with told us the handover were a useful source of information.

We observed two multidisciplinary team meetings. The meetings demonstrated staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care.

The service had strong and effective working relationships with relevant services outside the organisation. Care records we reviewed demonstrated good working across transition, referral and discharge pathways. There was evidence of liaison and communication with other providers and stakeholders. Information was shared between teams and services to support continuity of care.

There were processes and systems in place to support admissions, discharges and transfers of care. There were bed management and patient flow services at provider level that helped manage and facilitate this. There were clear pathways and referral procedures into the service. Staff worked with bed commissioners and local services to support discharge. Staff had access to policies and procedures to support transitions and pathways into and out of the service.

Patients we spoke with had accessed physical healthcare including meeting with the GP. None of the patients we spoke with had accessed services such as smoking cessation, but they were aware that they were available. Some of the patients we spoke with had accessed the local community, took part in walking groups and attended the onsite gym. Some of the patients we spoke with had been part of cookery and healthy eating classes.

Staff made sure patients had support for their physical health needs and access to interventions and activities that promoted healthier living. These included access to smoking cessation programmes, healthy eating sessions and physical exercise. Staff supported patients to attend a gym on-site as well as access to walking groups. Staff were in the process of arranging swimming sessions for one patient who had expressed an interest.

Staff completed regular physical health checks. They had received training to support those interventions as utilised the National Early Warning Score system to flag any concerns. Staff discussed physical health with patients as part of those checks and in ongoing care reviews.

There were processes to monitor physical health and identify possible healthy living interventions. These included physical health assessment on admission and ongoing physical health care. There were pathways to provide services such as smoking cessation. There was an onsite gym and access to a gym trainer to support patients in their exercise. Section 17 leave was used to support access to community-based exercise facilities such as swimming baths.

Patients we spoke with told us that there care and treatment was well coordinated and that staff worked together to support them. They told us that the care and support they received was helping them to improve their mental health and live as they wanted to.

Staff used recognised rating scales to assess and record the severity of patient conditions and care and treatment outcomes. The service completed Health of the nation outcome scales for patients but acknowledged that due to the nature of the ward some patients were discharged or transferred before these were fully completed. Information was shared with onward services when this occurred.

Staff took part in clinical audit and benchmarking initiatives. They were supported by audit, assurance and performance monitoring teams within the wider organisation. Results from audits and quality assurance processes were used to generate improvements

Patient outcomes were captured using recognised rating scales. Data on patient outcomes was reviewed and analysed within the hospital’s internal governance structure and in governance and performance meetings with commissioning bodies.

The majority of patients we spoke to consented to their treatment and understood their rights. One patient we spoke with did not feel they should be in hospital. We reviewed their care records and found that all appropriate authorisation was in place including a T3 form and the use of a second opinion appointed doctor. Patients we spoke with were aware of independent mental health advocacy services that visited the ward.

Staff we spoke with had completed training around the Mental Health Act and Mental Capacity Act. They were able to describe the five principles of mental capacity and give examples of when capacity had been assessed and considered as part of care and treatment. Staff understood the purpose of T2 and T3 forms and when they were required. They understood the process of best interest assessments.

We reviewed nine care records and found evidence of capacity being assessed and considered. We saw an example of a best interest process that met required standards. Family members had been involved and the process gave due consideration to the patients interests and wishes.

Staff received training on the Mental Capacity Act. At the time of our assessment compliance with the training was 95%. The hospital completed monthly consent to treatment audits that include Leo and Eve ward.